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Li Z, Chen P, Zhang Y, Chen J, Zheng S, Li W, Tang L, Liu Y, Zhao N. Serum BAFF levels are associated with the prognosis of idiopathic membranous nephropathy. Ren Fail 2024; 46:2391069. [PMID: 39143819 PMCID: PMC11328817 DOI: 10.1080/0886022x.2024.2391069] [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: 03/26/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE High serum levels of B-cell activation factor (BAFF) and a proliferation-inducing ligand (APRIL) have been observed in patients with idiopathic membranous nephropathy (iMN); however, their relationships with disease severity and progression remain unclear. METHODS Patients with iMN diagnosed via renal biopsy were enrolled in this study. The concentrations of BAFF and APRIL were determined using ELISA kits. Proteinuria remission, including complete remission (CR) and partial remission (PR), and renal function deterioration were defined as clinical events. The Cox proportional hazards method was used to analyze the relationship between cytokine levels and disease progression. RESULTS Seventy iMN patients were enrolled in this study, with a median follow-up time of 24 months (range 6-72 months). The serum levels of BAFF and APRIL were higher in iMN patients than in healthy controls but lower than those in minimal change disease (MCD) patients. The serum BAFF level was positively correlated with the serum APRIL level, serum anti-phospholipase A2 receptor (anti-PLA2R) antibody level, and 24-h proteinuria and negatively correlated with the serum albumin (ALB) level. However, no significant correlation was observed between the serum APRIL level and clinical parameters. According to the multivariate Cox proportional hazards regression model adjusted for sex, age, systolic blood pressure (SBP), estimated glomerular filtration rate (eGFR), immunosuppressive agent use, 24-h proteinuria, APRIL level, and anti-PLA2R antibody, only the serum BAFF level was identified as an independent predictor of PR (HR, 0.613; 95% CI, 0.405-0.927; p = 0.021) and CR of proteinuria (HR, 0.362; 95% CI, 0.202-0.648; p < 0.001). CONCLUSIONS A high serum BAFF level is associated with severe clinical manifestations and poor disease progression in patients with iMN.
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Affiliation(s)
- Zhaohui Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, P.R. China
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, P.R. China
| | - Ping Chen
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, P.R. China
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Institute of Nephrology, Jinan, Shandong, P.R. China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, Shandong, P.R. China
| | - Ying Zhang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, P.R. China
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Institute of Nephrology, Jinan, Shandong, P.R. China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, Shandong, P.R. China
| | - Juan Chen
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, P.R. China
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Institute of Nephrology, Jinan, Shandong, P.R. China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, Shandong, P.R. China
| | - Shanshan Zheng
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, P.R. China
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Institute of Nephrology, Jinan, Shandong, P.R. China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, Shandong, P.R. China
| | - Wenbin Li
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, P.R. China
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Institute of Nephrology, Jinan, Shandong, P.R. China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, Shandong, P.R. China
| | - Lijun Tang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, P.R. China
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Institute of Nephrology, Jinan, Shandong, P.R. China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, Shandong, P.R. China
| | - Yipeng Liu
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, P.R. China
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Institute of Nephrology, Jinan, Shandong, P.R. China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, Shandong, P.R. China
| | - Na Zhao
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, P.R. China
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Institute of Nephrology, Jinan, Shandong, P.R. China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, Shandong, P.R. China
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Gong X, He S, Cai P. Roles of TRIM21/Ro52 in connective tissue disease-associated interstitial lung diseases. Front Immunol 2024; 15:1435525. [PMID: 39165359 PMCID: PMC11333224 DOI: 10.3389/fimmu.2024.1435525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/19/2024] [Indexed: 08/22/2024] Open
Abstract
Multiple factors contribute to the development of connective tissue diseases (CTD), often alongside a range of interstitial lung diseases (ILD), including Sjögren's syndrome-associated ILD, systemic sclerosis-associated ILD, systemic lupus erythematosus-associated ILD, idiopathic inflammatory myositis-associated ILD. TRIM21(or Ro52), an E3 ubiquitin ligase, plays a vital role in managing innate and adaptive immunity, and maintaining cellular homeostasis, and is a focal target for autoantibodies in various rheumatic autoimmune diseases. However, the effectiveness of anti-TRIM21 antibodies in diagnosing CTD remains a matter of debate because of their non-specific nature. Recent studies indicate that TRIM21 and its autoantibody are involved in the pathogenesis of CTD-ILD and play an important role in diagnosis and prognosis. In this review, we focus on the contribution of TRIM21 in the pathogenesis of CTD-ILD, as well as the potential diagnostic value of its autoantibodies in different types of CTD-ILD for disease progression and potential as a novel therapeutic target.
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Affiliation(s)
| | | | - Pengcheng Cai
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Reyes-Huerta RF, Mandujano-López V, Velásquez-Ortiz MG, Alcalá-Carmona B, Ostos-Prado MJ, Reyna-Juárez Y, Meza-Sánchez DE, Juárez-Vega G, Mejía-Domínguez NR, Torres-Ruiz J, Gómez-Martín D, Maravillas-Montero JL. Novel B-cell subsets as potential biomarkers in idiopathic inflammatory myopathies: insights into disease pathogenesis and disease activity. J Leukoc Biol 2024; 116:84-94. [PMID: 38554062 DOI: 10.1093/jleuko/qiae083] [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: 10/31/2023] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024] Open
Abstract
Idiopathic inflammatory myopathies are a heterogeneous group of rare autoimmune disorders characterized by progressive muscle weakness and the histopathologic findings of inflammatory infiltrates in muscle tissue. Although their pathogenesis remains indefinite, the association of autoantibodies with clinical manifestations and the evidence of high effectiveness of depleting therapies suggest that B cells could be implicated. Therefore, we explored the landscape of peripheral B cells in this disease by multiparametric flow cytometry, finding significant numerical decreases in memory and double-negative subsets, as well as an expansion of the naive compartment relative to healthy controls, that contribute to defining disease-associated B-cell subset signatures and correlating with different clinical features of patients. Additionally, we determined the potential value of these subsets as diagnostic biomarkers, thus positioning B cells as neglected key elements possibly participating in idiopathic inflammatory myopathy onset or development.
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Affiliation(s)
- Raúl F Reyes-Huerta
- B cell Immunology Laboratory, Coordinación de la Investigación Científica, Universidad Nacional Autónoma de México, Circuito de la Investigación Científica S/N, CU, Coyoacán, Mexico City 04510, Mexico
- Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, Unidad de Posgrado, CU, Coyoacán, Mexico City 04510, Mexico
| | - Vladimir Mandujano-López
- B cell Immunology Laboratory, Coordinación de la Investigación Científica, Universidad Nacional Autónoma de México, Circuito de la Investigación Científica S/N, CU, Coyoacán, Mexico City 04510, Mexico
| | - Ma Guadalupe Velásquez-Ortiz
- B cell Immunology Laboratory, Coordinación de la Investigación Científica, Universidad Nacional Autónoma de México, Circuito de la Investigación Científica S/N, CU, Coyoacán, Mexico City 04510, Mexico
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Unidad de Posgrado, CU, Coyoacán, Mexico City 04510, Mexico
| | - Beatriz Alcalá-Carmona
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - María J Ostos-Prado
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Yatzil Reyna-Juárez
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - David E Meza-Sánchez
- B cell Immunology Laboratory, Coordinación de la Investigación Científica, Universidad Nacional Autónoma de México, Circuito de la Investigación Científica S/N, CU, Coyoacán, Mexico City 04510, Mexico
- Red de Apoyo a la Investigación, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán y Universidad Nacional Autónoma de México, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Guillermo Juárez-Vega
- Red de Apoyo a la Investigación, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán y Universidad Nacional Autónoma de México, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Nancy R Mejía-Domínguez
- Red de Apoyo a la Investigación, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán y Universidad Nacional Autónoma de México, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Jiram Torres-Ruiz
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Diana Gómez-Martín
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
- Red de Apoyo a la Investigación, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán y Universidad Nacional Autónoma de México, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - José L Maravillas-Montero
- B cell Immunology Laboratory, Coordinación de la Investigación Científica, Universidad Nacional Autónoma de México, Circuito de la Investigación Científica S/N, CU, Coyoacán, Mexico City 04510, Mexico
- Red de Apoyo a la Investigación, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán y Universidad Nacional Autónoma de México, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
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Shi Y, You H, Liu C, Qiu Y, Lv C, Zhu Y, Xu L, Wang F, Zhang M, Tan W. Elevated serum B-cell activator factor levels predict rapid progressive interstitial lung disease in anti-melanoma differentiation associated protein 5 antibody positive dermatomyositis. Orphanet J Rare Dis 2024; 19:170. [PMID: 38637830 PMCID: PMC11027411 DOI: 10.1186/s13023-024-03153-6] [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: 08/13/2023] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Rapid progressive interstitial lung disease (RP-ILD) is the leading cause of anti-melanoma differentiation associated protein 5 antibody positive dermatomyositis (anti-MDA5+DM) related death. Elevated serum B-cell activating factor (BAFF) levels have been implicated in connective tissue diseases associated ILD. Here, we evaluate whether BAFF could be a prognostic biomarker for predicting RP-ILD in anti-MDA5+DM patients. METHODS Serums were collected from 39 patients with anti-MDA5+DM (20 with RP-ILD and 19 with non-RP-ILD), 20 antisynthase syndrome (ASS) patients and 20 healthy controls (HC). BAFF concentration was measured by an enzyme-linked immunosorbent assay. RESULTS Serum BAFF level was higher in anti-MDA5+DM patients than those in ASS patients and HC (3882.32 ± 1880.09 vs. 2540.89 ± 1403.04 and 2486.28 ± 767.97 pg/mL, p = 0.0056 and 0.0038, respectively). Within anti-MDA5+DM groups, RP-ILD patients exhibited higher BAFF concentration than non-RP-ILD group (4549.78 ± 1839.97 vs. 3297.28 ± 1794.69 pg/mL, p = 0.04). The BAFF concentration was positively correlated with levels of C-reactive protein (CRP), dehydrogenase (LDH) and cytokeratin (CK) in anti-MDA5+DM patients (r = 0.350, p = 0.035; r = 0.393, p = 0.016; r = 0.518, p = 0.001; respectively). The best cut-off value of BAFF concentration was 2971.5 pg/mL by ROC curve (AUC area = 0.690, p = 0.045) and BAFF > 2971.5 pg/mL was an independent risk factor for RP-ILD using multivariate analysis (OR = 9.389, 95% CI = 1.609-54.769; p = 0.013). CONCLUSIONS Serum BAFF could be a useful prognostic biomarker for early detecting RP-ILD risk in anti-MDA5+DM patients.
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Affiliation(s)
- Yumeng Shi
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Hanxiao You
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Chang Liu
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Yulu Qiu
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Chengyin Lv
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Yujing Zhu
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Lingxiao Xu
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Fang Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Miaojia Zhang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, 210029, China.
| | - Wenfeng Tan
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, 210029, China.
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Honda M, Shimizu F, Sato R, Nakamori M. Contribution of Complement, Microangiopathy and Inflammation in Idiopathic Inflammatory Myopathies. J Neuromuscul Dis 2024; 11:5-16. [PMID: 38143369 PMCID: PMC10789353 DOI: 10.3233/jnd-230168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE OF REVIEW Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group characterized by muscle weakness and skin symptoms and are categorized into six subtypes: dermatomyositis (DM), polymyositis (PM), anti-synthetase syndrome (ASS), immune-mediated myopathy (IMNM), inclusion body myopathy (IBM), and overlap myositis. Myositis-specific autoantibodies were detected for the diagnosis and classification of IIM. This review highlights the pathogenic contributions of the complement system, microangiopathy, and inflammation in IIM. RECENT FINDINGS Deposition of complement around capillaries and/or the sarcolemma was observed in muscle biopsy specimens from patients with DM, ASS, and IMNM, suggesting the pathomechanism of complement-dependent muscle and endothelial cell injury. A recent study using human muscle microvascular endothelial cells showed that Jo-1 antibodies from ASS induce complement-dependent cellular cytotoxicity in vitro. Based on both clinical and pathological observations, antibody- and complement-mediated microangiopathy may contribute to the development of DM and anti-Jo-1 ASS. Juvenile DM is characterized by the loss of capillaries, perivascular inflammation, and small-vessel angiopathies, which may be related to microinfarction and perifascicular atrophy. Several serum biomarkers that reflect the IFN1 signature and microangiopathy are elevated in patients with DM. The pathological observation of myxovirus resistance protein A (MxA), which suggests a type 1 interferon (IFN1) signature in DM, supports the diagnosis and further understanding of the pathomechanism of IIM. A recent report showed that an increase in triggering receptor expressed on myeloid cells (TREM-1) around perimysial blood vessels and muscles in patients with IIM plays a role in triggering inflammation and promoting the migration of inflammatory cells by secreting proinflammatory cytokines, such as tumor necrosis factor α. SUMMARY The deposition of complement in muscles and capillaries is a characteristic feature of DM, ASS, and IMNM. Microangiopathy plays a pathogenic role in DM, possibly resulting in perifascicular atrophy. Further understanding of the detailed pathomechanism regarding complement, microangiopathy, and inflammation may lead to novel therapeutic approaches for IIM.
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Affiliation(s)
- Masaya Honda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Fumitaka Shimizu
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Ryota Sato
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Masayuki Nakamori
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Carstens PO, Müllar LM, Wrede A, Zechel S, Wachowski MM, Brandis A, Krause S, Zierz S, Schmidt J. Skeletal muscle fibers produce B-cell stimulatory factors in chronic myositis. Front Immunol 2023; 14:1177721. [PMID: 37731487 PMCID: PMC10508232 DOI: 10.3389/fimmu.2023.1177721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/16/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction We aimed to identify B-cell-mediated immunomechanisms in inclusion body myositis (IBM) and polymyositis (PM) as part of the complex pathophysiology. Materials and methods Human primary myotube cultures were derived from orthopedic surgery. Diagnostic biopsy specimens from patients with IBM (n=9) and PM (n=9) were analyzed for markers of B cell activation (BAFF and APRIL) and for chemokines that control the recruitment of B cells (CXCL-12 and CXCL-13). Results were compared to biopsy specimens without myopathic changes (n=9) and hereditary muscular dystrophy (n=9). Results The mRNA expression of BAFF, APRIL, and CXCL-13 was significantly higher in IBM and PM compared to controls. Patients with IBM displayed the highest number of double positive muscle fibers for BAFF and CXCL-12 (48%) compared to PM (25%), muscular dystrophy (3%), and non-myopathic controls (0%). In vitro, exposure of human myotubes to pro-inflammatory cytokines led to a significant upregulation of BAFF and CXCL-12, but APRIL and CXCL-13 remained unchanged. Conclusion The results substantiate the hypothesis of an involvement of B cell-associated mechanisms in the pathophysiology of IBM and PM. Muscle fibers themselves seem to contribute to the recruitment of B cells and sustain inflammation.
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Affiliation(s)
- Per-Ole Carstens
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Luisa M. Müllar
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Arne Wrede
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Institute of Neuropathology, Saarland University Medical Center and Medical Faculty of Saarland University, Homburg, Germany
| | - Sabrina Zechel
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin M. Wachowski
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Almuth Brandis
- Department of Pathology, Klinikum Region Hannover, Hannover, Germany
- Institute of Pathology and Neuropathology, Medical University Hannover, Hannover, Germany
| | - Sabine Krause
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of München, München, Germany
| | - Stephan Zierz
- Department of Neurology, University Hospital Halle/Saale, Halle, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neurology and Pain Treatment, Neuromuscular Center, Center for Translational Medicine, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei, Berlin, Germany
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Anang DC, Walter HAW, Lim J, Niewold I, van der Weele L, Aronica E, Eftimov F, Raaphorst J, van Schaik BDC, van Kampen AHC, van der Kooi AJ, de Vries N. B-cell receptor profiling before and after IVIG monotherapy in newly diagnosed idiopathic inflammatory myopathies. Rheumatology (Oxford) 2023; 62:2585-2593. [PMID: 36321862 PMCID: PMC10321087 DOI: 10.1093/rheumatology/keac602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/06/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To unravel B-cell receptor (BcR) characteristics in muscle tissues and peripheral blood and gain more insight into BcR repertoire changes in peripheral blood in idiopathic inflammatory myopathies (IIMs), and study how this correlates to the clinical response to IVIG. METHODS Nineteen treatment-naive patients with newly diagnosed IIM were prospectively treated with IVIG monotherapy. RNA-based BcR repertoire sequencing was performed in muscle biopsies collected before, and in peripheral blood (PB) collected before and nine weeks after IVIG treatment. Results were correlated to patients' clinical improvement based on the total improvement score (TIS). RESULTS Prior to IVIG treatment, BcR clones found in muscle tissue could be retrieved in peripheral blood. Nine weeks after IVIG treatment, new patient-specific dominant BcR clones appeared in peripheral blood while pre-treatment dominant BcR clones disappeared. The cumulative frequency of all dominant BcR clones before treatment was significantly higher in individuals who responded to IVIG compared with those who did not respond to IVIG, and correlated with a higher CK. During follow-up, a decrease in the cumulative frequency of all dominant clones correlated with a higher TIS. CONCLUSION In treatment-naive patients with newly diagnosed IIM, muscle tissue and peripheral blood share expanded BcR clones. In our study a higher cumulative frequency of dominant BcR clones in blood before treatment was associated with a higher CK and better treatment response, suggesting that response to IVIG may depend on the composition of the pre-treatment BcR repertoire.
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Affiliation(s)
| | | | - Johan Lim
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Ilse Niewold
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Genome analysis, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Linda van der Weele
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Barbera D C van Schaik
- Bioinformatics Laboratory, Department of Epidemiology and Data science, Amsterdam Public Health Institute, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Antoine H C van Kampen
- Bioinformatics Laboratory, Department of Epidemiology and Data science, Amsterdam Public Health Institute, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Niek de Vries
- Correspondence to: Niek de Vries, Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, PO. Box 22600, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. E-mail:
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Qiu R, Wang Z, Wei X, Sui H, Jiang Z, Yu XF. The pathogenesis of anti-signal recognition particle necrotizing myopathy: A Review. Biomed Pharmacother 2022; 156:113936. [DOI: 10.1016/j.biopha.2022.113936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
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Kim H, Huber AM, Kim S. Updates on Juvenile Dermatomyositis from the Last Decade: Classification to Outcomes. Rheum Dis Clin North Am 2021; 47:669-690. [PMID: 34635298 DOI: 10.1016/j.rdc.2021.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Juvenile dermatomyositis (JDM) is a heterogeneous disease with new classification criteria and updates in myositis-specific autoantibody and myositis-associated antibody groups. There are many validated assessment tools for assessing disease activity in JDM. Future studies will optimize these tools and improve feasibility in clinical and research contexts. Genetic and environmental risk factors, mechanisms of muscle pathology, role of interferon, vascular markers, and changes in immune cells provide insights to JDM pathogenesis. Outcomes have improved, but chronic disease, damage, and mortality highlight the need for better outcome predictors and treatments. Increased collaboration of stakeholders may help overcome research barriers and improve JDM treatment.
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Affiliation(s)
- Hanna Kim
- Juvenile Myositis Pathogenesis and Therapeutics Unit, National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, Building 10, 12N-240, Bethesda, MD 20892, USA.
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Division of Pediatric Rheumatology, 5850 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
| | - Susan Kim
- University of California, San Francisco, 550 16th Street, San Francisco, CA 94158, USA
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10
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Patwardhan A, Spencer CH. Biologics in refractory idiopathic inflammatory myositis (IIM): What experience in juvenile vs adult myositis tells us about the use of biologics in pediatric IIM. Mod Rheumatol 2021; 31:933-948. [PMID: 33499694 DOI: 10.1080/14397595.2021.1881027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Juvenile dermatomyositis (JDM) is an extremely heterogeneous orphan disease with limited amount of dedicated research on the subject matter. Recent research suggests that JDM may not just be the classic antibody driven complements mediated microangiopathy as was thought to be in the past. The etiopathogenesis of JDM also involves inappropriate stimulation of innate immune system followed by dysregulation of the adaptive immune response through dendritic cells. Many variable immune factors such as genetics, major histocompatibility complex expressions, immunohistochemical variabilities, and diversity in specific and associated autoantibodies may make individual IIM and JDM cases unique. The diversity in IIM and JDM also explains individual variability in response to specific therapies. Classifying and matching the right patients to the right treatment is crucial to the successful treatment of these patients with better outcomes. Sub-type specific biologic therapy may be the best current treatment that can match the patient to the best treatment options. A PubMed search was performed to find all the available cases of refractory myositis patients treated with biologics up to July 2020. Using this search this article reviews all the current biologic treatment options and experiences for both adults and children in the context of recent basic science to assist pediatric rheumatologists in choosing the optimal biologic therapy for a child with recalcitrant JDM.
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Affiliation(s)
| | - Charles H Spencer
- University of Mississippi Medical Center, Batson Children's Hospital, Jackson, MS, USA
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Möckel T, Basta F, Weinmann-Menke J, Schwarting A. B cell activating factor (BAFF): Structure, functions, autoimmunity and clinical implications in Systemic Lupus Erythematosus (SLE). Autoimmun Rev 2020; 20:102736. [PMID: 33333233 DOI: 10.1016/j.autrev.2020.102736] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/28/2020] [Indexed: 12/30/2022]
Abstract
The B cell activating factor (BAFF), or B lymphocyte stimulator (BLyS), is a B cell survival factor which supports autoreactive B cells and prevents their deletion. BAFF expression is closely linked with autoimmunity and is enhanced by genetic alterations and viral infections. Furthermore, BAFF seems to be involved in adipogenesis, atherosclerosis, neuro-inflammatory processes and ischemia reperfusion (I/R) injury. BAFF is commonly overexpressed in Systemic Lupus Erythematosus (SLE) and strongly involved in the pathogenesis of the disease. The relationship between BAFF levels, disease activity and damage accrual in SLE is controversial, but growing evidence is emerging on its role in renal involvement. Belimumab, a biologic BAFF inhibitor, has been the first biologic agent licensed for SLE therapy so far. As Rituximab (RTX) has been shown to increase BAFF levels following B cell depletion, the combination therapy of RTX plus belimumab (being evaluated in two RCT) seems to be a valuable option for several clinical scenarios. In this review we will highlight the growing body of evidence of immune and non-immune related BAFF expression in experimental and clinical settings.
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Affiliation(s)
- Tamara Möckel
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Fabio Basta
- Acura Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany
| | - Julia Weinmann-Menke
- Department of Internal Medicine I, Division of Nephrology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Schwarting
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Acura Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany
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12
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Zhao Y, Zhang W, Liu Y, Wang Z, Yuan Y. Factors associated with refractory autoimmune necrotizing myopathy with anti-signal recognition particle antibodies. Orphanet J Rare Dis 2020; 15:181. [PMID: 32641139 PMCID: PMC7341563 DOI: 10.1186/s13023-020-01431-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/28/2020] [Indexed: 12/21/2022] Open
Abstract
Background Autoimmune necrotizing myopathy with anti-signal recognition particle antibodies (ANM-SRP) is regarded as refractory myositis, whereby some patients respond poorly to conventional immunosuppression and require B cell depletion treatment. This study aimed to evaluate factors associated with refractory ANM-SRP. Results Clinical and pathological data from 48 patients with ANM-SRP were collected. We followed up clinical symptoms and image changes over 12 months. Univariate and multivariate analyses were undertaken to determine the associations between variables of interest and poor response to therapy. Refractory ANM-SRP appeared in 32.5% of patients who showed no or minimal improvement after 12 months of steroid therapy. The clinical risk factors for refractory patients were being male (OR, 19.57; P < 0.001), severe muscle weakness (OR, 7.51; P < 0.001) and concurrent interstitial lung disease (OR, 39.70; P < 0.001). The imaging refractory-related factor was the fatty infiltration rate of thigh muscles over 3 months (P = 0.022) and the pathological factor associated with refractory ANM-SRP was the high expression of B cell activating factor receptor (BAFF-R) in muscle (P = 0.036). Conclusion Being male, severe muscle weakness, concurrent interstitial lung disease, quick development of muscle fatty infiltration and more BAFF-R and B lymphocyte infiltration in muscle indicate a poor response to immunosuppressive therapy in patients with ANM-SRP.
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Affiliation(s)
- Yawen Zhao
- Department of Neurology, Peking University First Hospital, No. 8 Xishku Street, Xicheng District, Beijing, 100034, PR China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, No. 8 Xishku Street, Xicheng District, Beijing, 100034, PR China
| | - Yilin Liu
- Department of Neurology, Peking University First Hospital, No. 8 Xishku Street, Xicheng District, Beijing, 100034, PR China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, No. 8 Xishku Street, Xicheng District, Beijing, 100034, PR China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, No. 8 Xishku Street, Xicheng District, Beijing, 100034, PR China.
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13
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14
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Biomarkers in Adult Dermatomyositis: Tools to Help the Diagnosis and Predict the Clinical Outcome. J Immunol Res 2019; 2019:9141420. [PMID: 30766892 PMCID: PMC6350546 DOI: 10.1155/2019/9141420] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/09/2018] [Indexed: 12/22/2022] Open
Abstract
Dermatomyositis pathophysiology is complex. In recent years, medical research has identified molecules associated with disease activity. Besides providing insights into the driving mechanisms of dermatomyositis, these findings could provide potential biomarkers. Activity markers can be used to monitor disease activity in clinical trials and may also be useful in daily practice. This article reviews molecules that could be used as biomarkers for diagnosis and monitoring dermatomyositis disease activity.
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Wienke J, Deakin CT, Wedderburn LR, van Wijk F, van Royen-Kerkhof A. Systemic and Tissue Inflammation in Juvenile Dermatomyositis: From Pathogenesis to the Quest for Monitoring Tools. Front Immunol 2018; 9:2951. [PMID: 30619311 PMCID: PMC6305419 DOI: 10.3389/fimmu.2018.02951] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/30/2018] [Indexed: 12/26/2022] Open
Abstract
Juvenile Dermatomyositis (JDM) is a systemic immune-mediated disease of childhood, characterized by muscle weakness, and a typical skin rash. Other organ systems and tissues such as the lungs, heart, and intestines can be involved, but may be under-evaluated. The inflammatory process in JDM is characterized by an interferon signature and infiltration of immune cells such as T cells and plasmacytoid dendritic cells into the affected tissues. Vasculopathy due to loss and dysfunction of endothelial cells as a result of the inflammation is thought to underlie the symptoms in most organs and tissues. JDM is a heterogeneous disease, and several disease phenotypes, each with a varying combination of affected tissues and organs, are linked to the presence of myositis autoantibodies. These autoantibodies have therefore been extensively studied as biomarkers for the disease phenotype and its associated prognosis. Next to identifying the JDM phenotype, monitoring of disease activity and disease-inflicted damage not only in muscle and skin, but also in other organs and tissues, is an important part of clinical follow-up, as these are key determinants for the long-term outcomes of patients. Various monitoring tools are currently available, among which clinical assessment, histopathological investigation of muscle and skin biopsies, and laboratory testing of blood for specific biomarkers. These investigations also give novel insights into the underlying immunological processes that drive inflammation in JDM and suggest a strong link between the interferon signature and vasculopathy. New tools are being developed in the quest for minimally invasive, but sensitive and specific diagnostic methods that correlate well with clinical symptoms or reflect local, low-grade inflammation. In this review we will discuss the types of (extra)muscular tissue inflammation in JDM and their relation to vasculopathic changes, critically assess the available diagnostic methods including myositis autoantibodies and newly identified biomarkers, and reflect on the immunopathogenic implications of identified markers.
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Affiliation(s)
- Judith Wienke
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Claire T Deakin
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,NHR Biomedical Research Center at Great Ormond Hospital, London, United Kingdom.,Arthritis Research UK Center for Adolescent Rheumatology, UCL, UCLH and GOSH, London, United Kingdom
| | - Lucy R Wedderburn
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,NHR Biomedical Research Center at Great Ormond Hospital, London, United Kingdom.,Arthritis Research UK Center for Adolescent Rheumatology, UCL, UCLH and GOSH, London, United Kingdom
| | - Femke van Wijk
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Annet van Royen-Kerkhof
- Pediatric Rheumatology and Immunology, University Medical Center Utrecht, Utrecht, Netherlands
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16
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Abstract
The major forms of autoimmune myopathies include dermatomyositis (DM), polymyositis (PM), myositis associated with antisynthetase syndrome (ASS), immune-mediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM). While each of these conditions has unique clinical and histopathological features, they all share an immune-mediated component. These conditions can occur in isolation or can be associated with systemic malignancies or connective tissue disorders (overlap syndromes). As more has been learned about these conditions, it has become clear that traditional classification schemes do not adequately group patients according to shared clinical features and prognosis. Newer classifications are now utilizing myositis-specific autoantibodies which correlate with clinical and histopathological phenotypes and risk of malignancy, and help in offering prognostic information with regard to treatment response. Based on observational data and expert opinion, corticosteroids are considered first-line therapy for DM, PM, ASS, and IMNM, although intravenous immunoglobulin (IVIG) is increasingly being used as initial therapy in IMNM related to statin use. Second-line agents are often required, but further prospective investigation is required regarding the optimal choice and timing of these agents.
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Affiliation(s)
- Emer R McGrath
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.
| | - Christopher T Doughty
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Anthony A Amato
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
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Novel Therapeutic Options in Treatment of Idiopathic Inflammatory Myopathies. Curr Treat Options Neurol 2018; 20:37. [DOI: 10.1007/s11940-018-0521-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rider LG, Aggarwal R, Machado PM, Hogrel JY, Reed AM, Christopher-Stine L, Ruperto N. Update on outcome assessment in myositis. Nat Rev Rheumatol 2018; 14:303-318. [PMID: 29651119 PMCID: PMC6702032 DOI: 10.1038/nrrheum.2018.33] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The adult and juvenile myositis syndromes, commonly referred to collectively as idiopathic inflammatory myopathies (IIMs), are systemic autoimmune diseases with the hallmarks of muscle weakness and inflammation. Validated, well-standardized measures to assess disease activity, known as core set measures, were developed by international networks of myositis researchers for use in clinical trials. Composite response criteria using weighted changes in the core set measures of disease activity were developed and validated for adult and juvenile patients with dermatomyositis and adult patients with polymyositis, with different thresholds for minimal, moderate and major improvement in adults and juveniles. Additional measures of muscle strength and function are being validated to improve content validity and sensitivity to change. A health-related quality of life measure, which incorporates patient input, is being developed for adult patients with IIM. Disease state criteria, including criteria for inactive disease and remission, are being used as secondary end points in clinical trials. MRI of muscle and immunological biomarkers are promising approaches to discriminate between disease activity and damage and might provide much-needed objective outcome measures. These advances in the assessment of outcomes for myositis treatment, along with collaborations between international networks, should facilitate further development of new therapies for patients with IIM.
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Affiliation(s)
- Lisa G. Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Rohit Aggarwal
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Pedro M. Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | | | - Ann M. Reed
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicolino Ruperto
- Istituto Giannina Gaslini, Clinica Pediatria e Reumatologia, PRINTO, Genoa, Italy
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Serum BAFF in Indian patients with IIM: a retrospective study reveals novel clinico-phenotypic associations in children and adults. Clin Rheumatol 2018. [DOI: 10.1007/s10067-018-4046-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kobayashi N, Kobayashi I, Mori M, Sato S, Iwata N, Shigemura T, Agematsu K, Yokota S, Koike K. Increased Serum B Cell Activating Factor and a Proliferation-inducing Ligand Are Associated with Interstitial Lung Disease in Patients with Juvenile Dermatomyositis. J Rheumatol 2015; 42:2412-8. [PMID: 26472413 DOI: 10.3899/jrheum.140977] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Rapidly progressive interstitial lung disease (RP-ILD) is an intractable and fatal complication of juvenile dermatomyositis (JDM). This study evaluated serum levels of B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) in JDM patients with complicating ILD, and their association with ILD phenotypes, clinical variables, and anti-melanoma differentiation-associated gene 5 (MDA5). METHODS We measured the levels of BAFF, APRIL, and anti-MDA5 in the sera of 23 JDM patients with ILD [8 in the RP-ILD group and 15 in the chronic ILD (C-ILD) group], 17 JDM patients without ILD (non-ILD group), and 10 age-matched controls, using the ELISA method. ILD was identified by high-resolution computed tomography. RESULTS Serum BAFF titers were significantly higher in the JDM patients with RP-ILD versus those with C-ILD (p = 0.011) and in healthy controls (p = 0.0004). The C-ILD group had significantly higher levels of BAFF versus controls (p ≤ 0.0001). Serum APRIL was markedly elevated in the RP-ILD group as compared with the C-ILD group (p = 0.003) and controls (p = 0.006). In patients with ILD, both BAFF and APRIL levels were correlated with serum Krebs von den Lungen-6 and interleukin 18. Subjects with high titer anti-MDA5 (> 200 U) had higher levels of BAFF and APRIL than those with low titer anti-MDA5 (< 100 U; p = 0.019 and p = 0.0029, respectively), which may have been due to a relationship between RP-ILD and high anti-MDA5 titer. CONCLUSION Our findings of markedly elevated levels of BAFF and APRIL in patients with RP-ILD JDM suggest the potential importance of these cytokines in the diagnosis and treatment of RP-ILD accompanying JDM.
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Affiliation(s)
- Norimoto Kobayashi
- From the Department of Pediatrics, and Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University School of Medicine, Matsumoto; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama; Department of Rheumatology, Tokai University School of Medicine, Isehara; Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center, Ohbu, Japan.N. Kobayashi, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; I. Kobayashi, MD, PhD, Department of Pediatrics, Hokkaido University Graduate School of Medicine; M. Mori, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; S. Sato, MD, PhD, Department of Rheumatology, Tokai University School of Medicine; N. Iwata, MD, Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center; T. Shigemura, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; K. Agematsu, MD, PhD, Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University; S. Yokota, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; K. Koike, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine.
| | - Ichiro Kobayashi
- From the Department of Pediatrics, and Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University School of Medicine, Matsumoto; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama; Department of Rheumatology, Tokai University School of Medicine, Isehara; Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center, Ohbu, Japan.N. Kobayashi, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; I. Kobayashi, MD, PhD, Department of Pediatrics, Hokkaido University Graduate School of Medicine; M. Mori, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; S. Sato, MD, PhD, Department of Rheumatology, Tokai University School of Medicine; N. Iwata, MD, Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center; T. Shigemura, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; K. Agematsu, MD, PhD, Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University; S. Yokota, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; K. Koike, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine
| | - Masaaki Mori
- From the Department of Pediatrics, and Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University School of Medicine, Matsumoto; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama; Department of Rheumatology, Tokai University School of Medicine, Isehara; Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center, Ohbu, Japan.N. Kobayashi, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; I. Kobayashi, MD, PhD, Department of Pediatrics, Hokkaido University Graduate School of Medicine; M. Mori, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; S. Sato, MD, PhD, Department of Rheumatology, Tokai University School of Medicine; N. Iwata, MD, Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center; T. Shigemura, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; K. Agematsu, MD, PhD, Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University; S. Yokota, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; K. Koike, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine
| | - Shinji Sato
- From the Department of Pediatrics, and Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University School of Medicine, Matsumoto; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama; Department of Rheumatology, Tokai University School of Medicine, Isehara; Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center, Ohbu, Japan.N. Kobayashi, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; I. Kobayashi, MD, PhD, Department of Pediatrics, Hokkaido University Graduate School of Medicine; M. Mori, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; S. Sato, MD, PhD, Department of Rheumatology, Tokai University School of Medicine; N. Iwata, MD, Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center; T. Shigemura, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; K. Agematsu, MD, PhD, Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University; S. Yokota, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; K. Koike, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine
| | - Naomi Iwata
- From the Department of Pediatrics, and Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University School of Medicine, Matsumoto; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama; Department of Rheumatology, Tokai University School of Medicine, Isehara; Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center, Ohbu, Japan.N. Kobayashi, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; I. Kobayashi, MD, PhD, Department of Pediatrics, Hokkaido University Graduate School of Medicine; M. Mori, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; S. Sato, MD, PhD, Department of Rheumatology, Tokai University School of Medicine; N. Iwata, MD, Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center; T. Shigemura, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; K. Agematsu, MD, PhD, Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University; S. Yokota, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; K. Koike, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine
| | - Tomonari Shigemura
- From the Department of Pediatrics, and Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University School of Medicine, Matsumoto; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama; Department of Rheumatology, Tokai University School of Medicine, Isehara; Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center, Ohbu, Japan.N. Kobayashi, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; I. Kobayashi, MD, PhD, Department of Pediatrics, Hokkaido University Graduate School of Medicine; M. Mori, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; S. Sato, MD, PhD, Department of Rheumatology, Tokai University School of Medicine; N. Iwata, MD, Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center; T. Shigemura, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; K. Agematsu, MD, PhD, Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University; S. Yokota, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; K. Koike, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine
| | - Kazunaga Agematsu
- From the Department of Pediatrics, and Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University School of Medicine, Matsumoto; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama; Department of Rheumatology, Tokai University School of Medicine, Isehara; Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center, Ohbu, Japan.N. Kobayashi, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; I. Kobayashi, MD, PhD, Department of Pediatrics, Hokkaido University Graduate School of Medicine; M. Mori, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; S. Sato, MD, PhD, Department of Rheumatology, Tokai University School of Medicine; N. Iwata, MD, Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center; T. Shigemura, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; K. Agematsu, MD, PhD, Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University; S. Yokota, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; K. Koike, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine
| | - Shumpei Yokota
- From the Department of Pediatrics, and Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University School of Medicine, Matsumoto; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama; Department of Rheumatology, Tokai University School of Medicine, Isehara; Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center, Ohbu, Japan.N. Kobayashi, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; I. Kobayashi, MD, PhD, Department of Pediatrics, Hokkaido University Graduate School of Medicine; M. Mori, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; S. Sato, MD, PhD, Department of Rheumatology, Tokai University School of Medicine; N. Iwata, MD, Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center; T. Shigemura, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; K. Agematsu, MD, PhD, Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University; S. Yokota, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; K. Koike, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine
| | - Kenichi Koike
- From the Department of Pediatrics, and Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University School of Medicine, Matsumoto; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama; Department of Rheumatology, Tokai University School of Medicine, Isehara; Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center, Ohbu, Japan.N. Kobayashi, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; I. Kobayashi, MD, PhD, Department of Pediatrics, Hokkaido University Graduate School of Medicine; M. Mori, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; S. Sato, MD, PhD, Department of Rheumatology, Tokai University School of Medicine; N. Iwata, MD, Department of Immunology and Infectious Diseases, Aichi Children's Health and Medical Center; T. Shigemura, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine; K. Agematsu, MD, PhD, Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University; S. Yokota, MD, PhD, Department of Pediatrics, Yokohama City University Graduate School of Medicine; K. Koike, MD, PhD, Department of Pediatrics, Shinshu University School of Medicine
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Serum miR-338-5p, soluble B-cell-activating factor, allo-antibodies, and renal transplantation. Transplant Proc 2015; 47:337-42. [PMID: 25769569 DOI: 10.1016/j.transproceed.2014.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/23/2014] [Accepted: 11/19/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND The objective of the study was to explore the expression features of serum miR-338-5p and soluble B-cell-activating factor (sBAFF) in renal transplant recipients. METHODS Follow-up renal transplant recipients (n = 49) were enrolled in this study (male/female: 38/11). Healthy volunteers were controlled; 2 mL of peripheral blood from each subject was collected. Total RNA was extracted from serum by use of the miRNeasy Serum/Plasma Kit (QIAGEN), and miR-338-5p was amplified by means of quantitative real-time reverse transcriptase-polymerase chain reaction. sBAFF was detected by means of enzyme-linked immunoassay. LABScreen Mix (LSM12) (One Lambda) was used to test the level of anti-human leukocyte antigen (HLA) I antibody (Ab), anti-HLA II Ab, and anti-major histocompatibility complex class I chain-related A (MICA) Ab. All data are shown as mean ± SD and were analyzed by use of SPSS software 17.0. RESULTS Compared with healthy volunteers, serum miR-338-5p in recipients was statistically downregulated (2.79 ± 2.5 versus 0.09 ± 0.12, P < .001); sBAFF in recipients was significantly upregulated (1321 ± 950 pg/mL versus 534 ± 327 pg/mL, P < .01); serum anti-HLAII Ab, anti-MICA Ab, and anti-HLA+MICA Abs all statistically increased in recipients (P < .05). Spearman correlation analysis showed that miR-338-5p was significantly negatively correlated with sBAFF (r = -0.51, P < .001) and anti-HLA II antibody with mean fluorescence intensity value >1000 (r = -0.322, P < .05). Analysis results also suggested that sBAFF was significantly negatively correlated with anti-MICA Ab, with mean fluorescence intensity value >1000 (r = -0.579, P < .05). CONCLUSIONS miR-338-5p is closely correlated with the procedure of renal allograft antibody-mediated rejection.
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Morais SA, Vilas-Boas A, Isenberg DA. B-cell survival factors in autoimmune rheumatic disorders. Ther Adv Musculoskelet Dis 2015; 7:122-51. [PMID: 26288664 PMCID: PMC4530383 DOI: 10.1177/1759720x15586782] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Autoimmune rheumatic disorders have complex etiopathogenetic mechanisms in which B cells play a central role. The importance of factors stimulating B cells, notably the B-cell activating factor (BAFF) and A proliferation inducing ligand (APRIL) axis is now recognized. BAFF and APRIL are cytokines essential for B-cell proliferation and survival from the immature stages to the development of plasma cells. Their levels are increased in some subsets of patients with autoimmune disorders. Several recent biologic drugs have been developed to block this axis, namely belimumab [already licensed for systemic lupus erythematosus (SLE) treatment], tabalumab, atacicept and blisibimod. Many clinical trials to evaluate the safety and efficacy of these drugs in several autoimmune disorders are ongoing, or have been completed recently. This review updates the information on the use of biologic agents blocking BAFF/APRIL for patients with SLE, rheumatoid arthritis, Sjögren's syndrome and myositis.
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Affiliation(s)
- Sandra A Morais
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Andreia Vilas-Boas
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - David A Isenberg
- Centre for Rheumatology, University College London, Room 424, 4th Floor Rayne Building, 5 University Street, London WC1E 6JF, UK
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Dermatomyositis, polymyositis and immune-mediated necrotising myopathies. Biochim Biophys Acta Mol Basis Dis 2015; 1852:622-32. [DOI: 10.1016/j.bbadis.2014.05.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/18/2014] [Accepted: 05/20/2014] [Indexed: 12/11/2022]
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Lu X, Peng Q, Wang G. Discovery of new biomarkers of idiopathic inflammatory myopathy. Clin Chim Acta 2015; 444:117-25. [DOI: 10.1016/j.cca.2015.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 01/19/2023]
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Abstract
The idiopathic inflammatory myopathies (IIM) consist of rare heterogeneous autoimmune disorders that present with marked proximal and symmetric muscle weakness, except for distal and asymmetric weakness in inclusion body myositis. Despite many similarities, the IIM are fairly heterogeneous from the histopathologic and pathogenetic standpoints, and also show some clinical and treatment-response differences. The field has witnessed significant advances in our understanding of the pathophysiology and treatment of these rare disorders. This review focuses on dermatomyositis, polymyositis, and necrotizing myopathy, and examines current and promising therapies.
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Medrano-Campillo P, Sarmiento-Soto H, Álvarez-Sánchez N, Álvarez-Ríos AI, Guerrero JM, Rodríguez-Prieto I, Castillo-Palma MJ, Lardone PJ, Carrillo-Vico A. Evaluation of the immunomodulatory effect of melatonin on the T-cell response in peripheral blood from systemic lupus erythematosus patients. J Pineal Res 2015; 58:219-26. [PMID: 25612066 DOI: 10.1111/jpi.12208] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/15/2015] [Indexed: 12/23/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by the production of antinuclear autoantibodies. In addition, the involvement of CD4+ T-helper (Th) cells in SLE has become increasingly evident. Although the role of melatonin has been tested in some experimental models of lupus with inconclusive results, there are no studies evaluating the melatonin effect on cells from patients with SLE. Therefore, the aim of this study was to analyse the role of in vitro administered melatonin in the immune response of peripheral leukocytes from treated patients with SLE (n = 20) and age- and sex-matched healthy controls. Melatonin was tested for its effect on the production of key Th1, Th2, Th9, Th17 and innate cytokines. The frequency of T regulatory (Treg) cells and the expression of FOXP3 and BAFF were also explored. Our results are the first to show that melatonin decreased the production of IL-5 and to describe the novel role of melatonin in IL-9 production by human circulating cells. Additionally, we highlighted a two-faceted melatonin effect. Although it acted as a prototypical anti-inflammatory compound, reducing exacerbated Th1 and innate responses in PHA-stimulated cells from healthy subjects, it caused the opposite actions in immune-depressed cells from patients with SLE. Melatonin also increased the number of Treg cells expressing FOXP3 and offset BAFF overexpression in SLE patient cells. These findings open a new field of research in lupus that could lead to the use of melatonin as treatment or cotreatment for SLE.
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Affiliation(s)
- Pablo Medrano-Campillo
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
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Peng QL, Shu XM, Wang DX, Wang Y, Lu X, Wang GC. B-cell activating factor as a serological biomarker for polymyositis and dermatomyositis. Biomark Med 2014; 8:395-403. [PMID: 24712431 DOI: 10.2217/bmm.13.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM To investigate serum levels of B-cell activating factor (BAFF) in the patients with polymyositis (PM) and dermatomyositis (DM), and to systematically examine the association between serum BAFF levels and disease activity in PM/DM patients. PATIENTS & METHODS A cross-sectional analysis included 92 PM/DM patients and 25 healthy control subjects. A longitudinal study followed 24 patients. Serum BAFF concentrations were detected by the ELISA method. RESULTS Serum BAFF levels in PM/DM patients were significantly higher than those in healthy controls. A cross-sectional assessment revealed a modest correlation between serum BAFF levels and global disease activity and a mild correlation between serum BAFF levels and muscle disease activity. The longitudinal study showed that serum BAFF levels modestly correlated with global disease activity and muscle disease activity. CONCLUSION Resulting data showed high serum BAFF levels in PM/DM patients and suggested BAFF as a serological biomarker for PM/DM disease activity.
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Affiliation(s)
- Qing-Lin Peng
- Department of Rheumatology, China-Japan Friendship Hospital, Ying Hua East Road, Chao Yang District, Beijing 100029, China
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Bornacelly A, Mercado D, Acevedo N, Caraballo L. The strength of the antibody response to the nematode Ascaris lumbricoides inversely correlates with levels of B-Cell Activating Factor (BAFF). BMC Immunol 2014; 15:22. [PMID: 24906685 PMCID: PMC4067067 DOI: 10.1186/1471-2172-15-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 06/02/2014] [Indexed: 01/28/2023] Open
Abstract
Background B-Cell Activating Factor (BAFF) is a cytokine regulating antibody production. Polymorphisms in the gene encoding BAFF were associated with the antibody response to Ascaris but not to mite allergens. In the present study we evaluated the relationship between BAFF and specific antibodies against Ascaris and mites in 448 controls and 448 asthmatics. Soluble BAFF was measured by ELISA and BAFF mRNA by qPCR. Surface expression of BAFF and its receptor (BAFF-R) was analyzed by flow cytometry. Results Individuals with specific IgE levels to Ascaris >75th percentile had lower levels of soluble BAFF; those with specific IgG levels to Ascaris >75th percentile had reduced BAFF mRNA. Total IgE and specific IgE to mites were not related to BAFF levels. There were no differences in soluble BAFF or mRNA levels between asthmatics and controls. There was an inverse relationship between the cell-surface expression of BAFF-R on CD19+ B cells and BAFF levels at the transcriptional and protein level. Conclusions These findings suggest that differences in BAFF levels are related to the strength of the antibody response to Ascaris.
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Affiliation(s)
| | | | | | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cra 5, #7-77, 13-0015 Cartagena, Colombia.
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Abstract
Systemic lupus erythematosus (SLE) is characterized by multisystem immune-mediated injury in the setting of autoimmunity to nuclear antigens. The clinical heterogeneity of SLE, the absence of universally agreed clinical trial end points, and the paucity of validated therapeutic targets have, historically, contributed to a lack of novel treatments for SLE. However, in 2011, a therapeutic monoclonal antibody that neutralizes the cytokine TNF ligand superfamily member 13B (also known as B-cell-activating factor of the TNF family [BAFF]), belimumab, became the first targeted therapy for SLE to have efficacy in a randomized clinical trial. Because of its specificity, the efficacy of belimumab provides an opportunity to increase understanding of SLE pathophysiology. Although belimumab depletes B cells, this effect is not as powerful as that of other B-cell-directed therapies that have not been proven efficacious in randomized clinical trials. In this article, therefore, we review results suggesting that neutralizing BAFF can have effects on the immune system other than depletion of B cells. We also identify aspects of the BAFF system for which data in relation to SLE are still missing, and we suggest studies to investigate the pathogenesis of SLE and ways to refine anti-BAFF therapies. The role of a related cytokine, TNF ligand superfamily member 13 (also known as a proliferation-inducing ligand [APRIL]) in SLE is much less well understood, and hence this review focuses on BAFF.
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