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Joshua V, Hensvold AH, Reynisdottir G, Hansson M, Cornillet M, Nogueira L, Serre G, Nyren S, Karimi R, Eklund A, Sköld M, Grunewald J, Chatzidionysiou K, Catrina A. Association between number and type of different ACPA fine specificities with lung abnormalities in early, untreated rheumatoid arthritis. RMD Open 2021; 6:rmdopen-2020-001278. [PMID: 32917833 PMCID: PMC7520701 DOI: 10.1136/rmdopen-2020-001278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/16/2020] [Accepted: 08/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background Rheumatoid arthritis (RA)-associated anticitrullinated protein/peptide antibodies (ACPA) might originate at mucosal sites such as the lungs. We aimed to examine the relationship between the ACPA repertoire and lung abnormalities on high-resolution CT (HRCT) in patients with earlyuntreated RA. Methods 106 patients with newly diagnosed untreated RA were examined with HRCT of the lungs. Blood samples were analysed for presence of rheumatoid factor (RF) and ACPA using either a CCP2 detection kit or an immunochip containing 10 different citrullinated peptides. Association between HRCT findings and the antibody repertoire was assessed by logistic regression analysis. Results The number (%) of patients with HRCT abnormalities was 58 (54.7%) for parenchymal abnormalities and 68 (64.2%) for airway abnormalities. CCP2 IgG, RF IgA and antibodies against citrullinated fibrinogen were associated with the presence of parenchymal lung abnormalities. Interestingly, a high number of ACPA fine specificities gave a high risk of having parenchymal lung abnormalities at the time of RA diagnosis. No significant signals were identified between ACPA specificities and risk for airway abnormalities. Conclusions The presence of RF and ACPAs (especially against citrullinated fibrinogen peptides) as well as high number of ACPAs fine specificities are associated with parenchymal lung abnormalities in patients with early, untreated RA. This provides further support for an important pathogenic link between the lung and systemic autoimmunity, contributing to RA development.
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Affiliation(s)
- Vijay Joshua
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Aase Haj Hensvold
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Gudrun Reynisdottir
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Monica Hansson
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Cornillet
- Unité Différenciation Épithéliale et Autoimmunité Rhumatoïde, Unité Mixte de Recherche 1056, INSERM - Université de Toulouse, Toulouse, France
| | - Leonor Nogueira
- Unité Différenciation Épithéliale et Autoimmunité Rhumatoïde, Unité Mixte de Recherche 1056, INSERM - Université de Toulouse, Toulouse, France
| | - Guy Serre
- Unité Différenciation Épithéliale et Autoimmunité Rhumatoïde, Unité Mixte de Recherche 1056, INSERM - Université de Toulouse, Toulouse, France
| | - Sven Nyren
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Reza Karimi
- Division of Respiratory Medicine, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Eklund
- Division of Respiratory Medicine, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Sköld
- Division of Respiratory Medicine, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Grunewald
- Division of Respiratory Medicine, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Katerina Chatzidionysiou
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Anca Catrina
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Joshua V, Chatzidionysiou K, Reynisdottir G, Hensvold A, Hansson M, Nogueira L, Eklund A, Serre G, Grunewald J, Catrina A. FRI0137 Association between Number and Type of Different ACPA Fine Specificities and Parenchymal Lung Changes in High Resolution Computed Tomography in Patients with Early Rheumatoid Arthritis: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chatzidionysiou K, Reynisdottir G, Joshua V, Frisell T, Askling J, Catrina A. FRI0136 Risk for Lung Cancer in RA and Different RA Phenotypes: Results from A Population-Based Case-Control Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chatzidionysiou K, Reynisdottir G, Joshua V, Frisell T, Askling J, Catrina AI. A10.16 Risk for lung cancer in ra and different ra phenotypes: Results from a population-based case-control study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reynisdottir G, Olsen H, Joshua V, Engström M, Forsslund H, Karimi R, Sköld CM, Nyren S, Eklund A, Grunewald J, Catrina AI. Signs of immune activation and local inflammation are present in the bronchial tissue of patients with untreated early rheumatoid arthritis. Ann Rheum Dis 2015; 75:1722-7. [PMID: 26530319 DOI: 10.1136/annrheumdis-2015-208216] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [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: 07/12/2015] [Accepted: 09/20/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Events in the lungs might contribute to generation of anticitrullinated protein antibodies (ACPA) in rheumatoid arthritis (RA). We investigated if signs of immune activation are present in bronchial biopsies and bronchoalveolar lavage (BAL) of patients with early-untreated RA without clinical signs of lung involvement. METHODS Twenty-four patients with RA with symptom duration <1 year and naïve to disease-modifying antirheumatic drugs were subjected to bronchoscopy where BAL and mucosal bronchial biopsies were retrieved. For comparison, 15 bronchial biopsies and 79 BAL samples from healthy volunteers were available. Histological examination was performed to evaluate lymphocyte infiltration, presence of immune cells (T and B cells, plasma cells, dendritic cells and macrophages) and immune activation markers. Cell composition of BAL samples was analysed by differential counting and T cell subsets by flow cytometry. RESULTS Lymphocyte infiltration was more frequently found in ACPA-positive patients (50%) as compared with ACPA-negative patients (17%) and controls (13%). Germinal centres, B cells and plasma cells were only found in ACPA-positive patients. The frequency of T cells in bronchial biopsies of patients with ACPA-positive RA was positively associated with expression of immune activation markers. BAL samples of patients with ACPA-positive, but not ACPA-negative, RA had significantly higher relative numbers of lymphocytes and expressed higher levels of activation markers compared with controls. CONCLUSIONS Signs of immune cell accumulation and activation are present both in the bronchial tissue and in BAL of untreated patients with early RA without concomitant lung disease, strengthening the role of the lung compartment as an important player in ACPA-positive RA.
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Affiliation(s)
- Gudrun Reynisdottir
- Rheumatology Unit, Department of Medicine, Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
| | - Helga Olsen
- Division of Respiratory Medicine, Department of Medicine, Solna, Center for Molecular Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Vijay Joshua
- Rheumatology Unit, Department of Medicine, Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
| | - Marianne Engström
- Rheumatology Unit, Department of Medicine, Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
| | - Helena Forsslund
- Division of Respiratory Medicine, Department of Medicine, Solna, Center for Molecular Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Reza Karimi
- Division of Respiratory Medicine, Department of Medicine, Solna, Center for Molecular Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - C Magnus Sköld
- Division of Respiratory Medicine, Department of Medicine, Solna, Center for Molecular Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sven Nyren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Anders Eklund
- Division of Respiratory Medicine, Department of Medicine, Solna, Center for Molecular Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Grunewald
- Division of Respiratory Medicine, Department of Medicine, Solna, Center for Molecular Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anca I Catrina
- Rheumatology Unit, Department of Medicine, Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden
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Catrina AI, Ytterberg AJ, Reynisdottir G, Malmström V, Klareskog L. Lungs, joints and immunity against citrullinated proteins in rheumatoid arthritis. Nat Rev Rheumatol 2014; 10:645-53. [PMID: 25072264 DOI: 10.1038/nrrheum.2014.115] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rheumatoid arthritis (RA) is a prototype for a criterion-defined inflammatory disease, for which the aetiology and initial molecular pathogenesis has been elusive for a long time. We describe in this Review how studies on the interplay between specific immunity, alongside genetic and environmental predisposing factors, provide new tools to understand the molecular basis of distinct subsets of the disease. A particular emphasis is on the possibility that pathogenic immune reactions might be initiated at other sites than the joints, and that the lungs could harbour such sites. New data strengthen this concept, showing that local immunity towards citrullinated proteins and accompanying inflammation might be present in the lungs early during disease development. This progress makes RA an interesting case for the future development of therapies that might be directed against disease-inducing immunity even before inflammation and destruction of joints has begun.
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Affiliation(s)
- Anca I Catrina
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm S-17176, Sweden
| | - A Jimmy Ytterberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm S-17176, Sweden
| | - Gudrun Reynisdottir
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm S-17176, Sweden
| | - Vivianne Malmström
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm S-17176, Sweden
| | - Lars Klareskog
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm S-17176, Sweden
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Joshua V, Reynisdottir G, Ytterberg A, Engström M, Eklund A, Malmström V, Grunewald J, Klareskog L, Catrina A. OP0171 Characterization of Lung Inflammation and Identification of Shared Citrullinated Targets in the Lungs and Joints of Early RA. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ytterberg AJ, Joshua V, Reynisdottir G, Tarasova NK, Rutishauser D, Ossipova E, Haj Hensvold A, Eklund A, Sköld CM, Grunewald J, Malmström V, Jakobsson PJ, Rönnelid J, Padyukov L, Zubarev RA, Klareskog L, Catrina AI. Shared immunological targets in the lungs and joints of patients with rheumatoid arthritis: identification and validation. Ann Rheum Dis 2014; 74:1772-7. [PMID: 24817415 DOI: 10.1136/annrheumdis-2013-204912] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [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: 11/14/2013] [Accepted: 04/13/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Immunological events in the lungs might trigger production of anti-citrullinated protein antibodies during early rheumatoid arthritis (RA). We investigated the presence of shared immunological citrullinated targets in joints and lungs of patients with RA. PATIENTS AND METHODS Proteins extracted from bronchial (n=6) and synovial (n=7) biopsy specimens from patients with RA were investigated by mass spectrometry-based proteomics. One candidate peptide was synthesised and used to investigate by ELISA the presence of antibodies in patients with RA (n=393), healthy controls (n=152) and disease controls (n=236). HLA-DRB1 shared epitope (SE) alleles were detected in patients with RA. RESULTS Ten citrullinated peptides belonging to seven proteins were identified, with two peptides shared between the synovial and bronchial biopsy samples. Further analysis, using accurate mass and retention time, enabled detection of eight citrullinated peptides in synovial and seven in bronchial biopsy specimens, with five peptides shared between the synovial and bronchial biopsy specimens. Two citrullinated vimentin (cit-vim) peptides were detected in the majority of synovial and lung tissues. Antibodies to a synthesised cit-vim peptide candidate (covering both cit-vim peptides identified in vivo) were present in 1.8% of healthy controls, 15% of patients with RA, and 3.4% of disease controls. Antibodies to cit-vim peptide were associated with the presence of the SE alleles in RA. CONCLUSIONS Identical citrullinated peptides are present in bronchial and synovial tissues, which may be used as immunological targets for antibodies of patients with RA. The data provide further support for a link between lungs and joints in RA and identify potential targets for immunity that may mediate this link.
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Affiliation(s)
- A Jimmy Ytterberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Vijay Joshua
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Gudrun Reynisdottir
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Nataliya K Tarasova
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Dorothea Rutishauser
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Elena Ossipova
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Aase Haj Hensvold
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Anders Eklund
- Division of Respiratory Medicine, Department of Medicine, Karolinska Institutet, and Center for Molecular Medicine (CMM), Karolinska University Hospital, Stockholm, Sweden
| | - C Magnus Sköld
- Division of Respiratory Medicine, Department of Medicine, Karolinska Institutet, and Center for Molecular Medicine (CMM), Karolinska University Hospital, Stockholm, Sweden
| | - Johan Grunewald
- Division of Respiratory Medicine, Department of Medicine, Karolinska Institutet, and Center for Molecular Medicine (CMM), Karolinska University Hospital, Stockholm, Sweden
| | - Vivianne Malmström
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Per Johan Jakobsson
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Johan Rönnelid
- Clinical Immunology Unit, Uppsala University, Uppsala, Sweden
| | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Roman A Zubarev
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Klareskog
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Anca I Catrina
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Joshua V, Reynisdottir G, Ytterberg J, Engström M, Eklund A, Skold M, Jakobsson PJ, Rönnelid J, Malmström V, Klareskog L, Grunewald J, Catrina AI. A1.1 Characterisation of lung inflammation and identification of shared citrullinated targets in the lungs and joints of early rheumatoid arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reynisdottir G, Karimi R, Joshua V, Olsen H, Hensvold AH, Harju A, Engström M, Grunewald J, Nyren S, Eklund A, Klareskog L, Sköld CM, Irinel Catrina A. Structural Changes and Antibody Enrichment in the Lungs Are Early Features of Anti-Citrullinated Protein Antibody-Positive Rheumatoid Arthritis. Arthritis Rheumatol 2013; 66:31-9. [DOI: 10.1002/art.38201] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 09/12/2013] [Indexed: 01/18/2023]
Affiliation(s)
| | - Reza Karimi
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Vijay Joshua
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Helga Olsen
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Aase Haj Hensvold
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Anders Harju
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Marianne Engström
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Johan Grunewald
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Sven Nyren
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Anders Eklund
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Lars Klareskog
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Carl Magnus Sköld
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
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Reynisdottir G, Karimi R, Olsen H, Joshua V, Hensvold AH, Harju A, Engström M, Grunewald J, Nyren S, Eklund A, Klareskog L, Sköld M, Catrina AI. A1.4 Early Signs of Subclinical Inflammation and Local Antibody Production in Early Rheumatoid Lungs. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-203214.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ytterberg AJ, Reynisdottir G, Ossipova E, Rutishauser D, Hensvold A, Eklund A, Sköld M, Grunewald J, Lundberg K, Malmström V, Jakobsson PJ, Zubarev R, Klareskog L, Catrina AI. Identification of shared citrullinated immunological targets in the lungs and joints of patients with rheumatoid arthritis. Ann Rheum Dis 2012. [DOI: 10.1136/annrheumdis-2011-201231.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reynisdottir G, Joshua V, Nyren S, Hensvold A, Karimi R, Harju A, Engström M, Sköld M, Eklund A, Grunewald J, Klareskog L, Catrina AI. Lung changes detected by high resolution tomography are present in ACPA positive RA patients already at disease onset. Ann Rheum Dis 2012. [DOI: 10.1136/annrheumdis-2011-201231.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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