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Batsalova T, Dzhambazov B. Significance of Type II Collagen Posttranslational Modifications: From Autoantigenesis to Improved Diagnosis and Treatment of Rheumatoid Arthritis. Int J Mol Sci 2023; 24:9884. [PMID: 37373030 DOI: 10.3390/ijms24129884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Collagen type II (COL2), the main structural protein of hyaline cartilage, is considerably affected by autoimmune responses associated with the pathogenesis of rheumatoid arthritis (RA). Posttranslational modifications (PTMs) play a significant role in the formation of the COL2 molecule and supramolecular fibril organization, and thus, support COL2 function, which is crucial for normal cartilage structure and physiology. Conversely, the specific PTMs of the protein (carbamylation, glycosylation, citrullination, oxidative modifications and others) have been implicated in RA autoimmunity. The discovery of the anti-citrullinated protein response in RA, which includes anti-citrullinated COL2 reactivity, has led to the development of improved diagnostic assays and classification criteria for the disease. The induction of immunological tolerance using modified COL2 peptides has been highlighted as a potentially effective strategy for RA therapy. Therefore, the aim of this review is to summarize the recent knowledge on COL2 posttranslational modifications with relevance to RA pathophysiology, diagnosis and treatment. The significance of COL2 PTMs as a source of neo-antigens that activate immunity leading to or sustaining RA autoimmunity is discussed.
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Affiliation(s)
- Tsvetelina Batsalova
- Faculty of Biology, Paisii Hilendarski University of Plovdiv, 24 Tsar Assen Str., 4000 Plovdiv, Bulgaria
| | - Balik Dzhambazov
- Faculty of Biology, Paisii Hilendarski University of Plovdiv, 24 Tsar Assen Str., 4000 Plovdiv, Bulgaria
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2
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Moustakas AK, Nguyen H, James EA, Papadopoulos GK. Autoimmune susceptible HLA class II motifs facilitate the presentation of modified neoepitopes to potentially autoreactive T cells. Cell Immunol 2023; 390:104729. [PMID: 37301094 DOI: 10.1016/j.cellimm.2023.104729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/27/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
Rheumatoid arthritis (RA), multiple sclerosis (MS), type 1 diabetes (T1D), and celiac disease (CD), are strongly associated with susceptible HLA class II haplotypes. The peptide-binding pockets of these molecules are polymorphic, thus each HLA class II protein presents a distinct set of peptides to CD4+ T cells. Peptide diversity is increased through post-translational modifications, generating non-templated sequences that enhance HLA binding and/or T cell recognition. The high-risk HLA-DR alleles that confer susceptibility to RA are notable for their ability to accommodate citrulline, promoting responses to citrullinated self-antigens. Likewise, HLA-DQ alleles associated with T1D and CD favor the binding of deamidated peptides. In this review, we discuss structural features that promote modified self-epitope presentation, provide evidence supporting the relevance of T cell recognition of such antigens in disease processes, and make a case that interrupting the pathways that generate such epitopes and reprogramming neoepitope-specific T cells are key strategies for effective therapeutic intervention.
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Affiliation(s)
- Antonis K Moustakas
- Department of Food Science and Technology, Faculty of Environmental Sciences, Ionian University, GR26100 Argostoli, Cephalonia, Greece
| | - Hai Nguyen
- Center for Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA, USA
| | - Eddie A James
- Center for Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA, USA.
| | - George K Papadopoulos
- Laboratory of Biophysics, Biochemistry, Bioprocessing and Bioproducts, Faculty of Agricultural Technology, Technological Educational Institute of Epirus, GR47100 Arta, Greece
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3
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From vaccines to nanovaccines: A promising strategy to revolutionize rheumatoid arthritis treatment. J Control Release 2022; 350:107-121. [PMID: 35977582 DOI: 10.1016/j.jconrel.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
Rheumatoid arthritis (RA) is a joint-related autoimmune disease that is difficult to cure. Most therapeutics act to alleviate the symptoms but not correct the causes of RA. Novel strategies that specifically target the causes are highly needed for RA management. Currently, early interruption of RA is increasingly suggested but the corresponding therapeutics are not available. Vaccines that have shown great success to combat infection, cancer, degenerative diseases, autoimmune diseases, etc. are ideal candidates for a new generation of anti-RA therapeutics to correct the causes and prevent RA or interrupt RA in early phases. Anti-RA vaccines can be divided into two major categories. One is to induce neutralizing antibodies and the other is to induce antigen-specific immune tolerance. The vaccines are inherently linked to nanotechnology because they usually need a biomacromolecule or carrier to provoke sufficient immune responses. In the past decade, designed nanocarriers such as nanoparticles, liposomes, nanoemulsion, etc., have been applied to optimize the vaccines for autoimmune disease treatment. Nanotechnology endows vaccines with a higher biostability, tunable in vivo behavior, better targeting, co-delivery with stimulatory agents, regulatory effects on immune responses, etc. In this review, unmet medical needs for RA treatment and anti-RA vaccinology are first introduced. The development of anti-RA therapies from vaccines to nanovaccines are then reviewed and perspectives on how nanotechnology promotes vaccine development and advancement are finally provided. In addition, challenges for anti-RA vaccine development are summarized and advantages of nanovaccines are analyzed. In conclusion, nanovaccines will be a promising strategy to revolutionize the treatment of RA by correcting the causes in an early phase of RA.
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4
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Liu J, Gao J, Wu Z, Mi L, Li N, Wang Y, Peng X, Xu K, Wu F, Zhang L. Anti-citrullinated Protein Antibody Generation, Pathogenesis, Clinical Application, and Prospects. Front Med (Lausanne) 2022; 8:802934. [PMID: 35096892 PMCID: PMC8791387 DOI: 10.3389/fmed.2021.802934] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 12/18/2022] Open
Abstract
Anti-citrullinated protein antibodies (ACPAs) are autoantibodies commonly observed in patients with rheumatoid arthritis (RA). Currently, most of the mechanisms of ACPA formation and bone destruction are well-understood, however, some unknown mechanisms still exist. There have been many new advances in ACPA-related clinical applications and targeted therapies. However, the existence of different ACPA subtypes is a limitation of targeted therapy. Herein, we present an overview of the process of ACPA generation, the underlying pathogenesis, and relevant clinical application and prospects.
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5
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Wenhart C, Holthoff HP, Reimann A, Li Z, Faßbender J, Ungerer M. A fructosylated peptide derived from a collagen II T cell epitope for long-term treatment of arthritis (FIA-CIA) in mice. Sci Rep 2021; 11:17345. [PMID: 34462464 PMCID: PMC8405725 DOI: 10.1038/s41598-021-95193-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/21/2021] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease which affects primarily the joints. Peptides of several proteins have shown an effect in some experimental animal models of RA. We investigated arthritis development in male DBA/1 mice which were injected with bovine collagen II (bCII) and human fibrinogen (hFib) on days 0 and 21, leading to stable and reproducible disease induction in 100% of immunized mice (FIA-CIA). In a second study, two bCII-derived peptides were given three times in the course of 6 weeks after FIA-CIA induction to test for impact on arthritis. Mice were scored weekly for arthritis and anti-citrullinated peptide antibodies (ACPAs) were determined in the sera taken on days 0, 14, 35, 56 and 84. Histology of the hind paws was performed at the end of the experiment. Intravenous administration of peptide 90578, a novel fructosylated peptide derived from the immunodominant T cell epitope of bCII, at a dosage of 1 mg/kg resulted in significant beneficial effects on clinical outcome parameters and on the arthritis histology scores which was sustained over 12 weeks. Survival tended to be improved in peptide 90578-treated mice. Intravenous administration of pure soluble peptide 90578 without adjuvants is a promising approach to treat RA, with treatment starting at a time when ACPAs are already present. The results complement existing data on peptide "vaccination" of healthy animals, or on treatment using recombinant peptide expressing virus or complex biological compounds.
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Affiliation(s)
| | | | | | - Zhongmin Li
- Advancecor, 82152, Planegg-Martinsried, Germany
| | | | - Martin Ungerer
- ISAR Bioscience, Semmelweisstr. 5, 82152, Planegg-Martinsried, Germany.
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6
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Wang Q, Qin X, Fang J, Sun X. Nanomedicines for the treatment of rheumatoid arthritis: State of art and potential therapeutic strategies. Acta Pharm Sin B 2021; 11:1158-1174. [PMID: 34094826 PMCID: PMC8144894 DOI: 10.1016/j.apsb.2021.03.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/11/2020] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
Increasing understanding of the pathogenesis of rheumatoid arthritis (RA) has remarkably promoted the development of effective therapeutic regimens of RA. Nevertheless, the inadequate response to current therapies in a proportion of patients, the systemic toxicity accompanied by long-term administration or distribution in non-targeted sites and the comprised efficacy caused by undesirable bioavailability, are still unsettled problems lying across the full remission of RA. So far, these existing limitations have inspired comprehensive academic researches on nanomedicines for RA treatment. A variety of versatile nanocarriers with controllable physicochemical properties, tailorable drug release pattern or active targeting ability were fabricated to enhance the drug delivery efficiency in RA treatment. This review aims to provide an up-to-date progress regarding to RA treatment using nanomedicines in the last 5 years and concisely discuss the potential application of several newly emerged therapeutic strategies such as inducing the antigen-specific tolerance, pro-resolving therapy or regulating the immunometabolism for RA treatments.
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Affiliation(s)
- Qin Wang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education and School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Xianyan Qin
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education and School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Jiyu Fang
- Advanced Materials Processing and Analysis Center and Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Xun Sun
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
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7
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Li C, Chen X, Luo X, Wang H, Zhu Y, Du G, Chen W, Chen Z, Hao X, Zhang Z, Sun X. Nanoemulsions Target to Ectopic Lymphoids in Inflamed Joints to Restore Immune Tolerance in Rheumatoid Arthritis. NANO LETTERS 2021; 21:2551-2561. [PMID: 33687217 DOI: 10.1021/acs.nanolett.0c05110] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Inducing immune tolerance through repeated administration of self-antigens is a promising strategy for treating rheumatoid arthritis (RA), and current research indicates that coadministration of immunomodulators can further orchestrate the tolerogenic response. However, most of the clinical trials based on tolerance induction have negligible therapeutic effects. Peripheral lymphoid organs play critical roles in immunotherapy. Here, we design an engineered nanoemulsion for targeted codelivery of self-antigens and an immunomodulator to ectopic lymphoid structures (ELSs) in inflamed joints of RA. Namely, a citrullinated multiepitope self-antigen (CitP) and rapamycin are incorporated into the nanoemulsions (NEs@CitP/Rapa), which are fabricated by a facial method using commercialized pharmaceutical excipients. After intravenous administration, the nanoemulsion shows satisfactory accumulation in the inflamed paws and provides enhanced anti-inflammatory effect in various experimental murine models of RA. Our study provides a promising targeting strategy to induce immune tolerance for the treatment of RA.
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Affiliation(s)
- Chenglong Li
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Xiaoyan Chen
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Xianjin Luo
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Hairui Wang
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Yining Zhu
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Guangshen Du
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Wenfei Chen
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Zhengjun Chen
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Xinyan Hao
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Zhirong Zhang
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
| | - Xun Sun
- Key Laboratory of Drug Targeting and Drug Delivery Systems, Ministry of Education, West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R. China
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8
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Halpert G, Katz I, Shovman O, Tarasov S, Ganina KK, Petrova N, Tocut M, Volkov A, Barshack I, Blank M, Amital H. IVIG ameliorate inflammation in collagen-induced arthritis: projection for IVIG therapy in rheumatoid arthritis. Clin Exp Immunol 2021; 203:400-408. [PMID: 33020923 PMCID: PMC7874841 DOI: 10.1111/cei.13532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease that leads to joint destruction and disability. Despite a significant progress in administration of biological agents for RA patients, there is still a need for improved therapy. Intravenous immunoglobulins (IVIG), a pooled polyspecific immunoglobulin (Ig)G extracted from 5000 to 20 000 healthy subjects, showed beneficial therapeutic effect in patients with immune deficiency, sepsis and autoimmune diseases. The current study aimed to investigate the beneficial effect of treatment with IVIG in established collagen-induced arthritis in DBA/1j mice. Murine arthritis was induced in DBA/1j mice. Treatment with IVIG began when the disease was established. The clinical score was followed twice a week until day 48. The mice were bled for plasma and the paws were hematoxylin and eosin (H&E)-stained. Cytokine profile in the plasma was analyzed by Luminex technology and titers of circulating anti-collagen antibodies in the plasma was tested by enzyme-linked immunosorbent assay. Our results show that treatment with IVIG in murine significantly reduced the clinical arthritis score (P < 0·001). Moreover, mode of action showed that IVIG significantly reduced circulating levels of inflammatory cytokines [interferon (IFN)-γ, interleukin (IL)-1β, IL-17, IL-6, tumor necrosis factor (TNF)-α, P < 0·001], inhibiting anti-collagen antibodies (P < 0·001) in the plasma of collagen-induced arthritis mice. Importantly, histopathological examination revealed that IVIG treatment prevented the migration of inflammatory immune cells into the cartilage and synovium, reduced the extent of joint damage and preserved joint architecture. Our results proved for the first time the valuable anti-inflammatory treatment of IVIG in experimental RA. We propose IVIG therapy for a subgroup of patients with rheumatologically related diseases.
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MESH Headings
- Animals
- Arthritis, Experimental/immunology
- Arthritis, Experimental/metabolism
- Arthritis, Experimental/prevention & control
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/metabolism
- Arthritis, Rheumatoid/prevention & control
- Cartilage/drug effects
- Cartilage/immunology
- Cartilage/metabolism
- Cytokines/blood
- Disease Models, Animal
- Humans
- Immunoglobulins, Intravenous/administration & dosage
- Immunoglobulins, Intravenous/immunology
- Immunoglobulins, Intravenous/pharmacology
- Inflammation/immunology
- Inflammation/metabolism
- Inflammation/prevention & control
- Inflammation Mediators/blood
- Male
- Mice, Inbred DBA
- Neutrophil Infiltration/drug effects
- Neutrophil Infiltration/immunology
- Synovial Membrane/drug effects
- Synovial Membrane/immunology
- Synovial Membrane/metabolism
- Mice
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Affiliation(s)
- G. Halpert
- Zabludowicz Center for Autoimmune DiseasesSheba Medical Centeraffiliated with Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - I. Katz
- Zabludowicz Center for Autoimmune DiseasesSheba Medical Centeraffiliated with Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - O. Shovman
- Zabludowicz Center for Autoimmune DiseasesSheba Medical Centeraffiliated with Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - S. Tarasov
- OOO NPF Materia Medica HoldingMoscowRussia
- The Institute of General Pathology and PathophysiologyMoscowRussia
| | | | - N. Petrova
- OOO NPF Materia Medica HoldingMoscowRussia
- The Institute of General Pathology and PathophysiologyMoscowRussia
| | - M. Tocut
- Department of Medicine CWolfson Medical CenterSackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - A. Volkov
- Institute of PathologySheba Medical CenterAffiliated with Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - I. Barshack
- Institute of PathologySheba Medical CenterAffiliated with Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - M. Blank
- Zabludowicz Center for Autoimmune DiseasesSheba Medical Centeraffiliated with Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - H. Amital
- Zabludowicz Center for Autoimmune DiseasesSheba Medical Centeraffiliated with Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
- Department of Medicine BSheba Medical CenterTel HashomerRamat‐GanIsrael
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9
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Catrina A, Krishnamurthy A, Rethi B. Current view on the pathogenic role of anti-citrullinated protein antibodies in rheumatoid arthritis. RMD Open 2021; 7:e001228. [PMID: 33771834 PMCID: PMC8006837 DOI: 10.1136/rmdopen-2020-001228] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 12/24/2022] Open
Abstract
Epidemiological findings suggest a potential role for anti-citrullinated protein antibodies (ACPAs) in rheumatoid arthritis (RA) pathogenesis. ACPA-positive RA is associated with unique genetical and environmental risk factors, in contrast to seronegative RA. ACPA-positive healthy individuals are at risk of developing RA and can develop joint pain and bone loss already before disease onset. ACPA injection triggered bone loss and pain-like behaviour in mice and, in the presence of additional arthritis inducers, exacerbated joint inflammation. In cell culture experiments, ACPAs could bind to and modulate a variety of cellular targets, such as macrophages, osteoclasts, synovial fibroblasts, neutrophil granulocytes, mast cells, dendritic cells and platelets, further underlying a potential role for these autoantibodies in triggering pathogenic pathways and providing clues for their mechanisms of action. Patient-derived ACPA clones have been characterised by unique cellular effects and multiple ways to act on the target cells. ACPAs might directly induce stimulatory signals by ligating key citrullinated cell surface molecules or, alternatively, act as immune complexes on Fc receptors and potentially other molecules that recognise carbohydrate moieties. On the contrary to experimentally manufactured ACPA clones, patient-derived ACPAs are highly promiscuous and cross-reactive, suggesting a simultaneous binding to a range of functionally relevant and irrelevant targets. Moreover, several ACPA clones recognise carbamylated or acetylated targets as well. These features complicate the identification and description of ACPA-induced pathogenic mechanisms. In the current review, we summarise recent data on the functional properties of patient-derived ACPAs and present mechanistic models on how these antibodies might contribute to RA pathogenesis.
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Affiliation(s)
- Anca Catrina
- Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Akilan Krishnamurthy
- Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Bence Rethi
- Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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10
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Page A, Fusil F, Cosset FL. Antigen-specific tolerance approach for rheumatoid arthritis: Past, present and future. Joint Bone Spine 2021; 88:105164. [PMID: 33618000 DOI: 10.1016/j.jbspin.2021.105164] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/02/2021] [Indexed: 02/06/2023]
Abstract
Rheumatoid arthritis is a chronic systemic autoimmune disease, affecting mainly the joints. It is caused by an adaptive immune reaction against self-antigens, leading to the over production of inflammatory cytokines and autoantibodies, mainly mediated by autoreactive CD4+ T cells and pathological B cell clones. The treatment options currently available rely on palliative global immunosuppression and do not restore tolerance to self-components. Here, we review antigen-specific tolerance approaches that have been developed to inhibit or delete autoreactive clones, while maintaining a potent immune system for rheumatoid arthritis. The first attempts relied on the oral ingestion of self-reactive peptides, with lukewarm results in human clinical trials. To enhance treatment efficacy, self-peptides have been engineered and combined with immunosuppressive molecules. In addition, several routes of delivery have been tested, in particular, nanoparticles carrying self-antigens and immunomodulatory molecules. More recently, transfer of immune cells, such as tolerogenic dendritic cells or regulatory T cells, has been considered to restore tolerance. Although promising results have been obtained in mouse models, the translation to humans remains highly challenging, mainly because the disease is already well developed when treatments start and because patient's specific self-antigens are often unknown. Nevertheless, these approaches hold great promises for long-term RA treatment.
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Affiliation(s)
- Audrey Page
- CIRI - Centre international de recherche en infectiologie, Université de Lyon, Université Claude-Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, 46, allée d'Italie, 69007 Lyon, France
| | - Floriane Fusil
- CIRI - Centre international de recherche en infectiologie, Université de Lyon, Université Claude-Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, 46, allée d'Italie, 69007 Lyon, France
| | - François-Loïc Cosset
- CIRI - Centre international de recherche en infectiologie, Université de Lyon, Université Claude-Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, 46, allée d'Italie, 69007 Lyon, France.
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11
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Zhao Q, Duck LW, Huang F, Alexander KL, Maynard CL, Mannon PJ, Elson CO. CD4 + T cell activation and concomitant mTOR metabolic inhibition can ablate microbiota-specific memory cells and prevent colitis. Sci Immunol 2020; 5:5/54/eabc6373. [PMID: 33310866 DOI: 10.1126/sciimmunol.abc6373] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/09/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
Microbiota-reactive CD4+ T memory (TM) cells are generated during intestinal infections and inflammation, and can revert to pathogenic CD4+ T effector (TE) cells, resulting in chronicity of inflammatory bowel disease (IBD). Unlike TE cells, TM cells have a low rate of metabolism unless they are activated by reencountering cognate antigen. Here, we show that the combination of cell activation and metabolic checkpoint inhibition (CAMCI), by targeting key metabolic regulators mTORC and AMPK, resulted in cell death and anergy, but enhanced the induction of the regulatory subset. Parenteral application of this treatment with a synthetic peptide containing multiple flagellin T cell epitopes (MEP1) and metabolic inhibition successfully prevented the development of CD4+ T cell-driven colitis. Microbiota-specific CD4+ T cells, especially the pathogenic TE subsets, were decreased 10-fold in the intestinal lamina propria. Furthermore, using the CAMCI strategy, we were able to prevent antigen-specific TM cell formation upon initial antigen encounter, and ablate existing TM cells upon reactivation in mice, leading to an altered transcriptome in the remaining CD4+ T cells after ablation. Microbiota flagellin-specific CD4+ T cells from patients with Crohn's disease were ablated in a similar manner after CAMCI in vitro, with half of the antigen-specific T cells undergoing cell death. These results indicate that parenteral activation of microbiota-specific CD4+ T cells with concomitant metabolic inhibition is an effective way to ablate pathogenic CD4+ TM cells and to induce T regulatory (Treg) cells that provide antigen-specific and bystander suppression, supporting a potential immunotherapy to prevent or ameliorate IBD.
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Affiliation(s)
- Qing Zhao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lennard W Duck
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Fengyuan Huang
- Department of Genetics, Informatics Institute, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Katie L Alexander
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Craig L Maynard
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Peter J Mannon
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Charles O Elson
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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12
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Bassin EJ, Buckley AR, Piganelli JD, Little SR. TRI microparticles prevent inflammatory arthritis in a collagen-induced arthritis model. PLoS One 2020; 15:e0239396. [PMID: 32966314 PMCID: PMC7510963 DOI: 10.1371/journal.pone.0239396] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/06/2020] [Indexed: 12/28/2022] Open
Abstract
Despite recent progress in the treatment of rheumatoid arthritis (RA), many patients still fail to achieve remission or low disease activity. An imbalance between auto-reactive effector T cells (Teff) and regulatory T cells (Treg) may contribute to joint inflammation and damage in RA. Therefore, restoring this balance is a promising approach for the treatment of inflammatory arthritis. Accordingly, our group has previously shown that the combination of TGF-β-releasing microparticles (MP), rapamycin-releasing MP, and IL-2-releasing MP (TRI MP) can effectively increase the ratio of Tregs to Teff in vivo and provide disease protection in several preclinical models. In this study TRI MP was evaluated in the collagen-induced arthritis (CIA) model. Although this formulation has been tested previously in models of destructive inflammation and transplantation, this is the first model of autoimmunity for which this therapy has been applied. In this context, TRI MP effectively reduced arthritis incidence, the severity of arthritis scores, and bone erosion. The proposed mechanism of action includes not only reducing CD4+ T cell proliferation, but also expanding a regulatory population in the periphery soon after TRI MP administration. These changes were reflected in the CD4+ T cell population that infiltrated the paws at the onset of arthritis and were associated with a reduction of immune infiltrate and inflammatory myeloid cells in the paws. TRI MP administration also reduced the titer of collagen antibodies, however the contribution of this reduced titer to disease protection remains uncertain since there was no correlation between collagen antibody titer and arthritis score.
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Affiliation(s)
- Ethan J. Bassin
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Abigail R. Buckley
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jon D. Piganelli
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Steven R. Little
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Pharmaceutical Science, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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13
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Zampieri R, Brozzetti A, Pericolini E, Bartoloni E, Gabrielli E, Roselletti E, Lomonosoff G, Meshcheriakova Y, Santi L, Imperatori F, Merlin M, Tinazzi E, Dotta F, Nigi L, Sebastiani G, Pezzotti M, Falorni A, Avesani L. Prevention and treatment of autoimmune diseases with plant virus nanoparticles. SCIENCE ADVANCES 2020; 6:eaaz0295. [PMID: 32494704 PMCID: PMC7202875 DOI: 10.1126/sciadv.aaz0295] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/12/2020] [Indexed: 05/15/2023]
Abstract
Plant viruses are natural, self-assembling nanostructures with versatile and genetically programmable shells, making them useful in diverse applications ranging from the development of new materials to diagnostics and therapeutics. Here, we describe the design and synthesis of plant virus nanoparticles displaying peptides associated with two different autoimmune diseases. Using animal models, we show that the recombinant nanoparticles can prevent autoimmune diabetes and ameliorate rheumatoid arthritis. In both cases, this effect is based on a strictly peptide-related mechanism in which the virus nanoparticle acts both as a peptide scaffold and as an adjuvant, showing an overlapping mechanism of action. This successful preclinical testing could pave the way for the development of plant viruses for the clinical treatment of human autoimmune diseases.
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Affiliation(s)
- Roberta Zampieri
- Department of Biotechnology, University of Verona, Verona, Italy
- Diamante srl, Strada Le Grazie, 15, 37134 Verona, Italy
| | | | - Eva Pericolini
- Department of Surgical, Medical, Dental and Morphological Sciences with interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bartoloni
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Elena Gabrielli
- Department of Medicine, University of Perugia, Perugia, Italy
| | | | | | | | - Luca Santi
- Department of Agriculture and Forest Sciences, University of La Tuscia, Viterbo, Italy
| | - Francesca Imperatori
- Department of Agriculture and Forest Sciences, University of La Tuscia, Viterbo, Italy
| | - Matilde Merlin
- Department of Biotechnology, University of Verona, Verona, Italy
| | - Elisa Tinazzi
- Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Dotta
- Diabetes Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Laura Nigi
- Diabetes Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Umberto Di Mario Foundation ONLUS, Toscana Life Sciences, Siena, Italy
| | - Guido Sebastiani
- Diabetes Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Umberto Di Mario Foundation ONLUS, Toscana Life Sciences, Siena, Italy
| | - Mario Pezzotti
- Department of Biotechnology, University of Verona, Verona, Italy
| | - Alberto Falorni
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Linda Avesani
- Department of Biotechnology, University of Verona, Verona, Italy
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Peptide-Based Vaccination Therapy for Rheumatic Diseases. J Immunol Res 2020; 2020:8060375. [PMID: 32258176 PMCID: PMC7104265 DOI: 10.1155/2020/8060375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/28/2020] [Indexed: 02/06/2023] Open
Abstract
Rheumatic diseases are extremely heterogeneous diseases with substantial risks of morbidity and mortality, and there is a pressing need in developing more safe and cost-effective treatment strategies. Peptide-based vaccination is a highly desirable strategy in treating noninfection diseases, such as cancer and autoimmune diseases, and has gained increasing attentions. This review is aimed at providing a brief overview of the recent advances in peptide-based vaccination therapy for rheumatic diseases. Tremendous efforts have been made to develop effective peptide-based vaccinations against rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), while studies in other rheumatic diseases are still limited. Peptide-based active vaccination against pathogenic cytokines such as TNF-α and interferon-α (IFN-α) is shown to be promising in treating RA or SLE. Moreover, peptide-based tolerogenic vaccinations also have encouraging results in treating RA or SLE. However, most studies available now have been mainly based on animal models, while evidence from clinical studies is still lacking. The translation of these advances from experimental studies into clinical therapy remains impeded by some obstacles such as species difference in immunity, disease heterogeneity, and lack of safe delivery carriers or adjuvants. Nevertheless, advances in high-throughput technology, bioinformatics, and nanotechnology may help overcome these impediments and facilitate the successful development of peptide-based vaccination therapy for rheumatic diseases.
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15
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Sharabi A, Tsokos MG, Ding Y, Malek TR, Klatzmann D, Tsokos GC. Regulatory T cells in the treatment of disease. Nat Rev Drug Discov 2018; 17:823-844. [DOI: 10.1038/nrd.2018.148] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Helminths-based bi-functional molecule, tuftsin-phosphorylcholine (TPC), ameliorates an established murine arthritis. PLoS One 2018; 13:e0200615. [PMID: 30089122 PMCID: PMC6082512 DOI: 10.1371/journal.pone.0200615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/29/2018] [Indexed: 01/04/2023] Open
Abstract
A novel small molecule named tuftsin-phosphorylcholine (TPC), which is linked to the biological activity of helminths, was constructed. The current study address the effect of TPC treatment in established collagen-induced arthritis (CIA) mice and propose TPC bi-functional activity. TPC treatment was initiated when clinical score was 2 to 4. Arthritis scores in TPC treated mice were lower compared to mice treated with vehicle (P < 0.001). Joint staining showed normal joint structure in TPC-treated mice compared to control groups treated with phosphate buffered saline (PBS), phosphorylcholine, or tuftsin, which exhibited severely inflamed joints. TPC enhanced anti-inflammatory response due to increased IL-10 secretion, and reduced pro-inflammatory cytokine secretion (IL-1-β, IL-6, TNF-αP < 0.001). Furthermore, TPC therapy increased expansion of CD4+CD25+FOXP3+T regulatory cells and IL-10+CD5+CD1d+B regulatory cells. We propose that the immunomodulatory activity of TPC can be a result of a bi-specific activity of TPC: (a) The tuftsin part of the TPC shifts RAW macrophage cells from pro-inflammatory macrophages M1 to anti-inflammatory M2-secreting IL-10 (P < 0.001) through neuropilin-1 and (b) TPC significantly reduce mouse TLR4 expression via NFkB pathway by HEKTM cells (P < 0.02) via the phosphorylcholine site of the molecule. Our results indicate that TPC, significantly ameliorated established CIA by its immunomodulatory activity. These data could lead to a novel self bi-functional small molecule for treating patients with progressive RA.
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Zhang N, Nandakumar KS. Recent advances in the development of vaccines for chronic inflammatory autoimmune diseases. Vaccine 2018; 36:3208-3220. [PMID: 29706295 DOI: 10.1016/j.vaccine.2018.04.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/28/2018] [Accepted: 04/19/2018] [Indexed: 12/16/2022]
Abstract
Chronic inflammatory autoimmune diseases leading to target tissue destruction and disability are not only causing increase in patients' suffering but also contribute to huge economic burden for the society. General increase in life expectancy and high prevalence of these diseases both in elderly and younger population emphasize the importance of developing safe and effective vaccines. In this review, at first the possible mechanisms and risk factors associated with chronic inflammatory autoimmune diseases, such as rheumatoid arthritis (RA), multiple sclerosis (MS), systemic lupus erythematosus (SLE) and type 1 diabetes (T1D) are discussed. Current advances in the development of vaccines for such autoimmune diseases, particularly those based on DNA, altered peptide ligands and peptide loaded MHC II complexes are discussed in detail. Finally, strategies for improving the efficacy of potential vaccines are explored.
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Affiliation(s)
- Naru Zhang
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China; Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
| | - Kutty Selva Nandakumar
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China; Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden.
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18
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Gertel S, Karmon G, Szarka E, Shovman O, Houri-Levi E, Mozes E, Shoenfeld Y, Amital H. Anticitrullinated Protein Antibodies Induce Inflammatory Gene Expression Profile in Peripheral Blood Cells from CCP-positive Patients with RA. J Rheumatol 2018; 45:310-319. [PMID: 29335340 DOI: 10.3899/jrheum.170822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Anticitrullinated protein antibodies (ACPA) have major diagnostic significance in rheumatoid arthritis (RA). ACPA are directed against different citrullinated antigens, including filaggrin, fibrinogen, vimentin, and collagen. The presence of ACPA is associated with joint damage and extraarticular manifestations, suggesting that ACPA may have a significant role in the pathogenesis of RA. METHODS To verify the effect of ACPA on RA-immune cells, peripheral blood mononuclear cells (PBMC) from cyclic citrullinated peptide (CCP)-positive patients with RA and healthy controls were cocultured in vitro with ACPA. ACPA-positive stained cells were analyzed by flow cytometry and the effect of ACPA on mRNA expression levels was evaluated by real-time PCR. We tested whether the stimulatory effects induced by ACPA could be inhibited by the addition of a new multiepitope citrullinated peptide (Cit-ME). RESULTS We found that ACPA bind specifically to PBMC from CCP-positive patients with RA through the Fab portion. ACPA induce upregulation of pathogenic cytokine expression (4- to 13-fold increase) in PBMC derived from CCP-positive patients with RA. Moreover, ACPA upregulated IL-1β and IL-6 mRNA expression levels by 10- and 6-fold, respectively, compared to control IgG. Cit-ME, a genuine ligand of ACPA, inhibited the ACPA-induced upregulation of IL-1β and IL-6 by 30%. CONCLUSION ACPA bind to a limited percentage of PBMC and upregulate inflammatory cytokine expression, suggesting that ACPA is involved in RA pathogenesis. Targeting ACPA to decrease their pathogenic effects might provide a novel direction in developing therapeutic strategies for RA.
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Affiliation(s)
- Smadar Gertel
- From the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer; Department of Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel; Department of Immunology, Eötvös Loránd University, Budapest, Hungary. .,S. Gertel, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; G. Karmon, BsC, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; E. Szarka, PhD, Department of Immunology, Eötvös Loránd University; O. Shovman, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center; E. Houri-Levi, MD, Department of Medicine B, Sheba Medical Center; E. Mozes, PhD, Department of Immunology, The Weizmann Institute of Science; Y. Shoenfeld, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; H. Amital, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center.
| | - Gidi Karmon
- From the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer; Department of Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel; Department of Immunology, Eötvös Loránd University, Budapest, Hungary.,S. Gertel, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; G. Karmon, BsC, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; E. Szarka, PhD, Department of Immunology, Eötvös Loránd University; O. Shovman, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center; E. Houri-Levi, MD, Department of Medicine B, Sheba Medical Center; E. Mozes, PhD, Department of Immunology, The Weizmann Institute of Science; Y. Shoenfeld, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; H. Amital, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center
| | - Eszter Szarka
- From the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer; Department of Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel; Department of Immunology, Eötvös Loránd University, Budapest, Hungary.,S. Gertel, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; G. Karmon, BsC, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; E. Szarka, PhD, Department of Immunology, Eötvös Loránd University; O. Shovman, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center; E. Houri-Levi, MD, Department of Medicine B, Sheba Medical Center; E. Mozes, PhD, Department of Immunology, The Weizmann Institute of Science; Y. Shoenfeld, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; H. Amital, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center
| | - Ora Shovman
- From the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer; Department of Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel; Department of Immunology, Eötvös Loránd University, Budapest, Hungary.,S. Gertel, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; G. Karmon, BsC, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; E. Szarka, PhD, Department of Immunology, Eötvös Loránd University; O. Shovman, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center; E. Houri-Levi, MD, Department of Medicine B, Sheba Medical Center; E. Mozes, PhD, Department of Immunology, The Weizmann Institute of Science; Y. Shoenfeld, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; H. Amital, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center
| | - Esther Houri-Levi
- From the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer; Department of Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel; Department of Immunology, Eötvös Loránd University, Budapest, Hungary.,S. Gertel, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; G. Karmon, BsC, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; E. Szarka, PhD, Department of Immunology, Eötvös Loránd University; O. Shovman, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center; E. Houri-Levi, MD, Department of Medicine B, Sheba Medical Center; E. Mozes, PhD, Department of Immunology, The Weizmann Institute of Science; Y. Shoenfeld, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; H. Amital, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center
| | - Edna Mozes
- From the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer; Department of Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel; Department of Immunology, Eötvös Loránd University, Budapest, Hungary.,S. Gertel, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; G. Karmon, BsC, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; E. Szarka, PhD, Department of Immunology, Eötvös Loránd University; O. Shovman, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center; E. Houri-Levi, MD, Department of Medicine B, Sheba Medical Center; E. Mozes, PhD, Department of Immunology, The Weizmann Institute of Science; Y. Shoenfeld, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; H. Amital, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center
| | - Yehuda Shoenfeld
- From the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer; Department of Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel; Department of Immunology, Eötvös Loránd University, Budapest, Hungary.,S. Gertel, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; G. Karmon, BsC, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; E. Szarka, PhD, Department of Immunology, Eötvös Loránd University; O. Shovman, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center; E. Houri-Levi, MD, Department of Medicine B, Sheba Medical Center; E. Mozes, PhD, Department of Immunology, The Weizmann Institute of Science; Y. Shoenfeld, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; H. Amital, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center
| | - Howard Amital
- From the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer; Department of Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel; Department of Immunology, Eötvös Loránd University, Budapest, Hungary.,S. Gertel, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; G. Karmon, BsC, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; E. Szarka, PhD, Department of Immunology, Eötvös Loránd University; O. Shovman, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center; E. Houri-Levi, MD, Department of Medicine B, Sheba Medical Center; E. Mozes, PhD, Department of Immunology, The Weizmann Institute of Science; Y. Shoenfeld, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; H. Amital, MD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Sheba Medical Center
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Sakkas LI, Daoussis D, Liossis SN, Bogdanos DP. The Infectious Basis of ACPA-Positive Rheumatoid Arthritis. Front Microbiol 2017; 8:1853. [PMID: 29033912 PMCID: PMC5627006 DOI: 10.3389/fmicb.2017.01853] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/11/2017] [Indexed: 12/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is associated with HLA-DRB1 shared epitope (HLA-DRB1SE) and anti-citrullinated protein autoantibodies (ACPAs). ACPAs precedes the onset of clinical and subclinical RA. There are strong data for three infectious agents as autoimmunity triggers in RA, namely Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans causes of periodontal disease (PD), and Epstein-Barr virus (EBV). P. gingivalis expresses arginine gingipains, that cleave proteins at the arginine residues, and peptidyl arginine deiminase (PPAD), which citrullinates arginine residues of proteins, thus forming neoantigens that lead to ACPA production. Peripheral blood plasmablasts from ACPA+RA patients produce ACPAs the majority of which react against P. gingivalis. A. actinocycetemcomitans produces leukotoxin A, a toxin that forms pores in the neutrophil membranes and leads to citrullination and release of citrullinated autoantigens in the gums. EBV can infect B cells and epithelial cells and resides as latent infection in resting B cells. Abs against citrullinated peptides derived from EBV nuclear antigen appear years before RA and cross-react with human citrullinated fibrin. Citrullinated proteins are potential arthritogenic autoantigens in RA. The conversion of arginine to citrulline increases the peptide binding affinity to HLA-DRB1SE. Also, citrullinated fibrinogen induces arthritis in HLA-DRB1*0401 transgenic mice, and transfer of their splenic T cells causes arthritis to recipient mice.
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Affiliation(s)
- Lazaros I Sakkas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Daoussis
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Patras, Patras, Greece
| | - Stamatis-Nick Liossis
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Patras, Patras, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Immunomodulation of RA Patients' PBMC with a Multiepitope Peptide Derived from Citrullinated Autoantigens. Mediators Inflamm 2017; 2017:3916519. [PMID: 28751821 PMCID: PMC5497640 DOI: 10.1155/2017/3916519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/19/2017] [Accepted: 05/11/2017] [Indexed: 11/18/2022] Open
Abstract
Citrullinated peptides are used for measuring anticitrullinated protein antibodies (ACPA) in rheumatoid arthritis (RA). Accumulation of citrullinated proteins in the inflamed synovium suggests that they may be good targets for inducing peripheral tolerance. In view of the multiplicity of citrullinated autoantigens described as ACPA targets, we generated a multiepitope citrullinated peptide (Cit-ME) from the sequences of major citrullinated autoantigens: filaggrin, β-fibrinogen, vimentin, and collagen type II. We assessed the ability of Cit-ME or the citrullinated β60-74 fibrinogen peptide (β60-74-Fib-Cit) which bears immunodominant citrullinated epitopes (i) to modify cytokine gene expression and (ii) to modulate Treg and Th17 subsets in PBMC derived from newly diagnosed untreated RA patients. RA patient's PBMC incubated with Cit-ME or β60-74-Fib-Cit, showed upregulation of TGF-β expression (16% and 8%, resp.), and increased CD4+Foxp3+ Treg (22% and 19%, resp.). Both peptides were shown to downregulate the TNF-α and IL-1β expression; in addition, Cit-ME reduced CD3+IL17+ T cells. We showed that citrullinated peptides can modulate the expression of anti- and proinflammatory cytokines in PBMC from RA patients as well as the proportions of Treg and Th17 cells. These results indicate that citrullinated peptides could be active in vivo and therefore might be used as immunoregulatory agents in RA patients.
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Pozsgay J, Szekanecz Z, Sármay G. Antigen-specific immunotherapies in rheumatic diseases. Nat Rev Rheumatol 2017; 13:525-537. [DOI: 10.1038/nrrheum.2017.107] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Pre-symptomatic autoimmunity in rheumatoid arthritis: when does the disease start? Semin Immunopathol 2017; 39:423-435. [PMID: 28337522 PMCID: PMC5486797 DOI: 10.1007/s00281-017-0620-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 12/21/2022]
Abstract
It is well recognised that a state of autoimmunity, in which immunological tolerance is broken, precedes the development of symptoms in the majority of patients with rheumatoid arthritis (RA). For individuals who will later develop seropositive disease, this manifests as autoantibodies directed against proteins that have undergone specific post-translational modifications. There is evidence that the induction of this autoantibody response occurs at peripheral extra-articular mucosal sites, such as the periodontium and lung. In addition to their utility as diagnostic markers, these autoantibodies may have a pathogenic role that helps localise disease to the synovium. Alongside the development of autoantibodies, other factors contributing to pre-symptomatic autoimmunity may include dysbiosis of the gastrointestinal tract, abnormal development of lymphoid tissue, and dysregulated autonomic and lipid-mediated anti-inflammatory signalling. These factors combine to skew the balance between pro-inflammatory and anti-inflammatory signalling in a manner that is permissive for the development of clinical arthritis. We present data to support the concept that the transitions from at-risk states to systemic autoimmunity and then to classifiable RA depend on multiple “switches”. However, further prospective studies are necessary to define the molecular basis of these switches and the specific features of pre-symptomatic autoimmunity, so that preventative treatments can be targeted to individuals at high risk for RA. In this review, we analyse mechanisms that may contribute to the development of autoimmunity in at-risk individuals and discuss the relationship between this pre-symptomatic state and subsequent development of RA.
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Selection of epitopes from self-antigens for eliciting Th2 or Th1 activity in the treatment of autoimmune disease or cancer. Semin Immunopathol 2016; 39:245-253. [PMID: 27975138 DOI: 10.1007/s00281-016-0596-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/03/2016] [Indexed: 12/22/2022]
Abstract
Vaccines have been valuable tools in the prevention of infectious diseases, and the rapid development of new vectors against constantly mutating foreign antigens in viruses such as influenza has become a regular, seasonal exercise. Harnessing the immune response against self-antigens is not necessarily analogous or as achievable by iterative processes, and since the desired outcome includes leaving the targeted organism intact, requires some precision engineering. In vaccine-based treatment of autoimmunity and cancer, the proper selection of antigens and generation of the desired antigen-specific therapeutic immunity has been challenging. Both cases involve a threshold of existing, undesired immunity that must be overcome, and despite considerable academic and industry efforts, this challenge has proven to be largely refractory to vaccine approaches leveraging enhanced vectors, adjuvants, and administration strategies. There are in silico approaches in development for predicting the immunogenicity of self-antigen epitopes, which are being validated slowly. One simple approach showing promise is the functional screening of self-antigen epitopes for selective Th1 antitumor immunogenicity, or inversely, selective Th2 immunogenicity for treatment of autoimmune inflammation. The approach reveals the importance of confirming both Th1 and Th2 components of a vaccine immunogen; the two can confound one another if not parsed but may be used individually to modulate antigen-specific inflammation in autoimmune disease or cancer.
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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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Affiliation(s)
- Smadar Gertel
- Zabludowicz Center For Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center For Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Tel-Aviv, Israel
| | - Howard Amital
- Zabludowicz Center For Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel
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