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Dörner T, Kaul M, Szántó A, Tseng JC, Papas AS, Pylvaenaeinen I, Hanser M, Abdallah N, Grioni A, Santos Da Costa A, Ferrero E, Gergely P, Hillenbrand R, Avrameas A, Cenni B, Siegel RM. Efficacy and safety of remibrutinib, a selective potent oral BTK inhibitor, in Sjögren's syndrome: results from a randomised, double-blind, placebo-controlled phase 2 trial. Ann Rheum Dis 2024; 83:360-371. [PMID: 37932009 PMCID: PMC10894844 DOI: 10.1136/ard-2023-224691] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of remibrutinib in patients with moderate-to-severe Sjögren's syndrome (SjS) in a phase 2 randomised, double-blind trial (NCT04035668; LOUiSSE (LOU064 in Sjögren's Syndrome) study). METHODS Eligible patients fulfilling 2016 American College of Rheumatology/European League Against Rheumatism (EULAR) criteria for SjS, positive for anti-Ro/Sjögren's syndrome-related antigen A antibodies, with moderate-to-severe disease activity (EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) (based on weighted score) ≥ 5, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) ≥ 5) received remibrutinib (100 mg) either one or two times a day, or placebo for the 24-week study treatment period. The primary endpoint was change from baseline in ESSDAI at week 24. Key secondary endpoints included change from baseline in ESSDAI over time, change from baseline in ESSPRI over time and safety of remibrutinib in SjS. Key exploratory endpoints included changes to the salivary flow rate, soluble biomarkers, blood transcriptomic and serum proteomic profiles. RESULTS Remibrutinib significantly improved ESSDAI score in patients with SjS over 24 weeks compared with placebo (ΔESSDAI -2.86, p=0.003). No treatment effect was observed in ESSPRI score (ΔESSPRI 0.17, p=0.663). There was a trend towards improvement of unstimulated salivary flow with remibrutinib compared with placebo over 24 weeks. Remibrutinib had a favourable safety profile in patients with SjS over 24 weeks. Remibrutinib induced significant changes in gene expression in blood, and serum protein abundance compared with placebo. CONCLUSIONS These data show preliminary efficacy and favourable safety of remibrutinib in a phase 2 trial for SjS.
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Affiliation(s)
- Thomas Dörner
- Dept. Med./Rheumatology and Clinical Immunology, Charite Univ. Hospital, Berlin, Germany
| | - Martin Kaul
- Novartis Institutes for BioMedical Research, Basel, Switzerland
- Independent consultant, Neustadt, Germany
| | - Antónia Szántó
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Athena S Papas
- Oral Medicine, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | | | - Malika Hanser
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Nasri Abdallah
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Andrea Grioni
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | - Enrico Ferrero
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Peter Gergely
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | | | - Bruno Cenni
- Novartis Institutes for BioMedical Research, Basel, Switzerland
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Nagy G, Földesi R, Csípő I, Tarr T, Szűcs G, Szántó A, Bubán T, Szekanecz Z, Papp M, Kappelmayer J, Antal-Szalmás P. A novel way to evaluate autoantibody interference in samples with mixed antinuclear antibody patterns in the HEp-2 cell based indirect immunofluorescence assay and comparison of conventional microscopic and computer-aided pattern recognition. Clin Chim Acta 2024; 553:117747. [PMID: 38154766 DOI: 10.1016/j.cca.2023.117747] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND A major challenge of the HEp-2 cell-based indirect immunofluorescence (IIF) assays is the correct identification of the individual anti-nuclear antibodies (ANAs) if more than one is present in a sample. We created artificial mixes by pooling two different samples with a single autoantibody in different titers. Comparison of the expected and observed patterns and titers clarifies the interference between the two tested ANAs. METHODS Serum samples with a single homogeneous or speckled ANA pattern were serially diluted and mixed in 16 combinations, providing end-point titers of 1:5,120 to 1:80 for both patterns. These mixes were tested by a HEp-2 IIF assay and were evaluated by conventional evaluation, the EUROPattern (EPa) system and on-screen analysis. RESULTS Homogeneous pattern can alter the identification of the speckled pattern much more than vice versa, but both has an interfering effect on the other. The effect of the interfering on the tested pattern was higher if the titer of the former one was higher. The pattern recognition efficacy of conventional and the on-screen evaluation was similar and superior compared to the EPa analysis. CONCLUSIONS The application of artificial mixed samples can help the evaluation of the efficacy of manual and computer-aided ANA HEp-2 pattern recognition.
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Affiliation(s)
- Gábor Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Róza Földesi
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Csípő
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tünde Tarr
- Institute of Internal Medicine, Department of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gabriella Szűcs
- Institute of Internal Medicine, Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Antónia Szántó
- Institute of Internal Medicine, Department of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Bubán
- Department of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szekanecz
- Institute of Internal Medicine, Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mária Papp
- Department of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; European Reference Network on Hepatological Diseases, ERN RARE-LIVER, Debrecen, Hungary
| | - János Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Péter Antal-Szalmás
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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Flores-Chávez A, Brito-Zerón P, Ng WF, Szántó A, Rasmussen A, Priori R, Baldini C, Armagan B, Özkiziltaş B, Praprotnik S, Suzuki Y, Quartuccio L, Hernández-Molina G, Inanc N, Bartoloni E, Rischmueller M, Reis-de Oliveira F, Fernandes Moça Trevisani V, Jurcut C, Nordmark G, Carubbi F, Hofauer B, Valim V, Pasoto SG, Retamozo S, Atzeni F, Fonseca-Aizpuru E, López-Dupla M, Giacomelli R, Nakamura H, Akasbi M, Thompson K, Fanny Horváth I, Farris AD, Simoncelli E, Bombardieri S, Kilic L, Tufan A, Perdan Pirkmajer K, Fujisawa Y, De Vita S, Abacar K, Ramos-Casals M. Influence of exposure to climate-related hazards in the phenotypic expression of primary Sjögren's syndrome. Clin Exp Rheumatol 2023; 41:2437-2447. [PMID: 38019164 DOI: 10.55563/clinexprheumatol/pmbay6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To analyse how the key components at the time of diagnosis of the Sjögren's phenotype (epidemiological profile, sicca symptoms, and systemic disease) can be influenced by the potential exposure to climate-related natural hazards. METHODS For the present study, the following variables were selected for harmonisation and refinement: age, sex, country, fulfilment of 2002/2016 criteria items, dry eyes, dry mouth, and overall ESSDAI score. Climate-related hazards per country were defined according to the OECD and included seven climate-related hazard types: extreme temperature, extreme precipitation, drought, wildfire, wind threats, river flooding, and coastal flooding. Climatic variables were defined as dichotomous variables according to whether each country is ranked among the ten countries with the most significant exposure. RESULTS After applying data-cleaning techniques and excluding people from countries not included in the OECD climate rankings, the database study analysed 16,042 patients from 23 countries. The disease was diagnosed between 1 and 3 years earlier in people living in countries included among the top 10 worst exposed to extreme precipitation, wildfire, wind threats, river flooding, and coastal flooding. A lower frequency of dry eyes was observed in people living in countries exposed to wind threats, river flooding, and coastal flooding, with a level of statistical association being classified as strong (p<0.0001 for the three variables). The frequency of dry mouth was significantly lower in people living in countries exposed to river flooding (p<0.0001) and coastal flooding (p<0.0001). People living in countries included in the worse climate scenarios for extreme temperature (p<0.0001) and river flooding (p<0.0001) showed a higher mean ESSDAI score in comparison with people living in no-risk countries. In contrast, those living in countries exposed to worse climate scenarios for wind threats (p<0.0001) and coastal flooding (p<0.0001) showed a lower mean ESSDAI score in comparison with people living in no-risk countries. CONCLUSIONS Local exposure to extreme climate-related hazards plays a role in modulating the presentation of Sjögren across countries concerning the age at which the disease is diagnosed, the frequency of dryness, and the degree of systemic activity.
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Affiliation(s)
| | - Pilar Brito-Zerón
- Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, and NIHR Biomedical Research Centre & NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | | | - Berkan Armagan
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Burcugül Özkiziltaş
- Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Luca Quartuccio
- Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Gabriela Hernández-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Nevsun Inanc
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia
| | | | | | - Ciprian Jurcut
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, Bucharest, Romania
| | - Gunnel Nordmark
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Germany
| | - Valeria Valim
- University Hospital Cassiano Antonio Moraes (Hucam-Ufes/Ebserh), Federal University of Espírito Santo, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Soledad Retamozo
- Department of Rheumatology, Hospital Quirón Salud, Barcelona, Spain
| | | | | | | | - Roberto Giacomelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, and Research Unit of Immuno-Rheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Italy
| | - Hideki Nakamura
- Division of Haematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Kyle Thompson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, and NIHR Biomedical Research Centre & NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ildiko Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - A Darise Farris
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Edoardo Simoncelli
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | | | - Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Katja Perdan Pirkmajer
- Department of Rheumatology, University Medical Centre, Ljubljana, and Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Yuhei Fujisawa
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Salvatore De Vita
- Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Kerem Abacar
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, and Department of Medicine, University of Barcelona, Spain.
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4
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Brito-Zerón P, Flores-Chávez A, Ng WF, Fanny Horváth I, Rasmussen A, Priori R, Baldini C, Armagan B, Özkiziltaş B, Praprotnik S, Suzuki Y, Quartuccio L, Hernandez-Molina G, Abacar K, Bartoloni E, Rischmueller M, Reis-de Oliveira F, Fernandes Moça Trevisani V, Jurcut C, Fugmann C, Carubbi F, Hofauer B, Valim V, Pasoto SG, Retamozo S, Atzeni F, Fonseca-Aizpuru E, López-Dupla M, Giacomelli R, Nakamura H, Akasbi M, Thompson K, Szántó A, Farris AD, Villa M, Bombardieri S, Kilic L, Tufan A, Perdan Pirkmajer K, Fujisawa Y, de Vita S, Inanc N, Ramos-Casals M. Exposure to air pollution as an environmental determinant of how Sjögren's disease is expressed at diagnosis. Clin Exp Rheumatol 2023; 41:2448-2457. [PMID: 38019154 DOI: 10.55563/clinexprheumatol/p1r1j4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To analyse how the potential exposure to air pollutants can influence the key components at the time of diagnosis of Sjögren's phenotype (epidemiological profile, sicca symptoms, and systemic disease). METHODS For the present study, the following variables were selected for harmonization and refinement: age, sex, country, fulfilment of 2002/2016 criteria items, dry eyes, dry mouth, and overall ESSDAI score. Air pollution indexes per country were defined according to the OECD (1990-2021), including emission data of nitrogen and sulphur oxides (NO/SO), particulate matter (PM2.5 and 1.0), carbon monoxide (CO) and volatile organic compounds (VOC) calculated per unit of GDP, Kg per 1000 USD. RESULTS The results of the chi-square tests of independence for each air pollutant with the frequency of dry eyes at diagnosis showed that, except for one, all variables exhibited p-values <0.0001. The most pronounced disparities emerged in the dry eye prevalence among individuals inhabiting countries with the highest NO/SO exposure, a surge of 4.61 percentage points compared to other countries, followed by CO (3.59 points), non-methane (3.32 points), PM2.5 (3.30 points), and PM1.0 (1.60 points) exposures. Concerning dry mouth, individuals residing in countries with worse NO/SO exposures exhibited a heightened frequency of dry mouth by 2.05 percentage points (p<0.0001), followed by non-methane exposure (1.21 percentage points increase, p=0.007). Individuals inhabiting countries with the worst NO/SO, CO, and PM2.5 pollution levels had a higher mean global ESSDAI score than those in lower-risk nations (all p-values <0.0001). When systemic disease was stratified according to DAS into low, moderate, and high systemic activity levels, a heightened proportion of individuals manifesting moderate/severe systemic activity was observed in countries with worse exposures to NO/SO, CO, and PM2.5 pollutant levels. CONCLUSIONS For the first time, we suggest that pollution levels could influence how SjD appears at diagnosis in a large international cohort of patients. The most notable relationships were found between symptoms (dryness and general body symptoms) and NO/SO, CO, and PM2.5 levels.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
| | | | - Wan-Fai Ng
- Newcastle NIHR Biomedical Research Centre, The United Kingdom Primary Sjögren's Syndrome Registry, Newcastle upon Tyne, UK
| | - Ildiko Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | | | - Berkan Armagan
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Burcugül Özkiziltaş
- Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Yasuori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Luca Quartuccio
- Division of Rheumatology, Department of Medicine, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Kerem Abacar
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia
| | | | | | - Ciprian Jurcut
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, Bucharest, Romania
| | - Cecilia Fugmann
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Medical University Innsbruck, Austria
| | | | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Soledad Retamozo
- Department of Rheumatology, Hospital Quirón Salud, Barcelona, Spain
| | - Fabiola Atzeni
- IRCCS Galeazzi Orthopedic Institute, Milan, and Rheumatology Unit, University of Messina, Italy
| | | | | | - Roberto Giacomelli
- Clinical Unit of Rheumatology and Clinical Immunology, University of Rome Campus Biomedico, Rome, Italy
| | - Hideki Nakamura
- Division of Haematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Kyle Thompson
- Newcastle NIHR Biomedical Research Centre, The United Kingdom Primary Sjögren's Syndrome Registry, Newcastle upon Tyne, UK
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - A Darise Farris
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Martina Villa
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | | | - Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Katja Perdan Pirkmajer
- Department of Rheumatology, University Medical Centre, Ljubljana, and Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Yuhei Fujisawa
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Salvatore de Vita
- Division of Rheumatology, Department of Medicine, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Nevsun Inanc
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, and Department of Medicine, University of Barcelona, Spain.
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5
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Brito-Zerón P, Flores-Chávez A, Horváth IF, Rasmussen A, Li X, Olsson P, Vissink A, Priori R, Armagan B, Hernandez-Molina G, Praprotnik S, Quartuccio L, Inanç N, Özkızıltaş B, Bartoloni E, Sebastian A, Romão VC, Solans R, Pasoto SG, Rischmueller M, Galisteo C, Suzuki Y, Trevisani VFM, Fugmann C, González-García A, Carubbi F, Jurcut C, Shimizu T, Retamozo S, Atzeni F, Hofauer B, Melchor-Díaz S, Gheita T, López-Dupla M, Fonseca-Aizpuru E, Giacomelli R, Vázquez M, Consani S, Akasbi M, Nakamura H, Szántó A, Farris AD, Wang L, Mandl T, Gattamelata A, Kilic L, Pirkmajer KP, Abacar K, Tufan A, de Vita S, Bootsma H, Ramos-Casals M. Mortality risk factors in primary Sjögren syndrome: a real-world, retrospective, cohort study. EClinicalMedicine 2023; 61:102062. [PMID: 37457113 PMCID: PMC10344811 DOI: 10.1016/j.eclinm.2023.102062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Background What baseline predictors would be involved in mortality in people with primary Sjögren syndrome (SjS) remains uncertain. This study aimed to investigate the baseline characteristics collected at the time of diagnosis of SjS associated with mortality and to identify mortality risk factors for all-cause death and deaths related to systemic SjS activity measured by the ESSDAI score. Methods In this international, real-world, retrospective, cohort study, we retrospectively collected data from 27 countries on mortality and causes of death from the Big Data Sjögren Registry. Inclusion criteria consisted of fulfilling 2002/2016 SjS classification criteria, and exclusion criteria included chronic HCV/HIV infections and associated systemic autoimmune diseases. A statistical approach based on a directed acyclic graph was used, with all-cause and Sjögren-related mortality as primary endpoints. The key determinants that defined the disease phenotype at diagnosis (glandular, systemic, and immunological) were analysed as independent variables. Findings Between January 1st, 2014 and December 31, 2023, data from 11,372 patients with primary SjS (93.5% women, 78.4% classified as White, mean age at diagnosis of 51.1 years) included in the Registry were analysed. 876 (7.7%) deaths were recorded after a mean follow-up of 8.6 years (SD 7.12). Univariate analysis of prognostic factors for all-cause death identified eight Sjögren-related variables (ocular and oral tests, salivary biopsy, ESSDAI, ANA, anti-Ro, anti-La, and cryoglobulins). The multivariate CPH model adjusted for these variables and the epidemiological features showed that DAS-ESSDAI (high vs no high: HR = 1.68; 95% CI, 1.27-2.22) and cryoglobulins (positive vs negative: HR = 1.72; 95% CI, 1.22-2.42) were independent predictors of all-cause death. Of the 640 deaths with available information detailing the specific cause of death, 14% were due to systemic SjS. Univariate analysis of prognostic factors for Sjögren-cause death identified five Sjögren-related variables (oral tests, clinESSDAI, DAS-ESSDAI, ANA, and cryoglobulins). The multivariate competing risks CPH model adjusted for these variables and the epidemiological features showed that oral tests (abnormal vs normal results: HR = 1.38; 95% CI, 1.01-1.87), DAS-ESSDAI (high vs no high: HR = 1.55; 95% CI, 1.22-1.96) and cryoglobulins (positive vs negative: HR = 1.52; 95% CI, 1.16-2) were independent predictors of SjS-related death. Interpretation The key mortality risk factors at the time of SjS diagnosis were positive cryoglobulins and a high systemic activity scored using the ESSDAI, conferring a 2-times increased risk of all-cause and SjS-related death. ESSDAI measurement and cryoglobulin testing should be considered mandatory when an individual is diagnosed with SjS. Funding Novartis.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
| | | | - Ildiko Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Xiaomei Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China(Anhui Provincial Hosipital), Hefei, China
| | - Peter Olsson
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surger, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
- Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | - Berkan Armagan
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital “Santa Maria della Misericordia”, Udine, Italy
| | - Nevsun Inanç
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Burcugül Özkızıltaş
- Division of Rheumatology, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Wroclaw, Poland
| | - Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Roser Solans
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Sandra G. Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia
| | - Carlos Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | | | - Cecilia Fugmann
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Ciprian Jurcut
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, Bucharest, Romania
| | - Toshimasa Shimizu
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Soledad Retamozo
- Department of Rheumatology, Hospital Quirón Salud, Barcelona, Spain
| | - Fabiola Atzeni
- IRCCS Galeazzi Orthopedic Institute, Milan and Rheumatology Unit, University of Messina, Messina, Italy
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Munich, Germany
| | | | - Tamer Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Roberto Giacomelli
- Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy
| | - Marcos Vázquez
- Department of Rheumatology, Hospital de Clínicas, San Lorenzo, Paraguay
| | - Sandra Consani
- Internal Medicine, Hospital Maciel, and Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Hideki Nakamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A. Darise Farris
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Li Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China(Anhui Provincial Hosipital), Hefei, China
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | | | - Kerem Abacar
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Salvatore de Vita
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital “Santa Maria della Misericordia”, Udine, Italy
| | - Hendrika Bootsma
- Department of Rheumatology & Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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Mogyoróssy S, Nagy-Vincze M, Griger Z, Dankó K, Szabó NA, Szekanecz Z, Szűcs G, Szántó A, Bodoki L. Novel aspects of muscle involvement in immune-mediated inflammatory arthropathies and connective tissue diseases. Autoimmun Rev 2023; 22:103311. [PMID: 36889657 DOI: 10.1016/j.autrev.2023.103311] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
Myalgia, myopathy and myositis are the most important types of muscle impairment in immune-mediated inflammatory arthropathies and connective tissue diseases. Multiple pathogenetic and histological changes occur in the striated muscles of these patients. Clinically, the most important muscle involvement is the one that causes complaints to the patients. In everyday practice, insidious symptoms present a serious problem for the clinician; in many cases, it is difficult to decide when and how to treat the muscle symptoms that are often present only subclinically. In this work, authors review the international literature on the types of muscle problems in autoimmune diseases. In scleroderma histopathological picture of muscle shows a very heterogeneous picture, necrosis and atrophy are common. In rheumatoid arthritis and systemic lupus erythematosus, myopathy is a much less defined concept, further studies are needed to describe it. According to our view, overlap myositis should be recognized as a separate entity, preferably with distinct histological and serological characteristics. More studies are needed to describe muscle impairment in autoimmune diseases which may help to explore this topic more in depth and be of clinical use.
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Affiliation(s)
- Sándor Mogyoróssy
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Melinda Nagy-Vincze
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Griger
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Dankó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nóra Anna Szabó
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gabriella Szűcs
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Levente Bodoki
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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7
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Módis LV, Aradi Z, Horváth IF, Bencze J, Papp T, Emri M, Berényi E, Bugán A, Szántó A. Central Nervous System Involvement in Primary Sjögren's Syndrome: Narrative Review of MRI Findings. Diagnostics (Basel) 2022; 13:diagnostics13010014. [PMID: 36611306 PMCID: PMC9818673 DOI: 10.3390/diagnostics13010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Central nervous system (CNS) involvement is one of the numerous extraglandular manifestations of primary Sjögren's syndrome (pSS). Moreover, neurological complaints precede the sicca symptoms in 25-60% of the cases. We review the magnetic resonance imaging (MRI) lesions typical for pSS, involving the conventional examination, volumetric and morphometric studies, diffusion tensor imaging (DTI) and resting-state fMRI. The most common radiological lesions in pSS are white matter hyperintensities (WMH), scattered alterations hyperlucent on T2 and FLAIR sequences, typically located periventricularly and subcortically. Cortical atrophy and ventricular dilatation can also occur in pSS. Whilst these conditions are thought to be more common in pSS than healthy controls, DTI and resting-state fMRI alterations demonstrate evident microstructural changes in pSS. As pSS is often accompanied by cognitive symptoms, these MRI alterations are expectedly related to them. This relationship is not clearly delineated in conventional MRI studies, but DTI and resting-state fMRI examinations show more convincing correlations. In conclusion, the CNS manifestations of pSS do not follow a certain pattern. As the link between the MRI lesions and clinical manifestations is not well established, more studies involving larger populations should be performed to elucidate the correlations.
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Affiliation(s)
- László V. Módis
- Department of Behavioural Sciences, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
- Correspondence: ; Tel.: +36-52-411-600 (ext. 55252)
| | - Zsófia Aradi
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
| | - Ildikó Fanny Horváth
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
| | - János Bencze
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Tamás Papp
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Miklós Emri
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Ervin Berényi
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Antal Bugán
- Department of Behavioural Sciences, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
| | - Antónia Szántó
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
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8
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Inanc N, Kostov B, Priori R, Flores-Chavez A, Carubbi F, Szántó A, Valim V, Bootsma H, Praprotnik S, Fernandes Moça Trevisani V, Hernández-Molina G, Hofauer B, Pasoto SG, López-Dupla M, Bartoloni E, Rischmueller M, Devauchelle-Pensec V, Abacar K, Giardina F, Alunno A, Fanny Horváth I, de Wolff L, Caldas L, Retamozo S, Ramos-Casals M, Brito-Zerón P. Safety and efficacy of SARS-CoV-2 vaccination in 1237 patients with primary Sjögren syndrome. Clin Exp Rheumatol 2022; 40:2290-2297. [PMID: 36441656 DOI: 10.55563/clinexprheumatol/dt6klo] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the safety and efficacy of SARS-Cov-2 vaccination in patients with primary Sjögren syndrome (pSS) due to scarcity of data in this population. METHODS By the first week of May 2021, all Big Data SS Consortium centres patients who had received at least one dose of any SARS-CoV-2 vaccine were included in the study. The in-charge physician asked patients about local and systemic reactogenicity to collect SARS-CoV-2 vaccination data. RESULTS The vaccination data of 1237 patients were received. A total of 835 patients (67%) reported any adverse events (AEs), including local (53%) and systemic (50%) AEs. Subjective symptoms (63%) were the most common local AEs, followed by objective signs at the injection site (16%), and general symptoms were the most commonly reported systemic AEs (46%), followed by musculoskeletal (25%), gastrointestinal (9%), cardiopulmonary (3%), and neurological (2%). In addition, 141 (11%) patients reported a significant worsening/exacerbation of their pre-vaccination sicca symptoms and fifteen (1.2%) patients reported active involvement in the glandular (n=7), articular (n=7), cutaneous (n=6), pulmonary (n=2), and peripheral nervous system (n=1) domains due to post-vaccination SS flares. In terms of vaccination efficacy, breakthrough SARS-CoV-2 infection was confirmed after vaccination in three (0.24 %) patients, and positive anti-SARS-Cov-2 antibodies were detected in approximately 95% of vaccinated SS patients, according to data available. CONCLUSIONS Our data suggest that patients with pSS develop adequate humoral response and no severe AEs after SARS-CoV-2 vaccination and therefore raise no concerns about the vaccine's efficacy or safety profile in this population.
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Affiliation(s)
- Nevsun Inanc
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Belchin Kostov
- Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | - Alejandra Flores-Chavez
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain, and Consejo Nacional de Ciencia y Tecnología (CONACYT), Mexico
| | - Francesco Carubbi
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | | | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Miguel López-Dupla
- Department of Internal Medicine, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, SA, Australia
| | | | - Kerem Abacar
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Federico Giardina
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Ildikó Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Liseth de Wolff
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, the Netherlands
| | | | - Soledad Retamozo
- Grup de Recerca Consolidat en la Síndrome de Sjögren (GRESS), Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya, Spain
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona; Grup de Recerca Consolidat en la Síndrome de Sjögren (GRESS), Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya, Spain; and Department of Medicine, University of Barcelona, Spain.
| | - Pilar Brito-Zerón
- Grup de Recerca Consolidat en la Síndrome de Sjögren (GRESS), Agència de Gestió d'Ajuts Universitaris i deRecerca (AGAUR), Generalitat de Catalunya, and Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
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9
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Bencze D, Fekete T, Pfliegler W, Szöőr Á, Csoma E, Szántó A, Tarr T, Bácsi A, Kemény L, Veréb Z, Pázmándi K. Interactions between the NLRP3-Dependent IL-1β and the Type I Interferon Pathways in Human Plasmacytoid Dendritic Cells. Int J Mol Sci 2022; 23:ijms232012154. [PMID: 36293012 PMCID: PMC9602791 DOI: 10.3390/ijms232012154] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/06/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Generally, a reciprocal antagonistic interaction exists between the antiviral type I interferon (IFN) and the antibacterial nucleotide-binding oligomerization domain (NOD)-like receptor pyrin domain containing 3 (NLRP3)-dependent IL-1β pathways that can significantly shape immune responses. Plasmacytoid dendritic cells (pDCs), as professional type I IFN-producing cells, are the major coordinators of antiviral immunity; however, their NLRP3-dependent IL-1β secretory pathway is poorly studied. Our aim was to determine the functional activity of the IL-1β pathway and its possible interaction with the type I IFN pathway in pDCs. We found that potent nuclear factor-kappa B (NF-κB) inducers promote higher levels of pro-IL-1β during priming compared to those activation signals, which mainly trigger interferon regulatory factor (IRF)-mediated type I IFN production. The generation of cleaved IL-1β requires certain secondary signals in pDCs and IFN-α or type I IFN-inducing viruses inhibit IL-1β production of pDCs, presumably by promoting the expression of various NLRP3 pathway inhibitors. In line with that, we detected significantly lower IL-1β production in pDCs of psoriasis patients with elevated IFN-α levels. Collectively, our results show that the NLRP3-dependent IL-1β secretory pathway is inducible in pDCs; however, it may only prevail under inflammatory conditions, in which the type I IFN pathway is not dominant.
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Affiliation(s)
- Dóra Bencze
- Department of Immunology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Doctoral School of Molecular Cell and Immune Biology, University of Debrecen, 4032 Debrecen, Hungary
| | - Tünde Fekete
- Department of Immunology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Walter Pfliegler
- Department of Molecular Biotechnology and Microbiology, Faculty of Science and Technology, University of Debrecen, 4032 Debrecen, Hungary
| | - Árpád Szöőr
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Eszter Csoma
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Tünde Tarr
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Attila Bácsi
- Department of Immunology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Lajos Kemény
- Regenerative Medicine and Cellular Pharmacology Laboratory, Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Zoltán Veréb
- Regenerative Medicine and Cellular Pharmacology Laboratory, Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Kitti Pázmándi
- Department of Immunology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Correspondence: ; Tel./Fax: +36-52-417-159
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10
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Retamozo S, Acar-Denizli N, Horváth IF, Ng WF, Rasmussen A, Dong X, Li X, Baldini C, Olsson P, Priori R, Seror R, Gottenberg JE, Kruize AA, Hernandez-Molina G, Vissink A, Sandhya P, Armagan B, Quartuccio L, Sebastian A, Praprotnik S, Bartoloni E, Kwok SK, Kvarnstrom M, Rischmueller M, Soláns-Laqué R, Sene D, Pasoto SG, Suzuki Y, Isenberg DA, Valim V, Nordmark G, Nakamura H, Fernandes Moça Trevisani V, Hofauer B, Sisó-Almirall A, Giacomelli R, Devauchelle-Pensec V, Bombardieri M, Atzeni F, Hammenfors D, Maure B, Carsons SE, Gheita T, Sánchez-Berná I, López-Dupla M, Morel J, Inanç N, Fonseca-Aizpuru E, Morcillo C, Vollenweider C, Melchor S, Vázquez M, Díaz-Cuiza E, Consani-Fernández S, de-Miguel-Campo B, Szántó A, Bombardieri S, Gattamelata A, Hinrichs A, Sánchez-Guerrero J, Danda D, Kilic L, De Vita S, Wiland P, Gerli R, Park SH, Wahren-Herlenius M, Bootsma H, Mariette X, Ramos-Casals M, Brito-Zerón P. Influence of the age at diagnosis in the disease expression of primary Sjögren syndrome. Analysis of 12,753 patients from the Sjögren Big Data Consortium. Clin Exp Rheumatol 2021; 39 Suppl 133:166-174. [DOI: 10.55563/clinexprheumatol/egnd1i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Soledad Retamozo
- Instituto Modelo de Cardiología Privado SRL, Córdoba, and Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Argentina; and Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Nihan Acar-Denizli
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Ildiko Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Wan-Fai Ng
- Institute of Cellular Medicine, Newcastle University, and NIHR Biomedical Research Centre, Newcastle Upon Tyne, UK
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Xu Dong
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Xiaomei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | | | - Peter Olsson
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Sweden
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | - Raphaèle Seror
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Strasbourg University Hospital, Université de Strasbourg, CNRS, Strasbourg, France
| | - Aike A. Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Pulukool Sandhya
- Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore, India
| | - Berkan Armagan
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Wroclaw, Poland
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marika Kvarnstrom
- Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia
| | - Roser Soláns-Laqué
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Damien Sene
- Service de Médecine Interne 2, Hôpital Lariboisière, Université Paris VII, Assistance Publique-Hôpitaux de Paris 2, Paris, France
| | - Sandra G. Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - David A. Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, UK
| | - Valéria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Gunnel Nordmark
- Rheumatology, Department of Medical Sciences, University of Uppsala, Sweden
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Germany
| | - Antoni Sisó-Almirall
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, School of Medicine, University of l'Aquila, Italy
| | | | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, Queen Mary University of London, UK
| | - Fabiola Atzeni
- IRCCS Galeazzi Orthopaedic Institute, Milan and Rheumatology Unit, University of Messina, Italy
| | - Daniel Hammenfors
- Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Brenda Maure
- Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain
| | - Steven E. Carsons
- Division of Rheumatology, Allergy and Immunology, New York University Winthrop Hospital and NYU Langone Health, New York, NY, USA
| | - Tamer Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Isabel Sánchez-Berná
- Department of Internal Medicine, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | | | - Jacques Morel
- Department of Rheumatology, Teaching Hospital and University of Montpellier, France
| | - Nevsun Inanç
- Marmara University, School of Medicine, Istanbul, Turkey
| | | | - César Morcillo
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | | | - Sheila Melchor
- Department of Rheumatology, Hospital 12 de Octubre, Madrid, Spain
| | - Marcos Vázquez
- Department of Rheumatology, Hospital de Clínicas, San Lorenzo, Paraguay
| | - Ericka Díaz-Cuiza
- Departamento de Reumatología del Seguro Social Universitario y consultorio privado de Reumatología, Sucre, Bolivia
| | - Sandra Consani-Fernández
- Internal Medicine, Hospital Maciel, and Universidad de la República (UdelaR), Montevideo, Uruguay
| | | | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | | | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Italy
| | - Anneline Hinrichs
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Jorge Sánchez-Guerrero
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore, India
| | - Levent Kilic
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Wroclaw, Poland
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marie Wahren-Herlenius
- Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Xavier Mariette
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain.
| | - Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
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11
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V Módis L, Szántó A, Bugán A. Psychological features of primary Sjögren syndrome. Orv Hetil 2021; 162:1558-1566. [PMID: 34570718 DOI: 10.1556/650.2021.32234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A primer Sjögren-szindróma (pSS) krónikus autoimmun betegség, melynek elsődleges tünetei az exokrin mirigyeket érintő autoimmun folyamat következtében létrejövő szem- és szájszárazság, szisztémás manifesztációi között pedig a leggyakoribbak a szellemi és fizikai fáradtság és az ízületi fájdalmak. A betegség lélektani vonatkozásait nagy érdeklődés övezi; közleményünk a vonatkozó kutatási eredményeket foglalja össze a hátterükben húzódó pszichoneuroimmunmodulációs háttér rövid bemutatásával. A pSS pszichológiai tényezői közt a legrégebben vizsgáltak a depresszió és a szorongás. Ezek jelentős hatással vannak a betegek életminőségére, jóllétére, kognitív funkcióira, sőt a betegség aktivitására is. Bemutatjuk továbbá a stressz és a megküzdési stratégiák jellegzetes mintázatait pSS-ben, amelyek közt a betegségre jellemző maladaptív stratégiák a legjelentősebbek a patogenezis megértése és a kezelés szempontjából. Ilyenek a tagadás, a hasítás és a helyettesítés. Kitérünk a Sjögren-szindrómát kísérő személyiségjellemzőkre is, amely ígéretes terület, de kevés adat áll rendelkezésünkre; az eddigi vizsgálatok alapján a neuroticismus a leginkább pSS-re jellemző tényező. A kognitív funkciók érintettségének összefoglalása és az egyéb pszichológiai tényezők (szellemi fáradtság, szexualitás, testképzavar, életminőség) összegzése után egyértelműen levonható a következtetés, hogy a Sjögren-szindróma nemcsak biológiai, hanem pszichés, pszichoszociális és szociális jelenségszinteken is okoz zavarokat, tüneteket. Ezért rendkívül fontos a betegség biopszichoszociális szemléletű kezelése, a betegek aktív, intencionális részvétele a pSS-sel való megküzdésben. Orv Hetil. 2021; 162(39): 1558-1566. Summary. Primary Sjögren syndrome (pSS) is a chronic, autoimmune disorder. Primary symptoms are ocular and oral dryness as a of an autoimmune process affecting the exocrine glands. The most common systemic manifestations of the disease are mental and physical fatigue and arthralgia. Psychological features of pSS are studied with great interest; the present publication reviews the results of the related investigations alongside with the possible psychoneuroimmunomodulatory background. Among psychological factors in pSS, depression and anxiety have been studied the longest. These impact significantly the quality of life, wellbeing, cognitive functions and disease activity of the patients. Afterwards, we introduce the characteristic patterns of stress and coping mechanisms in pSS, among which maladaptive strategies, typical for the disorder are the most important regarding the pathogenesis and the therapy. These pSS-linked maladaptive strategies are denial, disengagement and focus and venting of emotions. As next, we give a summary about personality characteristics in pSS, which is a promising field to study, and yet very few related data are available; based on them, neuroticism seems to be the most common personality factor in Sjögren's. After summarizing briefly cognitive functions and other psychological features (mental fatigue, sexuality, body image disturbance and quality of life), it is evident that pSS is determined not only by biological but also by psychological, psychosocial and social disturbances. Hence, treating pSS patients with a biopsychosocial perspective is crucial and so is the active and intentional participation of patients in their recovery. Orv Hetil. 2021; 162(39): 1558-1566.
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Affiliation(s)
- László V Módis
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Magatartástudományi Intézet, Debrecen, Nagyerdei krt. 98., 4032.,2 Debreceni Egyetem, Általános Orvostudományi Kar, Belgyógyászati Intézet, Klinikai Immunológiai Tanszék, Debrecen
| | - Antónia Szántó
- 2 Debreceni Egyetem, Általános Orvostudományi Kar, Belgyógyászati Intézet, Klinikai Immunológiai Tanszék, Debrecen
| | - Antal Bugán
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Magatartástudományi Intézet, Debrecen, Nagyerdei krt. 98., 4032
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12
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Szabó K, Jámbor I, Szántó A, Horváth IF, Tarr T, Nakken B, Szodoray P, Papp G. The Imbalance of Circulating Follicular T Helper Cell Subsets in Primary Sjögren's Syndrome Associates With Serological Alterations and Abnormal B-Cell Distribution. Front Immunol 2021; 12:639975. [PMID: 33815392 PMCID: PMC8018236 DOI: 10.3389/fimmu.2021.639975] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/10/2020] [Accepted: 03/01/2021] [Indexed: 12/21/2022] Open
Abstract
Since B-cell hyperactivity and pathologic antibody response are key features in the immunopathogenesis of primary Sjögren's syndrome (pSS), the role of follicular T helper (TFH) cells as efficient helpers in the survival and differentiation of B cells has emerged. Our aim was to investigate whether a change in the balance of circulating (c)TFH subsets and follicular regulatory T (TFR) cells could affect the distribution of B cells in pSS. Peripheral blood of 38 pSS patients and 27 healthy controls was assessed for the frequencies of cTFH cell subsets, TFR cells, and certain B cell subpopulations by multicolor flow cytometry. Serological parameters, including anti-SSA, anti-SSB autoantibodies, immunoglobulin, and immune complex titers were determined as part of the routine diagnostic evaluation. Patients with pSS showed a significant increase in activated cTFH cell proportions, which was associated with serological results. Frequencies of cTFH subsets were unchanged in pSS patients compared to healthy controls. The percentages and number of cTFR cells exhibited a significant increase in autoantibody positive patients compared to patients with seronegative pSS. The proportions of transitional and naïve B cells were significantly increased, whereas subsets of memory B cells were significantly decreased and correlated with autoantibody production. Functional analysis revealed that the simultaneous blockade of cTFH and B cell interaction with anti-IL-21 and anti-CD40 antibodies decreased the production of IgM and IgG. Imbalance in TFH subsets and TFR cells indicates an ongoing over-activated humoral immune response, which contributes to the characteristic serological manifestations and the pathogenesis of pSS.
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Affiliation(s)
- Krisztina Szabó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ilona Jámbor
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tünde Tarr
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Britt Nakken
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Peter Szodoray
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Gábor Papp
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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13
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Nagy G, Csípő I, Tarr T, Szűcs G, Szántó A, Bubán T, Sipeki N, Szekanecz Z, Papp M, Kappelmayer J, Antal-Szalmás P. Anti-neutrophil cytoplasmic antibody testing by indirect immunofluorescence: Computer-aided versus conventional microscopic evaluation of routine diagnostic samples from patients with vasculitis or other inflammatory diseases. Clin Chim Acta 2020; 511:117-124. [PMID: 33002474 DOI: 10.1016/j.cca.2020.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/06/2020] [Revised: 08/29/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Detection of anti-neutrophil cytoplasmic antibodies (ANCA) by indirect immunofluorescence assays (IFA) is of diagnostic importance in vasculitides and some other inflammatory diseases. Automation of IFA may be beneficial in high-throughput clinical laboratories. An analytical appraisal of the EUROPattern (EPa) automated microscope and image analysis system has not been reported in a routine clinical laboratory setting testing samples from both vasculitis and non-vasculitis patients. METHODS Results of EPa and on-screen ANCA pattern recognition of 568 consecutive routine serum samples were compared to those of conventional visual evaluation. RESULTS Agreement of discrimination between negative and non-negative samples was 86.1% comparing EPa and conventional reading, and it increased to 96.7% after on-screen user validation. Importantly, from the 334 samples classified as negative by EPa 328 (98.2%) were also negative by conventional evaluation. Pattern recognition showed 'moderate' agreement between classical microscopic and EPa analysis (κ = 0.446) and 'very good' agreement after user validation (κ = 0.900). Misclassification by EPa was dominantly due to the presence of anti-nuclear/cytoplasmic antibodies (incorrect pattern, 80/568) and the lower fluorescence cut-off of the automated microscope (false positives, 73/568). CONCLUSIONS Automated ANCA testing by EPa is a reliable alternative of classical microscopic evaluation, though classification of sera needs correction by trained personnel during on-screen validation.
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Affiliation(s)
- Gábor Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Csípő
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tünde Tarr
- Institute of Internal Medicine, Department of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gabriella Szűcs
- Institute of Internal Medicine, Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Antónia Szántó
- Institute of Internal Medicine, Department of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Bubán
- Institute of Internal Medicine, Department of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nóra Sipeki
- Institute of Internal Medicine, Department of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szekanecz
- Institute of Internal Medicine, Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mária Papp
- Institute of Internal Medicine, Department of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - János Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Péter Antal-Szalmás
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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14
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Fekete T, Ágics B, Bencze D, Bene K, Szántó A, Tarr T, Veréb Z, Bácsi A, Pázmándi K. Regulation of RLR-Mediated Antiviral Responses of Human Dendritic Cells by mTOR. Front Immunol 2020; 11:572960. [PMID: 33013932 PMCID: PMC7516067 DOI: 10.3389/fimmu.2020.572960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/15/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022] Open
Abstract
To detect replicating viruses, dendritic cells (DCs) utilize cytoplasmic retinoic acid inducible gene-(RIG) I-like receptors (RLRs), which play an essential role in the subsequent activation of antiviral immune responses. In this study, we aimed to explore the role of the mammalian target of rapamycin (mTOR) in the regulation of RLR-triggered effector functions of human monocyte-derived DCs (moDCs) and plasmacytoid DCs (pDCs). Our results show that RLR stimulation increased the phosphorylation of the mTOR complex (mTORC) 1 and mTORC2 downstream targets p70S6 kinase and Akt, respectively, and this process was prevented by the mTORC1 inhibitor rapamycin as well as the dual mTORC1/C2 kinase inhibitor AZD8055 in both DC subtypes. Furthermore, inhibition of mTOR in moDCs impaired the RLR stimulation-triggered glycolytic switch, which was reflected by the inhibition of lactate production and downregulation of key glycolytic genes. Blockade of mTOR diminished the ability of RLR-stimulated moDCs and pDCs to secret type I interferons (IFNs) and pro-inflammatory cytokines, while it did not affect the phenotype of DCs. We also found that mTOR blockade decreased the phosphorylation of Tank-binding kinase 1 (TBK1), which mediates RLR-driven cytokine production. In addition, rapamycin abrogated the ability of both DC subtypes to promote the proliferation and differentiation of IFN-y and Granzyme B producing CD8 + T cells. Interestingly, AZD8055 was much weaker in its ability to decrease the T cell proliferation capacity of DCs and was unable to inhibit the DC-triggered production of IFN-y and Granyzme B by CD8 + T cells. Here we demonstrated for the first time that mTOR positively regulates the RLR-mediated antiviral activity of human DCs. Further, we show that only selective inhibition of mTORC1 but not dual mTORC1/C2 blockade suppresses effectively the T cell stimulatory capacity of DCs that should be considered in the development of new generation mTOR inhibitors and in the improvement of DC-based vaccines.
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Affiliation(s)
- Tünde Fekete
- Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Beatrix Ágics
- Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Molecular Cell and Immune Biology, University of Debrecen, Debrecen, Hungary
| | - Dóra Bencze
- Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Molecular Cell and Immune Biology, University of Debrecen, Debrecen, Hungary
| | - Krisztián Bene
- Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tünde Tarr
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Veréb
- Department of Dermatology and Allergology, Regenerative Medicine and Cellular Pharmacology Laboratory, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Attila Bácsi
- Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Kitti Pázmándi
- Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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15
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Acar-Denizli N, Horváth IF, Mandl T, Priori R, Vissink A, Hernandez-Molina G, Armagan B, Praprotnik S, Sebastian A, Bartoloni E, Rischmueller M, Pasoto SG, Nordmark G, Nakamura H, Fernandes Moça Trevisani V, Retamozo S, Carsons SE, Maure-Noia B, Sánchez-Berná I, López-Dupla M, Fonseca-Aizpuru E, Melchor Díaz S, Vázquez M, Díaz Cuiza PE, de Miguel Campo B, Ng WF, Rasmussen A, Dong X, Li X, Baldini C, Seror R, Gottenberg JE, Kruize AA, Sandhya P, Gandolfo S, Kwok SK, Kvarnstrom M, Solans R, Sene D, Suzuki Y, Isenberg DA, Valim V, Hofauer B, Giacomelli R, Devauchelle-Pensec V, Atzeni F, Gheita TA, Morel J, Izzo R, Kalyoncu U, Szántó A, Olsson P, Bootsma H, Ramos-Casals M, Kostov B, Brito-Zerón P. Systemic phenotype related to primary Sjögren's syndrome in 279 patients carrying isolated anti-La/SSB antibodies. Clin Exp Rheumatol 2020; 38 Suppl 126:85-94. [PMID: 33095152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the systemic phenotype associated with the presence of isolated anti-La/SSB antibodies in a large international registry of patients with primary Sjögren's syndrome (pSS) fulfilling the 2002 classification criteria. METHODS The Big Data Sjögren Project Consortium is an international, multicentre registry created in 2014. Baseline clinical information from leading centres on clinical research in SS of the 5 continents was collected. Combination patterns of anti-Ro/SSA-La/SSB antibodies at the time of diagnosis defined the following four immunological phenotypes: double positive (combined Ro/SSA and La/SSB,) isolated anti-Ro/SSA, isolated anti-La/SSB, and immunonegative. RESULTS The cohort included 12,084 patients (11,293 females, mean 52.4 years) with recorded ESSDAI scores available. Among them, 279 (2.3%) had isolated anti-La/SSB antibodies. The mean total ESSDAI score at diagnosis of patients with pSS carrying isolated anti-La/SSB was 6.0, and 80.4% of patients had systemic activity (global ESSDAI score ≥1) at diagnosis. The domains with the highest frequency of active patients were the biological (42.8%), glandular (36.8%) and articular (31.2%) domains. Patients with isolated anti-La/SSB showed a higher frequency of active patients in all ESSDAI domains but two (articular and peripheral nerve) in comparison with immune-negative patients, and even a higher absolute frequency in six clinical ESSDAI domains in comparison with patients with isolated anti-Ro/SSA. In addition, patients with isolated anti-La/SSB showed a higher frequency of active patients in two ESSDAI domains (pulmonary and glandular) with respect to the most active immunological subset (double-positive antibodies). Meanwhile, systemic activity detected in patients with isolated anti-La/SSB was overwhelmingly low. Even in ESSDAI domains where patients with isolated anti-La/SSB had the highest frequencies of systemic activity (lymphadenopathy and muscular), the percentage of patients with moderate or high activity was lower in comparison with the combined Ro/SSA and La/SSB group. CONCLUSIONS Patients carrying isolated La/SSB antibodies represent a very small subset of patients with a systemic SS phenotype characterised by a significant frequency of active patients in most clinical ESSDAI domains but with a relative low frequency of the highest severe organ-specific involvements. Primary SS still remains the best clinical diagnosis for this subset of patients.
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Affiliation(s)
- Nihan Acar-Denizli
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Ildiko-Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Sweden
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Italy
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Berkan Armagan
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, SA, Australia
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Gunnel Nordmark
- Rheumatology, Department of Medical Sciences, Uppsala University, Sweden
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Soledad Retamozo
- Instituto Modelo de Cardiología Privado SRL, Córdoba, and Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Steven E Carsons
- Division of Rheumatology, Allergy and Immunology, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Brenda Maure-Noia
- Department of Autoimmune Diseases, Complexo Hospitalario Universitario de Vigo, Spain
| | - Isabel Sánchez-Berná
- Department of Internal Medicine, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | | | | | | | - Marcos Vázquez
- Department of Rheumatology, Hospital de Clínicas, San Lorenzo, Paraguay
| | - P Ericka Díaz Cuiza
- Departamento de Reumatología del Seguro Social Universitario y consultorio privado de Reumatología, Sucre, Bolivia
| | | | - Wan-Fai Ng
- Institute of Cellular Medicine, Newcastle University, and NIHR Biomedical Research Centre, Newcastle Upon Tyne, UK
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Xu Dong
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Xiaomei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | | | - Raphaele Seror
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Strasbourg University Hospital, Université de Strasbourg, CNRS, Strasbourg, France
| | - Aike A Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Pulukool Sandhya
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Saviana Gandolfo
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marika Kvarnstrom
- Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Roser Solans
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Damien Sene
- Service de Médecine Interne 2, Hôpital Lariboisière, Université Paris VII, Assistance Publique-Hôpitaux de Paris, France
| | - Yasunori Suzuki
- Division of Rheumatology , Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - David A Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, UK
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Germany
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, School of Medicine, University of L'Aquila, Italy
| | | | - Fabiola Atzeni
- IRCCS Galeazzi Orthopaedic Institute, Milan and Rheumatology Unit, University of Messina, Italy
| | - Tamer A Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Jacques Morel
- Department of Rheumatology, Teaching Hospital and University of Montpellier, France
| | - Raffaella Izzo
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Italy
| | - Umut Kalyoncu
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Peter Olsson
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Sweden
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Manuel Ramos-Casals
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain.
| | - Belchin Kostov
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, and Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Pilar Brito-Zerón
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, and Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
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Erdei A, Steiber Z, Gazdag A, Bodor M, Berta E, Szász R, Szántó A, Ujhelyi B, Barna S, Berényi E, Nagy VE. [Differential diagnosis of Graves' orbitopathy. Case report]. Orv Hetil 2016; 157:310-5. [PMID: 26876268 DOI: 10.1556/650.2016.30381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the most common cause of exophthalmos. As eye symptoms usually coincide with the development of thyrotoxicosis, the diagnosis of the disease is rarely difficult. The aim of the authors was to summarize the differential diagnosis of Graves' orbitopathy based on literature review and presentation of their own four problematic cases on this topic. They conclude that symptoms similar to endocrine orbitopathy are present in other disorders. Endocrinologists need to be aware of these other conditions to avoid treatment failures.
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Affiliation(s)
- Annamária Erdei
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012
| | - Zita Steiber
- Szemészeti Klinika, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Annamária Gazdag
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012
| | - Miklós Bodor
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012.,Klinikai Farmakológiai Tanszék, Debreceni Egyetem, Gyógyszertudományi Kar Debrecen
| | - Eszter Berta
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012.,Klinikai Farmakológiai Tanszék, Debreceni Egyetem, Gyógyszertudományi Kar Debrecen
| | - Róbert Szász
- Belgyógyászati Intézet, Hematológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Antónia Szántó
- Belgyógyászati Intézet, Immunológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Bernadett Ujhelyi
- Szemészeti Klinika, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Sándor Barna
- Nukleáris Medicina Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Ervin Berényi
- Radiológiai Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - V Endre Nagy
- Belgyógyászati Intézet, Endokrinológia Tanszék, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4012
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Szántó A, Szabó K, Nagy G, Molnár C, Zeher M. Characterization and Comparison of Patient Subgroups Suspicious for IgG4-Related Disease and Malignant Lymphoma in Patients Followed-up for Sjögren's Syndrome. Pathol Oncol Res 2016; 22:579-85. [PMID: 26786867 DOI: 10.1007/s12253-016-0041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
Differential diagnosis of patients with Sjögren's syndrome (SS), IgG4-related disease (IgG4-RD) and SS patients having high risk for lymphoma (LHR) can be challenging. Some patients with IgG4-RD might be misdiagnosed as having SS. There are special symptoms of SS that raise the possibility of IgG4-RD whereas other symptoms identify patients as having LHR. The purpose of this study was to characterize and compare patients with SS, possible IgG4-RD and SS patients with LHR. Sixty-five SS patients were divided into 4 subgroups according to having possible IgG4-RD (n = 15), LHR (n = 16), eligible for both aforementioned groups (n = 20) and not eligible for either group (n = 14), respectively. Four patients fulfilled the diagnostic criteria for IgG4-RD. The serum levels of IgG4 were significantly higher in patients suspicious for IgG4-RD compared to that of LHR patients (0.46 g/l vs. 0.12 g/l, p = 0.032). Shared features of the patient groups (salivary gland swelling (SGS) and lymphadenopathy), were separately analysed: SGS patients had higher IgG4/IgG ratio (p = 0.036), lymphadenopathic patients had higher IgG4 levels (p = 0.042). Some patients may be "hidden" under the diagnosis of SS. Although patients with LHR and patients with possible IgG4-RD share some symptoms, they differ significantly regarding IgG4 levels and IgG4/IgG ratio.
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Affiliation(s)
- Antónia Szántó
- Division of Clinical Immunology, Medical Faculty, University of Debrecen, 22 Móricz Zs. Krt, Debrecen, H-4032, Hungary
| | - Katalin Szabó
- Department of Pediatrics, Jósa András County Hospital, 68 Szent István Street, Nyíregyháza, H-4400, Hungary
| | - Gábor Nagy
- Medical Faculty, Institute for Laboratory Medicine, University of Debrecen, 22 Móricz Zs. Krt, Debrecen, H-4032, Hungary
| | - Csaba Molnár
- Medical Faculty, Institute of Pathology, University of Debrecen, 98 Nagyerdei Krt., Debrecen, H-4032, Hungary
| | - Margit Zeher
- Division of Clinical Immunology, Medical Faculty, University of Debrecen, 22 Móricz Zs. Krt, Debrecen, H-4032, Hungary.
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Szabó K, Papp G, Szántó A, Tarr T, Zeher M. A comprehensive investigation on the distribution of circulating follicular T helper cells and B cell subsets in primary Sjögren's syndrome and systemic lupus erythematosus. Clin Exp Immunol 2015; 183:76-89. [PMID: 26358223 DOI: 10.1111/cei.12703] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 01/09/2023] Open
Abstract
Follicular T helper (Tfh) cells have a crucial role in regulating immune responses within secondary lymphoid follicles by directing B cell differentiation towards memory B cells and plasma cells. Because abnormal humoral responses are key features in both primary Sjögren's syndrome (pSS) and systemic lupus erythematosus (SLE), the aim of this study was to profile the pathological connection between peripheral Tfh cells and B cells in the two diseases. Twenty-five pSS patients, 25 SLE patients and 21 healthy controls were enrolled into the study. We determined the ratio of circulating Tfh-like cells, their interleukin (IL)-21 production and different B cell subsets by flow cytometry. We observed higher percentages of naive B cells in both diseases, while non-switched and switched memory B cells showed decreased frequencies. The proportions of double-negative B cells and plasmablasts were elevated in SLE and decreased in pSS. The percentages of transitional B cells and mature-naive B cells were higher in SLE. Patients with more severe disease course had an elevated ratio of TFH-like cells and increased IL-21 production. Moreover, expansion of Tfh-like cells correlated positively with parameters related to antibody secretion, including serum immunoglobulin (Ig)G, immune complexes (ICs) and autoantibodies. Correlation analysis between Tfh-like cells and certain B cell subsets revealed possible defects during B cell selection. In conclusion, our observations on the profound expansion of circulating Tfh-like cells and their IL-21 production, along with the characteristic aberrant peripheral B cell distribution in both pSS and SLE, indicate the prominent role of Tfh cell in the regulation of B cell selection.
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Affiliation(s)
- K Szabó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - G Papp
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - T Tarr
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - M Zeher
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Tarr T, Dérfalvi B, Győri N, Szántó A, Siminszky Z, Malik A, Szabó AJ, Szegedi G, Zeher M. Similarities and differences between pediatric and adult patients with systemic lupus erythematosus. Lupus 2014; 24:796-803. [PMID: 25516474 DOI: 10.1177/0961203314563817] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [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: 05/13/2014] [Accepted: 11/20/2014] [Indexed: 12/16/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease with highest prevalence among women of childbearing age. However, children younger than 16 years also can develop SLE (childhood-onset lupus/juvenile-type SLE). The aim of our study was to compare the clinical course of adult and pediatric-onset SLE. Data from 342 adult patients followed at the University of Debrecen, Hungary, and 79 children documented in the Hungarian National Pediatric SLE registry were analyzed using hospital medical records. Organ manifestations, laboratory parameters, and immunoserological characteristics were reviewed and the results were evaluated using SPSS for Windows software.Gender distribution was not significantly different between groups with disease starting in childhood vs adulthood. The prevalence of the following manifestations was significantly higher for pediatric than for adult-onset disease including: lupus nephritis (43% pediatric vs 26.4% for adult-onset), hematological disorders (57% vs 36.4%), photosensitivity (20% vs 9%), butterfly rash (61% vs 35.5%) and mucosal ulceration (11.4% vs 4%). For adult-onset SLE, neurological symptoms (30% vs 6%) and polyarthritis (86% vs 68%) occurred significantly more frequently than in children. Anti-SSA, anti-SSB and antiphospholipid antibodies were detected at significantly higher levels in adult-onset patients compared to those in pediatrics. Children were more commonly given high-dose intravenous immunoglobulin treatment (6.3% vs 0.6%) and mycophenolate mofetil (15.2% vs 5.3%) than adults.These results suggest that pediatric and adult-onset SLE differ in multiple aspects, and it is important to recognize these differences for optimal treatment and prognosis of these patients.
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Affiliation(s)
- T Tarr
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - B Dérfalvi
- 2nd. Department of Pediatrics, Semmelweis University Budapest, Hungary Department of Pediatrics, Dalhousie University-IWK Health Centre, Halifax, Canada
| | - N Győri
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - A Szántó
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - Z Siminszky
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - A Malik
- 1st. Department of Pediatrics and Research Laboratory of Hungarian Academy of Science, Semmelweis University Budapest, Hungary
| | - A J Szabó
- 1st. Department of Pediatrics and Research Laboratory of Hungarian Academy of Science, Semmelweis University Budapest, Hungary
| | - G Szegedi
- Department of Clinical Immunology, University of Debrecen, Hungary
| | - M Zeher
- Department of Clinical Immunology, University of Debrecen, Hungary
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Abstract
OBJECTIVES Although most reported patients with immunoglobulin G4-related disease (IgG4-RD) are from the Far East, we aimed to identify patients suffering from IgG4-RD in our University Centre in Debrecen, Hungary. METHOD Serum IgG4 levels were measured at 51 of our 800 patients followed up because of Sjögren's syndrome (SS) if one or more clinical signs during the disease course raised the possibility of IgG4-RD (persisting salivary gland swelling, absence of anti-Ro/SSA and anti-La/SSB antibodies in the serum, and positive salivary gland biopsy, coexistence of autoimmune pancreatitis, autoimmune hepatitis, or primary sclerosing cholangitis, persisting lymphadenopathy). Where available, histological samples of small salivary gland biopsies were revised to detect the particular features of IgG4-RD. Pathologists and surgeons were informed about the disease and asked to refer suspicious cases. RESULTS Based on our survey, eight patients were identified with IgG4-RD. Pancreatic, salivary gland, aortic, and retroperitoneal manifestations were detected. Of the 51 patients with SS, four appeared to have IgG4-RD, but eventually one was excluded. CONCLUSIONS Although IgG4-RD is not yet well known to physicians of Western countries, it occurs in Caucasians and probably in other races as well. Moreover, our eight cases diagnosed with IgG4-RD demonstrate a relatively large European patient population collected in a single centre. European clinicians, and especially rheumatologists, should be informed and at least certain laboratories should be prepared to investigate patient samples if the suspicion of IgG4-RD is raised. The main clinical significance of an accurate diagnosis is the extreme corticosteroid sensitivity of IgG4-RD.
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Affiliation(s)
- A Szántó
- Department of Medicine, Division of Clinical Immunology, University of Debrecen Medical and Health Science Centre , Hungary
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Griger Z, Szántó A, Szabó NA, Soltész P, Zeher M. [Severe necrotising primary vasculitis--case report]. Lege Artis Med 2008; 18:697-701. [PMID: 19227611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Vasculitis is an inflammatory disorder of the vessels, often associates with necrosis. The primary (idiopathic) form caused by distinct immunological mechanisms, the secondary form caused by infection, tumor, drugs or systemic autoimmune disease. CASE REPORT 57-year-old smoking female patient with a medical history of the left ankle fracture. Four days earlier had sore throat, at admission was febrile and generally weak and had severe pain in her lower extremities. Physical examination revealed numerous livid alterations in both lower extremities, necrotic change of some toes and new onset of diastolic hypertension. Elevated serum transaminase levels, severe thrombopenia, anemia, leukocytosis suggested the possibility of thrombotic thrombocytopenic purpura and vasculitis. Tests ruled out septic embolism, therefore we applied high dose steroid treatment and plasma exchange. Meanwhile the results fulfilled the classification criteria of polyarteritis nodosa (vasculitis, livedo reticularis, polyneuropathia and new onset of diastolic hypertension), accordingly we synchronized the treatment with fractionally administered intravenous cyclophosphamide. The process revealed responsive to therapy and the substantive function of the legs remained after surgical removal of the necrotic areas. CONCLUSIONS Early rapid diagnosis of vasculitis is fundamental and we emphasize the significance of the efficient treatment.
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Affiliation(s)
- Zoltán Griger
- Debreceni Egyetem, Orvos- es Egészségtudományi Centrum, Belgyógyászati Intézet, III. Sz. Belgyógyászati Klinika, H-4032, Debrecen.
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Szántó A, Kiss E, Sas A, Szegedi G, Zeher M. [Association of systemic lupus erythematosus and Sjögren's syndrome]. Orv Hetil 2005; 146:2533-8. [PMID: 16440498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Systemic lupus erythematosus and Sjögren's syndrome are multisystemic autoimmune diseases which can be associated to each other. OBJECTIVE To investigate if there are any distinct clinical, laboratory or serologic features due to the association of the two diseases that can influence the follow up of these patients. PATIENTS AND METHODS The authors proved the association of these two autoimmune diseases in 56 patients, and these patients' clinical, laboratory and immunoserologic alterations. 50 patients with Sjögren's syndrome and 50 patients with systemic lupus erythematosus were used as control groups. RESULTS Compared with Sjögren's syndrome alone, in the cases of the association of the diseases, rheumatoid factor was present less frequently, Ro/SS-A, La/SS-B and DNA antibodies were present more frequently, such as antiphospholipid autoantibodies and antiphospholipid syndrome. Anaemia, leukopenia and lymphopenia were detected more often and the patients were younger than in Sjögren's syndrome. Also, affection of the lung, kidney, skin, central nervous system and serous membranes are more common. The group with systemic lupus erythematosus differs in being older, having thyroiditis, Ro/SS-A, La/SS-B and DNA more frequently. CONCLUSION Definitive clinical, laboratory and serological features make the difference between the association of the two diseases and the diseases observed alone.
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Affiliation(s)
- Antónia Szántó
- Debreceni Egyetem Orvos- es Egészségtudományi Centrum, Belgyógyászati Intézet
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Szántó A, Csípo I, Zeher M. Sensitivity and specificity of anti-alpha-fodrin antibodies in primary Sjögren's syndrome. J Rheumatol 2005; 32:197; author reply 197-8. [PMID: 15630756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Abstract
OBJECTIVE The authors observed priapism as a side effect occuring during the intracavernous treatment of erectile dysfunction. Earlier priapism had been treated with an intracavernous injection of sympatomimetics; unfortunately several complications and contraindications were found. PATIENTS AND METHODS Methylene blue was applied in the treatment of five patients. First a corpus cavernosum punction was performed and some blood was aspirated from the penis. Finally 100 mg of Methylthionin Chlorati was injected into the corpus cavernosum. RESULTS A sufficient detumescence was observed in all of these cases. There were no complications. The method was applied effectively in two cases after an unsuccessful punction. CONCLUSION The autors recommend intravenous methylene blue for the treatment of priapism. According to their experience this method is free of complications and as effective as a sympathomimetics treatment. As they think, it can be recommended in any manifestations of priapism because its force of action appears to be both chemically and biologically clear.
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Affiliation(s)
- J Hübler
- Department of Urology, University of Pécs, Hungary.
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Hübler J, Szántó A. Re: malignant extragastrointestinal stromal tumor of bladder. J Urol 2004; 171:1244; author reply 1244. [PMID: 14767318 DOI: 10.1097/01.ju.0000112917.79903.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Somogyi L, Szántó A, Polyák L, Baranyay F, Drinóczy M. [Adjuvant BCG immunotherapy in the management of superficial bladder tumors]. Orv Hetil 1993; 134:1851-6. [PMID: 8355975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The net benefit of BCG immunotherapeutic prophylactic effect on recurrence of superficial bladder tumours was investigated. The BCG treatment group consisted of 121 stage Ta, T1 patients, while the control group, 49 patients, was treated only with transurethral resection. During 3-year follow-up recurrence rate in the control group was 55.1%, while in the BCG group in the two-and-a-half-year follow-up it was 23.9%. The yearly repeated 6-week cycles resulted in decrease of recurrence rate to 11.8%. The recurrence indexes were 2.2 and 0.6 in the control group and in the repeated treatment group respectively. A progression rate of 18.8% was recorded in the control group and 4.1% in the treatment group. Finally both clinical and investigative results were summarised and the necessity of repeated immunotherapeutic BCG courses were emphasized.
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Affiliation(s)
- L Somogyi
- Pécsi Orvostudományi Egyetem Urológiai Klinika, Budapest
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27
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Somogyi L, Szántó A, Polyák L, Baranyay F, Drinóczy M. Long-term BCG immune therapy of superficial bladder tumours. Int Urol Nephrol 1992; 24:131-7. [PMID: 1624256 DOI: 10.1007/bf02549640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Long-term local BCG treatment of superficial bladder tumours is described and the 5-year results are reviewed. Complications of major significance in the course of immune therapy did not occur, loss due to death was not recorded. PPD skin test failed to furnish extra information regarding the biologic behaviour of the tumour. Annual repeats of the therapy promise better results than one single 6-week course.
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Affiliation(s)
- L Somogyi
- Department of Urology, University Medical School, Pécs, Hungary
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28
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Kómár J, Szegvári M, Gloviczky Z, Szántó A. [Traumatic section of the median nerve without complete motor paresis: the Martin-Gruber anastomosis (author's transl)]. Nervenarzt 1978; 49:697-9. [PMID: 215923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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29
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Barabás G, Szántó A. [Modern technic of sialography]. Orv Hetil 1977; 118:760-1. [PMID: 846717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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30
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Szántó A, Világi G, Berentey E, Jákó J, Bodnár E. [Left partial pericardial defect]. Orv Hetil 1971; 112:3123-6. [PMID: 5159639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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31
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Niederland V, Világi G, Szántó A, Berentey E, Kertész T, Löblovics I, Littmann I. [Diagnosis of papillary muscle dysfunction]. Orv Hetil 1971; 112:1829-33. [PMID: 5124617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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32
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Világi G, Kerkovits G, Szántó A, Bodrogi G. [Idiopathic hypertrophic subaortic stenosis (IHSS) (obstructive cardiomyopathy)]. Orv Hetil 1970; 111:2645-52. [PMID: 4923175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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