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Zingg F, Ryser FS, Gloor AD, Polysopoulos C, Villiger PM, Maurer B, Christ L. Serum protein profiling reveals distinct patient clusters in giant cell arteritis. Rheumatology (Oxford) 2024:keae072. [PMID: 38323660 DOI: 10.1093/rheumatology/keae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVES We investigated the potential of serum proteins to distinguish clinical and molecular subtypes in patients with giant cell arteritis (GCA). METHODS Proximity extension assays were used to analyse 1463 proteins in serum samples from patients with new-onset GCA (n = 16) and after achieving remission (n = 13). Unsupervised and supervised cluster analyses were performed. RESULTS Unsupervised cluster analysis identified three distinct clusters based on the protein signature. Compared with cluster 2, patients of cluster 1 had less polymyalgia rheumatica symptoms, increased levels of macrophage migration inhibitory factor (MIF) and pronounced NF-kB, STAT5 and interleukin-1 signalling. The changes in serum proteins upon remission differed between cluster 1 and 2.Patients with cranial GCA were characterised by altered endothelial and Th17 signalling whereas patients not responding to treatment within the GUSTO-trial showed increased Th1 and diminished B cell signalling. Patients with anterior ischemic optic neuropathy displayed higher levels of CHI3L1 (YKL40), MMP12 and reduced levels of TIMP3. CONCLUSIONS Protein profiling identifies patient clusters in GCA with distinct proteomic features and therefore likely different pathophysiology. These unique proteomic footprints might lead to more targeted treatments in future.
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Affiliation(s)
- Flavia Zingg
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabio S Ryser
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Andrea D Gloor
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christos Polysopoulos
- Statistics and Data Management Group, Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Peter M Villiger
- Rheumatology and Immunology, Medical Center Monbijou, Bern, Switzerland
| | - Britta Maurer
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lisa Christ
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Christ L, Gloor AD, Kollert F, Gaber T, Buttgereit F, Reichenbach S, Villiger PM. Serum proteomics in giant cell arteritis in response to a three-day pulse of glucocorticoid followed by tocilizumab monotherapy (the GUSTO trial). Front Immunol 2023; 14:1165758. [PMID: 37287970 PMCID: PMC10242646 DOI: 10.3389/fimmu.2023.1165758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/02/2023] [Indexed: 06/09/2023] Open
Abstract
Objective Proteome analyses in patients with newly diagnosed, untreated giant cell arteritis (GCA) have not been reported previously, nor are changes of protein expression upon treatment with glucocorticoids (GC) and/or tocilizumab (TCZ) known. The GUSTO trial allows to address these questions, provides the opportunity to learn about the differential effects of GC and TCZ on proteomics and may help to identify serum proteins to monitor disease activity. Methods Serum samples obtained from 16 patients with new-onset GCA at different time points (day 0, 3, 10, and week 4, 24, 52) during the GUSTO trial (NCT03745586) were examined for 1436 differentially expressed proteins (DEPs) based on proximity extension assay technology. The patients received 500 mg methylprednisolone intravenously for 3 consecutive days followed by TCZ monotherapy. Results When comparing day 0 (before the first GC infusion) with week 52 (lasting remission), 434 DEPs (213↑, 221↓) were identified. In response to treatment, the majority of changes occurred within 10 days. GC inversely regulated 25 proteins compared to remission. No difference was observed between weeks 24 and 52 during established remission and ongoing TCZ treatment. Expression of CCL7, MMP12, and CXCL9 was not regulated by IL6. Conclusion Disease-regulated serum proteins improved within 10 days and were normalized within 24 weeks, showing a kinetic corresponding to the gradual achievement of clinical remission. The proteins inversely regulated by GC and TCZ shed light on the differential effects of the two drugs. CCL7, CXCL9, and MMP12 are biomarkers that reflect disease activity despite normalized C-reactive protein levels.
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Affiliation(s)
- Lisa Christ
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea D. Gloor
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Kollert
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Timo Gaber
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Stephan Reichenbach
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland
| | - Peter M. Villiger
- Medical Center Monbijou, Rheumatology and Immunology, Bern, Switzerland
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Gloor AD, Feldmeyer L, Rammlmair A, Schlapbach C, Wallach D, Borradori L. A relapsing localized variant of neutrophilic dermatosis triggered by tissue injury. Br J Dermatol 2020; 184:162-164. [PMID: 33169835 DOI: 10.1111/bjd.19418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/25/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
- A D Gloor
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Rammlmair
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - C Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - D Wallach
- Physician (Hon.) of Paris Hospitals, Paris, France
| | - L Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
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Abstract
Neutrophilic dermatoses (NDs) are a group of reactive, noninfectious autoinflammatory diseases characterized by (1) infiltration of the epidermis, dermis, and or/hypodermis by neutrophils; (2) their association with distinct diseases (eg, hematologic malignancy and chronic inflammatory diseases); (3) potential extracutaneous involvement; and (4) response to anti-inflammatory drugs, such as corticosteroids, dapsone, colchicine, and novel biologic therapies, such as the anti-interleukin-1 blockade. Although distinct NDs have been described, transitional forms with overlapping features are often identified. These justify a simplified classification of NDs with three major forms: superficial (epidermal or pustular) NDs, dermal (en plaques) NDs, and deep NDs. We review selected or novel variants of NDs, including subcorneal pustular dermatosis, the group of immunoglobulin A neutrophilic dermatoses, amicrobial pustular dermatosis of the folds, and neutrophilic urticarial dermatosis, as well as atypical forms of Sweet syndrome and pyoderma gangrenosum closely mimicking severe infectious diseases. Knowledge of these variants is essential for proper diagnosis, adequate management, and avoidance of a dangerous escalation of therapy, such as unnecessary immunosuppression or extensive surgery.
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Affiliation(s)
- Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Andrea D Gloor
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Gloor AD, Feldmeyer L, Borradori L. Neutrophilic dermatosis of the dorsal hands triggered by mechanical trauma. J Eur Acad Dermatol Venereol 2020; 35:e20-e21. [PMID: 32534462 DOI: 10.1111/jdv.16750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- A D Gloor
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
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Gloor AD, Yerly D, Adler S, Reichenbach S, Kuchen S, Seitz M, Villiger PM. Immuno-monitoring reveals an extended subclinical disease activity in tocilizumab-treated giant cell arteritis. Rheumatology (Oxford) 2018; 57:1795-1801. [DOI: 10.1093/rheumatology/key158] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Andrea D Gloor
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland
| | - Daniel Yerly
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland
| | - Sabine Adler
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland
| | - Stephan Reichenbach
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stefan Kuchen
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland
| | - Michael Seitz
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland
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