Immunogenicity of subcutaneous TNF inhibitors and its clinical significance in real-life setting in patients with spondyloarthritis

Key messages

Considerable proportion of patients with SpA have been immunized to the subcutaneous anti-TNF drug they are using. Concomitant use of MTX protects from immunization, whereas SASP does not. Patients with SpA using subcutaneous anti-TNF drugs can benefit from monitoring of the drug trough levels.

Abstract

Immunization to biological drugs can lead to decreased efficacy and increased risk of adverse effects. The objective of this cross-sectional study was to assess the extent and significance of immunization to subcutaneous tumor necrosis factor (TNF) inhibitors in axial spondyloarthritis (axSpA) patients in real-life setting. A serum sample was taken 1–2 days before the next drug injection. Drug trough concentrations, anti-drug antibodies (ADAb) and TNF-blocking capacity were measured in 273 patients with axSpA using subcutaneous anti-TNF drugs. The clinical activity of SpA was assessed using the Bath AS Disease Activity Index (BASDAI) and the Maastricht AS Entheses Score (MASES). ADAb were found in 11% of the 273 patients: in 21/99 (21%) of patients who used adalimumab, in 0/83 (0%) of those who used etanercept, in 2/79 (3%) of those who used golimumab and in 6/12 (50%) of those who used certolizumab pegol. Use of methotrexate reduced the risk of formation of ADAb, whereas sulfasalazine did not. Presence of ADAb resulted in decreased drug concentration and reduced TNF-blocking capacity. However, low levels of ADAb had no effect on TNF-blocking capacity and did not correlate with disease activity. The drug trough levels were below the consensus target level in 36% of the patients. High BMI correlated with low drug trough concentration. Patients with low drug trough levels had higher disease activity. The presence of anti-drug antibodies was associated with reduced drug trough levels, and the patients with low drug trough levels had higher disease activity. The drug trough levels were below target level in significant proportion of patients and, thus, measuring the drug concentration and ADAb could help to optimize the treatment in SpA patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00296-021-04955-8.

Physiological adaptations of the raccoon dog (Nyctereutes procyonoides) to seasonal fasting-fat and nitrogen metabolism and influence of continuous melatonin treatment

The raccoon dog (Nyctereutes procyonoides) is a middle-sized canid with profound autumnal fattening followed by winter sleep. This study investigated the effects of prolonged fasting-induced winter sleep on the fat and nitrogen metabolism of the species. Half of the animals were treated with continuous-release melatonin implants to induce artificial short photoperiod. Autumnal accumulation of fat was characterized by low plasma free fatty acid (FFA), diacylglycerol (DG), and triacylglycerol (TG) levels. After transition to winter catabolism, the circulating lipid levels increased due to enhanced lipolysis. Two months of fasting resulted in a steady 3.1 kg weight loss (28% of body mass, 0.47% day(-1)). Storage fat was mobilized during the winter sleep reflected by the elevated FFA and DG concentrations. The lowered insulin levels could be a stimulator for TG hydrolysis. The plasma total amino acid concentrations, urea levels, and urea-creatinine ratios decreased due to fasting, whereas ammonia and total protein concentrations remained stable. The effects of melatonin on energy metabolism were modest. The results indicate that the raccoon dog is well adapted to long-term wintertime fasting utilizing fat as the principal metabolic fuel. The species can maintain its protein catabolism constant for at least 60 days. Decreased cortisol and thyroid hormone concentrations may contribute to protein sparing.

Exact and efficient discrete random walk method for time-dependent two-dimensional environments

We present an exact method for speeding up random walk in two-dimensional complicated lattice environments. To this end, we derive the discrete two-dimensional probability distribution function for a diffusing particle starting at the center of a square of linear size s. This is used to propagate random walkers from the center of the square to sites which are nearest neighbors to its perimeter sites, thus saving O(s(2)) steps in numerical simulations. We discuss in detail how this method can be implemented efficiently. We examine its performance in the diffusion limited aggregation model which produces fractal structures, and in a one-sided step-growth model producing compact, fingerlike structures. We show that in both cases, the square propagator method reduces the computational effort by a factor proportional to the linear system size as compared to standard random walk.

Reproduction of the raccoon dog (Nyctereutes procyonoides) after feeding or food deprivation in winter

The wild raccoon dog (Nyctereutes procyonoides, Canidae, Carnivora) goes through autumn fattening followed by winter sleep. Farmed raccoon dogs also exhibit autumn fattening but not winter sleep, as a result of daily feeding and lack of nests. We studied the effects of food deprivation and winter sleep or active winter feeding on the physiology and reproduction of farm-born raccoon dogs. Eighty-six animals were put on a 2-month fast in November-December. The fast caused no deleterious effects on the health of the raccoon dogs. In the spring the food-deprived animals had slightly more cubs per mated female than the fed animals. There was a significant negative correlation between the number of cubs obtained and the mean body mass of the females at the beginning of the mating season. The highest mean number of cubs was obtained by the females that weighed 5-7 kg. The results indicate that the raccoon dog is finely adapted to a long period of food deprivation in the winter. Furthermore, winter sleep and food deprivation could be introduced to farm conditions by providing the raccoon dogs with nestboxes and withholding food for a period of 6-8 weeks in mid-winter.

Interface dynamics and kinetic roughening in fractals

We consider the dynamics and kinetic roughening of single-valued interfaces in two-dimensional fractal media. Assuming that the local height difference distribution function of the fronts obeys Levý statistics with a well-defined power-law decay exponent, we derive analytic expressions for the local scaling exponents. We also show that the kinetic roughening of the interfaces displays anomalous scaling and multiscaling in the relevant correlation functions. For invasion percolation models, the exponents can be obtained from the fractal geometry of percolation clusters. Our predictions are in excellent agreement with numerical simulations.

Fatty acids, lipids, and cytochrome p-450 monooxygenase in hepatic microsomes of minks fed fish-based diets and exposed to Aroclor 1242

Minks were fed different fish-based diets and exposed to 1 mg/d of the commercial polychlorinated biphenyl (PCB) mixture Aroclor 1242 for 4 wk (November-December 1995) or 21 wk (July-December 1998). In all the dietary groups, the PCBs increased hepatic phospholipid (PL) content. No significant increase was detected in hepatic triacylglycerols (TGs). In the minks fed the different fish diets, the PCBs caused qualitatively and quantitatively different changes in the microsomal fatty acids. In the minks that were fed a diet rich in fat and low in polyunsaturated fatty acids (PUFAs), the PCBs increased the percentage of oleic acid (18:1n-9, characteristic of the storage TGs) at the expense of n-3 PUFAs. This seemed to be due to inclusions of TGs in the membrane fragments and partly due to incorporation of TG-derived fatty acids into the membrane PLs. In addition, significant decrease of PUFAs was detected also in the hepatic TGs. The concomitant decrease in the concentrations of hepatic vitamin E suggested that lipid oxidation may also contribute to the decrease of the PUFAs. In the liver of the minks fed a low-fat but PUFA- and vitamin E-rich diet, the fatty acid changes due to the PCBs (the 21-wk exposure) remained small but the cytochrome P-450 system was significantly activated. In the minks fed Baltic herring (rich in organochlorines via the foodweb), the cytosolic glutathione S-transferase (GST) activity, levels of microsomal thiobarbituric acid-reactive substances (TBARS), and hepatic PLs were significantly elevated. In conclusion, in the mink the microsomal fatty acid changes were not directly connected with the ethoxyresorufin O-deethylase (EROD) activity or P-450 expression. Apparently, the PCBs produced definite fatty acid changes only in certain lipid matrices of tissue. In addition, a rich dietary supply of PUFAs and vitamin E may prevent these changes, even in a long-term subchronic exposure.

Effects of seasonality and fasting on the body mass and plasma growth hormone concentrations of the raccoon dog (Nyctereutes procyonoides) and the blue fox (Alopex lagopus)

Growth hormone (GH) promotes growth and endochondral ossification, but it is also important in the response to fasting due to its effects of increasing gluconeogenesis and lipolysis. In this study eleven raccoon dogs and blue foxes were followed for six months and their body mass and GH levels were measured. In November half of the animals of both species were put to a three-week fast. There were no significant differences in the GH levels between the animals of different ages and the subadults and adults both had quite low GH levels in the summer. Fasting had no effect on the GH levels of the raccoon dogs, but the fasting blue foxes had lower GH concentrations than the controls in Nov 16th. The control blue foxes experienced a significant increase in the GH levels in early November and the fasting blue foxes in late November. The GH concentrations of all the raccoon dogs rose in early December. As fasting did not cause an elevation in the GH levels but the concentrations increased with decreasing temperature and shortening daylength, the autumnal GH secretion of these species could be regulated by endogenous seasonal rhythms entrained by exogenous Zeitgebers such as temperature or photoperiod. The autumnal increase of GH levels contributes to the response to fasting as an adaptation to survive the winter months with inadequate nutrition. The raccoon dog which spends the coldest part of the winter in winter sleep seems to be better adapted to a total fast than the actively wintering blue fox.

Effects of seasonality and fasting on the plasma leptin and thyroxin levels of the raccoon dog (Nyctereutes procyonoides) and the blue fox (Alopex lagopus)

Plasma leptin and thyroxin concentrations of eleven raccoon dogs and eleven blue foxes were monitored for 6 months. Half of the animals were placed on a 3-week fast in November. Leptin levels were low in summer, but in October they rose significantly. In November, leptin concentrations decreased rapidly within a week although the body mass of the animals remained stable. There were no significant differences between experimental groups for raccoon dogs, but in blue foxes the fasting group had lower leptin levels than the control group. High thyroxin levels in summer decreased as autumn progressed, but thyroxin concentrations of the fasting groups increased at the end of the fast. Leptin levels of the raccoon dog and the blue fox are not determined only by the fat reserves of the animals, but they seem to reflect the autumnal deposition of fat at the onset of winter. Blue foxes have metabolic rates of active animals during the winter and higher leptin levels in December than raccoon dogs. The superficially hibernating raccoon dogs have low leptin levels after the onset of winter perhaps as an adaptation to fasting. J. Exp. Zool. 289:109-118, 2001.

Exogenous melatonin affects lipids and enzyme activities in mink (Mustela vison) liver

Exogenous melatonin as subcutaneous 2.7-mg implants was given to eight female and male minks in late July with an equal number of animals in the control groups. The liver enzyme activities and major lipids of liver and plasma were measured in October-November. Melatonin had very pronounced effects on the lipid and carbohydrate metabolism of the minks and there was also a clear sexual dimorphism. In the males, melatonin decreased the lipase esterase activity of the liver. In the liver of the females, however, melatonin increased the glucose-6-phosphatase activity. Due to melatonin treatment the liver triacylglycerol contents diminished in both sexes. At the same time, in the females the liver cholesterol levels were decreased. In the plasma lipids, the only change was a fall in the polar lipids of the melatonin-treated females. Melatonin seems to be responsible for the metabolic changes associated with the onset of wintering, especially for the acceleration of the deposition of subcutaneous fat reserves. The smaller females experience the effects of exogenous melatonin more rapidly than the males. Perhaps the smaller body size requires an earlier onset of metabolic preparation for the winter.

Plasma leptin and thyroxine of mink (Mustela vison) vary with gender, diet and subchronic exposure to PCBs

Female minks (Mustela vison) fed diets based on freshwater, marine or mixed fish were exposed to 1 mg of polychlorinated biphenyls (PCBs) a day for 21 weeks. The plasma leptin and thyroxine concentrations and the glucose-6-phosphatase and glycogen phophorylase activities in the liver were measured at the end of the experiment. The plasma thyroxine concentrations were significantly higher in the group exposed to PCBs. The mean plasma leptin concentration and glucose-6-phosphatase activity was the highest in the group that had the lowest body-mass index (BMI). The glycogen phophorylase activity was the highest in the freshwater fish-control group. The results suggest that the amount of fat in the body of the female minks is not the only determinant of the plasma leptin levels, but the leptin levels seem to rise with a lowered BMI unlike in rodents or humans. The positive correlation between the leptin levels and the glucose-6-phosphatase activity suggests increased gluconeogenesis with high leptin levels. Subchronic exposure to PCBs seems to have no effect on the plasma leptin levels or the glucose-6-phophatase activities, but it elevates significantly the plasma thyroxine levels with a mechanism that remains unknown.

Exogenous melatonin elevates the plasma leptin and thyroxine concentrations of the mink (Mustela vison)

Eight male and eight female minks were given exogenous melatonin as subcutaneous implants. The plasma leptin and thyroxine concentrations were measured. The leptin concentrations showed clear seasonal variations and differences between the experimental groups. In September most of the control females had undetectable plasma leptin concentrations, but the melatonin-treated females had detectable concentrations significantly higher than the leptin levels of the controls. Most of the males had undetectable leptin concentrations, too. In October the plasma leptin levels had increased significantly in all the groups except the control males. The melatonin-treated minks had significantly higher leptin levels than the controls. There was a significant rise in the thyroxine levels from September to October and the melatonin-treated groups had significantly higher thyroxine levels than the controls. The effects of exogenous melatonin are very pronounced in the mink. Melatonin elevates the plasma leptin and thyroxine levels possibly by direct and indirect mechanisms.

Percolation and spatial correlations in a two-dimensional continuum deposition model

We introduce a two-dimensional continuum deposition model of spatially extended objects, with an effective repulsive contact interaction between them represented by a parameter 0 < or = q < or = 1. For q = 0, the deposited network is uniformly random, while for q = 1 particles are not allowed to overlap. For 0 < or = q < 1, we carry out extensive simulations on fibers, needles, and disks to study the dependence of the percolation threshold on q. We derive expressions for the threshold near q = 0 and q = 1 and find good qualitative agreement with the simulations. The deposited networks produced by the model display nontrivial density correlations near percolation threshold. These are reflected in the appropriate spatial correlation functions. We study such functions close to q = 1 and derive an approximate expression for the pair distribution function.

Thermoregulation of polecat and raccoon dog: a comparative study with stoat, mink and blue fox

1. Oxygen consumption (ml X kg0.75 per min) in relation to ambient temperature (Ta) in the raccoon dog (Nyctereutes procyonoides), polecat (Mustela putorius), mink (Mustela vison) and stoat (Mustela erminea) is described by equations y = 14.2 - 0.23x, y = 26.3 - 0.47x, y = 26.9 - 0.33x and y = 39.0 - 1.06x, respectively. Resting metabolic rate (RMR) of blue fox (Alopex lagopus) could be measured only at thermoneutrality. 2. In polecats, calorigenic response to noradrenaline was about 40% above the RMR, while in raccoon dogs it was absent. 3. The cooling constant (per min) of deceased raccoon dogs was similar to that measured for blue fox (0.0008), but considerably higher than that measured for dog (beagle 0.0016) or polecats (0.0023-0.0031).