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Khoo T, Lilleker JB, Thong BYH, Leclair V, Lamb JA, Chinoy H. Epidemiology of the idiopathic inflammatory myopathies. Nat Rev Rheumatol 2023; 19:695-712. [PMID: 37803078 DOI: 10.1038/s41584-023-01033-0] [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: 09/05/2023] [Indexed: 10/08/2023]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of systemic autoimmune diseases that affect the skeletal muscles and can also involve the skin, joints, lungs and heart. The epidemiology of IIM is obscured by changing classification criteria and the inherent shortcomings of case identification using healthcare record diagnostic coding. The incidence of IIM is estimated to range from 0.2 to 2 per 100,000 person-years, with prevalence from 2 to 25 per 100,000 people. Although the effects of age and gender on incidence are known, there is only sparse understanding of ethnic differences, particularly in indigenous populations. The incidence of IIM has reportedly increased in the twenty-first century, but whether this is a genuine increase is not yet known. Understanding of the genetic risk factors for different IIM subtypes has advanced considerably. Infections, medications, malignancy and geography are also commonly identified risk factors. Potentially, the COVID-19 pandemic has altered IIM incidence, although evidence of this occurrence is limited to case reports and small case series. Consideration of the current understanding of the epidemiology of IIM can highlight important areas of interest for future research into these rare diseases.
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Affiliation(s)
- Thomas Khoo
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neuroscience, Manchester Academic Health Science Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Valérie Leclair
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
| | - Janine A Lamb
- Epidemiology and Public Health Group, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
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2
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Biliary atresia: Graft-versus-host disease with maternal microchimerism as an etiopathogenesis. Transfus Apher Sci 2022; 61:103410. [DOI: 10.1016/j.transci.2022.103410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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3
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Cagdas D. Maternofetal Transfusion, Maternal Chimerism, and Maternal Engraftment: A Mystery in Health and Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4154-4155. [PMID: 34749950 DOI: 10.1016/j.jaip.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Deniz Cagdas
- Division of Pediatric Immunology, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey.
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Di Cristofaro J, Karlmark KR, Kanaan SB, Azzouz DF, El Haddad M, Hubert L, Farge-Bancel D, Granel B, Harlé JR, Hachulla E, Pardoux E, Roudier J, Picard C, Lambert NC. Soluble HLA-G Expression Inversely Correlates With Fetal Microchimerism Levels in Peripheral Blood From Women With Scleroderma. Front Immunol 2018; 9:1685. [PMID: 30158921 PMCID: PMC6104483 DOI: 10.3389/fimmu.2018.01685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/09/2018] [Indexed: 01/22/2023] Open
Abstract
Women with scleroderma (SSc) maintain significantly higher quantities of persisting fetal microchimerism (FMc) from complete or incomplete pregnancies in their peripheral blood compared to healthy women. The non-classical class-I human leukocyte antigen (HLA) molecule HLA-G plays a pivotal role for the implantation and maintenance of pregnancy and has often been investigated in offspring from women with pregnancy complications. However data show that maternal HLA-G polymorphisms as well as maternal soluble HLA-G (sHLA-G) expression could influence pregnancy outcome. Here, we aimed to investigate the underlying role of maternal sHLA-G expression and HLA-G polymorphisms on the persistence of FMc. We measured sHLA-G levels by enzyme linked immunosorbent assay in plasma samples from 88 healthy women and 74 women with SSc. Male Mc was quantified by DYS14 real-time PCR in blood samples from 58 women who had previously given birth to at least one male child. Furthermore, eight HLA-G 5'URR/3'UTR polymorphisms, previously described as influencing HLA-G expression, were performed on DNA samples from 96 healthy women and 106 women with SSc. Peripheral sHLA-G was at lower concentration in plasma from SSc (76.2 ± 48.3 IU/mL) compared to healthy women (117.5 ± 60.1 IU/mL, p < 0.0001), independently of clinical subtypes, autoantibody profiles, disease duration, or treatments. Moreover, sHLA-G levels were inversely correlated to FMc quantities (Spearman correlation, p < 0.01). Finally, women with SSc had lower sHLA-G independently of the eight HLA-G 5'URR/3'UTR polymorphisms, although they were statistically more often homozygous than heterozygous for HLA-G polymorphism genotypes -716 (G/T), -201 (G/A), 14 bp (ins/del), and +3,142 (G/A) than healthy women. In conclusion, women with SSc display less sHLA-G expression independently of the eight HLA-G polymorphisms tested. This decreased production correlates with higher quantities of persisting FMc commonly observed in blood from SSc women. These results shed some lights on the contribution of the maternal HLA-G protein to long-term persistent fetal Mc and initiate new perspectives in this field.
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Affiliation(s)
- Julie Di Cristofaro
- Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguins", Marseille, France
| | - Karlin R Karlmark
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
| | - Sami B Kanaan
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
| | - Doua F Azzouz
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
| | - Marina El Haddad
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
| | - Lucas Hubert
- Immunogenetics Laboratory, EFS-Alpes Méditerranée, Marseille, France.,Antibody Therapeutics and Immunotargeting, CRCM, INSERM U1068, Institut Paoli Calmettes, Aix-Marseille Université, Marseille, France.,UM 105, CNRS UMR7258, Marseille, France
| | - Dominique Farge-Bancel
- Unité de Médecine Interne Maladies Auto-immunes et Pathologie Vasculaire (UF 04) Hôpital Saint Louis, AP-HP, Centre de Référence des Maladies auto-immunes systémiques Rares d'Île-de-France, FAI2R, EA 3518, Institut Universitaire d'Hématologie, Paris, France
| | - Brigitte Granel
- UMR-S 1076 Endothélium, Pathologies Vasculaires et Cibles Thérapeutiques - Faculté de Pharmacie, Marseille, France.,AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies autoimmunes systémiques, Marseille, France
| | - Jean Robert Harlé
- AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies autoimmunes systémiques, Marseille, France
| | - Eric Hachulla
- Service de Médecine Interne, Centre National de Référence de la Sclérodermie Systémique, Hôpital Claude Huriez, Lille, France
| | - Etienne Pardoux
- Aix Marseille Univ, CNRS, Centrale Marseille, I2M, Marseille, France
| | - Jean Roudier
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France.,Rhumatologie, IML, AP-HM, Hôpital Sainte Marguerite, Marseille, France
| | - Christophe Picard
- Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguins", Marseille, France.,Immunogenetics Laboratory, EFS-Alpes Méditerranée, Marseille, France
| | - Nathalie C Lambert
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
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López-Guisa JM, Howsmon R, Munro A, Blair KM, Fisher E, Hermes H, Zager R, Stevens AM. Chimeric maternal cells in offspring do not respond to renal injury, inflammatory or repair signals. CHIMERISM 2017; 2:42-9. [PMID: 21912718 DOI: 10.4161/chim.2.2.16446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 06/10/2011] [Accepted: 06/14/2011] [Indexed: 11/19/2022]
Abstract
Maternal microchimerism (MMc) can persist for years in a child, and has been implicated in the pathogenesis of chronic inflammatory autoimmune diseases. Chimeric cells may either contribute to disease by acting as immune targets or expand in response to signals of injury, inflammation or repair. We investigated the role of maternal cells in tissue injury in the absence of autoimmunity by quantifying MMc by quantitative PCR in acute and chronic models of renal injury: (1) reversible acute renal injury, inflammation and regeneration induced by rhabdomyolysis and (2) chronic injury leading to fibrosis after unilateral ureteral obstruction. We found that MMc is common in the mouse kidney. In mice congenic with their mothers neither acute nor chronic renal injury with fibrosis influenced the levels or prevalence of MMc. Maternal cells expressing MHC antigens not shared by offspring (H2(b/d)) were detected at lower levels in all groups of homozygous H2(b/b) or H2(d/d) offspring, with or without renal injury, suggesting that partial tolerance to low levels of alloantigens may regulate the homeostatic levels of maternal cells within tissues. Maternal cells homozygous for H2(b) were lost in H2(b/d) offspring only after acute renal failure, suggesting that an inflammatory stimulus led to loss of tolerance to homozygous maternal cells. The study suggests that elevated MMc previously found in association with human autoimmune diseases may not be a response to non-specific injury or inflammatory signals, but rather a primary event integral to the pathogenesis of autoimmunity.
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Azzouz DF, Rak JM, Balandraud N, Auger I, Martin M, Roudier J, Lambert NC. How microchimerism can impart HLA susceptibility in patients with rheumatoid arthritis. CHIMERISM 2017; 1:23-5. [PMID: 21327148 PMCID: PMC3035110 DOI: 10.4161/chim.1.1.12648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Rheumatoid arthritis, a chronic inflammatory joint disease, is strongly associated with
HLA-DRB1*01 and *04 alleles that have in common similar 5-amino acid motifs in the
third hypervariable region of DRB1 (QKRAA, QRRAA, RRRAA), the so called shared epitope
(SE). Most patients with RA carry 1 or 2 doses of the SE, with particular genetic
combinations at higher risk. In recent work we provided evidence that patients who lack
HLA-DRB1*01 and/or *04 alleles can acquire RA susceptibility through fetal,
maternal or iatrogenic microchimerism. We also discuss how Mc carrying HLA-DRB1*04
alleles is more likely to be present in the peripheral blood of RA patients compared to Mc
carrying HLA-DRB1*01 alleles. We further analyze our results in light of the hierarchy
for RA risk with different combinations of the SE. How Mc could contribute to RA
susceptibility and whether it also contributes to the hierarchy of risk observed with
particular combinations of SE-containing alleles is certainly the beginning of an
intriguing story and may offer hope for future therapeutic and/or preventative
interventions.
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Harrington WE, Kanaan SB, Muehlenbachs A, Morrison R, Stevenson P, Fried M, Duffy PE, Nelson JL. Maternal Microchimerism Predicts Increased Infection but Decreased Disease due to Plasmodium falciparum During Early Childhood. J Infect Dis 2017; 215:1445-1451. [PMID: 28329160 DOI: 10.1093/infdis/jix129] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background A mother's infection with placental malaria (PM) can affect her child's susceptibility to malaria, although the mechanism remains unclear. The fetus acquires a small amount of maternal cells and DNA known as maternal microchimerism (MMc), and we hypothesized that PM increases MMc and that MMc alters risk of Plasmodium falciparum malaria during infancy. Methods In a nested cohort from Muheza, Tanzania, we evaluated the presence and level of cord blood MMc in offspring of women with and without PM. A maternal-specific polymorphism was identified for each maternal-infant pair, and MMc was assayed by quantitative polymerase chain reaction. The ability of MMc to predict malaria outcomes during early childhood was evaluated in longitudinal models. Results Inflammatory PM increased the detection rate of MMc among offspring of primigravidae and secundigravidae, and both noninflammatory and inflammatory PM increased the level of MMc. Detectable MMc predicted increased risk of positive blood smear but, interestingly, decreased risk of symptomatic malaria and malaria hospitalization. Conclusions The acquisition of MMc may result in increased malaria infection but protection from malaria disease. Future studies should be directed at the cellular component of MMc, with attention to its ability to directly or indirectly coordinate anti-malarial immune responses in the offspring.
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Affiliation(s)
- Whitney E Harrington
- Department of Pediatrics, University of Washington School of Medicine/Seattle Children's Hospital, Washington
| | - Sami B Kanaan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Atis Muehlenbachs
- Department of Pathology, University of Washington, Seattle, Washington
| | - Robert Morrison
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Philip Stevenson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - J Lee Nelson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Rheumatology, University of Washington, Seattle
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9
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Abstract
During pregnancy maternal and fetal cells commute back and forth leading to fetal microchimerism in the mother and maternal microchimerism in the child that can persist for years after the birth. Chimeric fetal and maternal cells can be hematopoietic or can differentiate into somatic cells in multiple organs, potentially acting as targets for ‘autoimmunity' and so have been implicated in the pathogenesis of autoimmune diseases that resemble graft-versus-host disease after stem cell transplantation. Fetal cells have been found in women with systemic lupus erythematosus, both in the blood and a target organ, the kidney, suggesting that they may be involved in pathogenesis. Future studies will address how the host immune system normally tolerates maternal and fetal cells or how the balance may change during autoimmunity.
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Affiliation(s)
- A M Stevens
- Department of Pediatrics, University of Washington, Childrens Hospital and Regional Medical Center, 307 Westlake Ave N, Suite 300, Seattle, WA 98109, Washington, USA.
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10
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Leveque L, Khosrotehrani K. Feto-maternal allo-immunity, regulatory T cells and predisposition to auto-immunity. Does it all start in utero? CHIMERISM 2015; 5:59-62. [PMID: 25111980 DOI: 10.4161/chim.29844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
During gestation, maternal cells traffic to the fetus leading to the natural phenomenon of microchimerism. Although their persistence in offspring has been associated with several autoimmune disorders, the precise role of maternal cells in these disorders remains unclear. We aimed to evaluate whether alloreactive maternal T cells could directly trigger a graft-vs.-host like reaction or indirectly influence the development of the offspring's regulatory T cells (Treg) favoring autoimmunity. In a specific breeding strategy, we recently reported that maternal allogeneic T cells changed fetal Treg development and their quantities in mesenteric lymph nodes, leading to early signs of inflammation in the gut later in life. Although maternal microchimeric T cells were found in newborn tissues, we could not detect any cells in the gut from adult offspring where the inflammation occurred. Thus, strongly alloreactive maternal microchimeric T cells may indirectly drive the offspring to gut inflammation. We believe these results suggest a new mechanism for predisposition to auto-immunity.
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Affiliation(s)
- Lucie Leveque
- QIMR Berghofer Medical Research Institute; Brisbane, QLD Australia
| | - Kiarash Khosrotehrani
- The University of Queensland; UQ Centre for Clinical Research; Experimental Dermatology Group; Brisbane, QLD Australia
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11
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Stevens AM. Maternal microchimerism in health and disease. Best Pract Res Clin Obstet Gynaecol 2015; 31:121-30. [PMID: 26612343 DOI: 10.1016/j.bpobgyn.2015.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/31/2015] [Indexed: 12/19/2022]
Abstract
Circulating maternal cells transfer to the fetus during pregnancy, where they may integrate with the fetal immune and organ systems, creating a state of maternal microchimerism (MMc). MMc can persist throughout the child's life, and it has been implicated in the triggering or perpetuation of chronic inflammatory autoimmune diseases, in the context of specific major histocompatibility genes. Correlative data in humans have now been tested in animal model systems. Results suggest that maternal-fetal tolerance may have health implications far beyond the time of pregnancy and into the child's life.
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Affiliation(s)
- Anne M Stevens
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, 1900 9th Ave N, 9S-7, Seattle, WA 98101, USA.
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12
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Artlett CM, Sassi-Gaha S, Ramos RC, Miller FW, Rider LG. Chimeric cells of maternal origin do not appear to be pathogenic in the juvenile idiopathic inflammatory myopathies or muscular dystrophy. Arthritis Res Ther 2015; 17:238. [PMID: 26338728 PMCID: PMC4558637 DOI: 10.1186/s13075-015-0732-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/28/2015] [Indexed: 01/08/2023] Open
Abstract
Introduction Microchimeric cells have been studied for over a decade, with conflicting reports on their presence and role in autoimmune and other inflammatory diseases. To determine whether microchimeric cells were pathogenic or mediating tissue repair in inflammatory myopathies, we phenotyped and quantified microchimeric cells in juvenile idiopathic inflammatory myopathies (JIIM), muscular dystrophy (MD), and noninflammatory control muscle tissues. Method Fluorescence immunophenotyping for infiltrating cells with sequential fluorescence in situ hybridization was performed on muscle biopsies from ten patients with JIIM, nine with MD and ten controls. Results Microchimeric cells were significantly increased in MD muscle (0.079 ± 0.024 microchimeric cells/mm2 tissue) compared to controls (0.019 ± 0.007 cells/mm2 tissue, p = 0.01), but not elevated in JIIM muscle (0.043 ± 0.015 cells/mm2). Significantly more CD4+ and CD8+ microchimeric cells were in the muscle of patients with MD compared with controls (mean 0.053 ± 0.020/mm2 versus 0 ± 0/mm2p = 0.003 and 0.043 ± 0.023/mm2 versus 0 ± 0/mm2p = 0.025, respectively). No differences in microchimeric cells between JIIM, MD, and noninflammatory controls were found for CD3+, Class II+, CD25+, CD45RA+, and CD123+ phenotypes, and no microchimeric cells were detected in CD20, CD83, or CD45RO populations. The locations of microchimeric cells were similar in all three conditions, with MD muscle having more microchimeric cells in perimysial regions than controls, and JIIM having fewer microchimeric muscle nuclei than MD. Microchimeric inflammatory cells were found, in most cases, at significantly lower proportions than autologous cells of the same phenotype. Conclusions Microchimeric cells are not specific to autoimmune disease, and may not be important in muscle inflammation or tissue repair in JIIM.
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Affiliation(s)
- Carol M Artlett
- Department of Microbiology and Immunology, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA.
| | - Sihem Sassi-Gaha
- Department of Microbiology and Immunology, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129, USA.
| | - Ronald C Ramos
- Department of Medicine, Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA, 19107, USA. .,Present address: Agis Global, Business Development Executive, 1266 East Main Street, Stamford, CT, 06902, USA.
| | - Frederick W Miller
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Environmental Autoimmunity Group, Program of Clinical Research, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
| | - Lisa G Rider
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Environmental Autoimmunity Group, Program of Clinical Research, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
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Maternal microchimerism: lessons learned from murine models. J Reprod Immunol 2015; 108:12-25. [DOI: 10.1016/j.jri.2014.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/04/2014] [Accepted: 12/14/2014] [Indexed: 11/20/2022]
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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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Leveque L, Khosrotehrani K. Can maternal microchimeric cells influence the fetal response toward self antigens? CHIMERISM 2014. [DOI: 10.4161/chim.17589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Muraji T. Maternal microchimerism in biliary atresia: are maternal cells effector cells, targets, or just bystanders? CHIMERISM 2014; 5:1-5. [PMID: 24670921 DOI: 10.4161/chim.28576] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The etiology of biliary atresia (BA) is unknown; however, the liver histology is similar to that observed in immune-mediated hepatic disorders. Liver fibrosis in BA progresses even after bile drainage has been achieved by the Kasai operation. Maternal microchimerism has been purported to play a part in the pathogenesis of BA as well as certain autoimmune diseases. However, the role of maternal cells has not yet been determined in BA. Specifically, it is unknown whether these maternal cells function as maternal effector T lymphocytes, or targets or bystanders. We currently hypothesize that the first hit is due to GvHD interaction by engrafted maternal effector T lymphocytes. Furthermore, we suggest that the secondary effects that are manifested by progressive cirrhosis are caused either by maternal chimeric effector T lymphocytes (e.g., GvHD interaction) or targets (e.g., HvGD interaction). Based on our hypothesis, mixed lymphocyte reactions between patients and their mothers might shed light on the etiopathogenesis and prognostic indicators.
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Affiliation(s)
- Toshihiro Muraji
- Department of Pediatric Surgery; Child Health and Cancer Research Center; Ibaraki Children's Hospital; Ibaraki, Japan
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Bendon R, Coventry S, Bendon J, Nordmann A, Schikler K. Follow-up study of lympho-histiocytic villitis and incidental retroplacental hematoma. Pediatr Dev Pathol 2014; 17:94-101. [PMID: 24450427 DOI: 10.2350/13-10-1395-oa.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Placentas are usually submitted for pathologic examination based on obstetrical indications. We hypothesized that the placenta may have diagnostic value to the infant independent of obstetrical events. We specifically tested whether lymphohistiocytic villitis (noninfectious) would predict autoimmune or alloimmune disease based on transfer of activated maternal T-cells to the fetus and whether clinically silent placental separations (retroplacental hematomas, RPH) would predict neurologic injury in the infant. All placentas from consecutive deliveries had a routine pathologic examination of the placenta. The infants with placentas demonstrating inflammation of >1% of villi or RPH >2 cm and matched controls had their hospital charts reviewed and parental interviews by telephone at 5 to 7 years of age. The children of consented patients were also searched for in the office visits of the University of Louisville Pediatric Neurology and Rheumatology divisions. One thousand six hundred eighty-four patients consented to the follow-up study. We found no cases of autoimmune disease among 17 children with villitis >1%. Of 16 infants with RPH, 1 had cerebral palsy but with other placental findings, 1 had lethal hydranenecephaly, and the remainder had no adverse outcome. Of 15 children seen by a pediatric neurologist, none had the same placental lesion. The specific lesions of lymphohistiocytic villitis or asymptomatic RPH do not predict significant pediatric disease by 7 years of age. At least for these 2 lesions, the placenta does not have diagnostic value to the infant.
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Affiliation(s)
- Robert Bendon
- 1 Departments of Pathology and Pediatrics, University of Louisville, and Department of Pathology, Kosair Children's Hospital, Louisville, KY, USA
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Ye J, Vives-Pi M, Gillespie KM. Maternal microchimerism: increased in the insulin positive compartment of type 1 diabetes pancreas but not in infiltrating immune cells or replicating islet cells. PLoS One 2014; 9:e86985. [PMID: 24498006 PMCID: PMC3909047 DOI: 10.1371/journal.pone.0086985] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/19/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Maternal microchimeric cells (MMc) transfer across the placenta during pregnancy. Increased levels of MMc have been observed in several autoimmune diseases including type 1 diabetes but their role is unknown. It has been suggested that MMc are 1) effector cells of the immune response, 2) targets of the autoimmune response or 3) play a role in tissue repair. The aim of this study was to define the cellular phenotype of MMc in control (n = 14) and type 1 diabetes pancreas (n = 8). METHODS Using sex chromosome-based fluorescence in-situ hybridization, MMc were identified in male pancreas and their phenotype determined by concomitant immunofluorescence. RESULTS In normal pancreas, MMc positive for endocrine, exocrine, duct and acinar markers were identified suggesting that these cells are derived from maternal progenitors. Increased frequencies of MMc were observed in type 1 diabetes pancreas (p = 0.03) with particular enrichment in the insulin positive fraction (p = 0.01). MMc did not contribute to infiltrating immune cells or Ki67+ islet cell populations in type 1 diabetes. CONCLUSION These studies provide support for the hypothesis that MMc in human pancreas are derived from pancreatic precursors. Increased frequencies of MMc beta cells may contribute to the initiation of autoimmunity or to tissue repair but do not infiltrate islets in type 1 diabetes.
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MESH Headings
- Adolescent
- Adult
- Autoimmunity/genetics
- Autoimmunity/immunology
- Child
- Child, Preschool
- Chimerism
- Chromosomes, Human, X/genetics
- Chromosomes, Human, X/immunology
- Chromosomes, Human, Y/genetics
- Chromosomes, Human, Y/immunology
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/metabolism
- Female
- GATA4 Transcription Factor/immunology
- GATA4 Transcription Factor/metabolism
- Humans
- In Situ Hybridization, Fluorescence/methods
- Infant
- Insulin/immunology
- Insulin/metabolism
- Islets of Langerhans/immunology
- Islets of Langerhans/metabolism
- Ki-67 Antigen/immunology
- Ki-67 Antigen/metabolism
- Male
- Maternal-Fetal Exchange/genetics
- Maternal-Fetal Exchange/immunology
- Microscopy, Confocal
- Microscopy, Fluorescence
- Pancreas/embryology
- Pancreas/immunology
- Pancreas/metabolism
- Pregnancy
- Young Adult
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Affiliation(s)
- Jody Ye
- Diabetes and Metabolism Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Marta Vives-Pi
- Immunology Department, Institut de Recerca Germans Trias i Pujol, Carretera Canyet s/n, Badalona, Spain
| | - Kathleen M. Gillespie
- Diabetes and Metabolism Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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19
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Leveque L, Hodgson S, Peyton S, Koyama M, MacDonald KPA, Khosrotehrani K. Selective organ specific inflammation in offspring harbouring microchimerism from strongly alloreactive mothers. J Autoimmun 2013; 50:51-8. [PMID: 24268809 DOI: 10.1016/j.jaut.2013.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/26/2013] [Accepted: 10/31/2013] [Indexed: 01/25/2023]
Abstract
The origins of autoimmunity are not yet understood despite significant advances in immunology. The trafficking of maternal cells to the offspring represents the very first immunological event in foetal life and is reinforced during lactation. The persistence of maternal cells in offspring's tissues and circulation has been associated with several autoimmune disorders. However a direct causal effect has never been demonstrated. Maternal T cells specifically targeting foetal insulin producing cells have been shown to generate islet inflammation without directly participating in this process. Our objective was to evaluate if alloreactive maternal cells could directly trigger a graft-versus host like reaction or indirectly influence the development of the offspring's regulatory T cells favouring autoimmunity. We adopted a breeding strategy comparing genetically identical offspring from either strongly alloreactive transgenic mothers compared to immunodeficient mothers. We detected maternal alloreactive T cells in the offspring and early signs of inflammation in small intestine of 6 weeks old offspring. Interestingly, CD4(+) Foxp3(+) regulatory T cell frequency was diminished in mesenteric lymph nodes from eight months old offspring born of alloreactive mothers compared to offspring of immunodeficient mothers. Our study favours a hypothesis where highly alloreactive maternal cell microchimerism indirectly predisposes offspring to autoimmunity.
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Affiliation(s)
- Lucie Leveque
- The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Samantha Hodgson
- The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, Australia
| | - Stephen Peyton
- Pathology Queensland, Royal Brisbane Hospital, Brisbane, Australia
| | - Motoko Koyama
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Kiarash Khosrotehrani
- The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, Australia
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20
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Kanold AMJ, Svenungsson E, Gunnarsson I, Götherström C, Padyukov L, Papadogiannakis N, Uzunel M, Westgren M. A research study of the association between maternal microchimerism and systemic lupus erythematosus in adults: a comparison between patients and healthy controls based on single-nucleotide polymorphism using quantitative real-time PCR. PLoS One 2013; 8:e74534. [PMID: 24040274 PMCID: PMC3770650 DOI: 10.1371/journal.pone.0074534] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 08/05/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Naturally acquired microchimerism may arise in the mother and her child during pregnancy when bidirectional trafficking of cells occurs through the placental barrier. The occurrence of maternal microchimerism (maternal cells in the offspring) has been associated with several autoimmune diseases, especially in children. Systemic Lupus erythematosus (SLE) is an autoimmune disorder with a resemblance to graft-versus-host disease. The aim of this study was to investigate the association between maternal microchimerism in the blood and SLE. METHODOLOGY/PRINCIPAL FINDINGS Thirty-two patients with SLE, 17 healthy brothers of the patients, and an additional 12 unrelated healthy men were the subjects in this study. A single-nucleotide polymorphism unique to each mother was identified, and maternal microchimerism in the study group and in the control group was detected using a quantitative real-time polymerase chain reaction technique. No differences in the frequency or the concentration of maternal cells were apparent in the blood of patients with SLE or in that of the controls. Two patients and one control tested positive for maternal microchimerism, but the positive subjects were all negative at a follow-up 16 years later. The sensitivity of the method was estimated to 1/10.000. CONCLUSIONS/SIGNIFICANCE These results show no association between SLE and maternal microchimerism. The frequency of maternal microchimerism in the blood of adults overall may be lower than earlier reported.
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Affiliation(s)
- Anna Maria Jonsson Kanold
- Department of Obstetrics and Gynecology, Center for Fetal Medicine, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Elisabet Svenungsson
- Department of Medicine Solna, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Iva Gunnarsson
- Department of Medicine Solna, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Götherström
- Department of Obstetrics and Gynecology, Center for Fetal Medicine, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Division for Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Leonid Padyukov
- Department of Medicine Solna, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of PathologySection of Perinatal Pathology, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mehmet Uzunel
- Division for Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Westgren
- Department of Obstetrics and Gynecology, Center for Fetal Medicine, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden
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21
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Abstract
Maternal-fetal cellular trafficking (MFCT) is the bidirectional passage of cells that results in the presence of fetal cells in the mother and maternal cells in the fetus. This naturally occurring biological phenomenon has been implicated in the pathogenesis of autoimmune diseases in both mothers and children. However, MFCT may also have beneficial consequences in establishing and maintaining maternal-fetal tolerance and may have long-term consequences for transplantation tolerance. There is also evidence that trafficking is altered during pregnancy complications and fetal intervention. An improved understanding of cellular trafficking during pregnancy will lead to progress in multiple fields including autoimmunity, transplantation, and fetal surgery.
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Affiliation(s)
- Amar Nijagal
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research and The Fetal Treatment Center, University of California, San Francisco, California 94143-0570, USA
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22
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Ye Y, van Zyl B, Varsani H, Wedderburn LR, Ramanan A, Gillespie KM. Maternal microchimerism in muscle biopsies from children with juvenile dermatomyositis. Rheumatology (Oxford) 2012; 51:987-91. [PMID: 22271755 PMCID: PMC3354676 DOI: 10.1093/rheumatology/ker430] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 11/22/2011] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Recent advances in molecular techniques have revealed that there is bi-directional transfer of cells between mother and child during pregnancy, and the presence of a mother's cells in her child has been termed maternal microchimerism (MMc). There is the potential for maternal cells to provoke inappropriate immune responses in the child, which could be a factor in autoimmunity including JDM. The aim of this study was to determine whether maternal (female) cells could be detected in frozen muscle sections from seven males (age range 3-13 years) with JDM participating in the Juvenile Dermatomyositis National (U.K. and Ireland) Cohort Biomarker Study and Repository for Idiopathic Inflammatory Myopathies and sections of muscle controls (age range 2-12 years). METHODS At least 1000 cells from each section underwent FISH and confocal imaging through each nucleus. Concomitant IF for CD45 was used to determine whether MMc in muscle were lymphocytes. A non-parametric Mann-Whitney U-test was used to detect statistical differences. RESULTS The frequency of MMc was higher in JDM muscle (0.42-1.14%) than in controls (0.08-0.42%) P = 0.01. No CD45+ MMc were observed. CONCLUSION These data confirm an increased frequency of MMc in JDM. More detailed characterization of MMc is required, particularly using phenotypic markers, to explain the role of these cells in JDM.
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Affiliation(s)
- Yi Ye
- School of Clinical Sciences, University of Bristol, Bristol and Department of Rheumatology, Institute of Child Health, University College London, London, UK
| | - Berendine van Zyl
- School of Clinical Sciences, University of Bristol, Bristol and Department of Rheumatology, Institute of Child Health, University College London, London, UK
| | - Hemlata Varsani
- School of Clinical Sciences, University of Bristol, Bristol and Department of Rheumatology, Institute of Child Health, University College London, London, UK
| | - Lucy R. Wedderburn
- School of Clinical Sciences, University of Bristol, Bristol and Department of Rheumatology, Institute of Child Health, University College London, London, UK
| | - Athimalaipet Ramanan
- School of Clinical Sciences, University of Bristol, Bristol and Department of Rheumatology, Institute of Child Health, University College London, London, UK
| | - Kathleen M. Gillespie
- School of Clinical Sciences, University of Bristol, Bristol and Department of Rheumatology, Institute of Child Health, University College London, London, UK
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23
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Nelson JL. The otherness of self: microchimerism in health and disease. Trends Immunol 2012; 33:421-7. [PMID: 22609148 DOI: 10.1016/j.it.2012.03.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/06/2011] [Accepted: 03/24/2012] [Indexed: 12/19/2022]
Abstract
Microchimerism (Mc) refers to the harboring of a small number of cells (or DNA) that originated in a different individual. Naturally acquired Mc derives primarily from maternal cells in her progeny, or cells of fetal origin in women. Both maternal and fetal Mc are detected in hematopoietic cells including T and B cells, monocyte/macrophages, natural killer (NK) cells and granulocytes. Mc appears also to generate cells such as myocytes, hepatocytes, islet β cells and neurons. Here, the detrimental and beneficial potential of Mc is examined. The prevalence, diversity and durability of naturally acquired Mc, including in healthy individuals, indicates that a shift is needed from the conventional paradigm of 'self versus other' to a view of the normal 'self' as constitutively chimeric.
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Affiliation(s)
- J Lee Nelson
- Immunogenetics, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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24
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Nijagal A, Fleck S, MacKenzie TC. Maternal microchimerism in patients with biliary atresia: Implications for allograft tolerance. CHIMERISM 2012; 3:37-9. [PMID: 22772071 DOI: 10.4161/chim.20152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Maternal-fetal cellular trafficking during pregnancy results in bidirectional microchimerism with potentially long-term consequences for the mother and her fetus. Exposure of the fetus to maternal cells results in tolerance to non-inherited maternal antigens (NIMA) and may therefore impact transplant outcomes. We investigated the rates of graft failure and retransplantation after parental liver transplantation in pediatric recipients with biliary atresia (BA), a disease with high levels of maternal microchimerism. We observed significantly lower rates of graft failure and retransplantation in BA recipients of maternal livers compared with BA recipients of paternal livers. Importantly, recipients without BA had equivalent transplant outcomes with maternal and paternal organs, suggesting that increased maternal microchimerism in BA patients may be the underlying etiology for tolerance. These results support the concept that prenatal exposure to NIMA may have consequences for living-related organ transplantation.
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Affiliation(s)
- Amar Nijagal
- Eli and Edythe Broad Center of Regeneration Medicine, University of California at San Francisco, San Francisco, CA, USA
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25
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Clifton VL, Stark MJ, Osei-Kumah A, Hodyl NA. Review: The feto-placental unit, pregnancy pathology and impact on long term maternal health. Placenta 2011; 33 Suppl:S37-41. [PMID: 22118870 DOI: 10.1016/j.placenta.2011.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 11/10/2011] [Accepted: 11/11/2011] [Indexed: 11/27/2022]
Abstract
Pregnancy induces a number of alterations to maternal physiology to accommodate the increased demands made by the developing fetus and placenta. These alterations appear at least in part to be driven by products derived from the feto-placental unit, including microchimeric cells, as well as placental exosomes and microparticles, inducing changes to maternal physiology both during pregnancy and beyond. Further, increasing evidence suggests that some of these alterations are dependent on the sex of the fetus. Pre-eclampsia and asthma represent two common pregnancy complications that have provided valuable insight into how the feto-placental unit influences maternal physiology in a sex-specific manner. Pregnancy-induced alterations in maternal physiology may expose pre-existing subclinical pathologies and provide insight into future maternal health and disease. While most pregnancy-induced alterations to the maternal system are reversed following delivery, some can persist after parturition leading to cardiovascular, metabolic and autoimmune disease and increased risk of early mortality.
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Affiliation(s)
- V L Clifton
- The Robinson Institute, Obstetrics and Gynaecology, University of Adelaide, SA, Australia.
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26
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Robinson AB, Reed AM. Clinical features, pathogenesis and treatment of juvenile and adult dermatomyositis. Nat Rev Rheumatol 2011; 7:664-75. [PMID: 21947177 DOI: 10.1038/nrrheum.2011.139] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Juvenile and adult dermatomyositis (DM) have multiple commonalities, yet display differing prevalence of features, outcomes and comorbidities. In general, compared with the disease in adults, children with DM have more vasculopathy and a greater likelihood of calcinosis, periungual and gingival telangiectasias, and ulceration, but have a better long-term prognosis with improved survival. Adults with DM are more likely to have myositis-specific antibodies, develop interstitial lung disease, have amyopathic disease, and have a marked association with malignancy and other comorbidities. Both diseases have similar features on muscle biopsy and interferon gene signature, although subtle differences can exist in pathogenesis and pathology, such as more capillary loss and a greater degree of C5b-9 complement deposition in affected muscle of juvenile patients. Initiatives are underway to improve classification, markers of disease activity and ability to predict outcome of juvenile and adult DM. The purpose of this Review is to compare and contrast the unique features between juvenile and adult disease and to outline new initiatives in the field.
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Affiliation(s)
- Angela B Robinson
- Department of Pediatrics, Case Western Reserve University Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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27
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Leveque L, Khosrotehrani K. Can maternal microchimeric cells influence the fetal response toward self antigens? CHIMERISM 2011; 2:71-7. [PMID: 22163064 DOI: 10.4161/chim.2.3.17589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 07/24/2011] [Accepted: 08/01/2011] [Indexed: 01/04/2023]
Abstract
The origins of autoimmunity are still elusive despite significant advances in immunology. There is cumulative evidence that, beyond simple genetics, the maternal environment plays a critical role in the development of common autoimmune disorders, such as multiple sclerosis or diabetes. In recent years, the trafficking of maternal cells to the offspring has been clearly demonstrated. This microchimerism represents the very first immunological event in fetal life. The number of persisting maternal cells has been associated with several autoimmune disorders such as systemic sclerosis, juvenile dermatomyositis and diabetes. The precise role of the maternal cells in these disorders remains unclear. Based on recent experimental work in an animal model of juvenile diabetes, we will discuss the possibility of maternal cells modifying the response of the developing fetal immunity towards self.
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Affiliation(s)
- Lucie Leveque
- The University of Queensland Centre for Clinical Research; The University of Queensland; Brisbane, QLD Australia
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28
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Dermatomyositis developed in a recipient of allogeneic BMT; the differentiation of chronic GVHD and autoimmune disease. Bone Marrow Transplant 2011; 47:603-4. [DOI: 10.1038/bmt.2011.125] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kivity S, Ehrenfeld M. Can we explain the higher prevalence of autoimmune disease in women? Expert Rev Clin Immunol 2011; 6:691-4. [PMID: 20828274 DOI: 10.1586/eci.10.60] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Roy E, Leduc M, Guegan S, Rachdi L, Kluger N, Scharfmann R, Aractingi S, Khosrotehrani K. Specific maternal microchimeric T cells targeting fetal antigens in β cells predispose to auto-immune diabetes in the child. J Autoimmun 2011; 36:253-62. [PMID: 21414756 DOI: 10.1016/j.jaut.2011.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 02/04/2011] [Accepted: 02/06/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE During pregnancy there is an exchange of cells between the fetus and the mother including T lymphocytes that can persist after delivery. Previous studies have described an increased numbers of maternal cells in children with juvenile diabetes as compared to their unaffected siblings. Our objective was to assess the possibility for these chimeric T cells to trigger an anti-beta cell response. RESEARCH DESIGN AND METHODS We mated OT2 transgenic female mice having T cells specifically targeting ovalbumin to RIP-OVA males expressing ovalbumin in pancreatic β cells. This allowed us to examine RIP-OVA progeny from OT2 mothers to assess the consequences of maternal T cells acquired during gestation or lactation. We quantitatively analyzed the pancreas of RIP-OVA mice from OT2 mothers for islet infiltration and compared them to RIP-OVA mice not exposed to OT2 mothers or to wild-type mice from OT2 mothers. RESULTS RIP-OVA mice from OT2 mothers had significantly more peri-insulitis (p=0.0083) compared to wild-type littermates. Similarly RIP-OVA mice from OT2 mothers had more peri-insulitis as compared to RIP-OVA mice from RIP-OVA mothers (p=0.0073). Presence and specific anti-ovalbumin activity of maternal OT2 cells in the offsprings' peripheral lymphoid tissues was found in a separate group of mice. In animals presenting islet inflammation, CD3+ infiltrating cells in the pancreas were however derived from the offspring and not from OT2 mothers. In accordance, OT2 and RIP-OVA double transgenic mice with high levels of auto-reactive T cells had more peri-insulitis and sometimes intense insulitis when they were from OT2 mothers as compared to RIP-OVA mothers (p=0.046). CONCLUSIONS In highly specific fetal/maternal combinations, maternal T cells with activity against the offspring pancreatic beta cells, presumably chimeric in fetal organs, initiate islet inflammation and may therefore predispose to auto-immune diabetes.
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Affiliation(s)
- Edwige Roy
- UPMC Univ Paris 6, UMR_S938, Paris, France
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31
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Vanzyl B, Planas R, Ye Y, Foulis A, de Krijger RR, Vives-Pi M, Gillespie KM. Why are levels of maternal microchimerism higher in type 1 diabetes pancreas? CHIMERISM 2010; 1:45-50. [PMID: 21327046 PMCID: PMC3023622 DOI: 10.4161/chim.1.2.13891] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 08/27/2010] [Accepted: 10/08/2010] [Indexed: 02/05/2023]
Abstract
Maternal microchimerism (MMc) results from transfer of maternal cells to the fetus in pregnancy. These cells have been shown to persist into adulthood in healthy individuals and an increased frequency of MMc has been associated with autoimmune disease. Female (presumed maternal) islet beta cells have recently been identified at higher levels in pancreas from a child with T1D compared to three controls. There was, however, no evidence that these cells were the targets of autoimmune attack. The aim of this study was to analyze well-characterized T1D pancreases encompassing a spectrum in age at diagnosis, and duration of diabetes, for the presence of maternal microchimerism compared to control pancreases.Pancreas samples were available from six males with T1D and four male controls. Fluorescent-labeled probes were used to detect X and Y chromosomes. At least 1,000 cells, usually 4,000-8,000 cells underwent confocal imaging for each pancreas. The frequency of MMc was higher in T1D pancreases (range 0.31-0.80%, mean 0.58%) than in controls (0.24-0.50%, mean 0.38%) (p = 0.05). Intriguingly, clusters of 2-3 MMc were occasionally found in the pancreases, particularly T1D pancreases, suggesting replication of these cells. Concomitant FISH and immunofluorescence staining for insulin or CD45 was performed to phenotype cells of maternal origin. Insulin positive and insulin negative MMc were identified indicating that MMc contribute to the exocrine and endocrine compartments. No CD45 positive MMc were observed. These data confirm the presence of maternal cells in human pancreas and support previous observations that levels of MMc are higher in T1D pancreas compared to controls. MMc do not appear to be immune effector cells and those that stain positive for insulin within intact islets in T1D tissue appear healthy with no evidence that they are the focus of immune attack. This study adds support to the hypothesis that maternal stem cells have the capacity to cross the placental barrier and differentiate into both endocrine and exocrine cells but more detailed characterization of MMc in the pancreas is required.
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Affiliation(s)
- Berendine Vanzyl
- Diabetes and Metabolism; Department of Clinical Science at North Bristol; University of Bristol; Bristol, UK
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32
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Jonsson AM, Papadogiannakis N, Granath A, Haggstrom J, Schaffer M, Uzunel M, Westgren M. Maternal microchimerism in juvenile tonsils and adenoids. Pediatr Res 2010; 68:199-204. [PMID: 20531252 DOI: 10.1203/pdr.0b013e3181eb2eb4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
During pregnancy small amounts of cells pass between the mother and the fetus, and this transfer may give rise to a chimeric state that persist for years in both individuals. Both fetal and maternal microchimerism (MMc) have been associated with different autoimmune disorders. Information about MMc in tissues of healthy individuals is sparse but is important when looking for maternal cells within affected tissues of certain diseases. The aim of this study was to investigate the occurrence of maternal cells in tonsils and adenoids of 20 healthy children between the ages of 2 and 15 years. All the children underwent surgery because of recurrent tonsillitis or respiratory obstruction. MMc was detected using an RT-PCR assay based on differences in gene polymorphisms between mother and child. We found maternal cells in the tonsils and/or adenoids in four of 20 children. This frequency is less than the frequency of maternal cells found in the peripheral blood of healthy adults but in agreement with the previously reported frequency of maternal chimerism in control tissues
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Affiliation(s)
- Anna Maria Jonsson
- Department of Obstetrics and Gynecology, Karolinska Institute and Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
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33
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Abstract
There is increasing evidence for involvement of the mechanisms of the innate immune system in the pathogenesis of idiopathic inflammatory myopathies (IIMs), especially in the adult and juvenile forms of dermatomyositis. Juvenile dermatomyositis (JDM) is the most common form of childhood IIM, and this review focuses on recent advances in understanding the actions of the innate immune system in this condition. Over the last few years, great strides have been made in understanding immune dysregulation in IIM, including JDM. Novel autoantibodies have been identified, and new genetic contributions have been described. Among the most striking findings is type I interferon activity in JDM tissue and peripheral blood. This is in conjunction with the description of dysregulation of the major histocompatibility complex (MHC) class I gene and identification of plasmacytoid dendritic infiltrates as the possible cellular source of type I interferons. These findings also point toward the potential prognostic value of muscle biopsies and have helped expand our understanding of the etiopathogenesis of IIM.
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Affiliation(s)
- Sahil Khanna
- Division of Rheumatology, Department of Medicine and Pediatrics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA
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34
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Abstract
Juvenile dermatomyositis (JDM) is a rare, presumably autoimmune illness that causes proximal muscle weakness and a variety of typical cutaneous features. The study of this illness has been hampered by its rarity but, in recent years, important developments have increased our understanding of JDM. Genetic factors are likely important in the pathogenesis of JDM. These include several Human Leukocyte Antigen alleles, in particular those associated with the 8.1 ancestral haplotype and the tumor necrosis factor-alpha gene 308 polymorphism. Microchimerism, activation of plasmacytoid dendritic cells, and upregulation of type-1 interferon inducible genes also appear to play an important role in the pathogenesis of JDM. The study of JDM has also been limited by a lack of validated assessment tools. Recent work has validated the Childhood Myositis Assessment Scale and the Childhood Health Assessment Questionnaire as measures of muscle strength and function, and the Cutaneous Assessment Tool as a measure of skin disease activity and damage. Development of core sets of tools that should be used in all JDM studies has also been an important step. The use of magnetic resonance imaging and novel laboratory assessments (such as type-1 interferon inducible gene products, peripheral blood B cell and natural killer cell numbers, and myositis-associated and myositis-specific autoantibodies) are also playing an increasing role in the diagnosis and assessment of JDM. Current treatment is with corticosteroids, frequently in combination with other medications such as methotrexate or intravenous gammaglobulin. Newer therapies, such as anti-tumor necrosis factor agents and rituximab are currently being evaluated; it is not clear what role these medications will have in the future.
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Affiliation(s)
- Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
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35
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Wedderburn LR, Rider LG. Juvenile dermatomyositis: new developments in pathogenesis, assessment and treatment. Best Pract Res Clin Rheumatol 2009; 23:665-78. [PMID: 19853831 PMCID: PMC2774891 DOI: 10.1016/j.berh.2009.07.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Juvenile dermatomyositis (JDM) is a rare, potentially life-threatening systemic autoimmune disease primarily affecting muscle and skin. Recent advances in the recognition, standardised assessment and treatment of JDM have been greatly facilitated by large collaborative research networks. Through these networks, a number of immunogenetic risk factors have now been defined, as well as a number of potential pathways identified in the aetio-pathogenesis of JDM. Myositis-associated and myositis-specific autoantibodies are helping to sub-phenotype JDM, defined by clinical features, outcomes and immunogenetic risk factors. Partially validated tools to assess disease activity and damage have assisted in standardising outcomes. Aggressive treatment approaches, including multiple initial therapies, as well as new drugs and biological therapies for refractory disease, offer promise of improved outcomes and less corticosteroid-related toxicity.
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Affiliation(s)
- Lucy R Wedderburn
- Rheumatology Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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López De Padilla CM, Vallejo AN, Lacomis D, McNallan K, Reed AM. Extranodal lymphoid microstructures in inflamed muscle and disease severity of new-onset juvenile dermatomyositis. ACTA ACUST UNITED AC 2009; 60:1160-72. [PMID: 19333937 DOI: 10.1002/art.24411] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Juvenile dermatomyositis (DM) is an autoimmune disease of childhood characterized by lesions in skin and muscle that are populated by plasmacytoid dendritic cells (PDCs) and lymphocyte infiltrates. We undertook this study to examine the cellular composition, organization, and molecular milieu of the cellular infiltrates in muscle in juvenile DM and to correlate the infiltrates with clinical disease manifestations. METHODS Since PDCs and lymphocyte foci express CCL19 and CCL21, we investigated for in situ formation of lymphoid microstructures that could be sites of extranodal immune activation. RESULTS Analyses of muscle biopsy samples from children with new-onset juvenile DM showed 3 categories of lesions: diffuse infiltrates, lymphocytic aggregates lacking follicle-like organization, and follicle-like structures. The last of these exhibited elements of classic lymphoid follicles, including networks of follicular dendritic cells and high endothelial venules. They also expressed high levels of CXCL13 and lymphotoxins known to support lymphoid organogenesis. There were also resident naive CD45RA+ T cells and maternally derived B cells and PDCs. Patients with diffuse infiltrates or lymphocytic aggregates were responsive to standard therapy with steroids and methotrexate, but those with follicle-like structures tended to have severe disease that required additional agents such as intravenous Ig or rituximab. CONCLUSION These data suggest that lymphoneogenesis is a component of the early disease process in juvenile DM. Ectopic lymphoid structures could indicate a severe course of disease; their early detection could be a tool for disease management.
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Kroneis T, Gutstein-Abo L, Kofler K, Hartmann M, Hartmann P, Alunni-Fabbroni M, Walcher W, Dohr G, Petek E, Guetta E, Sedlmayr P. Automatic retrieval of single microchimeric cells and verification of identity by on-chip multiplex PCR. J Cell Mol Med 2009; 14:954-69. [PMID: 19453769 PMCID: PMC3823127 DOI: 10.1111/j.1582-4934.2009.00784.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The analysis of rare cells is not an easy task. This is especially true when cells representing a fetal microchimerism are to be utilized for the purpose of non-invasive prenatal diagnosis because it is both imperative and difficult to avoid contaminating the minority of fetal cells with maternal ones. Under these conditions, even highly specific biochemical markers are not perfectly reliable. We have developed a method to verify the genomic identity of rare cells that combines automatic screening for enriched target cells (based on immunofluorescence labelling) with isolation of single candidate microchimeric cells (by laser microdissection and subsequent laser catapulting) and low-volume on-chip multiplex PCR for DNA fingerprint analysis. The power of the method was tested using samples containing mixed cells of related and non-related individuals. Single-cell DNA fingerprinting was successful in 74% of the cells analysed (55/74), with a PCR efficiency of 59.2% (860/1452) for heterozygous loci. The identification of cells by means of DNA profiling was achieved in 100% (12/12) of non-related cells in artificial mixtures and in 86% (37/43) of cells sharing a haploid set of chromosomes and was performed on cells enriched from blood and cells isolated from tissue. We suggest DNA profiling as a standard for the identification of microchimerism on a single-cell basis.
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Affiliation(s)
- Thomas Kroneis
- Institute of Cell Biology, Histology and Embryology, Center for Molecular Medicine, Medical University of Graz, Graz, Austria
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Abstract
The observation that maternal cells can transfer from mother to child during pregnancy and differentiate into many different tissues including islet beta cells is exciting and intriguing, and to date has generated more questions than answers: Could these genetically distinct maternal cells play a role in the initiation of autoimmune diabetes in the child? Why do some individuals appear to have higher levels of maternal cells than others? What can we learn about how human beta cells differentiate from maternal stem cells? In this article, we review published data on maternal microchimerism in type 1 diabetes (and other autoimmune diseases) and discuss the technical limitations involved in the study of these maternally inherited cells. By improving the methodologies available for analysis of maternal cells in humans we will increasingly be in a position to answer the questions laid out above and to fully understand the biological insights generated by this experiment of nature.
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Abstract
Sexual dimorphism in anatomical, physiological and behavioural traits are characteristics of many vertebrate species. In humans, sexual dimorphism is also observed in the prevalence, course and severity of many common diseases, including cardiovascular diseases, autoimmune diseases and asthma. Although sex differences in the endocrine and immune systems probably contribute to these observations, recent studies suggest that sex-specific genetic architecture also influences human phenotypes, including reproductive, physiological and disease traits. It is likely that an underlying mechanism is differential gene regulation in males and females, particularly in sex steroid-responsive genes. Genetic studies that ignore sex-specific effects in their design and interpretation could fail to identify a significant proportion of the genes that contribute to risk for complex diseases.
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Affiliation(s)
- Carole Ober
- Department of Human Genetics, 920 East 58th Street, The University of Chicago, Chicago, Illinois 60637, USA.
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Abstract
PURPOSE OF REVIEW Powerful new methods are allowing identification of genetic risk factors in large populations of adults with autoimmune diseases. In this review, we describe the advantages and limitations of genetic methodologies, and how these methods have been used to discover candidate genes in smaller populations of pediatric patients. We also introduce novel concepts for nontraditional modes of genetic inheritance that may be important in the pathogenesis of autoimmunity. RECENT FINDINGS Candidate genes identified by linkage analyses and genome-wide association scans in adult populations have led to focused genetic studies in pediatric populations. Some genes are associated with subsets of both adult and pediatric patients; others appear to be age specific. Novel concepts in genetics have uncovered potential contributions of maternal compared with paternal transmission, noninherited maternal alleles that may work through maternal microchimerism, and sex-specific epigenetic mechanisms of immunoregulation. SUMMARY Advancing methods are leading to the discovery of genes associated with childhood autoimmune diseases. However, the genetic contribution to disease risk for any one gene remains less than 30% for most diseases, suggesting that pediatric autoimmunity is not primarily genetic in a classical sense. A combinatorial approach considering the contributions of multiple genes, mode of inheritance, and environmental influences will be required to fully understand the mechanisms of pathogenesis in pediatric autoimmune disease.
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Opiela SJ, Levy RB, Adkins B. Murine neonates develop vigorous in vivo cytotoxic and Th1/Th2 responses upon exposure to low doses of NIMA-like alloantigens. Blood 2008; 112:1530-8. [PMID: 18539903 PMCID: PMC2515119 DOI: 10.1182/blood-2007-08-106500] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 05/20/2008] [Indexed: 11/20/2022] Open
Abstract
Early life exposure to noninherited maternal antigens (NIMAs) may occur via transplacental transfer and/or breast milk. There are indications that early life exposure to NIMAs may lead to lifelong tolerance. However, there is mounting evidence that exposure to NIMAs may also lead to immunologic priming. Understanding how these different responses arise could be critical in transplantation with donor cells expressing NIMAs. We recently reported that murine neonates that received a transplant of low doses of NIMA-like alloantigens develop vigorous memory cytotoxic responses, as assessed by in vitro assays. Here, we demonstrate that robust allospecific cytotoxicity is also manifest in vivo. Importantly, at low doses, NIMA-expressing cells induced the development of in vivo cytotoxicity during the neonatal period. NIMA-exposed neonates also developed vigorous primary and memory allospecific Th1/Th2 responses that exceeded the responses of adults. Overall, we conclude that exposure to low doses of NIMA-like alloantigens induces robust in vivo cytotoxic and Th1/Th2 responses in neonates. These findings suggest that early exposure to low levels of NIMA may lead to long-term immunologic priming of all arms of T-cell adaptive immunity, rather than tolerance.
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Affiliation(s)
- Shannon J Opiela
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, FL 33136, USA
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Abstract
Juvenile dermatomyositis, the most common inflammatory myopathy of childhood, is a rare systemic autoimmune vasculopathy that is characterised by weakness in proximal muscles and pathognomonic skin rashes. The length of time before the initiation of treatment affects presenting symptoms, laboratory measures, and pathophysiology. It also affects disease outcomes, including the development of pathological calcifications, which are associated with increased morbidity. Both genetic and environmental risk factors seem to have a role in the cause of juvenile dermatomyositis; HLA B8-DRB1*0301 ancestral haplotype is a strong immunogenetic risk factor, and antecedent infections and birth seasonality suggest that environmental stimuli might increase risk. Activation of dendritic cells with upregulation of genes induced by type-1 interferon (alpha) in muscle and peripheral blood seems to be central to disease pathogenesis. Treatment often includes combinations of corticosteroids, methotrexate, and other immunosuppressive agents. Disease outcome, if treatment is initiated early, is generally good. Randomised controlled trials are needed to define the most effective treatments.
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Affiliation(s)
- Brian M Feldman
- Departments of Pediatrics, Health Policy Management and Evaluation, and Public Health Sciences, University of Toronto, Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada.
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Droitcourt C, Khosrotehran K, Halaby E, Aractingi S. Maternal cells are not responsible [corrected] for erythema toxicum neonatorum [corrected]. Pediatr Dermatol 2008; 25:411-3. [PMID: 18577067 DOI: 10.1111/j.1525-1470.2008.00703.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Brace MD, Peters O, Menzies P, King WA, Nino-Soto MI. Sex chromosome chimerism and the freemartin syndrome in Rideau Arcott sheep. Cytogenet Genome Res 2008; 120:132-9. [PMID: 18467837 DOI: 10.1159/000118752] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2007] [Indexed: 11/19/2022] Open
Abstract
In cattle, nearly all heifers born co-twin to a male are freemartins, XX/XY chimeras that exhibit a characteristic masculinized phenotype. However, in sheep, while litters containing males and females are common, freemartins are relatively rare. The primary aim of this study was to determine the frequency and features of XX/XY chimerism in female Rideau Arcott sheep. Also, breeding records were used to investigate the effect of litter size and sex ratios, as well as the genetic basis of the condition. Finally, the migration and transcriptional competence of cells of the opposite sex in the XX/XY female and male chimeras was explored. Genomic DNA (gDNA) from peripheral blood cells of ewes was screened by PCR for the male-specific SRY gene. Of 230 lambs screened, 10 were identified as chimeras. Litter size and sex ratio showed no statistically significant effect on the frequency of chimerism. PCR and FISH analysis confirmed the presence of opposite sex cells in female and male chimeras, and in the case of ewes, their migration to tissues other than blood. Transcriptional activity of SRY and AMH was detected in gonads of ewes, whereas XIST expression was detected in white blood cells of chimeric rams. It was concluded that the frequency of sex chromosome chimerism in Rideau Arcott sheep is estimated at 4.35%, with no significant effect of litter size and sex ratio. Moreover, as it was shown that opposite sex cells can migrate to tissues other than blood and be transcriptionally active in chimeric sheep, we speculate on the role they can play in these animals.
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Affiliation(s)
- M D Brace
- Department of Biomedical Science, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Megiorni F, Mora B, Bonamico M, Barbato M, Montuori M, Viola F, Trabace S, Mazzilli MC. HLA-DQ and susceptibility to celiac disease: evidence for gender differences and parent-of-origin effects. Am J Gastroenterol 2008; 103:997-1003. [PMID: 18177450 DOI: 10.1111/j.1572-0241.2007.01716.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Celiac disease (CD) is twice as frequent among female than male. Despite the large number of reports on the DQ2/DQ8 association, no systematic studies have investigated a possible different role of the HLA genes in the two genders. We performed case-control and family-based analyses of DR-DQ variants in a pediatric CD cohort with the aim of comparing female to male associations and to investigate the paternal/maternal inheritance of the disease-predisposing haplotypes. METHODS A total of 281 female and 156 male pediatric celiac patients, 292 nuclear families, and 551 controls were genotyped for HLA-DRB1, DQA1, and DQB1 loci. Odds ratio, parental origin of the disease-associated haplotypes, and transmission ratio distortion were evaluated in-between male and female cases. RESULTS DQ2/DQ8 were more frequent in female than in male patients (94% F, 85% M; P = 1.6 x 10(-3)) with a 99.1% and 90.5% calculated negative predictive value of the HLA test, respectively. Surprisingly, the majority of the 39 DQ2/DQ8 negative cases were male. The analysis of the DQ2 haplotype origin showed that 61% of female patients and 42% of male patients carried a paternal combination (P = 0.02). The transmission disequilibrium test (TDT) proved the major distortion in the DR3-DQ2 transmission from fathers to daughters. CONCLUSIONS CD is confirmed to be more prevalent in female than in male (F:M = 1.8) but, in DQ2/DQ8 negative patients, we found an unexpected male excess (F:M = 0.7). Moreover, only the inheritance of a paternal DQ2 haplotype led to a daughters predominance. These data show a role of HLA genes on the disease sex bias and suggest a possible different effect of parent-specific epigenetic modifications in the two genders.
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Affiliation(s)
- Francesca Megiorni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Jonsson AM, Uzunel M, Götherström C, Papadogiannakis N, Westgren M. Maternal microchimerism in human fetal tissues. Am J Obstet Gynecol 2008; 198:325.e1-6. [PMID: 18191801 DOI: 10.1016/j.ajog.2007.09.047] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 06/28/2007] [Accepted: 09/26/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the present study was to analyze the presence of maternal cells in human fetal tissues in the second trimester. STUDY DESIGN Tissues from 11 second-trimester fetuses terminated because of social reasons or because of malformations and/or trisomy were investigated. By cell sorting and polymerase chain reaction amplification, we studied the presence of maternal CD3+, CD19+, CD34+, and CD45+ in different fetal tissues and in placenta. RESULTS In the group of fetuses with normal karyotype and normal autopsy findings, 4 of 5 fetuses were positive for maternal microchimerism. In the group in which the fetuses were diagnosed with trisomy 21 and/or malformations, we found cells of maternal origin in 3 of 6 fetuses. CONCLUSION The results from this study indicate that maternal microchimerism is a common phenomenon in the second-trimester fetuses. Maternal cells of lymphoid and myeloid lineages and hematopoietic progenitors are widely distributed in the second-trimester fetuses.
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Affiliation(s)
- Anna Maria Jonsson
- Department of Obstetrics and Gynecology, the Center for Fetal Medicine, Karolinska University Hospital, Huddinge, Sweden.
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Compeyrot-Lacassagne S, Feldman BM. Inflammatory Myopathies in Children. Rheum Dis Clin North Am 2007; 33:525-53, vii. [DOI: 10.1016/j.rdc.2007.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mamyrova G, Kleiner DE, James-Newton L, Shaham B, Miller FW, Rider LG. Late-onset gastrointestinal pain in juvenile dermatomyositis as a manifestation of ischemic ulceration from chronic endarteropathy. ACTA ACUST UNITED AC 2007; 57:881-4. [PMID: 17530691 PMCID: PMC2099313 DOI: 10.1002/art.22782] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Gulnara Mamyrova
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Department of Health and Human Services, Bethesda, MD
| | - David E. Kleiner
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Laura James-Newton
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Department of Health and Human Services, Bethesda, MD
| | - Bracha Shaham
- University of Southern California School of Medicine, Division of Rheumatology, Children's Hospital, Los Angeles, California
| | - Frederick W. Miller
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Department of Health and Human Services, Bethesda, MD
| | - Lisa G. Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Department of Health and Human Services, Bethesda, MD
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Yunis EJ, Zuniga J, Romero V, Yunis EJ. Chimerism and tetragametic chimerism in humans: implications in autoimmunity, allorecognition and tolerance. Immunol Res 2007; 38:213-36. [DOI: 10.1007/s12026-007-0013-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 10/23/2022]
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Stevens AM. Do maternal cells trigger or perpetuate autoimmune diseases in children? Pediatr Rheumatol Online J 2007; 5:9. [PMID: 17550578 PMCID: PMC1892552 DOI: 10.1186/1546-0096-5-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 05/16/2007] [Indexed: 02/04/2023] Open
Abstract
The placental barrier is not the impenetrable wall that it was once presumed to be. During pregnancy, fetal cells pass into the mother, where they persist for decades after the pregnancy, leading to fetal microchimerism (FMc). Maternal cells also pass into the fetus, where they can persist long after birth of the child into adulthood, leading to maternal microchimerism(MMc). FMc and MMc represent foreign cells, and thus have been implicated in the pathogenesis of autoimmune diseases that resemble graft-versus-host disease after stem cell transplantation. FMc, hypothesized to contribute to the high predisposition of autoimmune diseases in women, has been reviewed recently. In patients who have never been pregnant, (children, males, and nulliparous females), MMc may represent the foreign cells that initiate or perpetuate chronic inflammatory disease.
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Affiliation(s)
- Anne M Stevens
- Department of Pediatrics, University of Washington, Children's Hospital and Regional Medical Center, 307 Westlake Ave N, Suite 300, Seattle, WA 98109, USA.
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