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Sheng N, Zhao L, Pang S, Wang W, Feng P, Zhao J, Chen X, Gao Y. A Cost-Effective and Labor-Saving Method for Detecting Human Leukocyte Antigen B27 Status via Sequence-Encoded Fluorescence Amplification Assay. J Mol Diagn 2024; 26:574-582. [PMID: 38677547 DOI: 10.1016/j.jmoldx.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/09/2024] [Accepted: 03/19/2024] [Indexed: 04/29/2024] Open
Abstract
Identification of human leukocyte antigen B27 (HLA-B27) by flow cytometry (FCM) has been widely applied in clinical practice for auxiliary diagnosis of ankylosing spondylitis (AS). However, FCM requires freshly prepared samples and relies on expensive equipment, reagents, and an experienced operator. To provide a cheaper and more convenient method for HLA-B27 detection, we proposed a new method termed sequence-encoded fluorescence amplification assay (SEFA), which specially recognized sequences of HLA-B27 gene (HLA-B∗27) covering current common subtypes in a single closed tube. SEFA could detect as low as 10 pg (equal to 3 copies) genomic DNA per reaction and distinguish HLA-B∗27 from other HLA-B alleles with highly similar sequences. A total of 288 clinical samples were tested by SEFA, including 181 patients with AS and 107 healthy controls. Compared with the detection results from FCM, two controversial samples of patients with AS were obtained and further confirmed to be consistent with SEFA by Sanger sequencing, indicating that this method was more accurate than FCM. Moreover, SEFA could detect HLA-B27 status by using supernatant from crude extract of 10-μL blood without commercial reagents. Overall, SEFA has the potential to be an alternative for HLA-B27 identification with the advantage of convenience and low cost, especially suitable for early diagnosis of AS in areas with limited medical resources.
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Affiliation(s)
- Nan Sheng
- Institute of Experimental and Clinical Immunology, Nantong First People's Hospital and Affiliated Hospital 2 of Nantong University, Nantong, China; Department of Rheumatology, Nantong First People's Hospital and Nantong Hospital of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Nantong, China
| | - Li Zhao
- Department of Laboratory Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Shuyun Pang
- Institute of Experimental and Clinical Immunology, Nantong First People's Hospital and Affiliated Hospital 2 of Nantong University, Nantong, China; Department of Rheumatology, Nantong First People's Hospital and Nantong Hospital of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Nantong, China
| | - Wenwen Wang
- Department of Rheumatology, Nantong First People's Hospital and Nantong Hospital of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Nantong, China
| | - Panfeng Feng
- Department of Pharmacy, Nantong First People's Hospital and Nantong Hospital of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Nantong, China
| | - Jing Zhao
- Department of Dermatology, Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, China
| | - Xiaoxiang Chen
- Institute of Experimental and Clinical Immunology, Nantong First People's Hospital and Affiliated Hospital 2 of Nantong University, Nantong, China; Department of Rheumatology, Nantong First People's Hospital and Nantong Hospital of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Nantong, China; Department of Rheumatology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China.
| | - Yingying Gao
- Department of Rheumatology, Nantong First People's Hospital and Nantong Hospital of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Nantong, China.
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Wendling D, Goupille P, Verhoeven F, Prati C. Can we consider a pre-clinical state of axial spondyloarthritis? Joint Bone Spine 2024; 91:105722. [PMID: 38582360 DOI: 10.1016/j.jbspin.2024.105722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/20/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France.
| | - Philippe Goupille
- Service de rhumatologie, UPR CNRS 4301 CBM, NMNS, université de Tours, CHU de Tours, Tours, France
| | - Frank Verhoeven
- Service de rhumatologie, université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France
| | - Clément Prati
- Service de rhumatologie, université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France
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Li Z, Khan MK, van der Linden SM, Winkens B, Villiger PM, Baumberger H, van Zandwijk H, Khan MA, Brown MA. HLA-B27, axial spondyloarthritis and survival. Ann Rheum Dis 2023; 82:1558-1567. [PMID: 37679034 DOI: 10.1136/ard-2023-224434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/10/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Ankylosing spondylitis (AS), and carriage of HLA-B27 gene in otherwise healthy individuals, are reportedly associated with increased mortality. We evaluated this hypothesis, using data from both a 35-year AS follow-up study and UK Biobank data. METHODS In 1985, 363 members of the Swiss AS Patient Society and 806 relatives were screened clinically and then radiographically for AS/axial spondyloarthritis (axSpA). Life expectancy was analysed in 377 axSpA patients having available pelvic radiographs and HLA-B27 status, comparing with matched Swiss population data. Survival in relation to HLA-B27 status in the general population was studied in UK Biobank European-ancestry participants (n=407 480, n=30 419 deaths). RESULTS AS patients have increased standardised mortality rate (SMR) compared with the general population (1.37, 95% CI 1.11 to 1.62). This increase was significant for HLA-B27-positive AS (SMR 1.38, 95% CI 1.11 to 1.65). Shortened life expectancy was observed among both HLA-B27-positive AS women (SMR 1.77, 95% CI 1.09 to 2.70) and men (SMR 1.31, 95% CI 1.02 to 1.59). Patients with non-radiographic axSpA (nr-axSpA) had significantly lower SMR: 0.44 (95% CI 0.23 to 0.77), compared with the general population. In the UK Biobank European-ancestry population cohort, HLA-B27 carriage was not significantly associated with any change in mortality (HR 1, 95% CI 0.97 to 1.1, p=0.349, adjusted by sex), in either males (HR 1, 95% CI 0.98 to 1.1, p=0.281) or females (HR 0.96, 95% CI 0.9 to 1, p=0.232), and no increase in vascular disease mortality was observed. DISCUSSION AS patients, but not nr-axSpA patients, have a significantly shortened life expectancy. Increased mortality is particularly significant among women with HLA-B27-positive AS. HLA-B27 carriage in the European-ancestry general population does not influence survival, or the risk of death due to vascular disease.
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Affiliation(s)
- Zhixiu Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Queensland University of Technology, Woolloongabba, Queensland, Australia
| | | | - Sjef M van der Linden
- University of Bern, Bern, Switzerland
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), University of Maastricht, Maastricht, The Netherlands
| | - Peter M Villiger
- University of Bern, Bern, Switzerland
- Department of Rheumatology and Clinical Immunology, Medical Center Monbijou, Bern, Switzerland
| | - Heinz Baumberger
- Former President of Swiss Ankylosing Spondylitis Patient Society, Flims, Switzerland
| | | | - Muhammad Asim Khan
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew A Brown
- Genomics England Ltd, London, UK
- Department of Medical and Molecular Genetics, King's College London, London, UK
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Khan MA. HLA-B*27 and Ankylosing Spondylitis: 50 Years of Insights and Discoveries. Curr Rheumatol Rep 2023; 25:327-340. [PMID: 37950822 DOI: 10.1007/s11926-023-01118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
PURPOSE OF REVIEW To commemorate the 50th anniversary of the groundbreaking discovery of a remarkably strong association between HLA-B*27 and ankylosing spondylitis (AS). RECENT FINDINGS In addition to HLA-B*27, more than 116 other recognized genetic risk variants have been identified, while epigenetic factors largely remain unexplored in this context. Among patients with AS who carry the HLA-B*27 gene, clonally expanded CD8 + T cells can be found in their bloodstream and within inflamed tissues. Moreover, the α and β chain motifs of these T-cell receptors demonstrate a distinct affinity for certain self- and microbial-derived peptides, leading to an autoimmune response that ultimately results in the onset of the disease. These distinctive peptide-binding and presentation characteristics are a hallmark of the disease-associated HLA-B*27:05 subtype but are absent in HLA-B*27:09, a subtype not associated with the disease, differing by only a single amino acid. This discovery represents a significant advancement in unraveling the 50-year-old puzzle of how HLA-B*27 contributes to the development of AS. These findings will significantly accelerate the process of identifying peptides, both self- and microbial-derived, that instigate autoimmunity. This, in return, will pave the way for the development of more accurate and effective targeted treatments. Moreover, the discovery of improved biomarkers, in conjunction with the emerging technology of electric field molecular fingerprinting, has the potential to greatly bolster early diagnosis capabilities. A very recently published groundbreak paper underscores the remarkable effectiveness of targeting and eliminating disease-causing T cells in a HLA-B*27 patients with AS. This pivotal advancement not only signifies a paradigm shift but also bolsters the potential for preventing the disease in individuals carrying high-risk genetic variants.
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Affiliation(s)
- Muhammad A Khan
- Case Western Reserve School of Medicine, Cleveland, OH, USA.
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Costantino F, Breban M. Family studies: A useful tool to better understand spondyloarthritis. Joint Bone Spine 2023; 90:105588. [PMID: 37201576 DOI: 10.1016/j.jbspin.2023.105588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
Spondyloarthritis (SpA) is an immune-mediated disease characterized by a high heritability, reflected by strong familial aggregation. Therefore, family studies are a powerful tool for elucidating the genetic basis of SpA. First, they helped to assess the relative importance of genetic and environmental factors and established the polygenic character of the disease. Family-based designs were also historically used to identify genetic factors of susceptibility through linkage analyses. In SpA, three whole-genome linkage studies were published in the 1990's, unfortunately with few consistent results. After having been put aside for several years in favour of case-control GWAS, there is a renewed interest in family-based designs in particular to detect rare variant associations. This review aims at summarizing what family studies have brought to the field of SpA genetics, from genetic epidemiology studies to the most recent rare variant analyses. It also highlights the potential interest of family history of SpA to help diagnosis and detection of patients at high risk to develop the disease.
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Affiliation(s)
- Félicie Costantino
- Rheumatology Department, AP-HP, Ambroise-Paré Hospital, 92100 Boulogne-Billancourt, France; Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, 78180 Montigny-Le-Bretonneux, France; Laboratory of Excellence INFLAMEX, Université Paris-Centre, Paris, France.
| | - Maxime Breban
- Rheumatology Department, AP-HP, Ambroise-Paré Hospital, 92100 Boulogne-Billancourt, France; Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, 78180 Montigny-Le-Bretonneux, France; Laboratory of Excellence INFLAMEX, Université Paris-Centre, Paris, France
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Axial Spondyloarthritis and Diagnostic Challenges: Over-diagnosis, Misdiagnosis, and Under-diagnosis. Curr Rheumatol Rep 2023; 25:47-55. [PMID: 36602692 DOI: 10.1007/s11926-022-01096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW This article aims to review the challenges in axial spondyloarthritis diagnosis and identify the possible contributing factors. RECENT FINDINGS The inability to reach an accurate diagnosis in a timely fashion can lead to treatment delays and worse disease outcomes. The lack of validated diagnostic criteria and the misuse of the currently available classification criteria could be contributing. There is also significant inter-reader variability in interpreting images, and the radiologic definitions of axial spondyloarthritis continue to be re-defined to improve their positive predictive value. The role of inflammatory back pain features, serologic biomarkers, genetics, and their diagnostic contribution to axial spondyloarthritis continues to be investigated. There is still a significant amount of delay in the diagnosis of axial spondyloarthritis. Appreciating the factors that contribute to this delay is of utmost importance to close the gap. It is similarly important to recognize other conditions that may present with symptoms that mimic axial spondyloarthritis so that misdiagnosis and wrong treatment can be avoided.
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Li Z, van der Linden SM, Khan MA, Baumberger H, Zandwijk HV, Khan MK, Villiger PM, Brown MA. Heterogeneity of axial spondyloarthritis: genetics, sex and structural damage matter. RMD Open 2022; 8:rmdopen-2022-002302. [PMID: 35523521 PMCID: PMC9083385 DOI: 10.1136/rmdopen-2022-002302] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/06/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) comprises both radiographic and non-radiographic disease. However, the paucity of specific objective measures for the disease and current classification criteria showing suboptimal specificity contribute to disease heterogeneity observed in clinical practice and research. We used a historical cohort of patients with axSpA to assess sources of heterogeneity. METHODS The study involved 363 axSpA probands recruited from membership of the Swiss Ankylosing Spondylitis Patient Society. Participants underwent examination by a rheumatologist, completed questionnaires and provided blood samples for HLA typing. Patients underwent radiography of sacroiliac joints and were categorised according to the New York (NY) criteria (ankylosing spondylitis (AS) or non-radiographic axSpA (nr-axSpA)) and HLA-B27 status. Genetic characterisation by single nucleotide polymorphism microarray was performed and AS polygenic risk scores (PRS) were calculated. RESULTS Considerable heterogeneity was observed. The male to female ratio for AS (NY+) was 3:1, but 1:1 for nr-axSpA. For HLA-27(+) AS, the ratio was 2.5:1, but nearly 1:1 for HLA-B27(-) disease. Women with nr-axSpA had strikingly lower mean PRS and lower HLA-B27 prevalence than men with nr-axSpA or NY(+) male and female patients with AS. PRS was able to distinguish male but not female patients with nr-axSpA from related healthy first-degree relatives. Radiographic sacroiliitis was strongly associated with HLA-B27, especially in men. CONCLUSION Women clinically diagnosed with axSpA but without radiographic sacroiliitis as a group have a disease that is distinct from AS by the modified New York criteria overall and from nr-axSpA in men. Given the high degree of heterogeneity, stratified or adjusted analysis of effectiveness studies is indicated, taking genetics, sex and radiographic damage (sacroiliitis) into account.
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Affiliation(s)
- Zhixiu Li
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Genomics and Personalised Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Sjef M van der Linden
- University of Bern, Bern, Switzerland.,Department of Internal Medicine, University of Maastricht, Maastricht, The Netherlands
| | - Muhammad Asim Khan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | | | | | - Peter M Villiger
- Medical Center Monbijou, Meikirch, Switzerland.,Rheumatology and Clinical Immunology, Medical Center Monbijou, Meikirch, Switzerland
| | - Matthew A Brown
- Department of Medical and Molecular Genetics, King's College London, London, UK .,Genomics England, London, UK
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