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Stuhlmüller B, Mans K, Tandon N, Bonin MO, Smiljanovic B, Sörensen TA, Schendel P, Martus P, Listing J, Detert J, Backhaus M, Neumann T, Winchester RJ, Burmester GR, Häupl T. Genomic stratification by expression of HLA-DRB4 alleles identifies differential innate and adaptive immune transcriptional patterns - A strategy to detect predictors of methotrexate response in early rheumatoid arthritis. Clin Immunol 2016; 171:50-61. [PMID: 27570220 DOI: 10.1016/j.clim.2016.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 12/11/2022]
Abstract
Effective drug selection is the current challenge in rheumatoid arthritis (RA). Treatment failure may follow different pathomechanisms and therefore require investigation of molecularly defined subgroups. In this exploratory study, whole blood transcriptomes of 68 treatment-naïve early RA patients were analyzed before initiating MTX. Subgroups were defined by serologic and genetic markers. Response related signatures were interpreted using reference transcriptomes of various cell types, cytokine stimulated conditions and bone marrow precursors. HLA-DRB4-negative patients exhibited most distinctive transcriptional differences. Preponderance of transcripts associated with phagocytes and bone marrow activation indicated response and transcripts of T- and B-lymphocytes non-response. HLA-DRB4-positive patients were more heterogeneous, but also linked failure to increased adaptive immune response. RT-qPCR confirmed reliable candidate selection and independent samples of responders and non-responders the functional patterning. In summary, genomic stratification identified different molecular pathomechanisms in early RA and preponderance of innate but not adaptive immune activation suggested response to MTX therapy.
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Affiliation(s)
- Bruno Stuhlmüller
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany.
| | - Karsten Mans
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Neeraj Tandon
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Marc O Bonin
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Biljana Smiljanovic
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Till A Sörensen
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Pascal Schendel
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Germany
| | | | - Jacqueline Detert
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Thomas Neumann
- Department of Rheumatology, University Medicine Jena, Germany
| | | | - Gerd-R Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Thomas Häupl
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
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