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The Genetic, Environmental, and Immunopathological Complexity of Autoantibody-Negative Rheumatoid Arthritis. Int J Mol Sci 2021; 22:ijms222212386. [PMID: 34830268 PMCID: PMC8618508 DOI: 10.3390/ijms222212386] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 12/19/2022] Open
Abstract
Differences in clinical presentation, response to treatment, and long-term outcomes between autoantibody-positive and -negative rheumatoid arthritis (RA) highlight the need for a better comprehension of the immunopathogenic events underlying the two disease subtypes. Whilst the drivers and perpetuators of autoimmunity in autoantibody-positive RA have started to be disclosed, autoantibody-negative RA remains puzzling, also due its wide phenotypic heterogeneity and its possible misdiagnosis. Genetic susceptibility appears to mostly rely on class I HLA genes and a number of yet unidentified non-HLA loci. On the background of such variable genetic predisposition, multiple exogeneous, endogenous, and stochastic factors, some of which are not shared with autoantibody-positive RA, contribute to the onset of the inflammatory cascade. In a proportion of the patients, the immunopathology of synovitis, at least in the initial stages, appears largely myeloid driven, with abundant production of proinflammatory cytokines and only minor involvement of cells of the adaptive immune system. Better understanding of the complexity of autoantibody-negative RA is still needed in order to open new avenues for targeted intervention and improve clinical outcomes.
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Wang Z, Lu X, Yao X, Liu X, Zhao L, Chang S, Zhang T, Niu B, Wang L. Relationship between HLA-DPA1 genetic polymorphism and anembryonic pregnancy. Mol Genet Genomic Med 2020; 8:e1046. [PMID: 31785132 PMCID: PMC6978238 DOI: 10.1002/mgg3.1046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Human leukocyte antigen (HLA)-DP is an HLA class II molecule. Overexpression of HLA class II molecules in placental trophoblast cells may induce pregnancy loss. However, the association between HLA-DP and pregnancy loss remains unclear. HLA-DPA1 is an HLA-DP peptide chain. The objective of this study was to assess the association between HLA-DPA1 genetic polymorphism and anembryonic pregnancy, a type of early pregnancy loss, in the Chinese population. METHODS A case-control study was designed to compare the frequencies of HLA-DPA1 gene polymorphisms in an anembryonic pregnancy group and a control group. Sixty-eight cases and 122 controls were recruited. Statistical analysis was performed to assess the correlation between single-nucleotide polymorphisms (SNPs) and anembryonic pregnancy susceptibility. MassARRAY high-throughput DNA analysis was used to analyze 19 HLA-DPA1 SNPs. To explore how HLA-DPA1 polymorphism could affect anembryonic pregnancy, HLA-DPA1 serum levels were analyzed by ELISA. RESULTS Homozygous typing of rs1431403 (CC and TT) significantly increased the risk of anembryonic pregnancy in the case group (ORCC = 3.13, 95% CI: 1.50-6.53; ORTT = 2.96, 95% CI: 1.31-6.66; ORCC+TT = 3.06, 95% CI: 1.62-5.78). In samples with high HLA-DPA1 levels (≥1,500 pg/ml), the homozygous rs1431403 genotypes (nCC = 21, 43.8%; nTT = 20, 57.1%) were observed more frequently than were heterozygous genotypes. CONCLUSION HLA-DPA1 rs1431403 may be a risk factor for anembryonic pregnancy in the Chinese population. Homozygous rs1431403 genotypes (CC and TT) may increase the risk of anembryonic pregnancy by aberrantly increasing the HLA-DPA1 levels.
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Affiliation(s)
- Zhendong Wang
- Laboratory of Biochemistry and Molecular BiologyShanxi Medical UniversityShanxiChina
| | - Xiaolin Lu
- Beijing Municipal Key Laboratory of Child Development and NutriomicsCapital Institute of PediatricsBeijingP.R. China
| | - Xiuying Yao
- Department of Obstetrics and GynecologyPLA General Hospital 263th Clinical DepartmentBeijingChina
| | - Xinli Liu
- Department of Obstetrics and GynecologyPLA General Hospital 263th Clinical DepartmentBeijingChina
| | - Linlin Zhao
- Department of Obstetrics and GynecologyPLA General Hospital 263th Clinical DepartmentBeijingChina
| | - Shaoyan Chang
- Beijing Municipal Key Laboratory of Child Development and NutriomicsCapital Institute of PediatricsBeijingP.R. China
| | - Ting Zhang
- Beijing Municipal Key Laboratory of Child Development and NutriomicsCapital Institute of PediatricsBeijingP.R. China
| | - Bo Niu
- Laboratory of Biochemistry and Molecular BiologyShanxi Medical UniversityShanxiChina
- Beijing Municipal Key Laboratory of Child Development and NutriomicsCapital Institute of PediatricsBeijingP.R. China
| | - Li Wang
- Beijing Municipal Key Laboratory of Child Development and NutriomicsCapital Institute of PediatricsBeijingP.R. China
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Nelson JL, Lambert NC. Rheumatoid arthritis: Forward and reverse inheritance - the yin and the yang. Nat Rev Rheumatol 2017; 13:396-397. [PMID: 28592894 PMCID: PMC5812457 DOI: 10.1038/nrrheum.2017.88] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The theory of Mendelian inheritance states that half our genes are maternal and half are paternal. This view is incomplete, as maternal–fetal exchange creates a legacy of non-native cells within an individual that can affect their health for better or worse, including contributing to their risk of developing autoimmune disease.
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Affiliation(s)
- J Lee Nelson
- Clinical Research Division, Immunogenetics, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, Washington 98109, USA; and at the Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Nathalie C Lambert
- Aix-Marseille University, INSERM, Gènes HLA-DR, 163 Avenue de Luminy, 13288 Marseille cedex 09, France
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Bell SW, Shenoi S, Nelson JL, Bhatti P, Mueller BA. Juvenile idiopathic arthritis in relation to perinatal and maternal characteristics: a case control study. Pediatr Rheumatol Online J 2017; 15:36. [PMID: 28494794 PMCID: PMC5425970 DOI: 10.1186/s12969-017-0167-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/01/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Existing data on associations between maternal and early childhood exposures and juvenile idiopathic arthritis (JIA) risk is scant and inconsistent with previous studies showing potential role for prematurity, number of siblings and infections. We explored JIA and International League of Associations for Rheumatology (ILAR) JIA categories in relation to selected infant (birthweight, size-for-gestational-age, gestational age), and maternal (parity, delivery type, prior fetal loss) characteristics that may be markers for exposures related to two pathways (hygiene hypothesis, microchimerism) potentially associated with autoimmune disorder occurrence. METHODS A case-control analysis with 1,234 JIA cases and 5,993 birth year-matched controls was conducted. Exposure information was obtained from WA state birth certificates. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for associations with maternal and early life exposures for JIA and JIA categories. RESULTS Greater maternal parity was associated with a decreased OR for JIA (most marked for persistent oligoarticular JIA, OR 0.32, 95% CI 0.15; 0.71, p for trend = 0.0001). Prior fetal loss (except for oligoarticular JIA) was associated with an increased OR for JIA. Prematurity was associated with increased risk of enthesitis related arthritis (OR 1.9, 95% CI: 1.3-2.9) and rheumatoid factor positive polyarticular JIA (OR 2.2, 95% CI: 1.0-4.8). CONCLUSIONS We observed associations of selected maternal factors with JIA, some of which varied across JIA categories. The findings of decreased ORs for JIA in relation to greater maternal parity may be consistent with the hygiene and microchimerism hypotheses. Future studies with biomarkers relevant to these hypotheses will help elucidate any associations.
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Affiliation(s)
- Samantha W. Bell
- 0000000122986657grid.34477.33Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA ,0000 0001 2297 6811grid.266102.1School of Medicine, University of California, San Francisco, San Francisco, CA USA ,0000 0001 2297 6811grid.266102.1University of California, San Francisco, 513 Parnassus Ave., Room S245, San Francisco, CA 94143 USA
| | - Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA USA
| | - J. Lee Nelson
- 0000 0001 2180 1622grid.270240.3Public Health Sciences Division, Fred Hutchison Cancer Research Center, Seattle, WA USA
| | - Parveen Bhatti
- 0000000122986657grid.34477.33Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA ,0000 0001 2180 1622grid.270240.3Public Health Sciences Division, Fred Hutchison Cancer Research Center, Seattle, WA USA
| | - Beth A. Mueller
- 0000000122986657grid.34477.33Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA ,0000 0001 2180 1622grid.270240.3Public Health Sciences Division, Fred Hutchison Cancer Research Center, Seattle, WA USA
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Burlingham WJ. Exosomes: The missing link between microchimerism and acquired tolerance? CHIMERISM 2015; 5:63-7. [PMID: 26679558 DOI: 10.1080/19381956.2015.1082026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
It has become increasingly clear that the immune system of viviparous mammals is much more in the business of acquiring tolerance to non-self antigens, than it is in rejecting cells that express them (for a recent review, highlighting the role of Treg cells, see ref. (1) ). It is also clear that both self-tolerance, and acquired tolerance to non-self is a dynamic process, with a natural ebb and flow. As has been often said of an effective team defense in sports, tolerance will "bend but does not break." How microchimerism, defined as the presence of extremely rare [1/10(4)-1/10(6)] cells of a genetically different individual, can induce either new immunogenetic pressures that push self-tolerance to the breaking point, or alternatively, provide relief from pre-existing immunogenetic risk, preventing development of autoimmune disease, remains a mystery. Indeed, the inability to directly correlate DNA-level microchimerism detected in blood samples by qPCR, with naturally occurring regulation to minor H and MHC alloantigens expressed by the rare cells themselves, has been frustrating to researchers in this field. (2) [Haynes, W.J. et al, this issue] However, recent developments in the areas of transplantation and reproductive immunology offer clues to how the effects of microchimerism can be amplified, and how a disproportionate immune impact might occur from a very limited cell source.
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Affiliation(s)
- William J Burlingham
- a Department of Surgery; Division of Transplantation ; University of Wisconsin ; Madison , WI , USA
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Ma KK, Nelson JL, Guthrie KA, Dugowson CE, Gammill HS. Adverse pregnancy outcomes and risk of subsequent rheumatoid arthritis. Arthritis Rheumatol 2014; 66:508-12. [PMID: 24574209 DOI: 10.1002/art.38247] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/22/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Pregnancy and reproductive outcomes have been associated with altered risk of some autoimmune diseases, including rheumatoid arthritis (RA). We sought to determine whether prior pregnancy resulting in a low birth weight (LBW) infant or preterm birth is associated with a risk of subsequent RA in the mother. METHODS We conducted an analysis of RA risk in parous women from a population-based prospective study of newly diagnosed cases of RA and age-matched healthy controls. The primary outcome measure was disease status (RA versus control), with exposures of prior preterm birth and prior delivery of an infant with LBW (≤2,500 gm), very low birth weight (VLBW; ≤1,500 gm), or extremely low birth weight (ELBW; ≤1,000 gm). A preplanned analysis including only rheumatoid factor (RF)-positive RA cases was also conducted. RESULTS A total of 202 RA cases and 1,102 controls were analyzed. Prior delivery of an infant with ELBW was associated with RA in the mother (relative risk [RR] 3.7 [95% confidence interval (95% CI) 1.0-13.2]). Prior VLBW (RR 4.0 [95% CI 1.3-11.4]) and ELBW (RR 5.5 [95% CI 1.4-22.5]) infants were associated with RF-positive RA. Prior LBW deliveries and preterm births were more common among RA cases than controls, but the differences were not statistically significant. CONCLUSION Compared to those with uncomplicated pregnancies, women with a prior VLBW or ELBW delivery had a higher risk of RA, particularly RF-positive RA. This association may reflect common risk factors for pregnancy complications and RA. Alternatively, complicated pregnancy itself may confer risk of subsequent RA.
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Abstract
PURPOSE OF REVIEW To review the association of pregnancy with the risk of subsequent development of rheumatic autoimmune diseases in women, including rheumatoid arthritis (RA), systemic lupus erythematosus, and scleroderma. RECENT FINDINGS There is a small but growing literature related to the risk of autoimmune rheumatic disease in association with pregnancy history. However, results conflict both in terms of the direction and magnitude of risk of disease in relationship to prior pregnancy history. Although anecdotal evidence tends to favor the premise that pregnancy is protective against certain diseases, such as RA, the heterogeneity of results precludes the ability to confirm an association in either direction. There is indication that time elapsed since pregnancy may influence risk, with the postpartum year being of particular relevance. SUMMARY To date, a clear pattern has not emerged regarding pregnancy and the future risk of autoimmune rheumatic diseases. This topic requires greater study, and given the strong female preponderance of these diseases, future research efforts should seek to resolve this important issue.
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Affiliation(s)
- Wendy Marder
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Somers
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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