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Costi S, Armiraglio E, Pregnolato F, Chighizola CB, Marino A, Randelli PS, Parafioriti A, Caporali R. Diagnostic and prognostic role of synovial tissue analysis in juvenile idiopathic arthritis: a monocentric study. RMD Open 2023; 9:e003296. [PMID: 38097272 PMCID: PMC10729056 DOI: 10.1136/rmdopen-2023-003296] [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: 05/08/2023] [Accepted: 09/11/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study investigates the diagnostic role of synovial tissue analysis in children presenting with arthritis and assesses its prognostic significance to predict clinical outcome in juvenile idiopathic arthritis (JIA). METHODS Synovial samples of paediatric patients undergoing synovial biopsy between 1995 and 2020 were analysed histologically and immunohistochemically. Relationships between histological/immunohistochemical parameters and clinical variables were assessed. RESULTS Synovial biopsy was performed for diagnosis in 65 cases allowing to correctly classify 79% of patients.At histological analysis on 42 JIA samples, any difference in the number of synovial lining layers, subsynovial elementary lesions, fibrin deposit, Krenn Synovitis Score, inflammatory infiltrate score and pattern emerged between JIA subsets or on treatment exposure. Synovial tissue analysis predicted outcome: higher number of synovial layers predicted worse disease course (>4 flares during follow-up; 4.5 vs 3.0, p=0.035), even after adjusting for age at diagnosis and observation time (OR 2.2, p=0.007); subjects who had switched>2 biological disease-modifying antirheumatic drugs had higher prevalence of subsynovial elementary lesions (55.6% vs 10.3%, p=0.005) and fibrin deposits in synovial lining (60.0% vs 22.6%, p=0.049), even after adjustment for observation time and age at diagnosis (OR 8.1, p=0.047). At immunohistochemistry on 31 JIA samples, higher CD3 expression was described in polyarticular compared with oligoarticular subset (p=0.040). Patients with severe disease course had higher CD20+ rate (OR 7, p=0.023), regardless of JIA subset and treatment exposure. CONCLUSIONS Synovial tissue analysis might support the clinicians in the diagnostic approach of paediatric patients presenting with arthritis and guide the clinical management in JIA.
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Affiliation(s)
- Stefania Costi
- Department of Rheumatology and Medical Sciences, Unit of Clinical Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milano, Italy
| | | | - Francesca Pregnolato
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Cecilia Beatrice Chighizola
- Department of Rheumatology and Medical Sciences, Unit of Clinical Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Achille Marino
- Department of Rheumatology and Medical Sciences, Unit of Clinical Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milano, Italy
| | - Pietro Simone Randelli
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
- Department of Orthopedics, ASST Gaetano Pini-CTO, Milano, Lombardia, Italy
| | | | - Roberto Caporali
- Department of Rheumatology and Medical Sciences, Unit of Clinical Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
- Department of Rheumatology and Medical Sciences, Unit of Clinical Rheumatology, ASST Gaetano Pini-CTO, Milano, Lombardia, Italy
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Medina HA, Eickhoff J, Edison JD. Thinking Inside the Box: Synovial Tissue Biopsy in Immune Checkpoint Inhibitor-Induced Arthritis. J Clin Rheumatol 2021; 27:S537-S540. [PMID: 31136415 DOI: 10.1097/rhu.0000000000001088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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3
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Saraiva F. Ultrasound-Guided Synovial Biopsy: A Review. Front Med (Lausanne) 2021; 8:632224. [PMID: 33968950 PMCID: PMC8100029 DOI: 10.3389/fmed.2021.632224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Ultrasound-guided synovial biopsy is a safe, well-tolerated, and effective method to collect good-quality synovial tissue from all types of joints for clinical and research purposes. Although synovial biopsy cannot be used to distinguish between types of inflammatory rheumatic disease, analysis of synovial tissue has led to remarkable advances in the understanding of the pathobiology of rheumatoid arthritis and other inflammatory rheumatic diseases. Synovitis is the hallmark of these diseases; hence, accessing the core of the pathological process, synovial tissue, provides an opportunity to gather information with potential diagnostic and prognostic utility.
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Affiliation(s)
- Fernando Saraiva
- Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar e Universitário de Lisboa Norte, Lisbon, Portugal.,Unidade de Investigação em Reumatologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Lakhanpal A, Smith MH, Donlin LT. Rheumatology in the era of precision medicine: synovial tissue molecular patterns and treatment response in rheumatoid arthritis. Curr Opin Rheumatol 2021; 33:58-63. [PMID: 33229974 DOI: 10.1097/bor.0000000000000767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW A critical unmet need in rheumatoid arthritis (RA) is the identification of biomarkers that predict which of the available medications will be most effective for an individual in order to lower disease activity sooner than is afforded by the current treat-to-target approach. Here we will discuss recent reports examining the potential for synovial tissue molecular, cellular, and spatial profiling in defining objective measures of treatment response and therein developing personalized medicine for RA. RECENT FINDINGS Recent high-dimensional molecular profiling of RA synovium has provided unprecedented resolution of the cell types and pathways in tissues affected by rheumatic diseases. Heightened attention to tissue architecture is also emerging as a means to classify individual disease variation that may allow patients to be further stratified by therapeutic response. Although this wealth of data may have already pinpointed promising biomarkers, additional studies, likely including tissue-based functional drug response assays, will be required to demonstrate how the complex tissue environment responds. SUMMARY Molecular, cellular, and more recently spatial profiling of the RA synovium are uncovering fundamental features of the disease. Current investigations are examining whether this information will provide meaningful biomarkers for individualized medicine in RA.
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Affiliation(s)
| | | | - Laura T Donlin
- Arthritis and Tissue Degeneration Program and the David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery
- Weill Cornell Medical College and Graduate School, New York, New York, USA
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5
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Carlberg K, Korotkova M, Larsson L, Catrina AI, Ståhl PL, Malmström V. Exploring inflammatory signatures in arthritic joint biopsies with Spatial Transcriptomics. Sci Rep 2019; 9:18975. [PMID: 31831833 PMCID: PMC6908624 DOI: 10.1038/s41598-019-55441-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/23/2019] [Indexed: 12/18/2022] Open
Abstract
Lately it has become possible to analyze transcriptomic profiles in tissue sections with retained cellular context. We aimed to explore synovial biopsies from rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients, using Spatial Transcriptomics (ST) as a proof of principle approach for unbiased mRNA studies at the site of inflammation in these chronic inflammatory diseases. Synovial tissue biopsies from affected joints were studied with ST. The transcriptome data was subjected to differential gene expression analysis (DEA), pathway analysis, immune cell type identification using Xcell analysis and validation with immunohistochemistry (IHC). The ST technology allows selective analyses on areas of interest, thus we analyzed morphologically distinct areas of mononuclear cell infiltrates. The top differentially expressed genes revealed an adaptive immune response profile and T-B cell interactions in RA, while in SpA, the profiles implicate functions associated with tissue repair. With spatially resolved gene expression data, overlaid on high-resolution histological images, we digitally portrayed pre-selected cell types in silico. The RA displayed an overrepresentation of central memory T cells, while in SpA effector memory T cells were most prominent. Consequently, ST allows for deeper understanding of cellular mechanisms and diversity in tissues from chronic inflammatory diseases.
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Affiliation(s)
- Konstantin Carlberg
- Department of Gene Technology, Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden.,Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marina Korotkova
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ludvig Larsson
- Department of Gene Technology, Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | - Anca I Catrina
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Patrik L Ståhl
- Department of Gene Technology, Royal Institute of Technology, Science for Life Laboratory, Stockholm, Sweden
| | - Vivianne Malmström
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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McGettrick HM. Synovial tissue biopsy analysis: unlocking the hidden secrets to personalised medicine? Arthritis Res Ther 2019; 21:90. [PMID: 30961644 PMCID: PMC6454756 DOI: 10.1186/s13075-019-1871-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Rheumatoid arthritis is an immune-mediated inflammatory disease of the synovium. Yet we still lack robust tissue-specific (synovial) biomarkers that are able to guide clinical decisions and stratify patients according to their disease subgroup and predicted response to treatment. The EULAR Synovitis Study Group and the OMERACT synovial tissue biopsy (STB) Special Interests Group have undertaken a consensus exercise to identify factors that are important for the standardisation of STB handling and analytical procedures in two situations—clinical practice and translational research.
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Affiliation(s)
- Helen Michelle McGettrick
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK.
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7
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Osteoarthritis phenotypes and novel therapeutic targets. Biochem Pharmacol 2019; 165:41-48. [PMID: 30831073 DOI: 10.1016/j.bcp.2019.02.037] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/28/2019] [Indexed: 02/07/2023]
Abstract
The success of disease-modifying osteoarthritis drug (DMOAD) development is still elusive. While there have been successes in preclinical and early clinical studies, phase 3 clinical trials have failed so far and there is still no approved, widely available DMOAD on the market. The latest research suggests that, among other causes, poor trial outcomes might be explained by the fact that osteoarthritis (OA) is a heterogeneous disease with distinct phenotypes. OA trials might be more successful if they would address and target a specific phenotype. The increasing availability of advanced techniques to detect particular OA characteristics expands the possibilities to distinguish between such potential OA phenotypes. Magnetic resonance imaging is among the key imaging techniques to stratify and monitor patients with changes in bone, cartilage and inflammation. Biochemical markers have mainly used as secondary parameters and could further delineate phenotypes. Moreover, post-hoc analyses of trial data have suggested the existence of distinct pain phenotypes and their relevance in the design of clinical trials. Although ongoing work in the field supports the concept of OA heterogeneity, this has not yet resulted in more effective treatment options. This paper reviews the current knowledge about potential OA phenotypes and suggests that combining patient clinical data, quantitative imaging, biochemical markers and utilizing data-driven approaches in patient selection and efficacy assessment will allow for more successful development of effective DMOADs.
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Coras R, Narasimhan R, Guma M. Liquid biopsies to guide therapeutic decisions in rheumatoid arthritis. Transl Res 2018; 201:1-12. [PMID: 30092207 PMCID: PMC6309446 DOI: 10.1016/j.trsl.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic, immune-mediated inflammatory disease that has transitioned from a debilitating disease to a chronic, controllable disease. This has been possible due to the introduction of new treatment strategies like "treat-to-target," in which the clinician treats the patient aggressively enough to reach low disease activity or remission, and the introduction of new therapeutic agents, such as biological therapies, which can lead to the prevention of damage by early diagnosis and initiation of treatment. Attention is now being directed toward identifying the optimal treatment for each patient, one that will be the most efficient and have the least number of side effects. Much work has been done to find serologic and synovial biomarkers of response to various RA treatments. Proteomics, genomics and, in the past few years, metabolomics, have all been used in the quest of identifying these biomarkers. Blood-based liquid biopsies provide a minimally invasive alternative to synovial biopsies to identify cellular and molecular signatures that can be used to longitudinally monitor response and allow for personalized medicine approach. Liquid biopsies are comprised of cell-free DNA, immune circulating cells, and extracellular vesicles, and are being increasingly and successfully used in the field of oncology for diagnosis, progression, prognosis, and prediction of response to treatment. Recently, researchers have also begun investigating the usefulness of liquid biopsies in the field of rheumatology; in this review, we will focus on the potential of liquid biopsy blood samples as biomarkers of response to treatment in patients with RA.
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Affiliation(s)
- Roxana Coras
- Department of Medicine, School of Medicine, La Jolla, California; University of California San Diego, San Diego, California; Department of Medicine, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
| | - Rekha Narasimhan
- Department of Medicine, School of Medicine, La Jolla, California; University of California San Diego, San Diego, California
| | - Monica Guma
- Department of Medicine, School of Medicine, La Jolla, California; University of California San Diego, San Diego, California; Department of Medicine, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain.
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9
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Mandelin AM, Homan PJ, Shaffer AM, Cuda CM, Dominguez ST, Bacalao E, Carns M, Hinchcliff M, Lee J, Aren K, Thakrar A, Montgomery AB, Bridges SL, Bathon JM, Atkinson JP, Fox DA, Matteson EL, Buckley CD, Pitzalis C, Parks D, Hughes LB, Geraldino-Pardilla L, Ike R, Phillips K, Wright K, Filer A, Kelly S, Ruderman EM, Morgan V, Abdala-Valencia H, Misharin AV, Budinger GS, Bartom ET, Pope RM, Perlman H, Winter DR. Transcriptional Profiling of Synovial Macrophages Using Minimally Invasive Ultrasound-Guided Synovial Biopsies in Rheumatoid Arthritis. Arthritis Rheumatol 2018; 70:841-854. [PMID: 29439295 DOI: 10.1002/art.40453] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 02/08/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Currently, there are no reliable biomarkers for predicting therapeutic response in patients with rheumatoid arthritis (RA). The synovium may unlock critical information for determining efficacy, since a reduction in the numbers of sublining synovial macrophages remains the most reproducible biomarker. Thus, a clinically actionable method for the collection of synovial tissue, which can be analyzed using high-throughput strategies, must become a reality. This study was undertaken to assess the feasibility of utilizing synovial biopsies as a precision medicine-based approach for patients with RA. METHODS Rheumatologists at 6 US academic sites were trained in minimally invasive ultrasound-guided synovial tissue biopsy. Biopsy specimens obtained from patients with RA and synovial tissue from patients with osteoarthritis (OA) were subjected to histologic analysis, fluorescence-activated cell sorting, and RNA sequencing (RNA-seq). An optimized protocol for digesting synovial tissue was developed to generate high-quality RNA-seq libraries from isolated macrophage populations. Associations were determined between macrophage transcriptional profiles and clinical parameters in RA patients. RESULTS Patients with RA reported minimal adverse effects in response to synovial biopsy. Comparable RNA quality was observed from synovial tissue and isolated macrophages between patients with RA and patients with OA. Whole tissue samples from patients with RA demonstrated a high degree of transcriptional heterogeneity. In contrast, the transcriptional profile of isolated RA synovial macrophages highlighted different subpopulations of patients and identified 6 novel transcriptional modules that were associated with disease activity and therapy. CONCLUSION Performance of synovial tissue biopsies by rheumatologists in the US is feasible and generates high-quality samples for research. Through the use of cutting-edge technologies to analyze synovial biopsy specimens in conjunction with corresponding clinical information, a precision medicine-based approach for patients with RA is attainable.
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Affiliation(s)
- Arthur M Mandelin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip J Homan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Carla M Cuda
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Emily Bacalao
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary Carns
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jungwha Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathleen Aren
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anjali Thakrar
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anna B Montgomery
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - John P Atkinson
- Washington University School of Medicine, St. Louis, Missouri
| | - David A Fox
- University of Michigan School of Medicine, Ann Arbor
| | - Eric L Matteson
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Christopher D Buckley
- University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Costantino Pitzalis
- William Harvey Research Institute and Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Deborah Parks
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Robert Ike
- University of Michigan School of Medicine, Ann Arbor
| | | | - Kerry Wright
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Andrew Filer
- University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Stephen Kelly
- William Harvey Research Institute and Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Eric M Ruderman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vince Morgan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - G Scott Budinger
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Richard M Pope
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Harris Perlman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Deborah R Winter
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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