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Picchianti-Diamanti A, Navarra A, Aiello A, Laganà B, Cuzzi G, Salmi A, Vanini V, Maggi F, Meschi S, Matusali G, Notari S, Agrati C, Salemi S, Di Rosa R, Passarini D, Di Gioia V, Sesti G, Conti F, Spinelli FR, Corpolongo A, Chimenti MS, Ferraioli M, Sebastiani GD, Benucci M, Li Gobbi F, Santoro AP, Capri A, Puro V, Nicastri E, Goletti D. Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine. Vaccines (Basel) 2023; 11:1684. [PMID: 38006015 PMCID: PMC10675674 DOI: 10.3390/vaccines11111684] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Objectives: We aimed to analyse the incidence and severity of breakthrough infections (BIs) in rheumatoid arthritis (RA) patients after a COronaVIrus Disease 2019 (COVID-19) vaccination booster dose. Methods: We enrolled 194 RA patients and 1002 healthcare workers (HCWs) as controls. Clinical, lifestyle and demographic factors were collected at the time of the third dose, and immunogenicity analyses were carried out in a subgroup of patients at 4-6 weeks after the third dose. Results: BIs were experienced by 42% patients (82/194) with a median time since the last vaccination of 176 days. Older age (>50 years; aHR 0.38, 95% CI: 0.20-0.74), receiving conventional synthetic disease modifying antirheumatic drugs (csDMARDs) (aHR 0.52, 95%CI: 0.30-0.90) and having a titre of neutralising antibodies >20 (aHR 0.36, 95% CI: 0.12-1.07) were identified as protective factors. Conversely, anti-IL6R treatment and anti-CD20 therapy increased BI probability. BIs were mostly pauci-symptomatic, but the hospitalisation incidence was significantly higher than in HCWs (8.5% vs. 0.19%); the main risk factor was anti-CD20 therapy. Conclusions: Being older than 50 years and receiving csDMARDs were shown to be protective factors for BI, whereas anti-IL6R or anti-CD20 therapy increased the risk. Higher neutralising antibody titres were associated with a lower probability of BI. If confirmed in a larger population, the identification of a protective cut-off would allow a personalised risk-benefit therapeutic management of RA patients.
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Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Assunta Navarra
- Epidemiology Department, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy;
| | - Alessandra Aiello
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
| | - Andrea Salmi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
| | - Valentina Vanini
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
- Unità Operativa Semplice (UOS) Professioni Sanitarie Tecniche, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (F.M.); (S.M.); (G.M.)
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (F.M.); (S.M.); (G.M.)
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (F.M.); (S.M.); (G.M.)
| | - Stefania Notari
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.N.); (C.A.)
| | - Chiara Agrati
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.N.); (C.A.)
- Department of Pediatric Hematology and Oncology, Bambino Gesù Pediatric Hospital, 00152 Rome, Italy
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Damiano Passarini
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Valeria Di Gioia
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Fabrizio Conti
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.C.); (F.R.S.)
| | - Francesca Romana Spinelli
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.C.); (F.R.S.)
| | - Angela Corpolongo
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.C.); (E.N.)
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of ‘Medicina dei Sistemi’, University of Rome ‘Tor Vergata’, 00133 Rome, Italy;
| | - Mario Ferraioli
- Department of Rheumatology, San Camillo Hospital, 00152 Rome, Italy; (M.F.); (G.D.S.)
| | | | - Maurizio Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL—Toscana Centro, 50122 Florence, Italy; (M.B.); (F.L.G.)
| | - Francesca Li Gobbi
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL—Toscana Centro, 50122 Florence, Italy; (M.B.); (F.L.G.)
| | - Anna Paola Santoro
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.P.S.); (A.C.); (V.P.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Andrea Capri
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.P.S.); (A.C.); (V.P.)
| | - Vincenzo Puro
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.P.S.); (A.C.); (V.P.)
| | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.C.); (E.N.)
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
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Farroni C, Aiello A, Picchianti-Diamanti A, Laganà B, Petruccioli E, Agrati C, Garbuglia AR, Meschi S, Lapa D, Cuzzi G, Petrone L, Vanini V, Salmi A, Altera AMG, Repele F, Grassi G, Bettini A, Vita S, Mariano A, Damiani A, Infantino M, Grossi V, Manfredi M, Niccoli L, Puro V, Rosa RD, Salemi S, Sesti G, Scolieri P, Bruzzese V, Benucci M, Cantini F, Nicastri E, Goletti D. Booster dose of SARS-CoV-2 mRNA vaccines strengthens the specific immune response of patients with rheumatoid arthritis: A prospective multicenter longitudinal study. Int J Infect Dis 2022; 125:195-208. [PMID: 36328289 PMCID: PMC9622025 DOI: 10.1016/j.ijid.2022.10.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 07/12/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To characterize the kinetics of humoral and T-cell responses in rheumatoid arthritis (RA)-patients followed up to 4-6 weeks (T3) after the SARS-CoV-2 vaccine booster dose. METHODS Health care workers (HCWs, n=38) and RA-patients (n=52) having completed the mRNA vaccination schedule were enrolled at T3. In each cohort, 25 subjects were also sampled after 5 weeks (T1) and 6 months (T2) from the first vaccine dose. The humoral response was assessed by measuring anti-Receptor-Binding Domain (RBD) and neutralizing antibodies, the T-cell response by interferon-(IFN)-γ-release assay (IGRA), T-cell cytokine production and B-cell phenotype at T3 by flow cytometry. RESULTS RA-patients showed a significant reduction of antibody titers from T1 to T2 and a significant increase at T3. T-cell response by IGRA persisted over time in RA-patients, while increased in HCWs. Most RA-patients scored positive for anti-RBD, neutralizing antibody and T-cell responses, although the magnitude was lower than HCWs. The spike-specific-cytokine response was mainly CD4+ T cells-restricted in both cohorts, and significantly lower with reduced IL-2 response and CD4-antigen-responding naïve T cells in RA-patients. Unswitched memory B-cells were reduced in RA-patients compared with HCWs independently of vaccination. CONCLUSIONS COVID-19 vaccine booster strengthens the humoral immunity in RA-patients even with a reduced cytokine-response.
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Affiliation(s)
- Chiara Farroni
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Alessandra Aiello
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, "Sapienza" University, S. Andrea University Hospital, 00189 Rome, Italy
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, "Sapienza" University, S. Andrea University Hospital, 00189 Rome, Italy
| | - Elisa Petruccioli
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Chiara Agrati
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Daniele Lapa
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Linda Petrone
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Valentina Vanini
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy,Unità Operativa Semplice (UOS) Professioni Sanitarie Tecniche, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Andrea Salmi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Anna Maria Gerarda Altera
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Federica Repele
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Germana Grassi
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Aurora Bettini
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Serena Vita
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Andrea Mariano
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Arianna Damiani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Valentina Grossi
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Laura Niccoli
- Rheumatology Department, Hospital of Prato, Prato Italy
| | - Vincenzo Puro
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, "Sapienza" University, S. Andrea University Hospital, 00189 Rome, Italy
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, "Sapienza" University, S. Andrea University Hospital, 00189 Rome, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, "Sapienza" University, S. Andrea University Hospital, 00189 Rome, Italy
| | - Palma Scolieri
- UOC di Medicina e Rete Reumatologica, Ospedale Nuovo Regina Margherita, Rome, Italy
| | - Vincenzo Bruzzese
- UOC di Medicina e Rete Reumatologica, Ospedale Nuovo Regina Margherita, Rome, Italy
| | - Maurizio Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | | | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy,Corresponding author: Translational Research Unit of the Research Department, National Institute for Infectious Diseases, Padiglione del Vecchio, Room 39, Via Portuense 292, Rome 00149, Italy. Tel.: +39 06 55170 906; fax: +39 06 5582 825
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Petrone L, Picchianti-Diamanti A, Sebastiani GD, Aiello A, Laganà B, Cuzzi G, Vanini V, Gualano G, Grifoni A, Ferraioli M, Castilletti C, Meschi S, Vaia F, Nicastri E, Sette A, Goletti D. Humoral and cellular responses to spike of δ SARS-CoV-2 variant in vaccinated patients with immune-mediated inflammatory diseases. Int J Infect Dis 2022; 121:24-30. [PMID: 35462039 PMCID: PMC9023365 DOI: 10.1016/j.ijid.2022.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/12/2022] [Accepted: 04/16/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES We assessed vaccination-induced antibody and cellular responses against spike from the ancestral strain and from the delta (δ) SARS-CoV-2 variant in patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressive therapy in comparison with immunocompetent subjects. METHODS We enrolled patients with IMID and immunocompetent subjects who completed the vaccination schedule within 4-6 months from the first dose. The interferon (IFN)-γ-response to spike peptides that were derived from the ancestral and the δ SARS-CoV-2 were measured by ELISA. Anti-Receptor Binding Domain IgG antibodies were also evaluated. RESULTS We enrolled 43 patients with IMID and nine immunocompetent subjects. No significant differences were found after comparing the specific immune response (IFN-γ) between patients with IMID and immunocompetent subjects to the ancestral (p = 0.36) or δ peptide pool (p = 0.51). Nevertheless, IFN-γ-specific responses to the ancestral or to the δ pools were reduced in subjects taking CTLA4-IgG or TNF-α inhibitors compared with subjects treated with IL-6 inhibitors or Disease Modifying Anti-Rheumatic Drugs. Regarding the antibody response, no significant differences were observed between patients with IMID and immunocompetent individuals. CONCLUSIONS Cellular responses to δ SARS-CoV-2 variant remain largely intact in patients with IMID. However, the magnitude of these responses is dependent on the specific IMID immunosuppressive regimen. Serological response was also similar between the IMID and control groups.
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Affiliation(s)
- Linda Petrone
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, "Sapienza" University, S. Andrea University Hospital, 00189 Rome, Italy
| | | | - Alessandra Aiello
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, "Sapienza" University, S. Andrea University Hospital, 00189 Rome, Italy
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Valentina Vanini
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy; Unità Operativa Semplice (UOS) Professioni Sanitarie Tecniche, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA, 92037, USA
| | - Mario Ferraioli
- Rheumatology, Allergology and Clinical Immunology, Dipartimento di medicina dei sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Concetta Castilletti
- Virology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Silvia Meschi
- Virology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Francesco Vaia
- UOC Direzione Sanitaria, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Emanuele Nicastri
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA, 92037, USA
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy.
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Gioia C, Picchianti-Diamanti A, Perricone R, Chimenti MS, Afeltra A, Navarini L, Migliore A, Massafra U, Bruzzese V, Scolieri P, Meschini C, Scapato P, Paroli M, Scrivo R, Conti F, Laganà B, Di Franco M. AB0380 ANTI-TNFα: ORIGINATORS vs BIOSIMILARS, COMPARISON IN CLINICAL RESPONSE ASSESSMENT IN A MULTICENTER COHORT OF PATIENTS WITH INFLAMMATORY ARTHROPATHIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTumor necrosis factor (TNF)-α is one of principal proinflammatory cytokines involved in pathogenesis of different inflammatory arthropathies as Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS). Biotechnological drugs, represented among others by monoclonal antibodies directed against TNF-α, lead to a revolution in RA and spondylarthritis treatment. They were the first biological drugs used to treat these diseases, with good results in terms of safety and efficacy. Also because of high cost of these drugs, for some years biosimilars have been introduced in clinical practice. Biosimilars are less expensive (in Italy, less of 30% than bioriginators); they underwent to a severe process of “comparability” to assess safety and efficacy like their originators. In Italy, AIFA authorized SB4 (etanercept biosimilar), SB5 and ABP501 (adalimumab biosimilars) after passing III-phase randomized clinical trials; but real-life data and registers are lacking.ObjectivesAim of this study is to compare biosimilars and bioriginators in terms of safety and efficacy in a real-life contest.MethodsWe consequently enrolled patients, affected by inflammatory arthropathies (RA, PsA, AS) and treated with biosimilars (SB4, ABP501), belonging to any of the main biological prescribing centers in the Lazio region, from 2017 to 2020. Moreover, we enrolled patients, affected by same inflammatory diseases, but treated with corresponding originator. Clinical and laboratory data as well as disease activity indices, were collected at recruitment (T0) and after 4 (T1), 8 (T2), 12 (T3) and 24 (T4) months of therapy. Adverse events were registered.ResultsThe multicenter cohort was composed by 455 patients treated with biosimilars (SB4/ABP501 276/179; F/M 307/146; naïve 56%, median age/IQR 55/46-65) and 436 treated with originators (etanercept/adalimumab 186/259, F/M 279/157, naïve 67,2%, median age/IQR 53/43-62). No differences were found about safety, but biosimilar group presented a higher number of discontinuations due to inefficacy (p<0.001), observed at all time-points. Female gender, to be smoker and b-DMARDs naïve, the initial non-response to the drug were predictive factors of reduced drug survival (p=0,05, p=0,046, p=0,001 respectively). Retention rate at 24 months was 81.1% for bioriginators and 76.5% for biosimilars (with a median retention time of 20.7 and 18.9 months, respectively) (p=0.002). Patients with remission/low disease activity achievement at T1 showed a cumulative survival of 90% to biosimilar therapy until at T4 (p=0.001); early adverse reactions instead represented an important cause of subsequent drug discontinuation (p=0.001).ConclusionReal-life data demonstrated the same safety between biosimilars and originators but a reduced biosimilar retention rate at 24 months, about 76%. Despite their loss efficacy, biosimilars could be considered valid and safe, and a good and less expensive alternative to the originators, allowing access to these innovative treatments to a wider patient population.References[1]Feldmann, M. & Maini, R. N. Anti-TNFα therapy of rheumatoid arthritis: what have we learned? Annu. Rev. Immunol. 2001;19, 163–196.[2]McInnes IB, Schett G (2007) Cytokines in the pathogenesis of rheumatoid arthritis. Nat Rev Immunol 7:429–442[3]Velayudhan J, Chen YF, Rohrbach A, Pastula C, Maher G, Thomas H, et al. Demonstration of functional similarity of proposed biosimilar ABP 501 to adalimumab. BioDrugs. 2016;30(4):339– 51.[4]Emery P, Vencovsky ́ J, Sylwestrzak A et al. Long-term safety and efficacy of SB4 (etanercept biosimilar) in patients with rheumatoid arthritis: comparison between continuing SB4 and switching from etanercept reference product to SB4. Ann Rheum Dis 2016; 75:236.Figure 1.Disclosure of InterestsNone declared
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Farroni C, Picchianti-Diamanti A, Aiello A, Nicastri E, Laganà B, Agrati C, Castilletti C, Meschi S, Colavita F, Cuzzi G, Casetti R, Grassi G, Petrone L, Vanini V, Salmi A, Repele F, Altera AMG, Maffongelli G, Corpolongo A, Salemi S, Di Rosa R, Nalli G, Sesti G, Vaia F, Puro V, Goletti D. Kinetics of the B- and T-Cell Immune Responses After 6 Months From SARS-CoV-2 mRNA Vaccination in Patients With Rheumatoid Arthritis. Front Immunol 2022; 13:846753. [PMID: 35309297 PMCID: PMC8924958 DOI: 10.3389/fimmu.2022.846753] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/02/2022] [Indexed: 12/16/2022] Open
Abstract
ObjectiveTo assess the kinetics of the humoral and cell-mediated responses after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in rheumatoid arthritis (RA) patients treated with different immunosuppressive therapies.MethodsFollowing vaccine completed schedule, health care workers (HCWs, n = 49) and RA patients (n = 35) were enrolled at 5 weeks (T1) and 6 months (T6) after the first dose of BNT162b2-mRNA vaccination. Serological response was assessed by quantifying anti-receptor-binding domain (RBD)-specific immunoglobulin G (IgG) and SARS-CoV-2 neutralizing antibodies, while cell-mediated response was assessed by a whole-blood test quantifying the interferon (IFN)-γ response to spike peptides. B-cell phenotype and IFN-γ-specific T-cell responses were evaluated by flow cytometry.ResultsAfter 6 months, anti-RBD antibodies were still detectable in 91.4% of RA patients, although we observed a significant reduction of the titer in patients under Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4)-Ig [median: 16.4 binding antibody units (BAU)/ml, interquartile range (IQR): 11.3–44.3, p < 0.0001] or tumor necrosis factor (TNF)-α inhibitors (median: 26.5 BAU/ml, IQR: 14.9–108.8, p = 0.0034) compared to controls (median: 152.7 BAU/ml, IQR: 89.3–260.3). All peripheral memory B-cell (MBC) subpopulations, in particular, the switched IgG+ MBCs (CD19+CD27+IgD-IgM-IgG+), were significantly reduced in RA subjects under CTLA-4-Ig compared to those in HCWs (p = 0.0012). In RA patients, a significantly reduced anti-RBD IgG titer was observed at T6 vs. T1, mainly in those treated with CTLA-4-Ig (p = 0.002), interleukin (IL)-6 inhibitors (p = 0.015), and disease-modifying antirheumatic drugs (DMARDs) ± corticosteroids (CCSs) (p = 0.015). In contrast, a weak nonsignificant reduction of the T-cell response was reported at T6 vs. T1. T-cell response was found in 65.7% of the RA patients at T6, with lower significant magnitude in patients under CTLA-4-Ig compared to HCWs (p < 0.0001). The SARS-CoV-2 IFN-γ-S-specific T-cell response was mainly detected in the CD4+ T-cell compartment.ConclusionsIn this study, in RA patients after 6 months from COVID-19 vaccination, we show the kinetics, waning, and impairment of the humoral and, to a less extent, of the T-cell response. Similarly, a reduction of the specific response was also observed in the controls. Therefore, based on these results, a booster dose of the vaccine is crucial to increase the specific immune response regardless of the immunosuppressive therapy.
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Affiliation(s)
- Chiara Farroni
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Alessandra Aiello
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Chiara Agrati
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Concetta Castilletti
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Rita Casetti
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Germana Grassi
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Linda Petrone
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Valentina Vanini
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Unità Operativa Semplice (UOS) Professioni Sanitarie Tecniche, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Andrea Salmi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Federica Repele
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Anna Maria Gerarda Altera
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gaetano Maffongelli
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Angela Corpolongo
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Gabriele Nalli
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Francesco Vaia
- Unità Operativa Complessa (UOC) Direzione Sanitaria, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Vincenzo Puro
- Unità Operativa Complessa (UOC) Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- *Correspondence: Delia Goletti,
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Picchianti-Diamanti A, Aiello A, Laganà B, Agrati C, Castilletti C, Meschi S, Farroni C, Lapa D, Najafi Fard S, Cuzzi G, Cimini E, Grassi G, Vanini V, Di Rosa R, Salemi S, Nalli G, Salmi A, Repele F, Altera AMG, Maffongelli G, Palazzolo C, Vita S, Leone S, Puro V, Capobianchi MR, Ippolito G, Nicastri E, Goletti D. ImmunosuppressiveTherapies Differently Modulate Humoral- and T-Cell-Specific Responses to COVID-19 mRNA Vaccine in Rheumatoid Arthritis Patients. Front Immunol 2021; 12:740249. [PMID: 34594343 PMCID: PMC8477040 DOI: 10.3389/fimmu.2021.740249] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 01/03/2023] Open
Abstract
Objective To assess in rheumatoid arthritis (RA) patients, treated with different immunosuppressive therapies, the induction of SARS-CoV-2-specific immune response after vaccination in terms of anti-region-binding-domain (RBD)-antibody- and T-cell-specific responses against spike, and the vaccine safety in terms of clinical impact on disease activity. Methods Health care workers (HCWs) and RA patients, having completed the BNT162b2-mRNA vaccination in the last 2 weeks, were enrolled. Serological response was evaluated by quantifying anti-RBD antibodies, while the cell-mediated response was evaluated by a whole-blood test quantifying the interferon (IFN)-γ-response to spike peptides. FACS analysis was performed to identify the cells responding to spike stimulation. RA disease activity was evaluated by clinical examination through the DAS28crp, and local and/or systemic clinical adverse events were registered. In RA patients, the ongoing therapeutic regimen was modified during the vaccination period according to the American College of Rheumatology indications. Results We prospectively enrolled 167 HCWs and 35 RA patients. Anti-RBD-antibodies were detected in almost all patients (34/35, 97%), although the titer was significantly reduced in patients under CTLA-4-inhibitors (median: 465 BAU/mL, IQR: 103-1189, p<0.001) or IL-6-inhibitors (median: 492 BAU/mL, IQR: 161-1007, p<0.001) compared to HCWs (median: 2351 BAU/mL, IQR: 1389-3748). T-cell-specific response scored positive in most of RA patients [24/35, (69%)] with significantly lower IFN-γ levels in patients under biological therapy such as IL-6-inhibitors (median: 33.2 pg/mL, IQR: 6.1-73.9, p<0.001), CTLA-4-inhibitors (median: 10.9 pg/mL, IQR: 3.7-36.7, p<0.001), and TNF-α-inhibitors (median: 89.6 pg/mL, IQR: 17.8-224, p=0.002) compared to HCWs (median: 343 pg/mL, IQR: 188-756). A significant correlation between the anti-RBD-antibody titer and spike-IFN-γ-specific T-cell response was found in RA patients (rho=0.432, p=0.009). IFN-γ T-cell response was mediated by CD4+ and CD8+ T cells. Finally, no significant increase in disease activity was found in RA patients following vaccination. Conclusion This study showed for the first time that antibody-specific and whole-blood spike-specific T-cell responses induced by the COVID-19 mRNA-vaccine were present in the majority of RA patients, who underwent a strategy of temporary suspension of immunosuppressive treatment during vaccine administration. However, the magnitude of specific responses was dependent on the immunosuppressive therapy administered. In RA patients, BNT162b2 vaccine was safe and disease activity remained stable.
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Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Alessandra Aiello
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Chiara Agrati
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Concetta Castilletti
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Chiara Farroni
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Daniele Lapa
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Saeid Najafi Fard
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Eleonora Cimini
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Germana Grassi
- Laboratory of Cellular Immunology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Valentina Vanini
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
- Unità Operativa Semplice (UOS) Professioni Sanitarie Tecniche, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Gabriele Nalli
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, Rome, Italy
| | - Andrea Salmi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Federica Repele
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Anna Maria Gerarda Altera
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Claudia Palazzolo
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Serena Vita
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Sara Leone
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Vincenzo Puro
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
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Biondo MI, Fiorentino C, Persechino S, Tammaro A, Koverech A, Bartolazzi A, Raffa S, Canzoni M, Picchianti-Diamanti A, Di Rosa R, Di Zenzo G, Scala E, Meneguzzi G, Ferlito C, Markovic M, Caporuscio S, Sorgi ML, Salemi S, Laganà B. May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature. Microorganisms 2021; 9:microorganisms9061235. [PMID: 34200214 PMCID: PMC8229970 DOI: 10.3390/microorganisms9061235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering skin disease, mainly observed in the elderly. Infections have been suggested as possible disease triggers. However, infections may even heavily influence the disease clinical course and mortality. A 75-year-old woman was admitted to hospital for severe erythematosus blistering disease, accompanied by hyper-eosinophilia and hyper-IgE. The culture of bullous fluid was positive for Enterococcus faecalis, the blood culture was positive for Staphylococcus aureus, and the urine culture was positive for Proteus mirabilis and Escherichia coli. Moreover, circulating anti-BP180 IgG was present and the histopathological/ultrastructural examination of a lesional skin biopsy was compatible with BP. High eosinophil levels (up to 3170/µL) were found throughout the clinical course, while values below 1000/µL were associated with clinical improvement. The total IgE was 1273 IU/mL, and specific anti-G/V-penicillin/ampicillin IgE antibodies were positive. The patient had a complete clinical recovery in two months with methyl-prednisolone (40 then 20 mg/day) and low-dose azathioprine (50 mg/day) as a steroid-sparing agent. The steroid treatment was tapered until interruption during a one-year period and intravenous immunoglobulins have been administered for three years in order for azathioprine to also be interrupted. The patient stopped any treatment five years ago and, in this period, has always been in good health. In this case, the contemporaneous onset of different bacterial infections and BP is suggestive of bacterial infections acting as BP trigger(s), with allergic and autoimmune pathways contributing to the disease pathogenesis.
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Affiliation(s)
- Michela Ileen Biondo
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Chiara Fiorentino
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Severino Persechino
- UOD di Dermatologia, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (S.P.); (A.T.)
| | - Antonella Tammaro
- UOD di Dermatologia, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (S.P.); (A.T.)
| | - Angela Koverech
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Armando Bartolazzi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Salvatore Raffa
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Marco Canzoni
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Andrea Picchianti-Diamanti
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Roberta Di Rosa
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Giovanni Di Zenzo
- Istituto Dermopatico dell’Immacolata, 00167 Roma, Italy; (G.D.Z.); (E.S.)
| | - Enrico Scala
- Istituto Dermopatico dell’Immacolata, 00167 Roma, Italy; (G.D.Z.); (E.S.)
| | - Giorgia Meneguzzi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Claudia Ferlito
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Milica Markovic
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Sara Caporuscio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Maria Laura Sorgi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Simonetta Salemi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
- Correspondence: (S.S.); (B.L.)
| | - Bruno Laganà
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
- Correspondence: (S.S.); (B.L.)
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8
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Picchianti-Diamanti A, Spinelli FR, Rosado MM, Conti F, Laganà B. Inhibition of Phosphodiesterase-4 in Psoriatic Arthritis and Inflammatory Bowel Diseases. Int J Mol Sci 2021; 22:ijms22052638. [PMID: 33807944 PMCID: PMC7961737 DOI: 10.3390/ijms22052638] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 12/16/2022] Open
Abstract
Phosphodiesterases (PDEs) are a heterogeneous superfamily of enzymes which catalyze the degradation of the intracellular second messengers cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Among PDEs, PDE4 is the most widely studied and characterized isoenzyme. PDE4 blocking can lead to increased levels of intracellular cAMP, which results in down-regulation of inflammatory responses by reducing the expression of tumor necrosis factor (TNF), interleukin (IL)-23, IL-17, interferon-γ, while increasing regulatory cytokines, such as IL-10. Therefore, PDE4 has been explored as a therapeutic target for the treatment of different chronic inflammatory conditions such as psoriatic arthritis (PsA) and inflammatory bowel disease (IBD). PsA shares clinical, genetic, and pathogenic features with IBD such as ulcerative colitis (UC) and Crohn’s disease (CD), and enteropathic spondyloarthritis (eSpA) represent a frequent clinical evidence of the overlap between gut and joint diseases. Current therapeutic options in PsA patients and underlying UC are limited to synthetic immunosuppressants and anti-TNF. Apremilast is an oral PDE4 inhibitor approved for the treatment of active PsA patients with inadequate response to synthetic immunosuppressants. The efficacy and a good safety profile observed in randomized clinical trials with apremilast in PsA patients have been confirmed by few studies in a real-life scenario. In addition, apremilast led to significant improvement in clinical and endoscopic features in UC patients in a phase II RCT. By now there are no available data regarding its role in eSpA patients. In view of the above, the use of apremilast in eSpA patients is a route that deserves to be deepened.
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Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, “Sapienza” University, 00189 Rome, Italy;
- Correspondence:
| | - Francesca Romana Spinelli
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.R.S.); (F.C.)
| | | | - Fabrizio Conti
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.R.S.); (F.C.)
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, “Sapienza” University, 00189 Rome, Italy;
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9
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Pagnini C, Picchianti-Diamanti A, Bruzzese V, Lorenzetti R, Luchetti MM, Martin Martin LS, Pica R, Scolieri P, Scribano ML, Zampaletta C, Chimenti MS, Lagana B. Vitamin D Signaling in Gastro-Rheumatology: From Immuno-Modulation to Potential Clinical Applications. Int J Mol Sci 2021; 22:ijms22052456. [PMID: 33671090 PMCID: PMC7957646 DOI: 10.3390/ijms22052456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/31/2022] Open
Abstract
In the last decades, the comprehension of the pathophysiology of bone metabolism and its interconnections with multiple homeostatic processes has been consistently expanded. The branch of osteoimmunology specifically investigating the link between bone and immune system has been developed. Among molecular mediators potentially relevant in this field, vitamin D has been recently pointed out, and abnormalities of the vitamin D axis have been described in both in vitro and in vivo models of inflammatory bowel diseases (IBD) and arthritis. Furthermore, vitamin D deficiency has been reported in patients affected by IBD and chronic inflammatory arthritis, thus suggesting the intriguing possibility of impacting the disease activity by the administration vitamin D supplements. In the present review, the complex interwoven link between vitamin D signaling, gut barrier integrity, microbiota composition, and the immune system was examined. Potential clinical application exploiting vitamin D pathway in the context of IBD and arthritis is presented and critically discussed. A more detailed comprehension of the vitamin D effects and interactions at molecular level would allow one to achieve a novel therapeutic approach in gastro-rheumatologic inflammatory diseases through the design of specific trials and the optimization of treatment protocols.
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Affiliation(s)
- Cristiano Pagnini
- Department of Gastroenterology and Digestive Endoscopy, S. Giovanni Addolorata Hospital, 00184 Rome, Italy;
| | - Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, Sapienza University, 00189 Rome, Italy;
- Correspondence:
| | - Vincenzo Bruzzese
- Department of Internal Medicine, Rheumatology and Gastroenterology, Nuovo Regina Margherita Hospital, 00153 Rome, Italy; (V.B.); (R.L.); (P.S.)
| | - Roberto Lorenzetti
- Department of Internal Medicine, Rheumatology and Gastroenterology, Nuovo Regina Margherita Hospital, 00153 Rome, Italy; (V.B.); (R.L.); (P.S.)
| | - Michele Maria Luchetti
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, 60131 Ancona, Italy;
| | | | - Roberta Pica
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, 00157 Rome, Italy;
| | - Palma Scolieri
- Department of Internal Medicine, Rheumatology and Gastroenterology, Nuovo Regina Margherita Hospital, 00153 Rome, Italy; (V.B.); (R.L.); (P.S.)
| | | | | | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, 00187 Rome, Italy;
| | - Bruno Lagana
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, Sapienza University, 00189 Rome, Italy;
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10
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Canzoni M, Marignani M, Sorgi ML, Begini P, Biondo MI, Caporuscio S, Colonna V, Casa FD, Conigliaro P, Marrese C, Celletti E, Modesto I, Peragallo MS, Laganà B, Picchianti-Diamanti A, Rosa RD, Ferlito C, Salemi S, D’Amelio R, Stroffolini T. Prevalence of Hepatitis B Virus Markers in Patients with Autoimmune Inflammatory Rheumatic Diseases in Italy. Microorganisms 2020; 8:microorganisms8111792. [PMID: 33207663 PMCID: PMC7696870 DOI: 10.3390/microorganisms8111792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
Chronic hepatitis B virus (HBV) infection may be reactivated by immunosuppressive drugs in patients with autoimmune inflammatory rheumatic diseases. This study evaluates HBV serum markers' prevalence in rheumatic outpatients belonging to Spondyloarthritis, Chronic Arthritis and Connective Tissue Disease diagnostic groups in Italy. The study enrolled 302 subjects, sex ratio (M/F) 0.6, mean age ± standard deviation 57 ± 15 years, 167 (55%) of whom were candidates for immunosuppressive therapy. The Spondyloarthritis group included 146 subjects, Chronic Arthritis 75 and Connective Tissue Disease 83 (two patients had two rheumatic diseases; thus, the sum is 304 instead of 302). Ten subjects (3%) reported previous anti-HBV vaccination and tested positive for anti-HBs alone with a titer still protective (>10 IU/mL). Among the remaining 292 subjects, the prevalence of positivity for HBsAg, isolated anti-HBc, anti-HBc/anti-HBs, and any HBV marker was 2%, 4%, 18%, and 24%, respectively. A total of 26/302 (9%) patients with γ-globulin levels ≤0.7 g/dL were more frequently (p = 0.03455) prescribed immunosuppressive therapy, suggesting a more severe rheumatic disease. A not negligible percentage of rheumatic patients in Italy are at potential risk of HBV reactivation related to immunosuppressive therapy. Before starting treatment, subjects should be tested for HBV markers. Those resulting positive should receive treatment or prophylaxis with Nucleos (t) ides analogue (NUCs) at high barrier of resistance, or pre-emptive therapy, according to the pattern of positive markers. HB vaccination is recommended for those who were never exposed to the virus.
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Affiliation(s)
- Marco Canzoni
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
- Correspondence: (M.C.); (M.M.); Tel.: +39-333-4460720 (M.C.)
| | - Massimo Marignani
- UOC Malattie Apparato Digerente e Fegato, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy;
- Correspondence: (M.C.); (M.M.); Tel.: +39-333-4460720 (M.C.)
| | - Maria Laura Sorgi
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Paola Begini
- UOC Malattie Apparato Digerente e Fegato, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy;
| | - Michela Ileen Biondo
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Sara Caporuscio
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Vincenzo Colonna
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Francesca Della Casa
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Paola Conigliaro
- UOC di Reumatologia, Dipartimento di “Medicina dei Sistemi”, Università di Tor Vergata, 00133 Roma, Italy;
| | - Cinzia Marrese
- Ambulatorio di Reumatologia, ASL Roma 1, Presidio Nuovo Regina Margherita, 00153 Roma, Italy;
| | - Eleonora Celletti
- Istituto di Clinica Medica, ASL Lanciano-Vasto-Chieti, 66100 Chieti, Italy;
| | - Irene Modesto
- Unità Operativa di Medicina Interna, Università degli Studi di Palermo, AO Ospedali Riuniti Villa Sofia-Cervello, PO Vincenzo Cervello, 90146 Palermo, Italy;
| | | | - Bruno Laganà
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Andrea Picchianti-Diamanti
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Roberta Di Rosa
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Claudia Ferlito
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Simonetta Salemi
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Raffaele D’Amelio
- UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.L.S.); (M.I.B.); (S.C.); (V.C.); (F.D.C.); (B.L.); (A.P.-D.); (R.D.R.); (C.F.); (S.S.); (R.D.)
| | - Tommaso Stroffolini
- Dipartimento di Malattie Infettive e Tropicali, Policlinico Umberto I, 00161 Roma, Italy;
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11
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Benfaremo D, Luchetti MM, Di Carlo M, Laganà B, Picchianti-Diamanti A, Carubbi F, Pica R, Chimenti MS, Lorenzetti R, Scolieri P, Bruzzese V, Benedetti A, Ramonda R, Giacomelli R, Salaffi F, Gabrielli A. Multicenter Validation of the DETAIL Questionnaire for the Screening of Spondyloarthritis in Patients With Inflammatory Bowel Diseases. J Rheumatol 2020; 48:179-187. [PMID: 32669448 DOI: 10.3899/jrheum.200364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Spondyloarthritis (SpA) is among the most frequent extraintestinal manifestations of inflammatory bowel diseases (IBD). In this study, we aimed to validate the DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire in a multicenter cohort of patients with IBD enrolled at 11 gastroenterology units. METHODS From October 2018 to March 2019, consecutive adult patients with IBD, either Crohn disease or ulcerative colitis, independently filled out the DETAIL questionnaire in the outpatient waiting room. Within 2 weeks a blinded rheumatologist assessed all the patients, irrespective of the DETAIL results, and classified them to be affected or not by SpA. The performance of the questions was evaluated through Bayesian analysis. RESULTS Overall, 418 patients with IBD filled out the DETAIL questionnaire. Upon rheumatological evaluation, 102 (24.4%) patients received a diagnosis of SpA. Of the 6 questions, the best performances were found in question 6 [positive likelihood ratio (LR)+ 3.77], reporting inflammatory back pain at night, and in question 3 (LR+ 3.31), exploring Achilles enthesitis. The presence of back pain lasting > 3 months (LR+ 2.91), back pain with inflammatory features (LR+ 2.55), and a history of dactylitis (LR+ 2.55), also showed a fairly good performance, whereas a history of peripheral synovitis was slightly worse (LR+ 2.16). The combination of at least 3 questions answered affirmatively yielded a posttest probability of SpA of 80% or more. The presence of alternative diagnoses, such as osteoarthritis or fibromyalgia, represented a minor confounder. CONCLUSION The DETAIL questionnaire is a useful tool for the early detection of SpA in IBD.
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Affiliation(s)
- Devis Benfaremo
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Michele Maria Luchetti
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Marco Di Carlo
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Bruno Laganà
- B. Laganà, MD, A. Picchianti-Diamanti, MD, PhD, Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome
| | - Andrea Picchianti-Diamanti
- B. Laganà, MD, A. Picchianti-Diamanti, MD, PhD, Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome
| | - Francesco Carubbi
- F. Carubbi, MD, PhD, R. Giacomelli, MD, PhD, Rheumatology Unit, University Hospital "S. Salvatore", Department of Clinical and Biotechnologic Sciences, University of L'Aquila
| | - Roberta Pica
- R. Pica, MD, UOS Gastroenterologia Territoriale, ASL Roma 2, Rome
| | - Maria Sole Chimenti
- M.S. Chimenti, MD, UOC Reumatologia, Dipartimento di Medicina dei Sistemi, Università di Tor Vergata, Roma
| | - Roberto Lorenzetti
- R. Lorenzetti, MD, UOC Gastroenterologia, Polo Ospedaliero Nuovo Regina Margherita - S.Spirito, Rome
| | - Palma Scolieri
- P. Scolieri, MD, V. Bruzzese, MD, UOC Medicina Interna e Reumatologia, Polo Ospedaliero Nuovo Regina Margherita - S.Spirito, Rome
| | - Vincenzo Bruzzese
- P. Scolieri, MD, V. Bruzzese, MD, UOC Medicina Interna e Reumatologia, Polo Ospedaliero Nuovo Regina Margherita - S.Spirito, Rome
| | - Antonio Benedetti
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Roberta Ramonda
- R. Ramonda, MD, PhD, UOC di Reumatologia, Dipartimento di Medicina DIMED, Università di Padova, Italy
| | - Roberto Giacomelli
- F. Carubbi, MD, PhD, R. Giacomelli, MD, PhD, Rheumatology Unit, University Hospital "S. Salvatore", Department of Clinical and Biotechnologic Sciences, University of L'Aquila
| | - Fausto Salaffi
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - Armando Gabrielli
- D. Benfaremo, MD, M.M. Luchetti, MD, M. Di Carlo, MD, F. Salaffi, MD, PhD, A. Gabrielli, MD, A. Benedetti, MD, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
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12
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Chimenti MS, Fonti GL, Conigliaro P, Sunzini F, Scrivo R, Navarini L, Triggianese P, Peluso G, Scolieri P, Caccavale R, Picchianti-Diamanti A, De Martino E, Salemi S, Birra D, Altobelli A, Paroli M, Bruzzese V, Laganà B, Gremese E, Conti F, Afeltra A, Perricone R. FRI0270 ONE-YEAR EFFECTIVENESS, RETENTION RATE AND SAFETY OF SECUKINUMAB IN ANKYLOSING SPONDYLITIS AND PSORIATIC ARTHRITIS: A REAL-LIFE MULTICENTRE STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Secukinumab (SEC) is the first interleukin-17A inhibitor showing efficacy in both ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in randomised trials, but real-life data are lacking.Objectives:In this prospective observational study, we evaluated the effectiveness and safety of SEC in patients with AS and PsA in a real-life setting.Methods:From September 2018 to September 2019, data were collected from 168 consecutive outpatients at baseline (T0) and at 6 (T6) and 12 months (T12) after starting SEC (39 AS, 23%; 129 PsA, 77%).Results:Significant improvement was seen at T6 and T12 for all clinical variables, including TJC, SJC, ESR, CRP, DAPSA, ASDAS-CRP, and BASDAI, as well as in patient-reported outcomes such as VAS-pain. By multivariable regression analysis, in AS patients high BASDAI at T0 correlated with diagnostic delay (R2=0.4; p=0.009) and peripheral joint involvement (R2=0.4; p=0.04). During follow-up, reduction of BASDAI positively correlated with high ESR (R2=0.65; p=0.04). ASDAS-CRP at T0 positively correlated with high ESR (R2=0.34; p=0.004). Reduction of ASDAS-CRP from T0 to T6 correlated with current smoking status (R2=0.42; p=0.0005). In PsA patients, reduction of DAPSA score from T0 to T12 negatively correlated with the presence of metabolic syndrome (R2=0.41; p= 0.0025). Retention rate showed good drug survival and an influence of female sex (Figure 1) in the survival curve in only AS patients, but no differences based on BMI, gender and lines of treatment were observed (Figure 2). SEC was well tolerated: Eleven patients discontinued treatment for non-severe adverse events.Conclusion:We demonstrated the effectiveness and safety of SEC in patients with AS and PsA in a real-life setting for the first time. No gender differences were observed; however, less clinical improvement was seen in smokers and in patients with metabolic syndromeReferences:No references.Disclosure of Interests:Maria Sole Chimenti: None declared, giulia lavinia fonti: None declared, Paola Conigliaro: None declared, flavia sunzini: None declared, Rossana Scrivo: None declared, luca navarini: None declared, paola triggianese: None declared, giusy peluso: None declared, Palma Scolieri: None declared, rosalba caccavale: None declared, Andrea Picchianti-Diamanti: None declared, erica de martino: None declared, simonetta salemi: None declared, domenico birra: None declared, Alessio Altobelli: None declared, marino paroli: None declared, Vincenzo Bruzzese: None declared, Bruno Laganà: None declared, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB, fabrizio conti Speakers bureau: BMS, Lilly, Abbvie, Pfizer, Sanofi, Antonella Afeltra: None declared, Roberto Perricone: None declared
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13
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Picchianti-Diamanti A, Lorenzetti R, Chimenti MS, Luchetti MM, Conigliaro P, Canofari C, Benfaremo D, Bruzzese V, Laganà B, Perricone R. Enteropathic spondyloarthritis: Results from a large nationwide database analysis. Autoimmun Rev 2019; 19:102457. [PMID: 31838160 DOI: 10.1016/j.autrev.2019.102457] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Spondyloarthrits (SpA) share clinical, genetic and immunological features with Inflammatory Bowel Diseases (IBD), and enteropathic SpA (eSpA) represent the clinical evidence of the association between gut and joint diseases. This cross-sectional study aimed to report data of eSpA patients collected from the first Italian database. PATIENTS AND METHODS A specific web-based interface has been created to insert and collect the main clinical, serologic and imaging data from patients with eSpA, as well as disease activity, comorbidities and treatment, in a real-life scenario. RESULTS Data were collected in 14 Italian centers (7 rheumatology and 7 gastroenterology units). A total of 347 eSpA patients were enrolled in the study. Type 1 peripheral eSpA was the most frequent form. Crohn' Disease (CD) was the most represented IBD. CD activity was similar among eSpA, whereas UC activity was slightly higher in the axial and mixed form than in the peripheral eSpA. The disease was active in less than half of axial eSpA patients and in only 18% of patients with peripheral eSpA. Furthermore, most of the patients had an inactive IBD. Nineteen percent of the total eSpA patients were free of therapy at the time of the enrollment and 61% of the patients were receiving biotechnological agents. CONCLUSIONS The multidisciplinary management of eSpA patients, favored by this ad hoc created web-based platform, allowed to obtain data from the largest eSpA cohort. The information coming of this database might advance knowledge of eSpA and improve their standard of care.
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Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome, Italy.
| | - Roberto Lorenzetti
- Department of Internal Medicine, Rheumatology and Gastroenterology, "Nuovo Regina Margherita" Hospital, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy.
| | - Michele Maria Luchetti
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy.
| | - Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy.
| | - Claudia Canofari
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy.
| | - Devis Benfaremo
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy.
| | - Vincenzo Bruzzese
- Department of Internal Medicine, Rheumatology and Gastroenterology, "Nuovo Regina Margherita" Hospital, Rome, Italy.
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome, Italy.
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
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14
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Fontana A, Panebianco C, Picchianti-Diamanti A, Laganà B, Cavalieri D, Potenza A, Pracella R, Binda E, Copetti M, Pazienza V. Gut Microbiota Profiles Differ among Individuals Depending on Their Region of Origin: An Italian Pilot Study. Int J Environ Res Public Health 2019; 16:ijerph16214065. [PMID: 31652705 PMCID: PMC6862301 DOI: 10.3390/ijerph16214065] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/14/2019] [Accepted: 10/19/2019] [Indexed: 12/19/2022]
Abstract
Background and aims: Microbiota heterogeneity among humans is mainly due to genetic background, age, dietary habits, lifestyle and local environments. In this study we investigated whether the gut microbiota profile of Italian healthy volunteers could differ based on their geographical origin. Materials and Methods: 16S rRNA gene sequencing was employed to analyze the gut microbiota of 31 healthy volunteers from three different Italian regions: Apulia (South), Lazio (Center) and Lombardy (North). Results: Differences in microbiota composition were detected when the study participants were grouped by their region of origin and when they were classified based on age classes (p-values < 0.05). Also species richness was significantly different both according to Italian Regions (median richness: 177.8 vs. 140.7 vs. 168.0 in Apulia, Lazio and Lombardy; p < 0.001) and according to age classes (median richness: 140.1 vs. 177.8 vs. 160.0 in subjects < 32, 32–41 and > 41 years; p < 0.001), whereas the Shannon index and beta diversity did not change. Conclusions: This study identified differences in the gut microbiota composition and richness among individuals with the same ethnicity coming from three different Italian regions. Our results underline the importance of studies on population-specific variations in human microbiota composition leading to geographically tailored approaches to microbiota engineering.
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Affiliation(s)
- Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
| | - Concetta Panebianco
- Division of Gastroenterology, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
| | - Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Duccio Cavalieri
- Department of Biology, University of Florence, 50019 Florence, Italy.
| | - Adele Potenza
- Dietetic and Clinical Nutrition Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
| | - Riccardo Pracella
- Cancer Stem Cells Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
| | - Elena Binda
- Cancer Stem Cells Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
| | - Valerio Pazienza
- Division of Gastroenterology, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
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15
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Caso F, Navarini L, Carubbi F, Picchianti-Diamanti A, Chimenti MS, Tasso M, Currado D, Ruscitti P, Ciccozzi M, Annarumma A, Laganà B, Perricone R, Afeltra A, Giacomelli R, Scarpa R, Costa L. Mediterranean diet and Psoriatic Arthritis activity: a multicenter cross-sectional study. Rheumatol Int 2019; 40:951-958. [PMID: 31605152 DOI: 10.1007/s00296-019-04458-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 07/29/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022]
Abstract
Diet is a modifiable factor implicated in chronic systemic inflammation, and the mediterranean dietary pattern is considered to be a healthy model in terms of morbidity and mortality. The main aim of this study was to evaluate the adherence to the mediterranean diet in patients with Psoriatic Arthritis (PsA) and its impact on disease activity. A cross-sectional observational study was conducted in a cohort of 211 consecutive PsA patients. We evaluated PsA activity by disease activity index for PSoriatic Arthritis (DAPSA) and composite psoriatic disease activity index (CPDAI). The NCEP-ACT III criteria were used to identify subjects with MetS, and in each subject, we evaluated body mass index (BMI). A validated 14-item questionnaire for the assessment of adherence to the mediterranean diet (PREDIMED) was recorded for all the enrolled subjects. Patients showed a median age of 55 (48-62) and disease duration was 76 (36-120) months. 27.01% of patients were classified as having MetS. The median of the mediterranean diet score (MDS) was 7 (6-9). A moderate adherence to mediterranean diet was found in 66.35% of the entire cohort; 15.64% and 18.01% of the patients showed low- and high adherence to the dietary pattern, respectively. We found a negative association between DAPSA and adherence to mediterranean diet (B = - 3.291; 95% CI - 5.884 to - 0.698). DAPSA was positively associated with BMI (B = 0.332; 95% CI 0.047-0.618) and HAQ ( B = 2.176; 95% CI 0.984-3.368). Results from our study evidenced that in PsA patients, higher levels of disease activity as measured by DAPSA correlated with low adherence to mediterranean diet, suggesting potential benefit of antinflammatory properties of this dietary pattern.
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Affiliation(s)
- Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy.
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Damiano Currado
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo Ciccozzi
- Unit of Clinical Laboratory Science, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonio Annarumma
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185, Rome, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
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16
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Picchianti-Diamanti A, Panebianco C, Salemi S, Sorgi ML, Di Rosa R, Tropea A, Sgrulletti M, Salerno G, Terracciano F, D'Amelio R, Laganà B, Pazienza V. Analysis of Gut Microbiota in Rheumatoid Arthritis Patients: Disease-Related Dysbiosis and Modifications Induced by Etanercept. Int J Mol Sci 2018; 19:ijms19102938. [PMID: 30261687 PMCID: PMC6213034 DOI: 10.3390/ijms19102938] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 12/24/2022] Open
Abstract
A certain number of studies were carried out to address the question of how dysbiosis could affect the onset and development of rheumatoid arthritis (RA), but little is known about the reciprocal influence between microbiota composition and immunosuppressive drugs, and how this interaction may have an impact on the clinical outcome. The aim of this study was to characterize the intestinal microbiota in a groups of RA patients treatment-naïve, under methotrexate, and/or etanercept (ETN). Correlations between the gut microbiota composition and validated immunological and clinical parameters of disease activity were also evaluated. In the current study, a 16S analysis was employed to explore the gut microbiota of 42 patients affected by RA and 10 healthy controls. Disease activity score on 28 joints (DAS-28), erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, anti-cyclic citrullinated peptides, and dietary and smoking habits were assessed. The composition of the gut microbiota in RA patients free of therapy is characterized by several abnormalities compared to healthy controls. Gut dysbiosis in RA patients is associated with different serological and clinical parameters; in particular, the phylum of Euryarchaeota was directly correlated to DAS and emerged as an independent risk factor. Patients under treatment with ETN present a partial restoration of a beneficial microbiota. The results of our study confirm that gut dysbiosis is a hallmark of the disease, and shows, for the first time, that the anti-tumor necrosis factor alpha (TNF-α) ETN is able to modify microbial communities, at least partially restoring a beneficial microbiota.
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Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Concetta Panebianco
- Gastroenterology Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, Viale dei Cappuccini, 1, 71013 San Giovanni Rotondo, Italy.
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Maria Laura Sorgi
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Alessandro Tropea
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Mayla Sgrulletti
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Gerardo Salerno
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Fulvia Terracciano
- Gastroenterology Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, Viale dei Cappuccini, 1, 71013 San Giovanni Rotondo, Italy.
| | - Raffaele D'Amelio
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy.
| | - Valerio Pazienza
- Gastroenterology Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, Viale dei Cappuccini, 1, 71013 San Giovanni Rotondo, Italy.
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17
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Picchianti-Diamanti A, Rosado MM, D'Amelio R. Infectious Agents and Inflammation: The Role of Microbiota in Autoimmune Arthritis. Front Microbiol 2018; 8:2696. [PMID: 29387048 PMCID: PMC5776018 DOI: 10.3389/fmicb.2017.02696] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 12/26/2017] [Indexed: 12/17/2022] Open
Abstract
In higher vertebrates, mucosal sites at the border between the internal and external environments, directly interact with bacteria, viruses, and fungi. Through co-evolution, hosts developed mechanisms of tolerance or ignorance toward some infectious agents, because hosts established "gain of function" interactions with symbiotic bacteria. Indeed, some bacteria assist hosts in different functions, among which are digestion of complex carbohydrates, and absorption and supply of vitamins. There is no doubt that microbiota modulate innate and acquired immune responses starting at birth. However, variations in quality and quantity of bacterial species interfere with the equilibrium between inflammation and tolerance. In fact, correlations between gut bacteria composition and the severity of inflammation were first described for inflammatory bowel diseases and later extended to other pathologies. The genetic background, environmental factors (e.g., stress or smoking), and diet can induce strong changes in the resident bacteria which can expose the intestinal epithelium to a variety of different metabolites, many of which have unknown functions and consequences. In addition, alterations in gut permeability may allow pathogens entry, thereby triggering infection and/or chronic inflammation. In this context, a local event occurring at a mucosal site may be the triggering cause of an autoimmune reaction that eventually involves distant sites or organs. Recently, several studies attributed a pathogenic role to altered oral microbiota in rheumatoid arthritis (RA) and to gut dysbiosis in spondyloarthritis (SpA). There is also growing evidence that different drugs, such as antibiotics and immunosuppressants, can influence and be influenced by the diversity and composition of microbiota in RA and SpA patients. Hence, in complex disorders such RA and SpA, not only the genetic background, gender, and immunologic context of the individual are relevant, but also the history of infections and the structure of the microbial community at mucosal sites should be considered. Here the role of the microbiota and infections in the initiation and progression of chronic arthritis is discussed, as well as how these factors can influence a patient's response to synthetic and biologic immunosuppressive therapy.
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Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Raffaele D'Amelio
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
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18
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Picchianti-Diamanti A, Rosado M, Pilozzi E, Markovic M, D'Amelio R, Laganà B. FRI0164 T Cells Expansion in Rheumatoid and Psoriatic Arthritis Patients under anti-TNF-alpha Agents. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Salemi S, Picchianti-Diamanti A, Germano V, Donatelli I, Di Martino A, Facchini M, Nisini R, Biselli R, Ferlito C, Podestà E, Cappella A, Milanetti F, Rossi F, Amodeo R, Tabacco F, Di Rosa R, Laganà B, D Amelio R. Influenza vaccine administration in rheumatoid arthritis patients under treatment with TNFalpha blockers: safety and immunogenicity. Clin Immunol 2009; 134:113-20. [PMID: 19846344 DOI: 10.1016/j.clim.2009.09.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 12/14/2022]
Abstract
Twenty-eight patients with low-moderate, stable rheumatoid arthritis (RA), under treatment with tumor necrosis factor (TNF) alpha blockers, were immunized at least once with non-adjuvanted trivalent influenza vaccine during three consecutive influenza seasons. Antibodies toward A influenza antigens significantly increased and reached protective levels, still detectable 6 months after vaccination, both in RA patients and healthy controls. Response to B antigen instead was only observed from the second year for healthy controls and in the third year for patients. No significant difference in disease activity and anti-nuclear antibodies was observed as a consequence of vaccine administration, whereas T regulatory cells showed a significant increase 30 days after immunization in RA patients. This study confirms safety of influenza vaccine administration in RA patients treated with TNFalpha blockers. The cohort follow-up revealed the overcoming of poor B vaccine antigen immunogenicity via repeated vaccinations. Finally, protective antibody response was still observed 6 months after vaccination.
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Affiliation(s)
- S Salemi
- Sapienza Università di Roma, II Facoltà di Medicina e Chirurgia, A.O. S. Andrea, Via di Grottarossa 1039, Roma 00189, Italy
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