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Liu X, Zhang X, Kang Y, Huang F, Liu S, Guo Y, Li Y, Yin C, Liu M, Han Q, Wang Q, Ye H, Yao H, Li C, Li J, Pingcuo W, Zhang Y, Su Y, Gao G, Li Z, Sun X. An autoantibody profile identified by human genome-wide protein arrays in rheumatoid arthritis. MedComm (Beijing) 2024; 5:e679. [PMID: 39132510 PMCID: PMC11317183 DOI: 10.1002/mco2.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 08/13/2024] Open
Abstract
Precise diagnostic biomarkers of anticitrullination protein antibody (ACPA)-negative and early-stage RA are still to be improved. We aimed to screen autoantibodies in ACPA-negative patients and evaluated their diagnostic performance. The human genome-wide protein arrays (HuProt arrays) were used to define specific autoantibodies from the sera of 182 RA patients and 261 disease and healthy controls. Statistical analysis was performed with SPSS 17.0. In Phase I study, 51 out of 19,275 recombinant proteins covering the whole human genome were selected. In Phase II validation study, anti-ANAPC15 (anaphase promoting complex subunit 15) exhibited 41.8% sensitivity and 91.5% specificity among total RA patients. There were five autoantibodies increased in ACPA-negative RA, including anti-ANAPC15, anti-LSP1, anti-APBB1, anti-parathymosin, and anti-UBL7. Anti-parathymosin showed the highest prevalence of 46.2% (p = 0.016) in ACPA-negative early stage (<2 years) RA. To further improve the diagnostic efficacy, a prediction model was constructed with 44 autoantibodies. With increased threshold for RA calling, the specificity of the model is 90.8%, while the sensitivity is 66.1% (87.8% in ACPA-positive RA and 23.8% in ACPA-negative RA) in independent testing patients. Therefore, HuProt arrays identified RA-associated autoantibodies that might become possible diagnostic markers, especially in early stage ACPA-negative RA.
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Affiliation(s)
- Xu Liu
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Xiaoying Zhang
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Yu‐Jian Kang
- Chongqing Key Laboratory of Intelligent Oncology for Breast CancerCancer HospitalSchool of MedicineChongqing UniversityChongqingChina
| | - Fei Huang
- General Medical DepartmentHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
| | - Shuang Liu
- Department of Rheumatology and ImmunologyFirst Affiliated Hospital of Kunming Medical University.KunmingChina
| | - Yixue Guo
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Yingni Li
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Changcheng Yin
- Beijing Protein InnovationB‐8, Airport Industrial ZoneBeijingChina
| | - Mingling Liu
- Department of Rheumatologythe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Qimao Han
- Department of RheumatologyThe First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine. No.24 Heping RoadXiangfang DistrictHarbinChina
| | - Qingwen Wang
- Department of Rheumatism and ImmunologyPeking University Shenzhen HospitalShenzhenChina
| | - Hua Ye
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Haihong Yao
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Chun Li
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Jiahe Li
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Wangzha Pingcuo
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Yan Zhang
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Yin Su
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Ge Gao
- State Key Laboratory of Protein and Plant Gene Research, School of Life SciencesBiomedical Pioneering Innovative Center (BIOPIC) & Beijing Advanced Innovation Center for Genomics (ICG)Center for Bioinformatics (CBI)Peking UniversityBeijingChina
| | - Zhanguo Li
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
| | - Xiaolin Sun
- Department of Rheumatology and ImmunologyPeking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135)BeijingChina
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Kronzer VL, Hayashi K, Crowson CS, Davis JM, McDermott GC, Cui J, Losina E, Juge PA, Cerhan JR, Sparks JA. Gene-respiratory disease interactions for rheumatoid arthritis risk. Semin Arthritis Rheum 2023; 63:152254. [PMID: 37595508 PMCID: PMC10840753 DOI: 10.1016/j.semarthrit.2023.152254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/30/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE We aimed to identify gene by respiratory tract disease interactions that increase RA risk. METHODS In this case-control study using the Mass General Brigham Biobank, we matched incident RA cases, confirmed by ACR/EULAR criteria, to four controls on age, sex, and electronic health record history. Genetic exposures included a validated overall genetic risk score (GRS) for RA, a Human Leukocyte Antigen (HLA) GRS for RA, and the MUC5B promoter variant, an established risk factor for RA-associated interstitial lung disease (ILD). Preceding respiratory tract diseases came from diagnosis codes (positive predictive value 86%). We estimated attributable proportions (AP) and multiplicative odds ratios (OR) with 95% confidence intervals (CI) for RA for each genetic and respiratory exposure using conditional logistic regression models, adjusting for potential confounders. RESULTS We identified 653 incident RA cases and 2,607 matched controls (mean 54 years, 76% female). The highest tertile of the overall GRS and the HLA GRS were both associated with increased RA risk (OR 2.28, 95% CI 1.89,2.74; OR 2.02, 95% CI 1.67-2.45). ILD and the HLA GRS exhibited a synergistic relationship for RA risk (OR for both exposures 4.30, 95% CI 1.28,14.38; AP 0.51, 95% CI-0.16,1.18). Asthma and the MUC5B promoter variant also exhibited a synergistic interaction for seropositive RA (OR for both exposures 2.58, 95% CI 1.10,6.07; AP 0.62, 95% CI 0.24,1.00). CONCLUSION ILD-HLA GRS and asthma-MUC5B promoter variant showed synergistic interactions for RA risk. Such interactions may prove useful for RA prevention and screening.
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Affiliation(s)
| | - Keigo Hayashi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital; Harvard Medical School, Boston, USA.
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
| | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
| | - Gregory C McDermott
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital; Harvard Medical School, Boston, USA.
| | - Jing Cui
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | - Elena Losina
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, USA.
| | - Pierre-Antoine Juge
- Dept of Rheumatology, DMU Locomotion, INSERM UMR1152, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France.
| | - James R Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital; Harvard Medical School, Boston, USA.
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Nandakumar KS, Fang Q, Wingbro Ågren I, Bejmo ZF. Aberrant Activation of Immune and Non-Immune Cells Contributes to Joint Inflammation and Bone Degradation in Rheumatoid Arthritis. Int J Mol Sci 2023; 24:15883. [PMID: 37958864 PMCID: PMC10648236 DOI: 10.3390/ijms242115883] [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: 09/27/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Abnormal activation of multiple immune and non-immune cells and proinflammatory factors mediate the development of joint inflammation in genetically susceptible individuals. Although specific environmental factors like smoking and infections are associated with disease pathogenesis, until now, we did not know the autoantigens and arthritogenic factors that trigger the initiation of the clinical disease. Autoantibodies recognizing specific post-translationally modified and unmodified antigens are generated and in circulation before the onset of the joint disease, and could serve as diagnostic and prognostic markers. The characteristic features of autoantibodies change regarding sub-class, affinity, glycosylation pattern, and epitope spreading before the disease onset. Some of these antibodies were proven to be pathogenic using animal and cell-culture models. However, not all of them can induce disease in animals. This review discusses the aberrant activation of major immune and non-immune cells contributing to joint inflammation. Recent studies explored the protective effects of extracellular vesicles from mesenchymal stem cells and bacteria on joints by targeting specific cells and pathways. Current therapeutics in clinics target cells and inflammatory pathways to attenuate joint inflammation and protect the cartilage and bones from degradation, but none cure the disease. Hence, more basic research is needed to investigate the triggers and mechanisms involved in initiating the disease and relapses to prevent chronic inflammation from damaging joint architecture.
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Affiliation(s)
- Kutty Selva Nandakumar
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, 17177 Stockholm, Sweden
- Department of Environmental and Biosciences, Halmstad University, 30118 Halmstad, Sweden; (I.W.Å.); (Z.F.B.)
| | - Qinghua Fang
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA;
| | - Isabella Wingbro Ågren
- Department of Environmental and Biosciences, Halmstad University, 30118 Halmstad, Sweden; (I.W.Å.); (Z.F.B.)
| | - Zoe Fuwen Bejmo
- Department of Environmental and Biosciences, Halmstad University, 30118 Halmstad, Sweden; (I.W.Å.); (Z.F.B.)
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Epidemiologic Opportunities and Challenges in Studying Environmental Risk Factors for Rheumatic Diseases. Rheum Dis Clin North Am 2022; 48:763-779. [PMID: 36332994 DOI: 10.1016/j.rdc.2022.06.001] [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: 12/14/2022]
Abstract
Most rheumatic diseases have a stronger environmental than hereditary etiology. This article summarizes the key environmental risk factors for rheumatic diseases, the data sources that generated these findings, and the key pitfalls with existing research that every rheumatology clinician should know. Emerging research opportunities hold promise to revolutionize this field, and soon.
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Venetsanopoulou AI, Alamanos Y, Voulgari PV, Drosos AA. Epidemiology of rheumatoid arthritis: genetic and environmental influences. Expert Rev Clin Immunol 2022; 18:923-931. [PMID: 35904251 DOI: 10.1080/1744666x.2022.2106970] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic systemic disease characterized by articular involvement and extra-articular manifestations. The incidence and prevalence of the disease vary across populations, and there is an ongoing debate on whether a change of RA occurrence over time exists or is due to methodological issues and other biases. Moreover, the disease's onset is related to an interaction of genetic and environmental factors that influence its expression. AREAS COVERED This review explores the latest knowledge on RA epidemiology and the possible risk factors associated with its presentation to identify potential warning signs that may in the future help disease management. EXPERT OPINION Current epidemiological evidence suggests a significant impact of smoking, sex hormones, and lifestyle status in RA occurrence. However, the association between these variables has not yet been thoroughly studied. Still, their effect must be interpreted as they may present subsequently integral indicators for a more rational approach of the disease.
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Affiliation(s)
- Aliki I Venetsanopoulou
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Yannis Alamanos
- Institute of Epidemiology, Preventive Medicine and Public Health, Corfu, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Abstract
Rheumatoid arthritis (RA) is currently diagnosed and treated once an individual displays the clinical findings of inflammatory arthritis (IA). However, growing evidence supports that there is a 'pre-RA' stage that can be identified through factors such as autoantibodies in absence of clinically apparent IA. In particular, biomarkers, including antibodies to citrullinated protein antigens (ACPA), demonstrate a high risk for future IA/RA, and multiple clinical trials have been developed to intervene in individuals in pre-RA to prevent or delay clinically apparent disease. Herein, we will discuss in more depth what is currently known about the natural history of RA, and the emerging possibility that early 'diagnosis' of RA-related autoimmunity followed by an intervention can lead to the delay or prevention of the first onset of clinically apparent RA.
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Kronzer VL, Huang W, Crowson CS, Davis JM, Vassallo R, Doyle TJ, Losina E, Sparks JA. Timing of sinusitis and other respiratory tract diseases and risk of rheumatoid arthritis. Semin Arthritis Rheum 2022; 52:151937. [PMID: 35042150 PMCID: PMC8820230 DOI: 10.1016/j.semarthrit.2021.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the association between timing of respiratory tract diseases and risk of rheumatoid arthritis (RA). METHODS This case-control study using the Mass General Brigham Biobank matched incident RA cases, confirmed by ACR/EULAR criteria, with at least seven years preceding electronic health record (EHR) data to three controls on age, sex, and EHR history from RA diagnosis (index date). We ascertained timing (>0-5 years/>5-10 years/>10 years) of the first documented respiratory tract disease prior to index date using diagnosis codes. We estimated odds ratios (OR) with 95% confidence intervals (CI) for RA for each respiratory exposure using logistic regression models, adjusting for potential confounders. We also conducted a stratified analysis by serostatus and smoking. RESULTS We identified 625 incident RA cases (median 56 years, 75% female, 57% seropositive) and 1,875 controls. Acute sinusitis was associated with RA only in the >5 to 10 years before RA (OR 3.90, 95% CI:1.90,8.01). In contrast, pneumonia was associated with RA only in the >0 to 5 years before RA (OR 1.73, 95% CI:1.00,3.00), and chronic respiratory tract diseases only >10 years before RA (OR 1.43, 95% CI:1.00,2.05). All respiratory tract diseases tended to show a stronger association with seronegative RA than seropositive RA, although the interaction was statistically significant only for chronic sinusitis (p=0.04). Respiratory diseases showed a nonsignificantly stronger association among smokers than nonsmokers. CONCLUSION Sinusitis and other respiratory diseases are associated with increased risk of RA, especially 5 years before RA onset. RA may begin many years before clinical onset.
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Affiliation(s)
- Vanessa L Kronzer
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,Corresponding Author: Vanessa L. Kronzer, , 200 First Street SW, Rochester, MN 55905, P: 651-308-1523 F: 507-266-1799
| | - Weixing Huang
- Division of Rheumatology, Inflammation, and Immunity; Brigham and Women’s Hospital; Harvard Medical School; Boston, USA
| | - Cynthia S. Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - John M. Davis
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracy J. Doyle
- Division of Pulmonary and Critical Care; Brigham and Women’s Hospital and Harvard Medical School; Boston, USA
| | - Elena Losina
- Department of Orthopedic Surgery; Brigham and Women’s Hospital; Boston, USA,Department of Biostatistics; Boston University School of Public Health; Boston, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity; Brigham and Women’s Hospital; Harvard Medical School; Boston, USA
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Kronzer VL, Huang W, Zaccardelli A, Crowson CS, Davis JM, Vassallo R, Doyle TJ, Losina E, Sparks JA. Association of sinusitis and upper respiratory tract diseases with incident rheumatoid arthritis: A case-control study. J Rheumatol 2021; 49:358-364. [PMID: 34654732 DOI: 10.3899/jrheum.210580] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to determine whether specific respiratory tract diseases are associated with increased rheumatoid arthritis (RA) risk. METHODS This case-control study within the Mass General Brigham Biobank matched newly diagnosed RA cases to three controls on age, sex, and electronic health record history. We identified RA using a validated algorithm and confirmed by medical record review. Respiratory tract disease exposure required one inpatient or two outpatient codes at least two years before index date of RA clinical diagnosis or matched date. Logistic regression models calculated odds ratios (OR) for RA with 95% confidence intervals (CI), adjusting for confounders. We then stratified by serostatus ("seropositive" was positive rheumatoid factor and/or anti-citrullinated protein antibodies) and smoking. RESULTS We identified 741 RA cases and 2,223 controls (both median age 55, 76% female). Acute sinusitis (OR 1.61, 95% CI:1.05,2.45), chronic sinusitis (OR 2.16, 95% CI:1.39,3.35), and asthma (OR 1.39, 95% CI:1.03,1.87) were associated with increased risk of RA. Acute respiratory tract disease burden during the pre-index exposure period was also associated with increased RA risk (OR 1.30 per 10 codes, 95% CI:1.08,1.55). Acute pharyngitis was associated with seronegative (OR 1.68, 95% CI:1.02,2.74) but not seropositive RA; chronic rhinitis/pharyngitis was associated with seropositive (OR 2.46, 95% CI:1.01,5.99) but not seronegative RA. Respiratory tract diseases tended towards higher associations in smokers, especially >10 packyears (OR 1.52, 95% CI:1.02,2.27; p=0.10 for interaction). CONCLUSION Acute/chronic sinusitis and pharyngitis and acute respiratory burden increased RA risk. The mucosal paradigm of RA pathogenesis may involve the upper respiratory tract.
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Affiliation(s)
- Vanessa L Kronzer
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Rheumatology, Inflammation, and Immunity; Brigham and Women's Hospital; Harvard Medical School; Boston, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care; Brigham and Women's Hospital and Harvard Medical School; Boston, USA; Department of Orthopedic Surgery; Brigham and Women's Hospital; Boston, USA. Funding: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases awards NIH-P30-AR072577 (VERITY Pilot & Feasibility award to VLK), K23 AR069688 (JAS), R03 AR075886 (JAS), L30 AR066953 (JAS), R03 HL148484 (TJD), and P30 AR070253 (Joint Biology Consortium). It was also supported by the R Bridge Award (JAS) from the Rheumatology Research Foundation. The funders had no role in the decision to publish or preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. Conflict of interest: The authors declare no conflicts of interest related to this work. Corresponding Author: Vanessa L. Kronzer, 200 First Street SW, Rochester, MN 55905
| | - Weixing Huang
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Rheumatology, Inflammation, and Immunity; Brigham and Women's Hospital; Harvard Medical School; Boston, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care; Brigham and Women's Hospital and Harvard Medical School; Boston, USA; Department of Orthopedic Surgery; Brigham and Women's Hospital; Boston, USA. Funding: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases awards NIH-P30-AR072577 (VERITY Pilot & Feasibility award to VLK), K23 AR069688 (JAS), R03 AR075886 (JAS), L30 AR066953 (JAS), R03 HL148484 (TJD), and P30 AR070253 (Joint Biology Consortium). It was also supported by the R Bridge Award (JAS) from the Rheumatology Research Foundation. The funders had no role in the decision to publish or preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. Conflict of interest: The authors declare no conflicts of interest related to this work. Corresponding Author: Vanessa L. Kronzer, 200 First Street SW, Rochester, MN 55905
| | - Alessandra Zaccardelli
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Rheumatology, Inflammation, and Immunity; Brigham and Women's Hospital; Harvard Medical School; Boston, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care; Brigham and Women's Hospital and Harvard Medical School; Boston, USA; Department of Orthopedic Surgery; Brigham and Women's Hospital; Boston, USA. Funding: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases awards NIH-P30-AR072577 (VERITY Pilot & Feasibility award to VLK), K23 AR069688 (JAS), R03 AR075886 (JAS), L30 AR066953 (JAS), R03 HL148484 (TJD), and P30 AR070253 (Joint Biology Consortium). It was also supported by the R Bridge Award (JAS) from the Rheumatology Research Foundation. The funders had no role in the decision to publish or preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. Conflict of interest: The authors declare no conflicts of interest related to this work. Corresponding Author: Vanessa L. Kronzer, 200 First Street SW, Rochester, MN 55905
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Rheumatology, Inflammation, and Immunity; Brigham and Women's Hospital; Harvard Medical School; Boston, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care; Brigham and Women's Hospital and Harvard Medical School; Boston, USA; Department of Orthopedic Surgery; Brigham and Women's Hospital; Boston, USA. Funding: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases awards NIH-P30-AR072577 (VERITY Pilot & Feasibility award to VLK), K23 AR069688 (JAS), R03 AR075886 (JAS), L30 AR066953 (JAS), R03 HL148484 (TJD), and P30 AR070253 (Joint Biology Consortium). It was also supported by the R Bridge Award (JAS) from the Rheumatology Research Foundation. The funders had no role in the decision to publish or preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. Conflict of interest: The authors declare no conflicts of interest related to this work. Corresponding Author: Vanessa L. Kronzer, 200 First Street SW, Rochester, MN 55905
| | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Rheumatology, Inflammation, and Immunity; Brigham and Women's Hospital; Harvard Medical School; Boston, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care; Brigham and Women's Hospital and Harvard Medical School; Boston, USA; Department of Orthopedic Surgery; Brigham and Women's Hospital; Boston, USA. Funding: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases awards NIH-P30-AR072577 (VERITY Pilot & Feasibility award to VLK), K23 AR069688 (JAS), R03 AR075886 (JAS), L30 AR066953 (JAS), R03 HL148484 (TJD), and P30 AR070253 (Joint Biology Consortium). It was also supported by the R Bridge Award (JAS) from the Rheumatology Research Foundation. The funders had no role in the decision to publish or preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. Conflict of interest: The authors declare no conflicts of interest related to this work. Corresponding Author: Vanessa L. Kronzer, 200 First Street SW, Rochester, MN 55905
| | - Robert Vassallo
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Rheumatology, Inflammation, and Immunity; Brigham and Women's Hospital; Harvard Medical School; Boston, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care; Brigham and Women's Hospital and Harvard Medical School; Boston, USA; Department of Orthopedic Surgery; Brigham and Women's Hospital; Boston, USA. Funding: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases awards NIH-P30-AR072577 (VERITY Pilot & Feasibility award to VLK), K23 AR069688 (JAS), R03 AR075886 (JAS), L30 AR066953 (JAS), R03 HL148484 (TJD), and P30 AR070253 (Joint Biology Consortium). It was also supported by the R Bridge Award (JAS) from the Rheumatology Research Foundation. The funders had no role in the decision to publish or preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. Conflict of interest: The authors declare no conflicts of interest related to this work. Corresponding Author: Vanessa L. Kronzer, 200 First Street SW, Rochester, MN 55905
| | - Tracy J Doyle
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Rheumatology, Inflammation, and Immunity; Brigham and Women's Hospital; Harvard Medical School; Boston, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care; Brigham and Women's Hospital and Harvard Medical School; Boston, USA; Department of Orthopedic Surgery; Brigham and Women's Hospital; Boston, USA. Funding: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases awards NIH-P30-AR072577 (VERITY Pilot & Feasibility award to VLK), K23 AR069688 (JAS), R03 AR075886 (JAS), L30 AR066953 (JAS), R03 HL148484 (TJD), and P30 AR070253 (Joint Biology Consortium). It was also supported by the R Bridge Award (JAS) from the Rheumatology Research Foundation. The funders had no role in the decision to publish or preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. Conflict of interest: The authors declare no conflicts of interest related to this work. Corresponding Author: Vanessa L. Kronzer, 200 First Street SW, Rochester, MN 55905
| | - Elena Losina
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Rheumatology, Inflammation, and Immunity; Brigham and Women's Hospital; Harvard Medical School; Boston, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care; Brigham and Women's Hospital and Harvard Medical School; Boston, USA; Department of Orthopedic Surgery; Brigham and Women's Hospital; Boston, USA. Funding: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases awards NIH-P30-AR072577 (VERITY Pilot & Feasibility award to VLK), K23 AR069688 (JAS), R03 AR075886 (JAS), L30 AR066953 (JAS), R03 HL148484 (TJD), and P30 AR070253 (Joint Biology Consortium). It was also supported by the R Bridge Award (JAS) from the Rheumatology Research Foundation. The funders had no role in the decision to publish or preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. Conflict of interest: The authors declare no conflicts of interest related to this work. Corresponding Author: Vanessa L. Kronzer, 200 First Street SW, Rochester, MN 55905
| | - Jeffrey A Sparks
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Rheumatology, Inflammation, and Immunity; Brigham and Women's Hospital; Harvard Medical School; Boston, USA; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care; Brigham and Women's Hospital and Harvard Medical School; Boston, USA; Department of Orthopedic Surgery; Brigham and Women's Hospital; Boston, USA. Funding: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases awards NIH-P30-AR072577 (VERITY Pilot & Feasibility award to VLK), K23 AR069688 (JAS), R03 AR075886 (JAS), L30 AR066953 (JAS), R03 HL148484 (TJD), and P30 AR070253 (Joint Biology Consortium). It was also supported by the R Bridge Award (JAS) from the Rheumatology Research Foundation. The funders had no role in the decision to publish or preparation of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the National Institutes of Health. Conflict of interest: The authors declare no conflicts of interest related to this work. Corresponding Author: Vanessa L. Kronzer, 200 First Street SW, Rochester, MN 55905
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9
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de Jesus VC, Singh M, Schroth RJ, Chelikani P, Hitchon CA. Association of Bitter Taste Receptor T2R38 Polymorphisms, Oral Microbiota, and Rheumatoid Arthritis. Curr Issues Mol Biol 2021; 43:1460-1472. [PMID: 34698096 PMCID: PMC8929115 DOI: 10.3390/cimb43030103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 02/06/2023] Open
Abstract
The association of taste genetics and the oral microbiome in autoimmune diseases such as rheumatoid arthritis (RA) has not been reported. We explored a novel oral mucosal innate immune pathway involving the bitter taste G protein-coupled receptor T2R38. This case–control study aimed to evaluate whether T2R38 polymorphisms associate with the buccal microbial composition in RA. Genomic DNA was obtained from buccal swabs of 35 RA patients and 64 non-RA controls. TAS2R38 genotypes were determined by Sanger sequencing. The buccal microbiome was assessed by Illumina MiSeq sequencing of the V4-16S rRNA gene. Bacterial community differences were analyzed with alpha and beta diversity measures. Linear discriminant analysis effect size identified taxa discriminating between RA versus non-RA and across TAS2R38 genotypes. TAS2R38 genotype frequency was similar between RA and non-RA controls (PAV/PAV; PAV/AVI; AVI/AVI: RA 42.9%; 45.7%; 11.4% versus controls 32.8%; 48.4%; 18.8%, chi-square (2, N = 99) = 2.1, p = 0.35). The relative abundance of Porphyromonas, among others, differed between RA and non-RA controls. The relative abundance of several bacterial species also differed across TAS2R38 genotypes. These findings suggest an association between T2R38 polymorphisms and RA buccal microbial composition. However, further research is needed to understand the impact of T2R38 in oral health and RA development.
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Affiliation(s)
- Vivianne Cruz de Jesus
- Manitoba Chemosensory Biology Research Group, Department of Oral Biology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W4, Canada; (V.C.d.J.); (R.J.S.)
- Children’s Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB R3E 3P4, Canada
| | - Manu Singh
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Robert J. Schroth
- Manitoba Chemosensory Biology Research Group, Department of Oral Biology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W4, Canada; (V.C.d.J.); (R.J.S.)
- Children’s Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB R3E 3P4, Canada
- Department of Preventive Dental Science, Rady Faculty of Health Sciences, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB R3E 0W4, Canada
| | - Prashen Chelikani
- Manitoba Chemosensory Biology Research Group, Department of Oral Biology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W4, Canada; (V.C.d.J.); (R.J.S.)
- Children’s Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB R3E 3P4, Canada
- Correspondence: (P.C.); (C.A.H.); Tel.: +1-204-789-3539 (P.C.); +1-204-787-1851 (C.A.H.); Fax: +1-204-789-3913 (P.C.); +1-204-787-2475 (C.A.H.)
| | - Carol A. Hitchon
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3A 1M4, Canada
- Correspondence: (P.C.); (C.A.H.); Tel.: +1-204-789-3539 (P.C.); +1-204-787-1851 (C.A.H.); Fax: +1-204-789-3913 (P.C.); +1-204-787-2475 (C.A.H.)
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10
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Wouters F, Maurits MP, van Boheemen L, Verstappen M, Mankia K, Matthijssen XME, Dorjée AL, Emery P, Knevel R, van Schaardenburg D, Toes REM, van der Helm-van Mil AHM. Determining in which pre-arthritis stage HLA-shared epitope alleles and smoking exert their effect on the development of rheumatoid arthritis. Ann Rheum Dis 2021; 81:48-55. [PMID: 34285049 DOI: 10.1136/annrheumdis-2021-220546] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/07/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The human leukocyte antigen-shared epitope (HLA-SE) alleles and smoking are the most prominent genetic and environmental risk factors for rheumatoid arthritis (RA). However, at which pre-arthritis stage (asymptomatic/symptomatic) they exert their effect is unknown. We aimed to determine whether HLA-SE and smoking are involved in the onset of autoantibody positivity, symptoms (clinically suspect arthralgia (CSA)) and/or progression to clinical arthritis. METHODS We performed meta-analyses on results from the literature on associations of HLA-SE and smoking with anti-citrullinated protein antibodies (ACPAs) in the asymptomatic population. Next, we studied associations of HLA-SE and smoking with autoantibody positivity at CSA onset and with progression to clinical inflammatory arthritis (IA) during follow-up. Associations in ACPA-positive patients with CSA were validated in meta-analyses with other arthralgia cohorts. Analyses were repeated for rheumatoid factor (RF), anti-carbamylated protein antibodies (anti-CarP) and anti-acetylated protein antibodies (AAPA). RESULTS Meta-analyses showed that HLA-SE is not associated with ACPA positivity in the asymptomatic population (OR 1.06 (95% CI:0.69 to 1.64)), whereas smoking was associated (OR 1.37 (95% CI: 1.15 to 1.63)). At CSA onset, both HLA-SE and smoking associated with ACPA positivity (OR 2.08 (95% CI: 1.24 to 3.49), OR 2.41 (95% CI: 1.31 to 4.43)). During follow-up, HLA-SE associated with IA development (HR 1.86 (95% CI: 1.23 to 2.82)), in contrast to smoking. This was confirmed in meta-analyses in ACPA-positive arthralgia (HR 1.52 (95% CI: 1.08 to 2.15)). HLA-SE and smoking were not associated with RF, anti-CarP or AAPA-positivity at CSA onset. Longitudinally, AAPA associated with IA development independent from ACPA and RF (HR 1.79 (95% CI: 1.02 to 3.16)), anti-CarP did not. CONCLUSIONS HLA-SE and smoking act at different stages: smoking confers risk for ACPA and symptom development, whereas HLA-SE mediates symptom and IA development. These data enhance the understanding of the timing of the key risk factors in the development of RA.
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Affiliation(s)
- Fenne Wouters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc P Maurits
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurette van Boheemen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - Marloes Verstappen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Annemarie L Dorjée
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rachel Knevel
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dirkjan van Schaardenburg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - René E M Toes
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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11
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Li H, Li L, Liu C, Cheng L, Yan S, Chen H, Li Y. Diagnostic value of anti-citrullinated α-enolase peptide 1 antibody in patients with rheumatoid arthritis: A systematic review and meta-analysis. Int J Rheum Dis 2021; 24:633-646. [PMID: 33713557 PMCID: PMC8252446 DOI: 10.1111/1756-185x.14093] [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: 10/28/2020] [Revised: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 12/27/2022]
Abstract
Aim To evaluate the diagnostic value of anti‐citrullinated α‐enolase peptide 1 (anti‐CEP 1) antibody in patients with rheumatoid arthritis (RA) by conducting a systematic review and meta‐analysis. Methods The PubMed, Web of Science, Embase, Scopus, and Cochrane Library databases were searched for relevant studies published until September 23, 2020. A bivariate mixed‐effects model was used to calculate the diagnostic indices from primary data of eligible studies. We performed meta‐regression and subgroup analysis to explore the sources of heterogeneity. Results Twenty‐four articles, with a total of 17 380 patients with RA and 7505 control participants, met the criteria for inclusion in the meta‐analysis. The pooled sensitivity, specificity, and positive and negative likelihood ratios for the anti‐CEP 1 antibody were 44% (95% CI: 38%‐51%), 97% (95% CI: 96%‐98%), and 14.81 (95% CI: 10.66‐20.57) and 0.57 (95% CI: 0.52‐0.64), respectively. The pooled positive and negative predictive values were 0.96 (95% CI: 0.95‐0.97) and 0.53 (95% CI: 0.43‐0.63), respectively. The area under the summary receiver operating characteristic curve was 0.86. Meta‐regression indicated that the anti‐CEP 1 antibody detection method may be a source of heterogeneity. The subgroup analysis of the group in which the anti‐CEP 1 antibody was detected by using a commercial enzyme‐linked immunosorbent assay (ELISA) kit had a sensitivity of 59% (95% CI: 50%‐68%) and a specificity of 93% (95% CI: 85%‐97%). Conclusions The anti‐CEP 1 antibody had moderate RA diagnostic value with relatively low sensitivity and high specificity. An ELISA may increase the RA diagnostic sensitivity.
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Affiliation(s)
- Haolong Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Liubing Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Chenxi Liu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Linlin Cheng
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Songxin Yan
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Haizhen Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.,Department of Clinical Laboratory, The First Hospital of Jilin University, Jilin, China
| | - Yongzhe Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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12
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Deane KD, Holers VM. Rheumatoid Arthritis Pathogenesis, Prediction, and Prevention: An Emerging Paradigm Shift. Arthritis Rheumatol 2021; 73:181-193. [PMID: 32602263 PMCID: PMC7772259 DOI: 10.1002/art.41417] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
Rheumatoid arthritis (RA) is currently diagnosed and treated when an individual presents with signs and symptoms of inflammatory arthritis (IA) as well as other features, such as autoantibodies and/or imaging findings, that provide sufficient confidence that the individual has RA-like IA (e.g., meeting established classification criteria) that warrants therapeutic intervention. However, it is now known that there is a stage of seropositive RA during which circulating biomarkers and other factors (e.g., joint symptoms) can be used to predict if and when an individual who does not currently have IA may develop future clinically apparent IA and classifiable RA. Indeed, the discovery of the "pre-RA" stage of seropositive disease has led to the development of several clinical trials in which individuals are studied to identify ways to delay or prevent the onset of clinically apparent IA/RA. This review focuses on several issues pertinent to understanding the prevention of RA. These include discussion of the pathogenesis of pre-RA development, prediction of the likelihood and timing of future classifiable RA, and a review of completed and ongoing clinical trials in RA prevention. Furthermore, this review discusses challenges and opportunities to be addressed to effect a paradigm shift in RA, where in the near future, proactive risk assessment focused on prevention of RA will become a public health strategy in much the same manner as cardiovascular disease is managed today.
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Affiliation(s)
- Kevin D. Deane
- Division of Rheumatology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - V. Michael Holers
- Division of Rheumatology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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13
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Lamacchia C, Courvoisier DS, Jarlborg M, Bas S, Roux-Lombard P, Möller B, Ciurea A, Finckh A, Bentow C, Martinez-Prat L, Mahler M, Gabay C, Nissen MJ. Predictive value of anti-CarP and anti-PAD3 antibodies alone or in combination with RF and ACPA for the severity of rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:4598-4608. [PMID: 33502443 DOI: 10.1093/rheumatology/keab050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/14/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this study was to analyse the predictive value of anti-carbamylated protein (anti-CarP) and anti-peptidyl-arginine deiminase type-3 (anti-PAD3) antibodies, alone or in combination with RF and ACPA, to identify patients at high risk of developing severe RA outcomes. METHODS Patients within the Swiss Clinical Quality Management registry with a biobank sample were tested for RF, ACPA, anti-CarP, and anti-PAD3 antibodies. We examined the association of each autoantibody with DAS28, HAQ and radiographic damage (Ratingen) at baseline and longitudinally. RESULTS Analyses included 851 established RA patients and 516 disease controls [axial spondyloarthritis (axSpA = 320) and PsA (196)]. Anti-CarP and anti-PAD3 antibodies were, respectively, present in 22.4% and 10.7% of the whole RA population, and in 13.2% and 3.8% of the RF and ACPA double seronegative patients. At baseline, RA patients with anti-PAD3 had higher DAS28 (4.2 vs 3.7; P= 0.005) and significantly more radiographic damage (14.9 vs 8.8; P= 0.02) than anti-PAD3-negative patients. In the ACPA-negative subgroup, baseline Ratingen scores were significantly higher in anti-PAD3-positive patients (P= 0.01). The combination of anti-PAD3, RF IgM, and ACPA was associated with significantly higher baseline radiographic scores than the double seropositive group (P= 0.04). The presence of any two of the previous autoantibodies was associated with significantly greater radiographic progression over 10 years than if all were absent (P= 0.02). There were no differences in RA outcome measures with regards to anti-CarP. CONCLUSIONS Anti-PAD3 antibodies are associated with higher disease activity and joint damage scores in RA patients.
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Affiliation(s)
| | | | | | | | | | - Burkhard Möller
- Department of Rheumatology, Immunology and Allergy, Bern University Hospital, Bern
| | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, Zurich, Switzerland
| | | | - Chelsea Bentow
- Research and Development, Inova Diagnostics, San Diego, CA, USA
| | | | - Michael Mahler
- Research and Development, Inova Diagnostics, San Diego, CA, USA
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14
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Qin G, Lin X, Liang P, Li Y, Zhou C, Kutty SN, Rikard H. [Strong inflammation is essential for expression of articular cartilage-specific citrullinated antigens]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1081-1089. [PMID: 32895186 DOI: 10.12122/j.issn.1673-4254.2020.08.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the expression of citrullinated epitopes in articular cartilage protein and whether its expression is sufficient to induce anti-citrullinated protein antibody (ACPA) response in mice. METHODS The experimental group was treated with different concentrations of lipopolysaccharide (LPS), heat-inactivated bacteria (Escherichia coli and Staphylococcus aureus) or specific monoclonal antibody against type Ⅱ collagen to induce citrullination of articular cartilage protein, with PBS as the control. Immunohistochemistry with the monoclonal antibody ACC4 (IgG1) that specifically binds to the citrullinated epitope of cartilage protein was performed for detecting the expression of citrullinated protein, with ACC1 (IgG2a) as a positive control antibody and L243 (IgG2a) and Hy2.15 (IgG1) as the negative isotype control. In the in vivo experiment, SD rats were subjected to injection of different doses of LPS in the right knee (with PBS as the controls in the left knee), and 3 days later frozen sections were prepared for immunohistochemical detection of the expression of citrullinated protein. Models of collagen-induced arthritis (CIA) established in different mouse strains were observed for incidence and severity of CIA. Serum samples collected from these models and the sera from rheumatoid arthritis patients were examined for anti-citrullinated protein antibody, and immunohistochemistry was performed to detect the expression of citrullinated protein in the cartilage of the mouse. RESULTS The citrullinated CII epitope-specific antibody ACC4 did not bind to articular cartilage tissues with different treatments as compared with the positive control antibody ACC1. The ACC4 antibody and the antibodies from patients with rheumatoid arthritis with high titers of anti-citrullinated protein antibody were capable of binding to the synovial tissue around the articular cartilage of the CIA. Luminex analysis showed that the anti-citrullinated protein antibody was lowly expressed in mouse serum, but the anti-type Ⅱ collagen triple helix structure peptide antibody exhibited strong reactivity. CONCLUSIONS Mild acute inflammatory response is not enough to cause citrullination of articular cartilage protein, and the expression of specific epitope requires a high-intensity inflammatory response. Inflammatory articular cartilage protein can express citrullinated epitopes in type Ⅱ collagen-induced arthritis in mice, but the expression of citrullinated epitopes is not sufficient to induce an immune response to anti-citrullinated antibodies. Stronger stimulation signals are required to induce an immune response for producing anti-citrullinated protein antibodies.
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Affiliation(s)
- Guicheng Qin
- SMU-KI United Medical Inflammation Center, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Xiaoyin Lin
- SMU-KI United Medical Inflammation Center, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Peibin Liang
- SMU-KI United Medical Inflammation Center, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Yanpeng Li
- SMU-KI United Medical Inflammation Center, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Chun Zhou
- SMU-KI United Medical Inflammation Center, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Selva Nandakumar Kutty
- SMU-KI United Medical Inflammation Center, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Holmdahl Rikard
- SMU-KI United Medical Inflammation Center, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China.,Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institute, SE-17177, Stockholm, Sweden
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15
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Ibrahim SSA, Salama MA, Selima E, Shehata RR. Sitagliptin and tofacitinib ameliorate adjuvant induced arthritis via modulating the cross talk between JAK/STAT and TLR-4/NF-κB signaling pathways. Life Sci 2020; 260:118261. [PMID: 32795539 DOI: 10.1016/j.lfs.2020.118261] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/31/2020] [Accepted: 08/08/2020] [Indexed: 12/13/2022]
Abstract
AIMS Rheumatoid arthritis is an autoimmune systemic disorder causing pain, swelling, stiffness, and disability in various joints. This work was designed to evaluate the effect of sitagliptin and tofacitinib on Janus kinase (JAK)/signaling transducer and activator of transcription (STAT) and toll like receptor (TLR-4)/nuclear factor kappa B (NF-κB) signaling pathways in adjuvant induced arthritis in rats. MATERIALS AND METHODS Severity of arthritis was evaluated and serum was analyzed for inflammatory mediators. The mRNA and protein expression level of the most important members of the two signaling pathways were determined. Lipid profile, transaminases and renal function parameters were assessed. KEY FINDINGS Sitagliptin and tofacitinib significantly decreased the level of inflammatory parameters, the mRNA and protein expression level of the members of JAK/STAT and TLR-4/NF-κB pathways with more prominent effect of sitagliptin on TLR-4/NF-κB pathway and more expected obvious effect of tofacitinib on JAK/STAT pathway. The combination offered additional anti-inflammatory effect by inhibiting the cross talk between these pathways as inhibition of NF-κB activation decreased the serum level of IL-6 preventing the activation of STAT-3 in tibiotarsal tissues. SIGNIFICANCE The combination of tofacitinib and sitagliptin normalized serum lipids and blood glucose level which could offer protection against cardiovascular diseases and caused partial reversal of serum transaminases and creatinine levels which can protect against tofacitinb's related hepato and nephrotoxicity. We could conclude that the combination of Sitagliptin with tofacitinib can offer synergistic anti-inflammatory effect and more protective action against side effects of tofacitinib.
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Affiliation(s)
| | | | - Eman Selima
- Department of Pharmacology, Medical Research Institute, Alexandria, Egypt
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16
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Klareskog L, Rönnelid J, Saevarsdottir S, Padyukov L, Alfredsson L. The importance of differences; On environment and its interactions with genes and immunity in the causation of rheumatoid arthritis. J Intern Med 2020; 287:514-533. [PMID: 32176395 DOI: 10.1111/joim.13058] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 12/19/2022]
Abstract
The current review uses rheumatoid arthritis (RA) as a prominent example for how studies on the interplay between environmental and genetic factors in defined subsets of a disease can be used to formulate aetiological hypotheses that subsequently can be tested for causality using molecular and functional studies. Major discussed findings are that exposures to airways from many different noxious agents including cigarette smoke, silica dust and more interact with major susceptibility genes, mainly HLA-DR genetic variants in triggering antigen-specific immune reactions specific for RA. We also discuss how several other environmental and lifestyle factors, including microbial, neural and metabolic factors, can influence risk for RA in ways that are different in different subsets of RA.The description of these processes in RA provides the best example so far in any immune-mediated disease of how triggering of immunity at one anatomical site in the context of known environmental and genetic factors subsequently can lead to symptoms that precede the classical inflammatory disease symptoms and later contribute also to the classical RA joint inflammation. The findings referred to in the review have led to a change of paradigms for very early therapy and prevention of RA and to efforts towards what we have named 'personalized prevention'. We believe that the progress described here for RA will be of relevance for research and practice also in other immune-mediated diseases.
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Affiliation(s)
- L Klareskog
- From the, Division of Rheumatology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital (Solna), Stockholm, Sweden
| | - J Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - S Saevarsdottir
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital (Solna), Stockholm, Sweden.,Faculty of Medicine, School of Health Sciences, University of Iceland, Karolinska Institutet, Stockholm, Sweden
| | - L Padyukov
- From the, Division of Rheumatology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital (Solna), Stockholm, Sweden
| | - L Alfredsson
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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17
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Wu EK, Ambrosini RD, Kottmann RM, Ritchlin CT, Schwarz EM, Rahimi H. Reinterpreting Evidence of Rheumatoid Arthritis-Associated Interstitial Lung Disease to Understand Etiology. Curr Rheumatol Rev 2020; 15:277-289. [PMID: 30652645 DOI: 10.2174/1573397115666190116102451] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/19/2018] [Accepted: 01/05/2019] [Indexed: 02/07/2023]
Abstract
Interstitial Lung Disease (ILD) is a well-known complication of rheumatoid arthritis (RA) which often results in significant morbidity and mortality. It is often diagnosed late in the disease process via descriptive criteria. Multiple subtypes of RA-ILD exist as defined by chest CT and histopathology. In the absence of formal natural history studies and definitive diagnostics, a conventional dogma has emerged that there are two major subtypes of RA-ILD (nonspecific interstitial pneumonia (NSIP) and Usual Interstitial Pneumonia (UIP)). These subtypes are based on clinical experience and correlation studies. However, recent animal model data are incongruous with established paradigms of RA-ILD and beg reassessment of the clinical evidence in order to better understand etiology, pathogenesis, prognosis, and response to therapy. To this end, here we: 1) review the literature on epidemiology, radiology, histopathology and clinical outcomes of the various RAILD subtypes, existing animal models, and current theories on RA-ILD pathogenesis; 2) highlight the major gaps in our knowledge; and 3) propose future research to test an emerging theory of RAILD that posits initial rheumatic lung inflammation in the form of NSIP-like pathology transforms mesenchymal cells to derive chimeric disease, and subsequently develops into frank UIP-like fibrosis in some RA patients. Elucidation of the pathogenesis of RA-ILD is critical for the development of effective interventions for RA-ILD.
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Affiliation(s)
- Emily K Wu
- Center for Musculoskeletal Research, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Department of Microbiology & Immunology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Robert D Ambrosini
- Department of Imaging Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - R Matthew Kottmann
- Division of Pulmonary Diseases and Critical Care, Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Christopher T Ritchlin
- Center for Musculoskeletal Research, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Division of Allergy, Immunology, Rheumatology, Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Edward M Schwarz
- Center for Musculoskeletal Research, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Department of Microbiology & Immunology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Homaira Rahimi
- Center for Musculoskeletal Research, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
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Friedlander HM, Ford JA, Zaccardelli A, Terrio AV, Cho MH, Sparks JA. Obstructive lung diseases and risk of rheumatoid arthritis. Expert Rev Clin Immunol 2020; 16:37-50. [PMID: 31774329 DOI: 10.1080/1744666x.2019.1698293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Smoking is an established risk factor for both lung diseases and rheumatoid arthritis (RA). Chronic mucosal airway inflammation may result in immune tolerance loss, neoantigen formation, and production of RA-related autoantibodies that increase the subsequent risk of RA. In this review, we aimed to summarize the current evidence supporting the role of obstructive lung diseases and subsequent risk of RA.Areas covered: We identified scientific articles discussing the biologic mechanisms linking mucosal airway inflammation and RA risk. We also identified studies investigating asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, chronic tuberculous and nontuberculous mycobacterial infections, and interstitial lung disease with subsequent risk for RA.Expert opinion: The current evidence supports the hypothesis that mucosal airway inflammation may increase the risk of developing RA. However, most studies investigating this relationship have been retrospective and may not have adequately addressed the role of smoking. Larger prospective studies may provide stronger evidence for obstructive lung disease and RA risk. Determining the role of obstructive lung disease in RA pathogenesis may provide opportunity for RA prevention and screening strategies, while identifying novel biologic mechanisms that could offer targets to improve treatment and outcomes.
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Affiliation(s)
- H Maura Friedlander
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Julia A Ford
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alessandra Zaccardelli
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Alexsandra V Terrio
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Michael H Cho
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, MA, USA.,Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, MA, USA
| | - Jeffrey A Sparks
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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19
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Meta-analysis: diagnostic accuracy of the citrullinated peptides derived from fibrinogen and vimentin in rheumatoid arthritis. Clin Rheumatol 2019; 39:1111-1120. [DOI: 10.1007/s10067-019-04845-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/15/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
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20
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Rantapää Dahlqvist S, Andrade F. Individuals at risk of seropositive rheumatoid arthritis: the evolving story. J Intern Med 2019; 286:627-643. [PMID: 31562671 PMCID: PMC6878216 DOI: 10.1111/joim.12980] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aetiology of the autoimmune disease rheumatoid arthritis (RA) involves a complex interplay between genetic and environmental factors that initiate many years before the onset of clinical symptoms. These interactions likely include both protective and susceptibility factors which together determine the risk of developing RA. More than 100 susceptibility loci have been linked to RA. The strongest association is with HLA-DRB1 alleles encoding antigen presenting molecules containing a unique sequence in the peptide-binding grove called the 'shared epitope'. Female sex, infections during childhood, lifestyle habits (e.g. smoking and diet) and distinct microbial agents, amongst many others, are interacting risk factors thought to contribute to RA pathogenesis by dysregulating the immune system in individuals with genetic susceptibility. Interestingly, patients with RA develop autoantibodies many years before the clinical onset of disease, providing strong evidence that the lack of tolerance to arthritogenic antigens is amongst the earliest events in the initiation of seropositive RA. Here, we will discuss the clinical and mechanistic evidence surrounding the role of different environmental and genetic factors in the phases leading to the production of autoantibodies and the initiation of symptomatic RA. Understanding this complexity is critical in order to develop tools to identify drivers of disease initiation and propagation and to develop preventive therapeutics.
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Affiliation(s)
- S Rantapää Dahlqvist
- Institution of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - F Andrade
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Zaccardelli A, Liu X, Ford JA, Cui J, Lu B, Chu SH, Schur PH, Speyer CB, Costenbader KH, Robinson WH, Sokolove J, Karlson EW, Camargo CA, Sparks JA. Asthma and elevation of anti-citrullinated protein antibodies prior to the onset of rheumatoid arthritis. Arthritis Res Ther 2019; 21:246. [PMID: 31753003 PMCID: PMC6868779 DOI: 10.1186/s13075-019-2035-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anti-citrullinated protein antibodies (ACPA) are central to rheumatoid arthritis (RA) pathogenesis and may develop at inflamed mucosa. We investigated whether asthma, a disease of airway mucosal inflammation, was associated with elevated ACPA before RA diagnosis. METHODS We performed a nested case-control study among women in two prospective cohorts, the Nurses' Health Study (NHS; 1976-2014) and NHSII (1989-2015). Blood was obtained on a subset (NHS: 1989-1990; NHSII: 1996-1999). Cases met 1987 ACR or 2010 ACR/EULAR RA criteria by medical record review and were classified as seropositive (ACPA+ or rheumatoid factor positivity) or seronegative by clinical laboratory testing at diagnosis. We identified RA cases with blood drawn before the date of RA diagnosis (index date), matching each to three controls by age, cohort, year, time from blood draw to index date, and menopause. Pre-RA ACPA elevation for cases was defined as >99th percentile of the control distribution on a research assay composed of autoantibodies targeting citrullinated protein epitopes or positivity on the second-generation commercial assay for cyclic citrullinated peptide. Asthma status and covariates were obtained through biennial questionnaires before blood draw. Conditional logistic regression estimated ORs and 95%CIs for RA by pre-RA ACPA and clinical serostatus, adjusted for matching factors, smoking pack-years, passive smoking, and body mass index (BMI). RESULTS We identified 284 incident RA cases and 849 matched controls; mean age at the index date was 61.2 years (SD 10.1). Blood was drawn 9.7 years (mean; SD 5.8) before the index date. We identified 96 (33.8%) RA cases with elevated pre-RA ACPA. At blood draw, 17.7% of pre-RA ACPA+ cases and 6.3% of matched controls (p = 0.0008) reported clinician-diagnosed asthma. After adjusting for matching factors, smoking pack-years, passive smoking, and BMI, asthma was significantly associated with pre-RA ACPA+ RA (OR 3.57, 95%CI 1.58,8.04). Asthma was not associated with overall RA (OR 1.45, 95%CI 0.91,2.31), but was significantly associated with seropositive RA (OR 1.79, 95%CI 1.01,3.18). CONCLUSIONS Asthma was strongly associated with ACPA elevation in blood drawn prior to RA diagnosis, independent of smoking. Chronic mucosal airway inflammation may contribute to ACPA development and RA pathogenesis.
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Affiliation(s)
- Alessandra Zaccardelli
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA
| | - Xinyi Liu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA
| | - Julia A Ford
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Jing Cui
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Bing Lu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Su H Chu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Peter H Schur
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Cameron B Speyer
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - William H Robinson
- Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jeremy Sokolove
- Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA.,GlaxoSmithKline, Vienna, Austria
| | - Elizabeth W Karlson
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Carlos A Camargo
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, #6016U, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
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22
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Lee HS, Kim K, Jung S, Hong M, Kim BM, Yoo DS, Moon JW, Baek J, Hwang SW, Park SH, Yang SK, Han B, Song K, Ye BD. Effects of smoking on the association of human leukocyte antigen with ulcerative colitis. J Gastroenterol Hepatol 2019; 34:1777-1783. [PMID: 31038770 DOI: 10.1111/jgh.14695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Tobacco smoking is a risk factor for gastrointestinal disorders, causing mucosal damage and impairing immune responses. However, smoking has been found to be protective against ulcerative colitis (UC). Human leukocyte antigen (HLA) is a major susceptibility locus for UC, and HLA-DRB1*15:02 has the strongest effect in Asians. This study investigated the effects of smoking on the association between HLA and UC. METHODS The study enrolled 882 patients with UC, including 526 never, 151 current, and 205 former smokers, and 3091 healthy controls, including 2124 never, 502 current, and 465 former smokers. Smoking-stratified analyses of HLA data were performed using a case-control approach. RESULTS In a case-control approach, HLA-DRB1*15:02 was associated with UC in never smokers (ORnever smokers = 3.20, Pnever smokers = 7.88 × 10-23 ) but not in current or former smokers (Pcurrent smokers = 0.72 and Pformer smokers = 0.33, respectively). In current smokers, HLA-DQB1*06 was associated with UC (ORcurrent smokers = 2.59, Pcurrent smokers = 6.39 × 10-12 ). No variants reached genome-wide significance in former smokers. CONCLUSIONS An association between UC and HLA-DRB1*15:02 was limited to never smokers. Our findings highlight that tobacco smoking modifies the effects of HLA on the risk of UC.
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Affiliation(s)
- Ho-Su Lee
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Stem Cell Immunomodulation Research Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kihyun Kim
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seulgi Jung
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myunghee Hong
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byoung Mok Kim
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae-Sung Yoo
- Division of Veterinary Epidemiology, Animal and Plant Quarantine Agency, Ministry of Agriculture Food and Rural Affair, Gimcheon, Republic of Korea
| | - Jung Won Moon
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Baek
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Wook Hwang
- Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hyoung Park
- Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Buhm Han
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyuyoung Song
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byong Duk Ye
- Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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23
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Zaccardelli A, Friedlander HM, Ford JA, Sparks JA. Potential of Lifestyle Changes for Reducing the Risk of Developing Rheumatoid Arthritis: Is an Ounce of Prevention Worth a Pound of Cure? Clin Ther 2019; 41:1323-1345. [PMID: 31196646 PMCID: PMC6684958 DOI: 10.1016/j.clinthera.2019.04.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/26/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Lifestyle may be important in the development of rheumatoid arthritis (RA). Therefore, changing behaviors may delay or even prevent RA onset. This article reviews the evidence basis for the associations of lifestyle factors with RA risk and considers future directions for possible interventions to reduce RA risk. METHODS The literature was reviewed for cross-sectional studies, case-control studies, cohort studies, and clinical trials investigating potentially modifiable lifestyle factors and RA risk or surrogate outcomes on the path toward development such as RA-related autoimmunity or inflammatory arthritis. The evidence related to cigarette smoking, excess weight, dietary intake, physical activity, and dental health for RA risk were summarized. FINDINGS Cigarette smoking has the strongest evidence base as a modifiable lifestyle behavior for increased seropositive RA risk. Smoking may increase seropositive RA risk through gene-environment interactions, increasing inflammation and citrullination locally in pulmonary/oral mucosa or systemically, thereby inducing RA-related autoimmunity. Prolonged smoking cessation may reduce seropositive RA risk. Evidence suggests that excess weight can increase RA risk, although this effect may differ according to sex, serologic status, and age at RA onset. TDietary intake may also affect RA risk: overall healthier patterns, high fish/omega-3 polyunsaturated fatty acid consumption, and moderate alcohol intake may reduce RA risk, whereas caffeine and sugar-sweetened soda consumption might increase RA risk. The impact of physical activity is less clear, but high levels may reduce RA risk. Periodontal disease might induce citrullination and RA-related autoimmunity, but the effect of dental hygiene behaviors on RA risk is unclear. Although the effect size estimates for these lifestyle factors on RA risk are generally modest, there may be relatively large public health benefits for targeted interventions given the high prevalence of these unhealthy behaviors. With the exception of smoking cessation, the impact of behavior change of these lifestyle factors on subsequent RA risk has not been established. Nearly all of the evidence for lifestyle factors and RA risk were derived from observational studies. IMPLICATIONS There are many potentially modifiable lifestyle factors that may affect RA risk. Improving health behaviors could have large public health benefits for RA risk given the high prevalence of many of the RA risk-related lifestyle factors. However, future research is needed to establish the effects of lifestyle changes on RA risk or surrogate outcomes such as RA-related autoimmunity or inflammatory arthritis.
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Affiliation(s)
- Alessandra Zaccardelli
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - H Maura Friedlander
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Julia A Ford
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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24
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"NETtling" the host: Breaking of tolerance in chronic inflammation and chronic infection. J Autoimmun 2019; 88:1-10. [PMID: 29100671 DOI: 10.1016/j.jaut.2017.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 12/31/2022]
Abstract
How and why we break tolerance to self-proteins still remains a largely unanswered question. Neutrophils have been identified as a rich source of autoantigens in a wide array of autoimmune diseases that arise as a consequence of different environmental and genetic factors, e.g. rheumatoid arthritis (RA), lupus, vasculitis, cystic fibrosis (CF) etc. Specifically, neutrophil extracellular trap (NET) formation has been identified as a link between innate and adaptive immune responses in autoimmunity. Autoantigens including neutrophil granular proteins (targeted by anti-neutrophil cytoplasmic antibodies, ANCA) as well as post-translationally modified proteins, i.e. citrullinated and carbamylated proteins targeted by anti-citrullinated protein antibodies (ACPA) and anti-carbamylated protein antibodies (ACarPA), respectively, localize to the NETs. Moreover, NETs provide stimuli to dendritic cells that potentiate adaptive autoimmune responses. However, while NETs promote inflammation and appear to induce humoral autoreactivity across autoimmune diseases, the antigen specificity of autoantibodies found in these disorders is striking. These unique autoantigen signatures suggest that not all NETs are created equal and that the environment in which NETs arise shapes their disease-specific character. In this review article, we discuss the effects of different stimuli on the mechanism of NET formation as well as how they contribute to antigen specificity in the breaking of immune tolerance. Specifically, we compare and contrast the autoreactive nature of NETs in two settings of chronic airway inflammation: one triggered by smoking, a recognized environmental NET stimulus in RA patients, and one mediated by Pseudomonas aeruginosa, the most prevalent lung pathogen in CF patients. Finally, we draw attention to novel findings that, together with the specific environmental/chemical stimuli, should be taken into account when investigating how and why antigen specificity arises in the context of NET formation.
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25
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Kalinkovich A, Gabdulina G, Livshits G. Autoimmunity, inflammation, and dysbiosis mutually govern the transition from the preclinical to the clinical stage of rheumatoid arthritis. Immunol Res 2018; 66:696-709. [DOI: 10.1007/s12026-018-9048-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Meyer P, Ally M, Hodkinson B, Anderson R, Tikly M. Diagnostic utility of, and influence of tobacco usage and genetic predisposition on, immunoglobulin A, rheumatoid factor and anti-citrullinated peptide auto-antibodies in South African rheumatoid arthritis patients. Afr Health Sci 2018; 18:295-303. [PMID: 30602956 PMCID: PMC6306983 DOI: 10.4314/ahs.v18i2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The immunoglobulin A isotypes of anti-cyclic citrullinated peptide antibodies (ACPA) and rheumatoid factor (RF) are associated with disease severity and progression in Caucasian rheumatoid arthritis (RA) patients, as well as with genetic predisposition and tobacco use. Objectives To compare levels of ACPA-IgA and RF-IgA with those of ACPA-IgG and cRF in a cohort of black South African RA patients and healthy controls.To investigate the relationship between IGA autoantibodies and disease severity, genetic predisposition and tobacco use Methods RF-IgA and ACPA-IgA were determined in a cohort of predominantly black South African RA patients (n=75) in relation to serodiagnostic and prognostic potential, as well as tobacco use and genetic predisposition. Healthy control subjects were included to determine sensitivity, specificity and predictive values. ACPA-IgG/IgA and RF-IgA were determined by enzyme immunoassay and hs-CRP and cRF by nephelometry. Cotinine levels were determined by ELISA. Results The frequencies of ACPA-IgA and RF-IgA were 31% and 88% respectively compared to 88% for both types of traditional autoantibody procedures. ACPA-IgA was significantly higher (p=0.007) in patients with short disease duration, while linear regression analysis revealed a positive relationship with baseline disease activity scores. Levels of ACPA-IgG and ACPA-IgA were significantly higher in tobacco users who carried the HLA shared epitope. Conclusion Although lacking in serodiagnostic superiority over cRF and ACPA-IgG, inclusion of RF-IgA and ACPA-IgA in autoantibody panels may provide insights into disease pathogenesis, interactions between tobacco usage and HLA genotype in the production of potentially disease-triggering ACPA-IgA antibodies.
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Affiliation(s)
- Pieter Meyer
- University of Pretoria, Immunology; NHLS, Immunology
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27
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Sparks JA, Lin TC, Camargo CA, Barbhaiya M, Tedeschi SK, Costenbader KH, Raby BA, Choi HK, Karlson EW. Rheumatoid arthritis and risk of chronic obstructive pulmonary disease or asthma among women: A marginal structural model analysis in the Nurses' Health Study. Semin Arthritis Rheum 2018; 47:639-648. [PMID: 29037522 PMCID: PMC5857435 DOI: 10.1016/j.semarthrit.2017.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/25/2017] [Accepted: 09/13/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We investigated whether RA increases risk for chronic obstructive pulmonary disease (COPD) or asthma independent of factors occurring before RA onset or mediating these respiratory morbidities after diagnosis, such as cigarette smoking. METHODS Within the prospective Nurses' Health Study (n = 121,701 women; 1976-2014), we identified an incident RA cohort and matched each woman with RA to 10 comparators without RA by age and year at index date of RA diagnosis, excluding women with COPD or asthma at baseline. Data were obtained through biennial questionnaires and medical records. We used marginal structural models to determine the independent effect of RA on incident COPD or asthma adjusting for confounders and time-varying mediators through inverse probability weighting. RESULTS We identified 843 women with RA, matched to 8,399 comparators without RA. Mean age was 59.8 years and mean follow-up after index date was 18.6 years (SD = 9.0) for women with RA, and 18.8 years (SD = 9.5) for comparators. We identified 68 (8.1%) incident COPD and 40 (4.7%) asthma cases among women with RA, and 459 (5.5%) COPD and 268 (3.2%) asthma cases among comparators. RA was associated with increased risk of COPD (HR = 1.52, 95% CI: 1.17-1.97) and asthma (HR = 1.55, 95% CI: 1.11-2.16) compared to comparators adjusted for the matching factors of age and calendar year at index date. After further adjustment for confounders and time-varying mediators occurring after index date, including smoking, RA was significantly associated with COPD (HR = 1.68, 95% CI: 1.36-2.07), but not asthma (HR = 1.11, 95% CI: 0.59-2.09) compared to non-RA comparators. Women with seropositive RA (HR = 1.60, 95% CI: 1.17-2.19) and seronegative RA (HR = 1.62, 95% CI: 1.09-2.40) had similar increased risk for COPD compared to non-RA comparators. CONCLUSION In this prospective cohort study, RA was associated with increased risk for incident COPD, independent of lifestyle confounders and mediators after diagnosis, including smoking.
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Affiliation(s)
- Jeffrey A Sparks
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Tzu-Chieh Lin
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Carlos A Camargo
- Harvard Medical School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Medha Barbhaiya
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Sara K Tedeschi
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Karen H Costenbader
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Benjamin A Raby
- Harvard Medical School, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Hyon K Choi
- Harvard Medical School, Boston, MA; Division of Rheumatology, Massachusetts General Hospital, Boston, MA
| | - Elizabeth W Karlson
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Cappelli LC, Konig MF, Gelber AC, Bingham CO, Darrah E. Smoking is not linked to the development of anti-peptidylarginine deiminase 4 autoantibodies in rheumatoid arthritis. Arthritis Res Ther 2018; 20:59. [PMID: 29566742 PMCID: PMC5865363 DOI: 10.1186/s13075-018-1533-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
Background Defining environmental factors responsible for development of autoimmunity in rheumatoid arthritis (RA) is critical for understanding mechanisms of disease initiation and propagation. Notably, a history of cigarette smoking has been implicated in the genesis of RA and is associated with worse disease outcomes. Antibodies to peptidylarginine deiminase 4 (PAD4) are also associated with more severe RA. A subset of patients who have PAD4 autoantibodies that cross-react with PAD3 (anti-PAD3/4) are at the highest risk for interstitial lung disease, and this risk is augmented by a history of cigarette smoking. It is unclear, however, if smoking is etiologically linked to the development of anti-PAD4 antibodies. Methods Patients were included in this study if they had physician-diagnosed RA as well as DNA, serum, and a date-matched clinical assessment (n = 274). Anti-PAD4 and anti-CCP antibodies were measured by immunoprecipitation and ELISA, respectively; shared epitope (SE) status was determined by HLA-DRβ1 genotyping. Logistic regression analysis was used to evaluate associations of smoking with PAD4 antibodies, with adjustment for relevant demographic and clinical features. Stratified analyses by disease duration and shared epitope status were also performed. Results Anti-PAD4 antibodies were present in 25% of RA patients, with 50% of these individuals having anti-PAD3/4 cross-reactive antibodies. Anti-PAD4 antibodies were significantly associated with a longer disease duration, SE alleles, and anti-CCP antibodies. Importantly, there were no significant differences in smoking history between anti-PAD4 positive and negative groups in univariate analyses, stratified analyses, or multivariable models. However, an inverse relationship between smoking and anti-PAD4 antibodies was suggested by a lower prevalence of current smokers among patients with anti-PAD3/4 antibodies compared to antibody negative individuals (p = 0.04). Further, the lowest levels of anti-PAD4 antibodies were observed in current smokers (p = 0.14), and a significant association of SE and anti-PAD4 antibodies was only present among never smokers (p = 0.01). Conclusions Smoking history was not associated with anti-PAD4 antibodies in patients with RA. The finding that anti-PAD4 antibodies were not associated with smoking suggests that other environmental factors may contribute to the development of autoimmunity to PAD4 in these patients.
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Affiliation(s)
- Laura C Cappelli
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
| | - Maximilian F Konig
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA.,Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Allan C Gelber
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
| | - Clifton O Bingham
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
| | - Erika Darrah
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA.
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Sparks JA, Chang SC, Nguyen USDT, Barbhaiya M, Tedeschi SK, Lu B, Costenbader KH, Zhang Y, Choi HK, Karlson EW. Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty-Six Years of Prospective Followup. Arthritis Care Res (Hoboken) 2017; 70:19-29. [PMID: 28464477 DOI: 10.1002/acr.23269] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/25/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate whether rheumatoid arthritis (RA) diagnosis influences smoking behavior changes and whether these changes were associated with mortality. METHODS We identified an incident RA cohort in the Nurses' Health Study (NHS; 1976-2012). Behavioral data were collected through biennial questionnaires. We created a comparison cohort, matching RA cases to women without RA by age and calendar year at the index date of RA diagnosis. To investigate smoking behavior changes in the early RA period, sustained cessation was defined as permanently quitting within 4 years of the RA/index date. We used Cox regression to obtain hazard ratios (HRs) for mortality, comparing sustained smoking cessation to continued smoking. RESULTS Among 121,700 women in the NHS, we identified 938 with incident RA matched to 8,951 non-RA comparators. Among current smokers, 40.0% with RA permanently quit smoking in the early RA period, compared to 36.1% of comparators (odds ratio for sustained cessation 1.18 [95% confidence interval (95% CI) 0.88, 1.58]). There were 313 deaths (33.4%) in the RA cohort and 2,042 (22.8%) among comparators. Compared to continued smoking, sustained cessation was associated with similarly decreased mortality in both the RA (HR 0.58 [95% CI 0.33, 1.01]) and comparison (HR 0.47 [95% CI 0.39, 0.58]) cohorts. Women with RA had higher mortality for >5 post-RA pack-years (HR 3.67 [95% CI 2.80, 4.81]) than comparators with >5 post-index pack-years (HR 1.88 [95% CI 1.62, 2.17]; P < 0.001 for interaction; reference: ever-smoker non-RA women with 0 post-index pack-years). CONCLUSION Sustained smoking cessation within 4 years of RA diagnosis reduced mortality risk, with a similar effect observed among non-RA comparators. Smoking >5 pack-years after RA diagnosis significantly increased mortality beyond the risk of non-RA comparators.
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Affiliation(s)
- Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shun-Chiao Chang
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Uyen-Sa D T Nguyen
- University of Massachusetts School of Medicine, Worcester, and Boston University School of Medicine, Boston
| | - Medha Barbhaiya
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sara K Tedeschi
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yuqing Zhang
- Boston University School of Medicine, Boston, Massachusetts
| | - Hyon K Choi
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth W Karlson
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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30
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Tedeschi SK, Cui J, Arkema EV, Robinson WH, Sokolove J, Lingampalli N, Sparks JA, Karlson EW, Costenbader KH. Elevated BMI and antibodies to citrullinated proteins interact to increase rheumatoid arthritis risk and shorten time to diagnosis: A nested case-control study of women in the Nurses' Health Studies. Semin Arthritis Rheum 2017; 46:692-698. [PMID: 27939764 PMCID: PMC5348285 DOI: 10.1016/j.semarthrit.2016.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/02/2016] [Accepted: 09/08/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Overweight/obesity and anti-citrullinated protein antibodies (ACPA) increase rheumatoid arthritis (RA) risk. We investigated the relationship between body mass index (BMI) and ACPA, tested for an interaction between BMI and ACPA for RA risk, and examined effects of BMI and ACPA on time to RA diagnosis. DESIGN Within the Nurses' Health Studies, blood samples were collected before diagnosis from medical record-confirmed incident RA cases and matched controls. Multiplex assays measured 7 ACPA subtypes (biglycan, clusterin, enolase, fibrinogen, histone 2A, histone 2B, and vimentin). Logistic regression analyses tested the association of BMI and ACPA and for a multiplicative interaction between BMI groups (≥25 vs. <25kg/m2) and ACPA positivity (≥2 vs. <2 subtypes), adjusting for age, smoking, alcohol use, and HLA-shared epitope. In case-only analyses, log-rank tests compared time from blood draw to RA onset by cross-classified BMI/ACPA status. RESULTS Among 255 pre-RA cases and 778 matched controls, 15.7% vs. 2.1% (p<0.001) had ≥2 ACPA and 49.4% vs. 40.2% (p<0.01) were overweight/obese. Continuous BMI was not associated with presence of ≥2 ACPA [OR per kg/m2 unit BMI: 1.03 (95% CI: 0.97-1.09)]. However, there was a multiplicative interaction between elevated BMI and the presence of ≥2 ACPA for RA risk (p = 0.027). Women with BMI≥25kg/m2 and ≥2 ACPA had OR 22.7 (95% CI: 6.64-77.72) for RA. Median time to RA differed by BMI/ACPA group (overall log-rank p<0.001) and was shortest among women with ≥2 ACPA and BMI≥25kg/m2 [45.0 months, IQR: 17.5-72.5] and longest in women with <2 ACPA and BMI<25kg/m2 [125.0 months, IQR: 72.0-161.0] (pairwise log-rank p = 0.002). CONCLUSION Elevated BMI and presence of ACPA interacted to increase RA risk. Time to RA onset was shortest among overweight/obese women with ≥2 ACPA.
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Affiliation(s)
- Sara K Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
| | - Jing Cui
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | | | - William H Robinson
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA
| | - Jeremy Sokolove
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA
| | - Nithya Lingampalli
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Elizabeth W Karlson
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Karen H Costenbader
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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Corsiero E, Pratesi F, Prediletto E, Bombardieri M, Migliorini P. NETosis as Source of Autoantigens in Rheumatoid Arthritis. Front Immunol 2016; 7:485. [PMID: 27895639 PMCID: PMC5108063 DOI: 10.3389/fimmu.2016.00485] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/21/2016] [Indexed: 12/29/2022] Open
Abstract
In neutrophils (but also in eosinophils and in mast cells), different inflammatory stimuli induce histone deimination, chromatin decondensation, and NET formation. These web-like structures that trap and kill microbes contain DNA, cationic granule proteins, and antimicrobial peptides, but the most abundant proteins are core histones. Histones contained in NETs have been deiminated, and arginines are converted in citrullines. While deimination is a physiological process amplified in inflammatory conditions, only individuals carrying genetic predisposition to develop rheumatoid arthritis (RA) make antibodies to deiminated proteins. These antibodies, collectively identified as anti-citrullinated proteins/peptides antibodies (ACPA), react with different deiminated proteins and display partially overlapping specificities. In this paper, we will summarize current evidence supporting the role of NETosis as critical mechanism in the breach of tolerance to self-antigens and in supporting expansion and differentiation of autoreactive cells. In fact, several lines of evidence connect NETosis with RA: RA unstimulated synovial fluid neutrophils display enhanced NETosis; sera from RA patients with Felty's syndrome bind deiminated H3 and NETs; a high number of RA sera bind deiminated H4 contained in NETs; human monoclonal antibodies generated from RA synovial B cells decorate NETs and bind deiminated histones. In RA, NETs represent on one side an important source of autoantigens bearing posttranslational modifications and fueling the production of ACPA. On the other side, NETs deliver signals that maintain an inflammatory milieu and contribute to the expansion and differentiation of ACPA-producing B cells.
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Affiliation(s)
- Elisa Corsiero
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London , London , UK
| | - Federico Pratesi
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa , Italy
| | - Edoardo Prediletto
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London , London , UK
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London , London , UK
| | - Paola Migliorini
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa , Italy
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32
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Sapir-Koren R, Livshits G. Rheumatoid arthritis onset in postmenopausal women: Does the ACPA seropositive subset result from genetic effects, estrogen deficiency, skewed profile of CD4(+) T-cells, and their interactions? Mol Cell Endocrinol 2016; 431:145-63. [PMID: 27178986 DOI: 10.1016/j.mce.2016.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 12/28/2022]
Abstract
Rheumatoid arthritis (RA) incidence displays a differentiated age-dependent female-to-male ratio in which women outnumber men. Evidence that the peak incidence of RA in women coincides with menopause age, suggests a potential estrogenic role to disease etiology. Estrogens exert physiologically both stimulatory and inhibitory effects on the immune system. Epidemiologic and animal model studies with estrogen deprivation or supplementation suggested estrogens as to play, mainly, a protective role in RA immunopathology. In this review, we propose that some yet unidentified disturbances associated with estrogen circulating levels, differentiated by the menopausal status, play a major role in women's RA susceptibility. We focus on the interaction between estrogen deprivation and genetic risk alleles for anti-citrullinated protein antibodies (ACPA) seropositive RA, as a major driving force for increased immune reactivity and RA susceptibility, in postmenopausal women. This opens up new fields for research concerning the association among different irregular estrogenic conditions, the cytokine milieu, and age/menopausal status bias in RA.
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Affiliation(s)
- Rony Sapir-Koren
- Human Population Biology Research Group, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gregory Livshits
- Human Population Biology Research Group, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Lilian and Marcel Pollak Chair of Biological Anthropology, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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33
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Raslan HM, Attia HR, Salama I, Ibrahim MH, Hassan EM, El Hussieny MS, El Menyawi MM, Amr KS. Association of PTPN22 1858C→T polymorphism, HLA-DRB1 shared epitope and autoantibodies with rheumatoid arthritis. Rheumatol Int 2016; 36:1167-75. [PMID: 27324632 DOI: 10.1007/s00296-016-3511-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 06/14/2016] [Indexed: 02/05/2023]
Abstract
To assess impact of PTPN22 1858C→T polymorphism, HLA shared epitope and autoantibodies on susceptibility and severity of rheumatoid arthritis (RA). A total of 150 RA patients and 150 controls were included in the study. Anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor isotypes (IgG, IgM and IgA) were assayed by ELISA. PTPN22 1858C→T polymorphism was performed by RFLP analysis and HLA-DRB1 genotyping by PCR-SSP analysis. Single-view, anteroposterior radiographs of the hands and feet were obtained on all RA patients. The results showed association of PTPN22 1858 T allele with RA (OR = 2.3, 95 % CI 1.5-3.5) and bone erosion (OR = 2.9, 95 % CI 1.1-7.6). The associations increased with the combination of positive autoantibodies, HLA-DRB1 SE with PTPN22 1858 T allele carriage. The highest association was with the combination with anti-CCP antibodies (OR = 47.3, 95 % CI 10.9-204.4 for RA and OR = 69.4, 95 % CI 15.8-305.5 for erosion p < 0.001). Combination of PTPN22 1858 T allele carriage with negative RF isotypes or with absence HLA-DRB1 SE showed no significant association with RA. The presence of PTPN22 1858C→T polymorphism with HLA SE and autoantibodies increases risk of RA development and erosive disease.
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Affiliation(s)
- Hala M Raslan
- Internal Medicine Department, National Research Centre, El Buhouth street 2311, Dokki, Egypt.
| | - Hanaa R Attia
- Clinical and Chemical Pathology Department, National Research Centre, El Buhouth street 2311, Dokki, Egypt
| | - Iman Salama
- Community Medicine Research Department, National Research Centre, El Buhouth street 2311, Dokki, Egypt
| | - Mona Hamed Ibrahim
- Clinical and Chemical Pathology Department, National Research Centre, El Buhouth street 2311, Dokki, Egypt
| | - Eman Mahmoud Hassan
- Clinical and Chemical Pathology Department, National Research Centre, El Buhouth street 2311, Dokki, Egypt
| | - Mohamed S El Hussieny
- Biological Anthropology Department, National Research Centre, El Buhouth street 2311, Dokki, Egypt
| | - Manal M El Menyawi
- Internal Medicine Department, Kasr Al Aini Hospital, Kasr Al Aini street, Cairo, Egypt
| | - Khalda S Amr
- Medical Molecular Genetic Department, National Research Centre, El Buhouth street 2311, Dokki, Egypt
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Van de Wiele T, Van Praet JT, Marzorati M, Drennan MB, Elewaut D. How the microbiota shapes rheumatic diseases. Nat Rev Rheumatol 2016; 12:398-411. [PMID: 27305853 DOI: 10.1038/nrrheum.2016.85] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The human gut harbours a tremendously diverse and abundant microbial community that correlates with, and even modulates, many health-related processes. The mucosal interfaces are particularly active sites of microorganism-host interplay. Growing insight into the characteristic composition and functionality of the mucosal microbiota has revealed that the microbiota is involved in mucosal barrier integrity and immune function. This involvement affects proinflammatory and anti-inflammatory processes not only at the epithelial level, but also at remote sites such as the joints. Here, we review the role of the gut microbiota in shaping local and systemic immune responses and how disturbances in the host-microorganism interplay can potentially affect the development and progression of rheumatic diseases. Increasing our understanding of how to promote host-microorganism homeostasis could therefore reveal novel strategies for the prevention or alleviation of rheumatic disease.
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Affiliation(s)
- Tom Van de Wiele
- Laboratory of Microbial Ecology and Technology (LabMET), Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, Ghent, B-9000, Belgium
| | - Jens T Van Praet
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center, Ghent University, 'Fiers-Schell-Van Montagu' building, Technologiepark 927, B-9052 Ghent (Zwijnaarde), Belgium.,Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000 Bruges, Belgium
| | - Massimo Marzorati
- Laboratory of Microbial Ecology and Technology (LabMET), Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, Ghent, B-9000, Belgium
| | - Michael B Drennan
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center, Ghent University, 'Fiers-Schell-Van Montagu' building, Technologiepark 927, B-9052 Ghent (Zwijnaarde), Belgium
| | - Dirk Elewaut
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center, Ghent University, 'Fiers-Schell-Van Montagu' building, Technologiepark 927, B-9052 Ghent (Zwijnaarde), Belgium
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35
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Johansson L, Pratesi F, Brink M, Ärlestig L, D'Amato C, Bartaloni D, Migliorini P, Rantapää-Dahlqvist S. Antibodies directed against endogenous and exogenous citrullinated antigens pre-date the onset of rheumatoid arthritis. Arthritis Res Ther 2016; 18:127. [PMID: 27255888 PMCID: PMC4891920 DOI: 10.1186/s13075-016-1031-0] [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: 04/13/2016] [Accepted: 05/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anti-citrullinated-peptide antibodies (ACPA) have been detected in individuals with developing rheumatoid arthritis (RA) before the onset of symptom, with an initially limited spectrum of reactivities that gradually broadens. The aim was to analyze the evolution of ACPA response pre-dating symptom onset, using four selected citrullinated exogenous and endogenous antigens. METHODS A cohort of 521 individuals sampled before symptoms of RA appeared and 272 population controls were identified from the Biobank of Northern Sweden; 241 samples from patients with early RA were also collected. ACPA were detected by ELISA on viral citrullinated peptides (VCP) derived from Epstein-Barr-virus nuclear antigen (EBNA)1 and EBNA2 (VCP1 and VCP2) and histone-4-derived citrullinated peptides (HCP1 and HCP2). RESULTS In pre-symptomatic individuals vs. patients with early RA, anti-VCP1 antibodies were detected in 10.4 % vs. 36.1 %, anti-VCP2 in 17.1 % vs. 52.3 %, anti-HCP1 in 10.2 % vs. 37.3 %, and anti-HCP2 in 16.3 % vs. 48.5 %, respectively. Anti-VCP and anti-HCP concentrations were significantly increased in pre-symptomatic individuals vs. controls (p < 0.001) and were increased approaching symptom onset. Anti-VCP and anti-HCP appeared simultaneously (median (IQR) 5.3 (6) years before symptom onset) and in combination yielded a high-risk ratio for disease development (OR = 8.0-18.9). Anti-VCP2 and anti-HCP2 antibodies were associated with HLA-DRB1*0401 in pre-symptomatic individuals. Three peptidylarginine deiminase (PAD)I3/PADI4 single nucleotide polymorphisms (SNPs) were significantly associated with anti-HCP1. CONCLUSIONS Anti-VCP and anti-HCP antibodies pre-date symptom onset and predict disease development, but no hierarchy of citrullinated epitopes can be identified. These results suggest that no inciting citrullinated antigen so far described is common to all patients with RA. The association between PADI3/PADI4 polymorphism and anti-HCP1 antibodies suggests a novel link between deimination and production of ACPA.
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Affiliation(s)
- Linda Johansson
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Federico Pratesi
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mikael Brink
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Lisbeth Ärlestig
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Claudia D'Amato
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Debora Bartaloni
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Migliorini
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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36
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Martínez G, Gómez JA, Bang H, Martínez-Gamboa L, Roggenbuck D, Burmester GR, Torres B, Prada D, Feist E. Carbamylated vimentin represents a relevant autoantigen in Latin American (Cuban) rheumatoid arthritis patients. Rheumatol Int 2016; 36:781-91. [PMID: 27038800 PMCID: PMC4873524 DOI: 10.1007/s00296-016-3472-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
Smoking produces substances that activate proinflammatory, prothrombotic and vasoconstrictive mediators via posttranslational carbamylation of proteins. As a new consequence of carbamylation, induction of anti-carbamylated autoantibodies were observed in rheumatoid arthritis (RA) patients, sometimes prior to onset of the disease. The overall aim of this study was to characterize the reactivity of different isotypes of autoantibodies against carbamylated antigens of vimentin in relation to established rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA) and markers of disease activity in a so far largely uncharacterized population of Latin American (Cuban) patients with RA. Antigenic properties of carbamylated vimentin as well as vimentin peptides were analyzed in 101 patients with RA, 50 disease controls and 51 healthy controls. The diagnostic performance was compared with established commercial ELISA rheumatoid factor, anti-cyclic citrullinated peptide antibodies of second generation (anti-CCP2) and anti-mutated citrullinated vimentin (anti-MCV) antibodies. Prevalence of anti-MCV IgG (86 %), anti-carbamylated vimentin (carbVIM) IgG (77 %) and anti-carbamylated MCV (carbMCV) IgG antibodies (65 %) was higher than the classical RF IgM (60 %) and anti-CCP2 IgG (52 %) in this RA cohort. Of note, smoking status was associated with positive IgG antibody reactivity against CCP2 in 75.0 % and against MCV in 90 % of patients. Furthermore, IgM antibody response against carbMCV and carbVIM was observed in 80 and 90.0 % of smokers, respectively. Due to a high sensitivity of the IgM antibody isotype of anti-carbVIM of 85.2 %, the combination of ACPA with anti-carbVIM IgM provided the best diagnostic performance so far achieved in a RA cohort of this ethnic origin. We demonstrate a high prevalence of anti-carbVIM antibodies and correlation with smoking in Latin American (Cuban) RA patients. Anti-carbVIM IgM represents an useful marker in ACPA-negative patients and, in combination with ACPA IgG assays, optimizes the strategy for autoantibody testing.
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Affiliation(s)
- Goitybell Martínez
- Department for Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany. .,Immunology Laboratory, National Center of Medical Genetic, Havana, Cuba.
| | | | | | - Lorena Martínez-Gamboa
- Department for Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Dirk Roggenbuck
- Faculty of Science, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.,Medipan GmbH, Dahlewitz/Berlin, Germany
| | - Gerd-Rüdiger Burmester
- Department for Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Barbara Torres
- Immunology Laboratory, National Center of Medical Genetic, Havana, Cuba
| | | | - Eugen Feist
- Department for Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
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37
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Anderson R, Meyer PWA, Ally MMTM, Tikly M. Smoking and Air Pollution as Pro-Inflammatory Triggers for the Development of Rheumatoid Arthritis. Nicotine Tob Res 2016; 18:1556-65. [PMID: 26957528 DOI: 10.1093/ntr/ntw030] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/27/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Smoking is now well recognized not only as a risk factor for rheumatoid arthritis (RA), but also as a determinant of disease activity, severity, response to therapy, and possibly mortality. METHODS Studies, mostly recent, which have provided significant insights into the molecular and cellular mechanisms which underpin the pathogenesis of smoking-related RA, as well as the possible involvement of other types of outdoor and indoor pollution form the basis of this review. RESULTS Smoking initiates chronic inflammatory events in the lungs. These, in turn, promote the release of the enzymes, peptidylarginine deiminases 2 and 4 from smoke-activated, resident and infiltrating pulmonary phagocytes. Peptidylarginine deiminases mediate conversion of various endogenous proteins to putative citrullinated autoantigens. In genetically susceptible individuals, these autoantigens trigger the production of anti-citrullinated peptide, pathogenic autoantibodies, an event which precedes the development of RA. CONCLUSIONS An increasing body of evidence has linked chronic inflammatory events in the lungs of smokers, to the production of anti-citrullinated peptide autoantibodies and development of RA. Creation of awareness of the associated risks, assessment of smoking status and implementation of compelling antismoking strategies must be included in the routine clinical management of patients presenting with suspected RA. IMPLICATIONS Chronic inflammatory mechanisms operative in the lungs of smokers lead to the production of anti-citrullinated protein antibodies which, in turn, drive the development of RA. These mechanistic insights not only reinforce the association between smoking and risk for RA, but also the necessity to increase the level of awareness in those at highest risk.
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Affiliation(s)
- Ronald Anderson
- Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa;
| | - Pieter W A Meyer
- Department of Immunology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa
| | - Mahmood M T M Ally
- Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mohammed Tikly
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sparks JA, Karlson EW. The Roles of Cigarette Smoking and the Lung in the Transitions Between Phases of Preclinical Rheumatoid Arthritis. Curr Rheumatol Rep 2016; 18:15. [PMID: 26951253 PMCID: PMC4941234 DOI: 10.1007/s11926-016-0563-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While the etiology of rheumatoid arthritis (RA) remains to be fully elucidated, recent research has advanced the understanding of RA pathogenesis to the point where clinical trials for RA prevention are underway. The current paradigm for RA pathogenesis is that individuals progress through distinct preclinical phases prior to the onset of clinically apparent RA. These preclinical RA phases consist of genetic risk, local inflammation, presence of RA-related autoantibodies, asymptomatic systemic inflammation, and early non-specific symptoms prior to clinical seropositive RA. Epidemiologic studies have been important in forming hypotheses related to the biology occurring in preclinical RA. Specifically, studies associating cigarette smoking with overall RA risk as well as transitions between phases of preclinical RA were vital in helping to establish the lung as a potential important initiating site in the pathogenesis of seropositive RA. Herein, we review the epidemiology associating smoking with transitions in preclinical phases of RA as well as the recent literature supporting the lung as a critical site in RA pathogenesis.
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Affiliation(s)
- Jeffrey A. Sparks
- Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 20115, USA
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39
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Brink M, Hansson M, Mathsson-Alm L, Wijayatunga P, Verheul MK, Trouw LA, Holmdahl R, Rönnelid J, Klareskog L, Rantapää-Dahlqvist S. Rheumatoid factor isotypes in relation to antibodies against citrullinated peptides and carbamylated proteins before the onset of rheumatoid arthritis. Arthritis Res Ther 2016; 18:43. [PMID: 26860413 PMCID: PMC4748586 DOI: 10.1186/s13075-016-0940-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/21/2016] [Indexed: 11/20/2022] Open
Abstract
Background The presence of rheumatoid factor (RF), anti-carbamylated protein antibodies (anti-CarP) and antibodies against citrullinated protein and peptides (ACPA) precedes the onset of symptoms of rheumatoid arthritis (RA) by several years. Relationships between the development of these antibodies are not obvious. Methods Three isotypes [immunoglobulin A (IgA), IgG and IgM) of RF were analysed in 321 pre-symptomatic individuals who provided 598 samples collected a median of 6.2 (interquartile range 7.2) years before the onset of symptoms, and in 492 population control subjects. All samples were donated to the Biobank of Northern Sweden. RF isotypes were analysed using the EliA system (Phadia GmbH, Freiburg, Germany) with 96 % specificity according to receiver operating characteristic curves. Ten ACPA specificities were analysed using the ImmunoCAP ISAC system, and anti-CCP2 and anti-CarP antibodies were evaluated using enzyme-linked immunosorbent assays. Results The frequencies of RF isotypes in pre-symptomatic individuals were significantly increased compared with control subjects (p < 0.0001). In samples collected ≥15 years before the onset of symptoms, the IgA-RF isotype was significantly more prevalent than the most frequent ACPAs. Combinations of IgM- and IgA-RF isotypes with ACPA specificities [α-enolase (CEP-1/Eno5–21)], fibrinogen (Fib)β36–52, Fibα580–600, filaggrin (CCP-1/Fil307–324) and anti-CCP2 antibodies were associated with a significantly shorter time to onset of symptoms (p < 0.001–0.05). Using conditional inference tree analysis, anti-CCP2 in combination with anti-filaggrin antibodies gave the highest probability, 97.5 %, for disease development. Conclusions RF isotypes predicted the development of RA, particularly in combination with ACPA, anti-CCP2 or anti-CarP antibodies. The highest probability for disease development was the presence of anti-CCP2 and anti-filaggrin antibodies. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-0940-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mikael Brink
- Division of Rheumatology, Department of Public Health and Clinical Medicine, Umeå University, SE-90185, Umeå, Sweden.
| | - Monika Hansson
- Rheumatology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Linda Mathsson-Alm
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. .,Thermo Fisher Scientific, Uppsala, Sweden.
| | | | - Marije K Verheul
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Leendert A Trouw
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Rikard Holmdahl
- Medical Inflammation Research, Medical Biophysics and Biochemistry, Karolinska Institute, Solna, Stockholm, Sweden.
| | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - Lars Klareskog
- Rheumatology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Solbritt Rantapää-Dahlqvist
- Division of Rheumatology, Department of Public Health and Clinical Medicine, Umeå University, SE-90185, Umeå, Sweden.
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Corsiero E, Bombardieri M, Carlotti E, Pratesi F, Robinson W, Migliorini P, Pitzalis C. Single cell cloning and recombinant monoclonal antibodies generation from RA synovial B cells reveal frequent targeting of citrullinated histones of NETs. Ann Rheum Dis 2015; 75:1866-75. [PMID: 26659717 PMCID: PMC5036240 DOI: 10.1136/annrheumdis-2015-208356] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/01/2015] [Indexed: 12/24/2022]
Abstract
Objectives Rheumatoid arthritis (RA) is characterised by breach of self-tolerance towards citrullinated antigens with generation of anti-citrullinated peptide/proteins antibodies (ACPA). Currently, the nature and source of citrullinated antigens driving the humoral autoimmune response within synovial ectopic lymphoid structures (ELS) is a crucial unknown aspect of RA pathogenesis. Here we characterised the autoreactive B-cell response of lesional B cells isolated from ELS+RA synovium. Methods Single synovial tissue CD19+cells were Fluorescence Activated Cell Sorting (FACS)-sorted and VH/VL Ig genes cloned to generate recombinant monoclonal antibodies (rmAbs) from patients with ELS+/ACPA+RA. Results RA-rmAbs immunoreactivity analysis provided the following key findings: (1) in a chIP-based array containing 300 autoantigens and in a ‘citrullinome’ multiplex assay, a strong reactivity against citrullinated histones H2A/H2B (citH2A/H2B) was observed in ∼40% of RA-rmAbs, followed by cit-fibrinogen and cit-vimentin; (2) anti-citH2A/H2B-reactive RA-rmAbs (but not anti-citH2A/H2B negative) selectively recognised neutrophil extracellular traps (NETs) from peripheral blood and/or RA joint neutrophils; (3) anti-citH2A/citH2B and anti-NET immunobinding was dependent on affinity maturation and was completely abrogated following reversion of hypermutated IgVH/VL genes to germline sequences; (4) ELS+ (not ELS−) RA synovial tissues engrafted into Severe Combined ImmunoDeficiency (SCID) mice released human anti-citH2A/citH2B and anti-NET antibodies in association with the intra-graft expression of CXCL13 and lymphotoxin (LT)-β, two master regulators of ELS. Conclusion We provided novel evidence that B cells differentiated within synovial ELS in the RA joints frequent target deiminated proteins which could be generated during NETosis of RA synovial neutrophils including histones. Thus, NETs could represent a source of citrullinated antigens fuelling the ACPA autoimmune response within the RA synovium.
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Affiliation(s)
- Elisa Corsiero
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Michele Bombardieri
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Emanuela Carlotti
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Federico Pratesi
- Clinical Immunology and Allergy Unit, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Paola Migliorini
- Clinical Immunology and Allergy Unit, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Costantino Pitzalis
- Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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41
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Fisher BA, Cartwright AJ, Quirke AM, de Pablo P, Romaguera D, Panico S, Mattiello A, Gavrila D, Navarro C, Sacerdote C, Vineis P, Tumino R, Lappin DF, Apatzidou D, Apazidou D, Culshaw S, Potempa J, Michaud DS, Riboli E, Venables PJ. Smoking, Porphyromonas gingivalis and the immune response to citrullinated autoantigens before the clinical onset of rheumatoid arthritis in a Southern European nested case-control study. BMC Musculoskelet Disord 2015; 16:331. [PMID: 26537917 PMCID: PMC4634856 DOI: 10.1186/s12891-015-0792-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/24/2015] [Indexed: 12/13/2022] Open
Abstract
Background Antibodies to citrullinated proteins (ACPA) occur years before RA diagnosis. Porphyromonas gingivalis expresses its own peptidylarginine deiminase (PPAD), and is a proposed aetiological factor for the ACPA response. Smoking is a risk factor for both ACPA-positive RA and periodontitis. We aimed to study the relation of these factors to the risk of RA in a prospective cohort. Methods We performed a nested case–control study by identifying pre-RA cases in four populations from the European Prospective Investigation into Cancer and nutrition, matched with three controls. Data on smoking and other covariates were obtained from baseline questionnaires. Antibodies to CCP2 and citrullinated peptides from α-enolase, fibrinogen, vimentin and PPAD were measured. Antibodies to arginine gingipain (RgpB) were used as a marker for P.gingivalis infection and validated in a separate cohort of healthy controls and subjects with periodontitis. Results We studied 103 pre-RA cases. RA development was associated with several ACPA specificities, but not with antibodies to citrullinated PPAD peptides. Antibody levels to RgpB and PPAD peptides were higher in smokers but were not associated with risk of RA or with pre-RA autoimmunity. Former but not current smoking was associated with antibodies to α-enolase (OR 4.06; 95 % CI 1.02, 16.2 versus 0.54; 0.09-3.73) and fibrinogen peptides (OR 4.24; 95 % CI 1.2-14.96 versus 0.58; 0.13-2.70), and later development of RA (OR 2.48; 95 % CI 1.27-4.84 versus 1.57; 0.85-2.93), independent of smoking intensity. Conclusions Smoking remains a risk factor for RA well before the clinical onset of disease. In this cohort, P.gingivalis is not associated with pre-RA autoimmunity or risk of RA in an early phase before disease-onset. Antibodies to PPAD peptides are not an early feature of ACPA ontogeny.
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Affiliation(s)
- Benjamin A Fisher
- Rheumatology Research Group, Centre for Translational Inflammation Research, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2WB, UK.
| | | | - Anne-Marie Quirke
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.
| | - Paola de Pablo
- Rheumatology Research Group, Centre for Translational Inflammation Research, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2WB, UK.
| | - Dora Romaguera
- School of Public Health, Imperial College London, London, UK. .,CIBER-OBN (Fisiopatología de la Obesidad y Nutrición), Madrid, Spain.
| | - Salvatore Panico
- Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy.
| | - Amalia Mattiello
- Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy.
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Murcia, Spain.
| | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Murcia, Spain.
| | | | | | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, ASP Ragusa, Ragusa, Italy.
| | - David F Lappin
- University of Glasgow Dental School, University of Glasgow, Glasgow, UK.
| | | | - Danae Apazidou
- University of Glasgow Dental School, University of Glasgow, Glasgow, UK.
| | - Shauna Culshaw
- University of Glasgow Dental School, University of Glasgow, Glasgow, UK.
| | - Jan Potempa
- Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland. .,Oral Health and Systemic Research Group, School of Dentistry, University of Louisville, Louisville, USA.
| | - Dominique S Michaud
- School of Public Health, Imperial College London, London, UK. .,Department of Epidemiology, Brown University School of Public Health, Providence, USA.
| | - Elio Riboli
- School of Public Health, Imperial College London, London, UK.
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