1
|
Pontarini E, Sciacca E, Chowdhury F, Grigoriadou S, Rivellese F, Murray-Brown WJ, Lucchesi D, Fossati-Jimack L, Nerviani A, Jaworska E, Ghirardi GM, Giacomassi C, Emery P, Ng WF, Sutcliffe N, Everett C, Fernandez C, Tappuni A, Seror R, Mariette X, Porcher R, Cavallaro G, Pulvirenti A, Verstappen GM, de Wolff L, Arends S, Bootsma H, Lewis MJ, Pitzalis C, Bowman SJ, Bombardieri M. Serum and Tissue Biomarkers Associated With Composite of Relevant Endpoints for Sjögren Syndrome (CRESS) and Sjögren Tool for Assessing Response (STAR) to B Cell-Targeted Therapy in the Trial of Anti-B Cell Therapy in Patients With Primary Sjögren Syndrome (TRACTISS). Arthritis Rheumatol 2024; 76:763-776. [PMID: 38073013 DOI: 10.1002/art.42772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE This study aimed to identify peripheral and salivary gland (SG) biomarkers of response/resistance to B cell depletion based on the novel concise Composite of Relevant Endpoints for Sjögren Syndrome (cCRESS) and candidate Sjögren Tool for Assessing Response (STAR) composite endpoints. METHODS Longitudinal analysis of peripheral blood and SG biopsies was performed pre- and post-treatment from the Trial of Anti-B Cell Therapy in Patients With Primary Sjögren Syndrome (TRACTISS) combining flow cytometry immunophenotyping, serum cytokines, and SG bulk RNA sequencing. RESULTS Rituximab treatment prevented the worsening of SG inflammation observed in the placebo arm, by inhibiting the accumulation of class-switched memory B cells within the SG. Furthermore, rituximab significantly down-regulated genes involved in immune-cell recruitment, lymphoid organization alongside antigen presentation, and T cell co-stimulatory pathways. In the peripheral compartment, rituximab down-regulated immunoglobulins and auto-antibodies together with pro-inflammatory cytokines and chemokines. Interestingly, patients classified as responders according to STAR displayed significantly higher baseline levels of C-X-C motif chemokine ligand-13 (CXCL13), interleukin (IL)-22, IL-17A, IL-17F, and tumor necrosis factor-α (TNF-α), whereas a longitudinal analysis of serum T cell-related cytokines showed a selective reduction in both STAR and cCRESS responder patients. Conversely, cCRESS response was better associated with biomarkers of SG immunopathology, with cCRESS-responders showing a significant decrease in SG B cell infiltration and reduced expression of transcriptional gene modules related to T cell costimulation, complement activation, and Fcγ-receptor engagement. Finally, cCRESS and STAR response were associated with a significant improvement in SG exocrine function linked to transcriptional evidence of SG epithelial and metabolic restoration. CONCLUSION Rituximab modulates both peripheral and SG inflammation, preventing the deterioration of exocrine function with functional and metabolic restoration of the glandular epithelium. Response assessed by newly developed cCRESS and STAR criteria was associated with differential modulation of peripheral and SG biomarkers, emerging as novel tools for patient stratification.
Collapse
Affiliation(s)
| | | | | | | | - Felice Rivellese
- Queen Mary University of London and Bart's Health NHS Trust, London, UK
| | | | | | | | | | | | | | | | | | - Wan Fai Ng
- Newcastle University and NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne, UK
| | | | | | | | - Anwar Tappuni
- Queen Mary University of London and Bart's Health NHS Trust, London, UK
| | - Raphael Seror
- Université' Paris-Saclay, and AP-HP, Hôpital Bicêtre, Le Kremlin, Bicêtre, France
| | - Xavier Mariette
- Université' Paris-Saclay, and AP-HP, Hôpital Bicêtre, Le Kremlin, Bicêtre, France
| | - Raphael Porcher
- Université Paris Cité, Centre de Recherche Épidémiologie et Statistiques Paris, France
| | | | | | - Gwenny M Verstappen
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Liseth de Wolff
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Suzanne Arends
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Miles J Lewis
- Queen Mary University of London and Bart's Health NHS Trust, London, UK
| | | | - Simon J Bowman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | |
Collapse
|
2
|
Radenska-Lopovok SG, Karanova MS, Zanozin AS, Rodionova EB, Palshina SG, Tsvetanov MS, Tregubova AV, Vasilev VI. [Evaluation of morphological activity of primary Sjogren's syndrome on bioptates of minor salivary glands]. Arkh Patol 2023; 85:5-9. [PMID: 36785956 DOI: 10.17116/patol2023850115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND The results of the morphological study of the minor salivary glands can be used to assess the activity of the primary Sjogren's syndrome and to decide on adequate therapy.The existing protocol of The Sjögren's International Clinical Collaborative Alliance (SICCA) prescribes the methodology for examining biopsy specimens for suspected Sjögren's disease, however, experts interpret data from the analysis of histological preparations differently. OBJECTIVE To identify morphological forms of sialadenitis, as well as to determine the focus score in Russian patients based on the retrospective analysis of minor salivary glands biopsies of patients with primary Sjogren's syndrome. MATERIAL AND METHODS Biopsies of minor salivary glands were studied in 92 patients with primary Sjogren's syndrome and 42 patients without rheumatic disease. RESULTS Focal lymphocytic sialadenitis was detected in 69 patients with primary Sjogren's syndrome. The focus score in patients with primary Sjogren's syndrome was 7.32 (2.8-14.17). In patients without rheumatic diseases, this index was 0.48 (p<0.05). Patients with confluent lymphocytic foci need immunohistochemical examination and dynamic monitoring to exclude lymphoproliferative diseases. CONCLUSION The index of morphological activity of sialadenitis in primary Sjogren's syndrome ranges from 2.8 to 14.17 and reflects the activity of the underlying disease.It should be taken into account in the diagnosis and prescription of adequate therapy. Further study of the correlations of morphological and clinical and laboratory parameters will lead to clarification of the criterion signs of the disease.
Collapse
Affiliation(s)
- S G Radenska-Lopovok
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - M S Karanova
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - A S Zanozin
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - S G Palshina
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - M S Tsvetanov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Tregubova
- National Medical Research center for obstetrics, gynecology and perinatology named after V.I. Kulakov, Moscow, Russia
| | | |
Collapse
|
3
|
Verstappen GM, Kroese FGM, Bootsma H. Stumbles in Sjögren's syndrome drug development: where to look for the next big leap? Expert Rev Clin Immunol 2020; 16:1043-1045. [PMID: 33196342 DOI: 10.1080/1744666x.2021.1831915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Gwenny M Verstappen
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| |
Collapse
|
4
|
Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune disease, which involves salivary glands (SG) and extra glandular organs. Today, Sjögren's patients' diagnosis is based on classification criteria taking into account five objective tests, including histology, immunology, two ophthalmological tests, and salivary flow evaluation. To date, the challenge is to find the right imaging tool for diagnosis, follow up, and prognosis of pSS. The objective of this review is to describe as to what are these imaging modalities and particularly the place and validity of salivary glands ultrasonography (SGUS) in the diagnosis and follow-up strategy of patients with suspected pSS. Moreover, new noninvasive tools are emerging, including elastography, a new ultrasonography technique that provides an estimate of tissue elasticity, MRI, MR sialography, and 18 fluorodeoxyglucose-positron emission tomography. Although new imaging opportunities are available, SGUS should be the first-line choice in pSS because of its accessibility, feasibility over time, and sensitivity to change.
Collapse
|
5
|
Jonsson R, Brokstad KA, Jonsson MV, Delaleu N, Skarstein K. Current concepts on Sjögren's syndrome - classification criteria and biomarkers. Eur J Oral Sci 2018; 126 Suppl 1:37-48. [PMID: 30178554 PMCID: PMC6586012 DOI: 10.1111/eos.12536] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 12/13/2022]
Abstract
Sjögren's syndrome is a lymphoproliferative disease with autoimmune features characterized by mononuclear cell infiltration of exocrine glands, notably the lacrimal and salivary glands. These lymphoid infiltrations lead to dryness of the eyes (keratoconjunctivitis sicca), dryness of the mouth (xerostomia), and, frequently, dryness of other surfaces connected to exocrine glands. Sjögren's syndrome is associated with the production of autoantibodies because B-cell activation is a consistent immunoregulatory abnormality. The spectrum of the disease extends from an organ-specific autoimmune disorder to a systemic process and is also associated with an increased risk of B-cell lymphoma. Current treatments are mainly symptomatic. As a result of the diverse presentation of the syndrome, a major challenge remains to improve diagnosis and therapy. For this purpose an international set of classification criteria for primary Sjögren's syndrome has recently been developed and validated and seems well suited for enrolment in clinical trials. Salivary gland biopsies have been examined and histopathology standards have been developed, to be used in clinical trials and patient stratification. Finally, ultrasonography and saliva meet the need of non-invasive imaging and sampling methods for discovery and validation of disease biomarkers in Sjögren's syndrome.
Collapse
Affiliation(s)
- Roland Jonsson
- Broegelmann Research LaboratoryDepartment of Clinical ScienceUniversity of BergenBergenNorway
- Department of RheumatologyHaukeland University HospitalBergenNorway
| | - Karl A. Brokstad
- Broegelmann Research LaboratoryDepartment of Clinical ScienceUniversity of BergenBergenNorway
| | - Malin V. Jonsson
- Department of Clinical Dentistry – Section for Oral and Maxillofacial RadiologyUniversity of BergenBergenNorway
| | - Nicolas Delaleu
- Broegelmann Research LaboratoryDepartment of Clinical ScienceUniversity of BergenBergenNorway
- 2C SysBioMedContraSwitzerland
| | - Kathrine Skarstein
- Gade Laboratory for PathologyDepartment of Clinical MedicineUniversity of BergenBergenNorway
- Department of PathologyHaukeland University HospitalBergenNorway
| |
Collapse
|
6
|
Schreiber K, Nocturne G, Cornec D, Daïen CI. Lymphocytes as Biomarkers of Therapeutic Response in Rheumatic Autoimmune Diseases, Is It a Realistic Goal? Clin Rev Allergy Immunol 2018; 53:277-290. [PMID: 28560621 DOI: 10.1007/s12016-017-8614-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Many therapies are available for patients with rheumatoid arthritis (RA) while biological therapies have limited effects in patients with systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS). In both cases, biomarkers predicting drug response would be very useful to guide clinicians in their choice. We performed a systematic review to evaluate the value of lymphocyte phenotyping as a marker of therapeutic response. Of the 1063 articles retrieved, 39 fulfilled inclusion criteria and were included in the present review (25 for RA, 10 for SLE, and 4 for pSS). Lymphocyte phenotyping was described as a biomarker of therapeutic response in many studies, but most results could not be confirmed by independent teams using multivariate analysis. The most consistent result might be the association between rituximab response and the levels of memory B cells before therapy, although some studies were controversial. Thus, lymphocyte phenotyping cannot yet be proposed as a biomarker of response in rheumatic autoimmune diseases. The lack of reproducibility between studies may be explained by technical issues influencing lymphocyte phenotyping so standardization procedures should be developed for future studies. The patients' characteristics vary between studies, and large population studies, including a wide range of patients' characteristics and biomarkers, are required to provide predictive models for clinical outcomes. The use of new flow cytometry techniques such as single-cell mass cytometry technology might also help finder reliable biomarkers in the future.
Collapse
Affiliation(s)
- Kristina Schreiber
- Rheumatology Department, Lapeyronie Hospital and Montpellier I University, Montpellier, France
| | | | | | - Claire I Daïen
- Rheumatology Department, Lapeyronie Hospital and Montpellier I University, Montpellier, France.
- Institute of Molecular Genetic, UMR 5535, CNRS, Montpellier, France.
| |
Collapse
|
7
|
Fisher BA, Emery P, Pitzalis C, Bombardieri M, Bowman SJ. Response to: Can ultrasound of the major salivary glands assess histopathological changes induced by treatment with rituximab in primary Sjögren’s syndrome? Ann Rheum Dis 2018; 78:e28. [DOI: 10.1136/annrheumdis-2018-213340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 11/04/2022]
|
8
|
Mossel E, Delli K, Arends S, Haacke EA, van der Vegt B, van Nimwegen JF, Stel AJ, Spijkervet FKL, Vissink A, Kroese FGM, Bootsma H. Can ultrasound of the major salivary glands assess histopathological changes induced by treatment with rituximab in primary Sjögren's syndrome? Ann Rheum Dis 2018. [PMID: 29523521 DOI: 10.1136/annrheumdis-2018-213332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Esther Mossel
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Erlin A Haacke
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jolien F van Nimwegen
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Alja J Stel
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
9
|
Popov Y, Salomon-Escoto K. Gastrointestinal and Hepatic Disease in Sjogren Syndrome. Rheum Dis Clin North Am 2018; 44:143-151. [DOI: 10.1016/j.rdc.2017.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
10
|
Fisher BA, Everett CC, Rout J, O'Dwyer JL, Emery P, Pitzalis C, Ng WF, Carr A, Pease CT, Price EJ, Sutcliffe N, Makdissi J, Tappuni AR, Gendi NST, Hall FC, Ruddock SP, Fernandez C, Hulme CT, Davies KA, Edwards CJ, Lanyon PC, Moots RJ, Roussou E, Richards A, Sharples LD, Bombardieri M, Bowman SJ. Effect of rituximab on a salivary gland ultrasound score in primary Sjögren's syndrome: results of the TRACTISS randomised double-blind multicentre substudy. Ann Rheum Dis 2017; 77:412-416. [PMID: 29275334 PMCID: PMC5867400 DOI: 10.1136/annrheumdis-2017-212268] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare the effects of rituximab versus placebo on salivary gland ultrasound (SGUS) in primary Sjögren's syndrome (PSS) in a multicentre, multiobserver phase III trial substudy. METHODS Subjects consenting to SGUS were randomised to rituximab or placebo given at weeks 0, 2, 24 and 26, and scanned at baseline and weeks 16 and 48. Sonographers completed a 0-11 total ultrasound score (TUS) comprising domains of echogenicity, homogeneity, glandular definition, glands involved and hypoechoic foci size. Baseline-adjusted TUS values were analysed over time, modelling change from baseline at each time point. For each TUS domain, we fitted a repeated-measures logistic regression model to model the odds of a response in the rituximab arm (≥1-point improvement) as a function of the baseline score, age category, disease duration and time point. RESULTS 52 patients (n=26 rituximab and n=26 placebo) from nine centres completed baseline and one or more follow-up visits. Estimated between-group differences (rituximab-placebo) in baseline-adjusted TUS were -1.2 (95% CI -2.1 to -0.3; P=0.0099) and -1.2 (95% CI -2.0 to -0.5; P=0.0023) at weeks 16 and 48. Glandular definition improved in the rituximab arm with an OR of 6.8 (95% CI 1.1 to 43.0; P=0.043) at week 16 and 10.3 (95% CI 1.0 to 105.9; P=0.050) at week 48. CONCLUSIONS We demonstrated statistically significant improvement in TUS after rituximab compared with placebo. This encourages further research into both B cell depletion therapies in PSS and SGUS as an imaging biomarker. TRIAL REGISTRATION NUMBER 65360827, 2010-021430-64; Results.
Collapse
Affiliation(s)
- Benjamin A Fisher
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Colin C Everett
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Rout
- Birmingham Dental Hospital, Birmingham, UK
| | - John L O'Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Emery
- Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Costantino Pitzalis
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Wan-Fai Ng
- Institute of Cellular Medicine, University of Newcastle, Newcastle-upon-Tyne, UK
| | - Andrew Carr
- Newcastle Dental Hospital, Newcastle-upon-Tyne, UK
| | - Colin T Pease
- Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | | | | | - Jimmy Makdissi
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anwar R Tappuni
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Frances C Hall
- Department of Clinical Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - Sharon P Ruddock
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Catherine Fernandez
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Claire T Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kevin A Davies
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Christopher John Edwards
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Peter C Lanyon
- Nottingham University Hospitals NHS Trust, and Nottingham NHS Treatment Centre, Nottingham, UK
| | - Robert J Moots
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Euthalia Roussou
- Barking Havering and Redbridge University Hospitals NHS trust (BHRUT), King George Hospital, Goodmayes, UK
| | | | - Linda D Sharples
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Michele Bombardieri
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Simon J Bowman
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
11
|
Carvajal Alegria G, Costa S, Jousse-Joulin S, Marcorelles P, Pers JO, Saraux A, Devauchelle-Pensec V, Cornec D. What is the agreement between pathological features of parotid gland and labial salivary gland biopsies? Ann Rheum Dis 2017; 77:e37. [PMID: 28970211 DOI: 10.1136/annrheumdis-2017-212289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/02/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Guillermo Carvajal Alegria
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Sebastian Costa
- INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France.,Laboratoire d'Anatomie Pathologique et Cytologie, Hôpital Morvan, CHRU Brest, Brest, France
| | - Sandrine Jousse-Joulin
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Pascale Marcorelles
- Laboratoire d'Anatomie Pathologique et Cytologie, Hôpital Morvan, CHRU Brest, Brest, France
| | - Jacques-Olivier Pers
- INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Alain Saraux
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Valérie Devauchelle-Pensec
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Divi Cornec
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| |
Collapse
|
12
|
Fisher BA, Jonsson R, Daniels T, Bombardieri M, Brown RM, Morgan P, Bombardieri S, Ng WF, Tzioufas AG, Vitali C, Shirlaw P, Haacke E, Costa S, Bootsma H, Devauchelle-Pensec V, Radstake TR, Mariette X, Richards A, Stack R, Bowman SJ, Barone F. Standardisation of labial salivary gland histopathology in clinical trials in primary Sjögren's syndrome. Ann Rheum Dis 2017; 76:1161-1168. [PMID: 27965259 PMCID: PMC5530351 DOI: 10.1136/annrheumdis-2016-210448] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/28/2016] [Accepted: 11/19/2016] [Indexed: 12/31/2022]
Abstract
Labial salivary gland (LSG) biopsy is used in the classification of primary Sjögren's syndrome (PSS) and in patient stratification in clinical trials. It may also function as a biomarker. The acquisition of tissue and histological interpretation is variable and needs to be standardised for use in clinical trials. A modified European League Against Rheumatism consensus guideline development strategy was used. The steering committee of the ad hoc working group identified key outstanding points of variability in LSG acquisition and analysis. A 2-day workshop was held to develop consensus where possible and identify points where further discussion/data was needed. These points were reviewed by a subgroup of experts on PSS histopathology and then circulated via an online survey to 50 stakeholder experts consisting of rheumatologists, histopathologists and oral medicine specialists, to assess level of agreement (0-10 scale) and comments. Criteria for agreement were a mean score ≥6/10 and 75% of respondents scoring ≥6/10. Thirty-nine (78%) experts responded and 16 points met criteria for agreement. These points are focused on tissue requirements, identification of the characteristic focal lymphocytic sialadenitis, calculation of the focus score, identification of germinal centres, assessment of the area of leucocyte infiltration, reporting standards and use of prestudy samples for clinical trials. We provide standardised consensus guidance for the use of labial salivary gland histopathology in the classification of PSS and in clinical trials and identify areas where further research is required to achieve evidence-based consensus.
Collapse
Affiliation(s)
- Benjamin A Fisher
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
- Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Troy Daniels
- Department of Orofacial Sciences, University of California San Francisco, San Francisco California, USA
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, Queen Mary University of London, London, UK
| | - Rachel M Brown
- Department of Pathology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Peter Morgan
- Department of Pathology, King's College London, London, UK
| | | | - Wan-Fai Ng
- Musculoskeletal Research Group and NIHR Biomedical Research Centre in Ageing and Chronic Diseases, Newcastle University, Newcastle, UK
| | | | - Claudio Vitali
- Section of Rheumatology, Casa di Cura di Lecco, Lecco, Italy
| | - Pepe Shirlaw
- Department of Oral Medicine, King's College London, London, UK
| | - Erlin Haacke
- Department of Pathology, University of Groningen, Groningen, The Netherlands
| | - Sebastian Costa
- Department of Pathology, Brest University Hospital, Brest, France
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, Groningen, The Netherlands
| | | | - Timothy R Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Xavier Mariette
- Rheumatology Department, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, INSERM U1184, Le Kremlin-Bicêtre, France
| | - Andrea Richards
- Department of Oral Medicine, Dental Hospital, Birmingham, UK
| | - Rebecca Stack
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
| | - Simon J Bowman
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
- Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Francesca Barone
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
| |
Collapse
|
13
|
The value of rituximab treatment in primary Sjögren's syndrome. Clin Immunol 2017; 182:62-71. [PMID: 28478105 DOI: 10.1016/j.clim.2017.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Abstract
The rationale for B cell depletion therapy with rituximab in primary Sjögren's syndrome relies upon the well-established role of B cell hyperactivity in immunopathogenesis. In line with this notion, several biomarkers of B cell activity are significantly affected by treatment, both in the target organs and periphery. In contrast to most biological outcomes, clinical outcomes are not consistent between studies. Although two large RCTs did not meet their primary endpoint, several beneficial clinical effects of treatment have been shown. As discussed in this review, differences in study design and patient characteristics could explain the variation in results. Interestingly, a newly developed composite endpoint of subjective and objective outcomes did show a significant effect of rituximab in one of the large RCTs. Response predictors need to be identified to define more targeted inclusion criteria and achieve precision medicine. The positive effects seen on biological and clinical parameters warrant future studies to investigate this promising treatment modality.
Collapse
|
14
|
Abstract
Primary Sjögren's syndrome (SS) is a common chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands, mainly salivary and lacrimal, resulting in oral and ocular dryness, although virtually any organ system can be affected. SS-related systemic manifestations are classified as either related to the presence of periepithelial infiltrates in exocrine and parenchymal organs or resulting from immunocomplex deposition due to B cell hyperactivity with increased risk for B cell lymphoma development. Activation of both innate and adaptive immune pathways contributes to disease pathogenesis, with prominent interferon (IFN) signatures identified in both peripheral blood and affected salivary gland tissues. Recently, LINE-1 genomic repeat elements have been proposed as potential triggers of type I IFN pathway activation in SS through activation of Toll-like receptor-dependent and -independent pathways. In view of the increasingly appreciated variability of SS, elucidation of distinct operating pathways in relation to diverse clinical phenotypes and selection of the optimal therapeutic intervention remain major challenges. Inhibition of cathepsin S molecules, blockade of costimulation through administration of abatacept and inhibitors of B7-related molecules and CD40, blockade of B cell function and B cell survival factors, and disruption of the formation of ectopic germinal centers are considered the main therapeutic targets. Well-controlled multicenter clinical trials are ongoing and data are awaited.
Collapse
Affiliation(s)
- Clio P Mavragani
- Department of Physiology, School of Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece;
| |
Collapse
|
15
|
Cornec D, Jousse-Joulin S, Costa S, Marhadour T, Marcorelles P, Berthelot JM, Hachulla E, Hatron PY, Goeb V, Vittecoq O, Nowak E, Pers JO, Devauchelle-Pensec V, Saraux A. High-Grade Salivary-Gland Involvement, Assessed by Histology or Ultrasonography, Is Associated with a Poor Response to a Single Rituximab Course in Primary Sjögren's Syndrome: Data from the TEARS Randomized Trial. PLoS One 2016; 11:e0162787. [PMID: 27662653 PMCID: PMC5035078 DOI: 10.1371/journal.pone.0162787] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 08/29/2016] [Indexed: 01/11/2023] Open
Abstract
Purpose To determine whether the severity of salivary-gland involvement, assessed using salivary gland ultrasonography [SGUS], histological focus score, or the unstimulated whole salivary flow [UWSF], was associated with the response to rituximab in patients with primary Sjögren’s syndrome [pSS]. Materials and Methods Among the 120 patients with pSS enrolled in the randomised TEARS trial of rituximab versus placebo, 35 underwent either centralised minor salivary-gland biopsy or SGUS at inclusion. The echostructure of each parotid and submandibular gland was graded on a scale of 0 to 4. Histologic minor salivary gland involvement was assessed by the focus score. Among rituximab-treated patients with available data (n = 14), half met the Sjögren’s Syndrome Responder Index [SSRI]-30 definition of a response at week 24. Results The SGUS score correlated positively to the focus score [r = 0.61] and negatively to the UWSF [r = -0.68]. The focus score was not correlated to the UWSF. The median total SGUS grade at inclusion was 9 [6-11] in responders versus 16 [11-16] in non-responders [p = 0.04]. The proportion of SSRI-30 responders was 0% among patients with SGUS grade 4 and 88% among those with SGUS grade ≤3. Low baseline SGUS scores were associated with sicca-related outcomes improvement, but not with fatigue or biological improvement. Median baseline focus score was 0.3 [0.0–1.3] in the responders versus 4.0 [2.7–5.3] in the non-responders [p = 0.02]. Baseline UWSF was not associated with the response rate. Conclusion In patients with pSS, the highest SGUS grade or a high histological focus score is associated with absence of a response to a single rituximab course after 6 months. Further studies, including more patients and different treatment strategies, are required to confirm the clinical utility of these potential biomarkers in pSS.
Collapse
Affiliation(s)
- Divi Cornec
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Boulevard Tanguy Prigent, 29609 Brest, France
- EA2216, INSERM ESPRI, ERI29, Laboratoire d’Immunothérapies et Pathologies lymphocytaires B, Université de Brest, and Labex "IGO", Brest, France
| | - Sandrine Jousse-Joulin
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Boulevard Tanguy Prigent, 29609 Brest, France
- EA2216, INSERM ESPRI, ERI29, Laboratoire d’Immunothérapies et Pathologies lymphocytaires B, Université de Brest, and Labex "IGO", Brest, France
| | - Sebastian Costa
- Laboratoire d’Anatomie Pathologique et Cytologie, Hôpital Morvan, CHRU Brest, Avenue Foch, 29609 Brest, France
| | - Thierry Marhadour
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Boulevard Tanguy Prigent, 29609 Brest, France
| | - Pascale Marcorelles
- Laboratoire d’Anatomie Pathologique et Cytologie, Hôpital Morvan, CHRU Brest, Avenue Foch, 29609 Brest, France
| | | | - Eric Hachulla
- Service de Médecine Interne, Claude Huriez Hospital, Université Lille Nord-de-France, 59037 Lille Cedex, France
| | - Pierre-Yves Hatron
- Service de Médecine Interne, Claude Huriez Hospital, Université Lille Nord-de-France, 59037 Lille Cedex, France
| | - Vincent Goeb
- Service de Rhumatologie, CHRU de Rouen, 76230 Bois-Guillaume, France
| | - Olivier Vittecoq
- Service de Rhumatologie, CHRU de Rouen, 76230 Bois-Guillaume, France
| | | | - Jacques-Olivier Pers
- EA2216, INSERM ESPRI, ERI29, Laboratoire d’Immunothérapies et Pathologies lymphocytaires B, Université de Brest, and Labex "IGO", Brest, France
| | - Valérie Devauchelle-Pensec
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Boulevard Tanguy Prigent, 29609 Brest, France
- EA2216, INSERM ESPRI, ERI29, Laboratoire d’Immunothérapies et Pathologies lymphocytaires B, Université de Brest, and Labex "IGO", Brest, France
| | - Alain Saraux
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Boulevard Tanguy Prigent, 29609 Brest, France
- EA2216, INSERM ESPRI, ERI29, Laboratoire d’Immunothérapies et Pathologies lymphocytaires B, Université de Brest, and Labex "IGO", Brest, France
- * E-mail:
| |
Collapse
|
16
|
Sambataro D, Sambataro G, Dal Bosco Y, Polosa R. Present and future of biologic drugs in primary Sjögren's syndrome. Expert Opin Biol Ther 2016; 17:63-75. [PMID: 27616561 DOI: 10.1080/14712598.2017.1235698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Primary Sjögren's (pSS) syndrome is a chronic, autoimmune, and systemic disease characterized by xerostomia, xerophthalmia, muscle pain and fatigue. The disease may be complicated by a systemic involvement, such as a pulmonary fibrosis or the development of lymphoma which severely worsens the prognosis. Actually, there are no recommendations for the management of pSS. However, recent advances in the understanding of its pathogenesis have uncovered some pathways that have potential as therapeutic targets. Areas covered: In this review, the authors present the biologic drugs potentially valuable to the treatment of pSS in light of its physiopathology with a 'bird's eye' view of future prospects. The authors took into account relevant studies published from 2004 to 2016. Expert opinion: Biological treatment in pSS is a promising opportunity to potentially control disease activity and prevent its complication. Currently, inhibition of B-cell and IL-17 pathways seem to be the most promising avenues. New achievements in the knowledge of pSS pathophysiology are necessary in order to try to simultaneously predict the predominant pathogenic pathway, the kind of patients at major risk to develop a more severe disease, and the appropriate biological therapy to use.
Collapse
Affiliation(s)
- Domenico Sambataro
- a Department of Clinical and Experimental Medicine, Teaching Hospital Policlinico 'G. Rodolico' , University of Catania , Catania , Italy.,b Outpatient Clinic of Rheumatology accredited to National Health System , 'Artroreuma srl' , Mascalucia , Italy
| | - Gianluca Sambataro
- b Outpatient Clinic of Rheumatology accredited to National Health System , 'Artroreuma srl' , Mascalucia , Italy
| | - Ylenia Dal Bosco
- a Department of Clinical and Experimental Medicine, Teaching Hospital Policlinico 'G. Rodolico' , University of Catania , Catania , Italy
| | - Riccardo Polosa
- a Department of Clinical and Experimental Medicine, Teaching Hospital Policlinico 'G. Rodolico' , University of Catania , Catania , Italy
| |
Collapse
|
17
|
Abstract
Primary Sjögren syndrome (pSS) is a progressive autoimmune disease characterized by sicca and systemic manifestations. In this Review, we summarize the available data on topical and systemic medications, according to clinical signs and disease activity, and we describe the ongoing studies using biologic drugs in the treatment of pSS. Expanding knowledge about the epidemiology, classification criteria, systemic activity scoring (ESSDAI) and patient-reported outcomes (ESSPRI) is driving active research. Treatment decisions are based on the evaluation of symptoms and extraglandular manifestations. Symptomatic treatment is usually appropriate, whereas systemic treatment is reserved for systemic manifestations. Sicca is managed by education, environment modification, elimination of contingent offending drugs, artificial tears, secretagogues and treatments for complications. Mild systemic signs such as fatigue are treated by exercise. Pain can require short-term moderate-dose glucocorticoid therapy and, in some cases, disease-modifying drugs. Severe and acute systemic manifestations indicate treatment with glucocorticoids and/or immunosuppressant drugs. The role for biologic agents is promising, but no double-blind randomized controlled trials (RCTs) proving the efficacy of these drugs are available. Targets for new treatments directed against the immunopathological mechanisms of pSS include epithelial cells, T cells, B-cell overactivity, the interferon signature, proinflammatory cytokines, ectopic germinal centre formation, chemokines involved in lymphoid cell homing, and epigenetic modifications.
Collapse
Affiliation(s)
- Alain Saraux
- EA2216, INSERM ESPRI ERI29, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Université de Brest, Labex 'Immunotherapy, Graft, Oncology', 29609 Brest Cedex, France.,Department of Rheumatology, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France
| | - Jacques-Olivier Pers
- Department of Rheumatology, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France
| | - Valérie Devauchelle-Pensec
- EA2216, INSERM ESPRI ERI29, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Université de Brest, Labex 'Immunotherapy, Graft, Oncology', 29609 Brest Cedex, France.,Department of Rheumatology, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France
| |
Collapse
|
18
|
Delli K, Haacke EA, Kroese FGM, Pollard RP, Ihrler S, van der Vegt B, Vissink A, Bootsma H, Spijkervet FKL. In primary Sjögren's syndrome high absolute numbers and proportions of B cells in parotid glands predict responsiveness to rituximab as defined by ESSDAI, but not by SSRI. Ann Rheum Dis 2016; 75:e34. [DOI: 10.1136/annrheumdis-2016-209317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 11/03/2022]
|