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Deibel E, Carreira PE, Vonk M, Del Papa N, Bečvář R, Guillén-Del-Castillo A, Campochiaro C, Poormoghim H, Liem S, Lazzaroni MG, Giollo A, Mekinian A, de Vries-Bouwstra J, De Santis M, Balbir-Gurman A, Mihai C, De Luca G, Moiseev S, Zanatta E, Foti R, Rednic S, Denton C, Cutolo M, Belloli L, Airo P, Garzanova L, Moroncini G, İnanç M, Panopoulos S, Tandaipan JL, Chatelus E, Rosato E, Kuwana M, Yavuz S, Alegre-Sancho JJ, Smith V, Szűcs G, Henes J, Rodríguez-Pintó I, Atzeni F, Spierings J, Truchetet ME, Milchert M, Brito de Araujo D, Riemekasten G, Bernardino V, Martin T, Del Galdo F, Vacca A, Mendoza F, Midtvedt Ø, Murdaca G, Santiago T, Codullo V, Cacciapaglia F, Walker U, Brunborg C, Tirelli F, Allanore Y, Furst DE, Matucci M, Gabrielli A, Distler O, Hoffmann-Vold AM. Does the Impact of COVID-19 on Patients With Systemic Sclerosis Change Over Time? Arthritis Care Res (Hoboken) 2024; 76:88-97. [PMID: 37667424 DOI: 10.1002/acr.25226] [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: 03/31/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The outcome of patients with COVID-19 improved over the pandemic, including patients with systemic rheumatic diseases. However, data on patients with systemic sclerosis (SSc) are lacking. This study aimed to assess the outcome of patients with both SSc and COVID-19 over several waves. METHODS Patients with both SSc and COVID-19 who were registered in the European Scleroderma Trials and Research group (EUSTAR) were collected between April 2020 and April 2021. Patients were assigned to waves 1, 2, or 3 depending on the date of their COVID-19 diagnosis. Primary endpoints were death, intensive care unit stay, or ventilatory support (severe outcome). Subgroup analyses of patients who were hospitalized or died were conducted. General and SSc-specific characteristics and treatment were compared over the waves. Descriptive statistics and multivariate logistic regression were applied. RESULTS A total of 333 patients were included; 57 patients (17%) had a severe outcome, and 30 patients (9%) died. Compared to wave 1, significantly fewer patients with SSc suffered from severe COVID-19 in waves 2 and 3 (28.2% vs 9.8% and 12.7%; P < 0.001), fewer patients required hospitalization (46.7% vs 19.6% and 25.5%; P < 0.001) or ventilatory support (24.0% vs 8.7% and 10.9%; P = 0.001), and fewer patients died (15.7% vs 5.0% and 7.5%; P = 0.011). Patients were significantly younger, more often men, had less frequent arterial hypertension, and less SSc cardiac involvement over waves 1 to 3. Patients received significantly less medium to high doses of corticosteroids as they did SSc treatment. CONCLUSION The outcome of patients with both SSc and COVID-19 improved significantly over time because of intrinsic and extrinsic factors.
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Affiliation(s)
- Elisabeth Deibel
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Madelon Vonk
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Radim Bečvář
- 1st Medical School, Charles University, Praha, Czech Republic
| | | | | | | | - Sophie Liem
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | - Maria De Santis
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy, and Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carina Mihai
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Sergey Moiseev
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Rosario Foti
- A.O.U. Policlinico S. Marco Catania, Catania, Italy
| | - Simona Rednic
- University of Medicine & Pharmacy "Iuliu Hatieganu" Cluj, Cluj-Napoca, Romania
| | | | | | - Laura Belloli
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Paolo Airo
- ASST Spedali Civili of Brescia, University of Brescia, Italy
| | - Liudmila Garzanova
- VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Gianluca Moroncini
- Università Politecnica delle Marche, Polo Didattico, University of Ancona, Ancona, Italy
| | | | | | | | - Emmanuel Chatelus
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares Est/Sud-Ouest (RESO), Strasbourg, France
| | | | | | | | | | - Vanessa Smith
- Ghent University, Ghent University Hospital, and VIB Inflammation Research Center (IRC), Ghent, Belgium
| | | | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases (INDIRA), University Hospital Tuebingen, Tuebingen, Germany
| | | | | | | | | | | | | | - Gabriela Riemekasten
- University Clinic Schleswig Holstein Lübeck, University of Lübeck, Lübeck, Germany
| | - Vera Bernardino
- Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Thierry Martin
- Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Nouvel Hôpital Civil, Strasbourg, France
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, Leeds, UK
| | | | | | | | - Giuseppe Murdaca
- University of Genova and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Tânia Santiago
- Centro Hospital e Universitário de Coimbra, University of Coimbra, Portugal
| | | | | | | | | | - Francesca Tirelli
- University Hospital Zurich, University of Zurich, Zurich, Switzerland, and University of Padova, Padova, Italy
| | | | | | - Marco Matucci
- University of Florence, Florence, Italy and IRCCS San Raffaele Hospital, Milan, Italy
| | - Armando Gabrielli
- Università Politecnica delle Marche, Polo Didattico, University of Ancona, Ancona, Italy
| | - Oliver Distler
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna-Maria Hoffmann-Vold
- University Hospital Zurich, University of Zurich, Zurich, Switzerland and Oslo University Hospital, Oslo, Norway
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2
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Spiera R, Kuwana M, Khanna D, Hummers L, Frech TM, Stevens W, Matucci-Cerinic M, Kafaja S, Distler O, Jun JB, Levy Y, Leszcyzński P, Gordon J, Steen V, Lee EB, Jankowski T, Litinsky I, Chung L, Hsu V, Mayes M, Sandorfi N, Simms RW, Finzel S, de Vries-Bouwstra J, Constantine S, Dgetluck N, Dinh Q, Bloom BJ, Furst DE, White B, Denton CP. Efficacy and Safety of Lenabasum, a Cannabinoid Type 2 Receptor Agonist, in a Phase 3 Randomized Trial in Diffuse Cutaneous Systemic Sclerosis. Arthritis Rheumatol 2023; 75:1608-1618. [PMID: 37098795 DOI: 10.1002/art.42510] [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: 02/22/2023] [Revised: 02/22/2023] [Accepted: 03/14/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE This phase 3 study was undertaken to investigate the efficacy and safety of lenabasum, a cannabinoid type 2 receptor agonist, in patients with diffuse cutaneous systemic sclerosis (dcSSc). METHODS A multinational double-blind study was conducted in 365 dcSSc patients who were randomized and dosed 1:1:1 with lenabasum 20 mg, lenabasum 5 mg, or placebo, each twice daily and added to background treatments, including immunosuppressive therapies (IST). RESULTS The primary end point, the American College of Rheumatology combined response index in dcSSc (CRISS) at week 52 for lenabasum 20 mg twice a day versus placebo, was not met, with CRISS score of 0.888 versus 0.887 (P = 0.4972, using mixed models repeated measures [MMRM]). The change in the modified Rodnan skin thickness score (MRSS) at week 52 for lenabasum 20 mg twice a day versus placebo was -6.7 versus -8.1 (P = 0.1183, using MMRM). Prespecified analyses showed higher CRISS scores, greater improvement in MRSS, and lower decline in forced vital capacity in patients on background mycophenolate and those who were taking IST for ≤1 year. No deaths or excess in serious or severe adverse events related to lenabasum were observed. CONCLUSION A benefit of lenabasum in dcSSc was not demonstrated. Most patients were treated with background IST, and treatment with mycophenolate mofetil in particular was associated with better outcomes. These findings support the use of IST in the treatment of dcSSc and highlight the challenge of demonstrating a treatment effect when investigational treatment is added to standard of care IST. These findings have relevance to trial design in SSc, as well as to clinical care.
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Affiliation(s)
| | - Masataka Kuwana
- Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | | | - Laura Hummers
- John Hopkins University School of Medicine, Baltimore, Maryland
| | - Tracy M Frech
- University of Utah and Salt Lake City VA Health Care System, Salt Lake City, Utah
| | - Wendy Stevens
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Suzanne Kafaja
- David Geffen School of Medicine at University of California, Los Angeles (UCLA)
| | - Oliver Distler
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jae-Bum Jun
- Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Yair Levy
- Meir Medical Center, Kfar Saba, Israel
| | | | | | - Virginia Steen
- Georgetown University School of Medicine, Washington, DC
| | - Eun Bong Lee
- Seoul National University College of Medicine, Seoul, South Korea
| | - Tomasz Jankowski
- Klinika Reumatologii Ukladowych Chorob Tkanki Lacznej Szpital Uniwersytecki, Bydgozzcz, Poland
| | | | - Lorina Chung
- Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, California
| | - Vivien Hsu
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Maureen Mayes
- McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Nora Sandorfi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert W Simms
- Boston University School of Medicine, Boston, Massachusetts
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, University Medical Center, Universitätsklinikum Freiburg, Freiburg, Germany
| | | | | | | | - Quinn Dinh
- Corbus Pharmaceuticals, Inc., Norwood, Massachusetts
| | | | - Daniel E Furst
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy, David Geffen School of Medicine at UCLA, Los Angeles, California, and University of Washington, Seattle, UK
| | - Barbara White
- Corbus Pharmaceuticals, Inc., Norwood, Massachusetts
| | - Christopher P Denton
- UCL Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
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Lescoat A, Huang S, Carreira PE, Siegert E, de Vries-Bouwstra J, Distler JHW, Smith V, Del Galdo F, Anic B, Damjanov N, Rednic S, Ribi C, Bancel DF, Hoffmann-Vold AM, Gabrielli A, Distler O, Khanna D, Allanore Y. Cutaneous Manifestations, Clinical Characteristics, and Prognosis of Patients With Systemic Sclerosis Sine Scleroderma: Data From the International EUSTAR Database. JAMA Dermatol 2023; 159:837-847. [PMID: 37378994 PMCID: PMC10308295 DOI: 10.1001/jamadermatol.2023.1729] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/22/2022] [Accepted: 05/01/2023] [Indexed: 06/29/2023]
Abstract
Importance Systemic sclerosis (SSc) sine scleroderma (ssSSc) is a subset of SSc defined by the absence of skin fibrosis. Little is known about the natural history and skin manifestations among patients with ssSSc. Objective To characterize the clinical phenotype of patients with ssSSc compared with patients with limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) within the EUSTAR database. Design, Setting, and Participants This longitudinal observational cohort study based on the international EUSTAR database included all patients fulfilling the classification criteria for SSc assessed by the modified Rodnan Skin score (mRSS) at inclusion and with at least 1 follow-up visit; ssSSc was defined by the absence of skin fibrosis (mRSS = 0 and no sclerodactyly) at all available visits. Data extraction was performed in November 2020, and data analysis was performed from April 2021 to April 2023. Main Outcomes and Measures Main outcomes were survival and skin manifestations (onset of skin fibrosis, digital ulcers, telangiectasias, puffy fingers). Results Among the 4263 patients fulfilling the inclusion criteria, 376 (8.8%) were classified as having ssSSc (mean [SD] age, 55.3 [13.9] years; 345 [91.8%] were female). At last available visit, in comparison with 708 patients with lcSSc and 708 patients with dcSSc with the same disease duration, patients with ssSSc had a lower prevalence of previous or current digital ulcers (28.2% vs 53.1% in lcSSc; P < .001; and 68.3% in dcSSc; P < .001) and puffy fingers (63.8% vs 82.4% in lcSSc; P < .001; and 87.6% in dcSSc; P < .001). By contrast, the prevalence of interstitial lung disease was similar in ssSSc and lcSSc (49.8% and 57.1%; P = .03) but significantly higher in dcSSc (75.0%; P < .001). Skin telangiectasias were associated with diastolic dysfunction in patients with ssSSc (odds ratio, 4.778; 95% CI, 2.060-11.081; P < .001). The only independent factor for the onset of skin fibrosis in ssSSc was the positivity for anti-Scl-70 antibodies (odds ratio, 3.078; 95% CI, 1.227-7.725; P = .02). Survival rate was higher in patients with ssSSc (92.4%) compared with lcSSc (69.4%; P = .06) and dcSSc (55.5%; P < .001) after up to 15 years of follow-up. Conclusions and Relevance Systemic sclerosis sine scleroderma should not be neglected considering the high prevalence of interstitial lung disease (>40%) and SSc renal crisis (almost 3%). Patients with ssSSc had a higher survival than other subsets. Dermatologists should be aware that cutaneous findings in this subgroup may be associated with internal organ dysfunction. In particular, skin telangiectasias in ssSSc were associated with diastolic heart dysfunction.
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Affiliation(s)
- Alain Lescoat
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Scleroderma Program, University of Michigan, Ann Arbor
| | - Suiyuan Huang
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Scleroderma Program, University of Michigan, Ann Arbor
| | | | | | | | | | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Francesco Del Galdo
- Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, Leeds, United Kingdom
| | - Branimir Anic
- Division of Clinical Immunology and Rheumatology, University of Zagreb School of Medicine and University Hospital Centre, Zagreb, Croatia
| | - Nemanja Damjanov
- Institute of Rheumatology, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Camillo Ribi
- Department of Clinical Immunology and Allergy, Lausanne, Switzerland
| | - Dominique Farge Bancel
- Department of Internal Medicine: CRMR MATHEC, Maladies Auto-Immunes et Thérapie Cellulaire, Centre de Référence des Maladies Auto-Immunes Systémiques Rares d’Ile-de-France, FAI2R, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Université de Paris-Cité, Paris, France
| | | | - Armando Gabrielli
- Arche Polytechnic University, Institute of Clinical Medicine, University of Ancona, Ancona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Scleroderma Program, University of Michigan, Ann Arbor
| | - Yannick Allanore
- Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP, Paris, France
- INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
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4
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Colalillo A, Pellicano C, Ananyeva LP, Hachulla E, Cuomo G, Györfi AH, Czirják L, de Vries-Bouwstra J, Mouthon L, Poormoghim H, Del Galdo F, Hunzelmann N, Spierings J, Kuwana M, Rosato E. Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio and Cardiorenal Syndrome Type 2 in the Systemic Sclerosis EUSTAR Cohort. Arthritis Care Res (Hoboken) 2023. [PMID: 37458105 DOI: 10.1002/acr.25196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the association between the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio and estimated glomerular filtration rate (eGFR) and their association with mortality in the European Scleroderma Trials and Research (EUSTAR) cohort. METHODS Patients with systemic sclerosis (SSc) from the EUSTAR database with TAPSE, sPAP, and parameters required to calculate eGFR were included. Logistic regression and Cox regression analysis were performed to evaluate TAPSE/sPAP as a risk factor for chronic kidney disease (CKD) and overall survival. RESULTS A total of 2,370 patients with SSc were included; 284 (12%) patients had CKD stage 3a-5. TAPSE/sPAP (odds ratio [OR] 0.479; 95% CI 0.310-0.743; P < 0.001), arterial hypertension (OR 3.118; 95% CI 2.173-4.475; P < 0.001), diastolic dysfunction (OR 1.670; 95% CI 1.148-2.428; P < 0.01), and N-terminal pro-B-type natriuretic peptide (OR 1.165; 95% CI 1.041-1.304; P < 0.01) were associated with CKD stage 3a-5. TAPSE/sPAP ≤0.32 mm/mm Hg (hazard ratio [HR] 3.589; 95% CI 2.236-5.761; P < 0.001), eGFR <60 mL/min per 1.73 m2 (HR 2.818; 95% CI 1.777-4.468; P < 0.001), and age (HR 1.782; 95% CI 1.348-2.356; P < 0.001) were the most significant predictive factors for all-cause mortality. A total of 276 patients with SSc had pulmonary hypertension (PH) confirmed by right heart catheterization, with 69 (25%) having CKD stage 3a-5. No difference was found in eGFR between patients with PH with reduced or normal cardiac index. CONCLUSION Reduced TAPSE/sPAP ratio is independently associated with CKD. TAPSE/sPAP ratio ≤0.32 mm/mm Hg and eGFR <60 mL/min per 1.73 m2 are prognostic factors for all-cause mortality. In patients with SSc with PH, eGFR is independent by reduced cardiac output.
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Affiliation(s)
| | | | | | - Eric Hachulla
- Hôpital Claude Huriez and University of Lille, Lille, France
| | | | | | | | | | - Luc Mouthon
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris, and Université Paris Cité, Paris, France
| | - Hadi Poormoghim
- Firoozgar Hospital and Iran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Masataka Kuwana
- Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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5
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Campochiaro C, Hoffmann-Vold AM, Avouac J, Henes J, de Vries-Bouwstra J, Smith V, Siegert E, Airò P, Oksel F, Pellerito R, Vanthuyne M, Pozzi MR, Inanc M, Sibilia J, Gabrielli A, Distler O, Allanore Y. Sex influence on outcomes of patients with systemic sclerosis-associated interstitial lung disease: a EUSTAR database analysis. Rheumatology (Oxford) 2023; 62:2483-2491. [PMID: 36413079 DOI: 10.1093/rheumatology/keac660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/20/2022] [Accepted: 11/08/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in systemic sclerosis (SSc) patients. We aimed to investigate the impact of sex on SSc-ILD. METHODS EUSTAR SSc patients with radiologically confirmed ILD and available percentage predicted forced vital capacity (%pFVC) were included. Demographics and disease features were recorded. A change in %pFVC over 12 months (s.d. 6) (cohort 1) was classified into stable (≤4%), mild (5-9%) and large progression (≥10%). In those with 2-year longitudinal %pFVC (cohort 2), the %pFVC change at each 12-month (s.d. 6) interval was calculated. Logistic regression analyses [odds ratio (OR) and 95% CI] and Cox proportional hazards models adjusted for age and %pFVC were applied. RESULTS A total of 1136 male and 5253 female SSc-ILD patients were identified. Males were significantly younger, had a shorter disease duration, had a higher prevalence of CRP elevation and frequently had diffuse cutaneous involvement. In cohort 1 (1655 females and 390 males), a higher percentage of males had stable ILD (74.4% vs 69.4%, P = 0.056). In multivariable analysis, disease duration and %pFVC [OR 0.99 (95% CI 0.98, 0.99) and OR 0.97 (95% CI 0.95, 0.99), respectively] in males and age, %pFVC and anti-centromere [OR 1.02 (95% CI 1.00, 1.04), OR 0.97 (95% CI 0.96, 0.98) and OR 0.39 (95% CI 0.245, 0.63), respectively] in females were associated with large progression. The 1-year mortality rate was higher in males (5.1% vs 2.5%, P = 0.013). In cohort 2 (849 females and 209 males), a higher percentage of females showed periods of large progression (11.7% vs 7.7%, P = 0.023), the percentage of patients with none, one or two periods of worsening was not different. The overall death rate was 30.9% for males and 20.4% in females (P < 0.001). In the survival analysis, male sex was a predictor of mortality [OR 1.95 (95% CI 1.66, 2.28)]. CONCLUSIONS Male SSc-ILD patients have a poorer prognosis and sex-specific predictors exist in SSc-ILD.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Jerome Avouac
- Service de Rheumatologie, Cochin Hospital, APHP, Universite Paris Descartes, Paris, France
| | - Jörg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-Inflammatory Diseases and Department of Internal Medicine II (Haematology, Oncology, Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | | | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Paolo Airò
- Rheumatology and Clinical Immunology Department, Spedali Civili, Brescia, Italy
| | - Fahrettin Oksel
- Department of Internal Medicine, Division of Rheumatology, Ege University, Faculty of Medicine, Izmir, Turkey
| | | | - Marie Vanthuyne
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Jean Sibilia
- Service de Rheumatologie, RESO: Centre de Reference des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest, Hôpital De Hautepierre, Strasbourg, France
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Universita' Politecnica Delle Marche, Ancona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yannick Allanore
- Service de Rheumatologie, Cochin Hospital, APHP, Universite Paris Descartes, Paris, France
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6
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Cabral-Marques O, Moll G, Catar R, Preuß B, Bankamp L, Pecher AC, Henes J, Klein R, Kamalanathan AS, Akbarzadeh R, van Oostveen W, Hohberger B, Endres M, Koolmoes B, Levarht N, Postma R, van Duinen V, van Zonneveld AJ, de Vries-Bouwstra J, Fehres C, Tran F, do Vale FYN, da Silva Souza KB, Filgueiras IS, Schimke LF, Baiocchi GC, de Miranda GC, da Fonseca DLM, Freire PP, Hackel AM, Grasshoff H, Stähle A, Müller A, Dechend R, Yu X, Petersen F, Sotzny F, Sakmar TP, Ochs HD, Schulze-Forster K, Heidecke H, Scheibenbogen C, Shoenfeld Y, Riemekasten G. Autoantibodies targeting G protein-coupled receptors: An evolving history in autoimmunity. Report of the 4th international symposium. Autoimmun Rev 2023; 22:103310. [PMID: 36906052 DOI: 10.1016/j.autrev.2023.103310] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 02/09/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
G protein-coupled receptors (GPCR) are involved in various physiological and pathophysiological processes. Functional autoantibodies targeting GPCRs have been associated with multiple disease manifestations in this context. Here we summarize and discuss the relevant findings and concepts presented in the biennial International Meeting on autoantibodies targeting GPCRs (the 4th Symposium), held in Lübeck, Germany, 15-16 September 2022. The symposium focused on the current knowledge of these autoantibodies' role in various diseases, such as cardiovascular, renal, infectious (COVID-19), and autoimmune diseases (e.g., systemic sclerosis and systemic lupus erythematosus). Beyond their association with disease phenotypes, intense research related to the mechanistic action of these autoantibodies on immune regulation and pathogenesis has been developed, underscoring the role of autoantibodies targeting GPCRs on disease outcomes and etiopathogenesis. The observation repeatedly highlighted that autoantibodies targeting GPCRs could also be present in healthy individuals, suggesting that anti-GPCR autoantibodies play a physiologic role in modeling the course of diseases. Since numerous therapies targeting GPCRs have been developed, including small molecules and monoclonal antibodies designed for treating cancer, infections, metabolic disorders, or inflammatory conditions, anti-GPCR autoantibodies themselves can serve as therapeutic targets to reduce patients' morbidity and mortality, representing a new area for the development of novel therapeutic interventions.
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Affiliation(s)
- Otávio Cabral-Marques
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil; Laboratory of Medical Investigation 29, University of São Paulo School of Medicine, São Paulo, Brazil; Department of Pharmacy and Postgraduate Program of Health and Science, Federal University of Rio Grande do Norte, Natal, Brazil; Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Interunit Postgraduate Program on Bioinformatics, Institute of Mathematics and Statistics (IME), University of Sao Paulo (USP), Sao Paulo, Brazil.
| | - Guido Moll
- Department of Nephrology and Internal Intensive Care Medicine, Charité University Hospital, Berlin, Germany; BIH Center for Regenerative Therapies (BCRT) and Berlin-Brandenburg School for Regenerative Therapies (BSRT), all Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Rusan Catar
- Department of Nephrology and Internal Intensive Care Medicine, Charité University Hospital, Berlin, Germany
| | - Beate Preuß
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Lukas Bankamp
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Ann-Christin Pecher
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Joerg Henes
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Reinhild Klein
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - A S Kamalanathan
- Centre for BioSeparation Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Reza Akbarzadeh
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Wieke van Oostveen
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Bettina Hohberger
- Department of Ophthalmology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany.; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Stroke Research Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Bryan Koolmoes
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Nivine Levarht
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Rudmer Postma
- LUMC, Department of Internal Medicine (Nephrology), Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden, the Netherlands
| | - Vincent van Duinen
- LUMC, Department of Internal Medicine (Nephrology), Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden, the Netherlands
| | - Anton Jan van Zonneveld
- LUMC, Department of Internal Medicine (Nephrology), Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden, the Netherlands
| | - Jeska de Vries-Bouwstra
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Cynthia Fehres
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Florian Tran
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Fernando Yuri Nery do Vale
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Igor Salerno Filgueiras
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Lena F Schimke
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Gabriela Crispim Baiocchi
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Gustavo Cabral de Miranda
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Dennyson Leandro Mathias da Fonseca
- Interunit Postgraduate Program on Bioinformatics, Institute of Mathematics and Statistics (IME), University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Paula Paccielli Freire
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Alexander M Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Stähle
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Antje Müller
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Ralf Dechend
- Experimental and Clinical Research Center, A collaboration of Max Delbruck Center for Molecular Medicine and Charité Universitätsmedizin, and HELIOS Clinic, Department of Cardiology and Nephrology, Berlin 13125, Germany
| | - Xinhua Yu
- Priority Area Chronic Lung Diseases, Research Center Borstel (RCB), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Frank Petersen
- Priority Area Chronic Lung Diseases, Research Center Borstel (RCB), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Franziska Sotzny
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
| | - Thomas P Sakmar
- Laboratory of Chemical Biology and Signal Transduction, The Rockefeller University, New York, NY, USA
| | - Hans D Ochs
- University of Washington School of Medicine and Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Carmen Scheibenbogen
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany.
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7
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Garaiman A, Steigmiller K, Gebhard C, Mihai C, Dobrota R, Bruni C, Matucci-Cerinic M, Henes J, de Vries-Bouwstra J, Smith V, Doria A, Allanore Y, Dagna L, Anić B, Montecucco C, Kowal-Bielecka O, Martin M, Tanaka Y, Hoffmann-Vold AM, Held U, Distler O, Becker MO. Use of platelet inhibitors for digital ulcers related to systemic sclerosis: EUSTAR study on derivation and validation of the DU-VASC model. Rheumatology (Oxford) 2023; 62:SI91-SI100. [PMID: 35904554 DOI: 10.1093/rheumatology/keac405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/22/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To develop and validate the prognostic prediction model DU-VASC to assist the clinicians in decision-making regarding the use of platelet inhibitors (PIs) for the management of digital ulcers in patients with systemic sclerosis. Secondly, to assess the incremental value of PIs as predictor. METHODS We analysed patient data from the European Scleroderma Trials and Research group registry (one time point assessed). Three sets of derivation/validation cohorts were obtained from the original cohort. Using logistic regression, we developed a model for prediction of digital ulcers (DUs). C-Statistics and calibration plots were calculated to evaluate the prediction performance. Variable importance plots and the decrease in C-statistics were used to address the importance of the predictors. RESULTS Of 3710 patients in the original cohort, 487 had DUs and 90 were exposed to PIs. For the DU-VASC model, which includes 27 predictors, we observed good calibration and discrimination in all cohorts (C-statistic = 81.1% [95% CI: 78.9%, 83.4%] for the derivation and 82.3% [95% CI: 779.3%, 85.3%] for the independent temporal validation cohort). Exposure to PIs was associated with absence of DUs and was the most important therapeutic predictor. Further important factors associated with absence of DUs were lower modified Rodnan skin score, anti-Scl-70 negativity and normal CRP. Conversely, the exposure to phosphodiesterase-5 inhibitor, prostacyclin analogues or endothelin receptor antagonists seemed to be associated with the occurrence of DUs. Nonetheless, previous DUs remains the most impactful predictor of DUs. CONCLUSION The DU-VASC model, with good calibration and discrimination ability, revealed that PI treatment was the most important therapy-related predictor associated with reduced DU occurrence.
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Affiliation(s)
| | - Klaus Steigmiller
- Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich
| | | | - Cosimo Bruni
- Department of Rheumatology, University Hospital Zurich.,Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Scleroderma Unit, AOUC, Florence
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Scleroderma Unit, AOUC, Florence.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute.,Faculty of Medicine and Surgery of the Vita-Salute San Raffaele University, Milan, Italy
| | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II (Hematology, Oncology, Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | | | - Vanessa Smith
- Department of Internal Medicine, Ghent University.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute.,Faculty of Medicine and Surgery of the Vita-Salute San Raffaele University, Milan, Italy
| | - Branimir Anić
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb and University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Carlomaurizio Montecucco
- Department of Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Mickael Martin
- Internal Medicine, Poitiers University Hospital, Poitiers, France
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | | | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics
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8
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Elhai M, Sritharan N, Boubaya M, Balbir-Gurman A, Siegert E, Hachulla E, de Vries-Bouwstra J, Riemekasten G, Distler JHW, Rosato E, Del Galdo F, Mendoza FA, Furst DE, de la Puente C, Hoffmann-Vold AM, Gabrielli A, Distler O, Bloch-Queyrat C, Allanore Y. Stratification in systemic sclerosis according to autoantibody status versus skin involvement: a study of the prospective EUSTAR cohort. Lancet Rheumatol 2022; 4:e785-e794. [PMID: 38265945 DOI: 10.1016/s2665-9913(22)00217-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The current subclassification of systemic sclerosis into cutaneous subtypes does not fully capture the heterogeneity of the disease. We aimed to compare the performances of stratification into LeRoy's cutaneous subtypes versus stratification by autoantibody status in systemic sclerosis. METHODS For this cohort study, we assessed people with systemic sclerosis in the multicentre international European Scleroderma Trials and Research (EUSTAR) database. Individuals positive for systemic-sclerosis autoantibodies of two specificities were excluded, and remaining individuals were classified by cutaneous subtype, according to their systemic sclerosis-specific autoantibodies, or both. We assessed the performance of each model to predict overall survival, progression-free survival, disease progression, and different organ involvement. The three models were compared by use of the area under the curve (AUC) of the receiver operating characteristic and the net reclassification improvement (NRI). Missing data were imputed. FINDINGS We assessed the database on July 26, 2019. Of 16 939 patients assessed for eligibility, 10 711 patients were included: 1647 (15·4%) of 10 709 were male, 9062 (84·6%) were female, mean age was 54·4 (SD 13·8) years, and mean disease duration was 7·9 (SD 8·2) years. Information regarding cutaneous subtype was available for 10 176 participants and antibody data were available for 9643 participants. In the prognostic analysis, there was no difference in AUC for overall survival (0·82, 95% CI 0·81-0·84 for cutaneous only vs 0·84, 0·82-0·85 for antibody only vs 0·84, 0·83-0·86 for combined) or for progression-free survival (0·70, 0·69-0·71 vs 0·71, 0·70-0·72 vs 0·71, 0·70-0·72). However, at 4 years the NRI showed substantial improvement for the antibody-only model compared with the cutaneous-only model in prediction of overall survival (0·57, 0·46-0·71 for antibody only vs 0·29, 0·19-0·39 for cutaneous only) and disease progression (0·36, 0·29-0·46 vs 0·21, 0·14-0·28). The antibody-only model did better than the cutaneous-only model in predicting renal crisis (AUC 0·72, 0·70-0·74 for antibody only vs 0·66, 0·64-0·69 for cutaneous only) and lung fibrosis leading to restrictive lung function (AUC 0·76, 0·75-0·77 vs 0·71, 0·70-0·72). The combined model improved the prediction of digital ulcers and elevated systolic pulmonary artery pressure, but did poorly for cardiac involvement. INTERPRETATION The autoantibody-only model outperforms cutaneous-only subsetting for risk stratifying people with systemic sclerosis in the EUSTAR cohort. Physicians should be aware of these findings at the time of decision making for patient management. FUNDING World Scleroderma Foundation.
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Affiliation(s)
- Muriel Elhai
- INSERM U1016, Cochin Hospital, AP-HP, University of Paris, Paris, France; Department of Rheumatology, University Hospital Zürich, Zürich, Switzerland
| | - Nanthara Sritharan
- Department of Clinical Research, Paris Seine Saint Denis Hospital, AP-HP, Bobigny, France
| | - Marouane Boubaya
- Department of Clinical Research, Paris Seine Saint Denis Hospital, AP-HP, Bobigny, France
| | - Alexandra Balbir-Gurman
- B Shine Rheumatology Institute, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Elise Siegert
- Department of Rheumatology, Charité University Hospital, Berlin, Germany
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France, Inserm, CHU Lille, U1286 - INFINITE, University of Lille, Lille, France
| | | | | | - Jörg H W Distler
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Del Galdo
- Scleroderma Programme, Institute of Molecular Medicine, Division of Musculoskeletal Diseases, University of Leeds, Leeds, UK
| | - Fabian A Mendoza
- Thomas Jefferson Scleroderma Center Division of Rheumatology and Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel E Furst
- Arthritis Association of Southern California, Los Angeles, CA, USA
| | | | | | - Armando Gabrielli
- Università Politecnica delle Marche, Ancona, Italy; Azienda Ospedali Riuniti, Ancona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, Zürich, Switzerland
| | - Coralie Bloch-Queyrat
- Department of Clinical Research, Paris Seine Saint Denis Hospital, AP-HP, Bobigny, France
| | - Yannick Allanore
- INSERM U1016, Cochin Hospital, AP-HP, University of Paris, Paris, France.
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9
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Lescoat A, Huscher D, Schoof N, Airò P, de Vries-Bouwstra J, Riemekasten G, Hachulla E, Doria A, Rosato E, Hunzelmann N, Montecucco C, Gabrielli A, Hoffmann-Vold AM, Distler O, Ben Shimol J, Cutolo M, Allanore Y. Systemic sclerosis-associated interstitial lung disease in the EUSTAR database: analysis by region. Rheumatology (Oxford) 2022:6759366. [PMID: 36222557 DOI: 10.1093/rheumatology/keac576] [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: 05/11/2022] [Revised: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The prevalence and characteristics of systemic sclerosis-associated interstitial lung disease (SSc-ILD) vary between geographical regions worldwide. The objectives of this study were to explore the differences in terms of prevalence, phenotype, treatment, and prognosis in patients with SSc-ILD from predetermined geographical regions in the EUSTAR database. METHODS Patients were clustered into seven geographical regions. Clinical characteristics and survival of patients with SSc-ILD were compared among these pre-determined regions. RESULTS For baseline analyses, 9260 SSc patients were included, with 6732 for survival analyses. The prevalence of SSc-ILD in the overall population was 50.2%, ranging from 44.0% in "Western Europe & Nordic countries" to 67.5% in "Eastern European, Russia & Baltic countries". In all regions, anti-topoisomerase antibodies were associated with SSc-ILD. Management also significantly differed; mycophenolate mofetil was prescribed at baseline in 31.6% of patients with SSc-ILD in "America (North & South)" and 31.7% in "Middle East" but only 4.3% in "Asia & Oceania" (P < 0.0001). Patients from "America (North & South)" and "Middle East" had the highest survival rate at the end of follow-up (85.8% and 85.2%, respectively). CONCLUSION Our study highlights key differences among regions in terms of clinical presentation and prognosis of SSc-ILD. This work also demonstrates that the management of SSc-ILD is highly variable among the different regions considered, suggesting that efforts are still needed for the standardisation of medical practice in the treatment of this disease.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes 1, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, France, Rennes
| | - Dörte Huscher
- Charité Universitätsmedizin, Institute of Biostatistics and Clinical Epidemiology, Berlin, Germany
| | - Nils Schoof
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Paolo Airò
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Gabriela Riemekasten
- Department of Rheumatology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Eric Hachulla
- Univ. Lille, INFINITE-Institute for Translational Research in Inflammation, Lille, France.,Univ. Lille, CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, F-59000, France.,Inserm, Lille, U1286, F-59000, France
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Nicolas Hunzelmann
- Department of Dermatology, University of Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Carlomaurizio Montecucco
- Rheumatology Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Armando Gabrielli
- Dipartimento Di Scienze Cliniche E Molecolari, Clinica Medica, Università Politecnica Delle Marche, Ancona, Italy
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Jennifer Ben Shimol
- Department of Medicine, E. Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy-IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy
| | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
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10
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Hoffmann-Vold AM, Distler O, Bruni C, Denton CP, de Vries-Bouwstra J, Matucci Cerinic M, Vonk MC, Gabrielli A. Systemic sclerosis in the time of COVID-19. The Lancet Rheumatology 2022; 4:e566-e575. [PMID: 35891634 PMCID: PMC9302939 DOI: 10.1016/s2665-9913(22)00130-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic represents one of the biggest challenges of the 21st century. In addition to the general effect on society and health-care systems, patients with systemic sclerosis and their physicians face specific challenges related to the chronic nature of their disease, the involvement of multiple organs, and the use of immunosuppressive treatments. Data from registries and single centre cohorts indicate that the risk of contracting SARS-CoV-2 does not seem to increase substantially in people with systemic sclerosis; conversely, severe COVID-19 outcomes are seen more frequently in these patients than in the general population. Vaccination against SARS-CoV-2 is therefore highly recommended for patients with systemic sclerosis; however, no specific recommendations are available regarding the different vaccine platforms. Both patients and physicians should be aware that the effectiveness of vaccines might be reduced in patients taking immunosuppressive therapy, because antibody responses might be blunted, specifically in patients treated with rituximab and mycophenolate mofetil.
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Affiliation(s)
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cosimo Bruni
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Christopher P Denton
- Centre for Rheumatology, Royal Free Campus, University College London, London, UK
| | | | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, University of Florence, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Madelon C Vonk
- Department of the Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Armando Gabrielli
- Fondazione di Medicina Molecolare e Terapia Cellulare, Università Politecnica delle Marche, Ancona, Italy
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11
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Pachera E, Assassi S, Salazar GA, Stellato M, Renoux F, Wunderlin A, Blyszczuk P, Lafyatis R, Kurreeman F, de Vries-Bouwstra J, Messemaker T, Feghali-Bostwick CA, Rogler G, van Haaften WT, Dijkstra G, Oakley F, Calcagni M, Schniering J, Maurer B, Distler JH, Kania G, Frank-Bertoncelj M, Distler O. Long noncoding RNA H19X is a key mediator of TGF-β-driven fibrosis. J Clin Invest 2021; 130:4888-4905. [PMID: 32603313 DOI: 10.1172/jci135439] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 12/09/2019] [Accepted: 06/17/2020] [Indexed: 12/22/2022] Open
Abstract
TGF-β is a master regulator of fibrosis, driving the differentiation of fibroblasts into apoptosis-resistant myofibroblasts and sustaining the production of extracellular matrix (ECM) components. Here, we identified the nuclear long noncoding RNA (lncRNA) H19X as a master regulator of TGF-β-driven tissue fibrosis. H19X was consistently upregulated in a wide variety of human fibrotic tissues and diseases and was strongly induced by TGF-β, particularly in fibroblasts and fibroblast-related cells. Functional experiments following H19X silencing revealed that H19X was an obligatory factor for TGF-β-induced ECM synthesis as well as differentiation and survival of ECM-producing myofibroblasts. We showed that H19X regulates DDIT4L gene expression, specifically interacting with a region upstream of the DDIT4L gene and changing the chromatin accessibility of a DDIT4L enhancer. These events resulted in transcriptional repression of DDIT4L and, in turn, in increased collagen expression and fibrosis. Our results shed light on key effectors of TGF-β-induced ECM remodeling and fibrosis.
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Affiliation(s)
- Elena Pachera
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Shervin Assassi
- Division of Rheumatology, Department of Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Gloria A Salazar
- Division of Rheumatology, Department of Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Mara Stellato
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Florian Renoux
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Adam Wunderlin
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Przemyslaw Blyszczuk
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Lafyatis
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fina Kurreeman
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Tobias Messemaker
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Wouter T van Haaften
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, Netherlands
| | - Fiona Oakley
- Newcastle Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Janine Schniering
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Jörg Hw Distler
- Department of Internal Medicine 3, University of Erlangen, Erlangen, Germany
| | - Gabriela Kania
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Mojca Frank-Bertoncelj
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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12
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Spierings J, Schriemer R, Dittmar S, de Pundert L, de Vries-Bouwstra J, van den Ende E, Vonk M. Requirements for systemic sclerosis expert centres in the Netherlands: A Delphi consensus study. J Scleroderma Relat Disord 2021; 6:96-101. [PMID: 35382248 PMCID: PMC8922637 DOI: 10.1177/2397198320953063] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022]
Abstract
Introduction: Systemic sclerosis is a rare and complex disease. Optimal management of patients requires knowledge and experience and, importantly, intensive collaboration between hospitals and multidisciplinary teams. Definition and recognition of expert centres in systemic sclerosis is currently lacking, which complicates collaboration between centres and leaves patients poorly informed. The aim of this study was to develop a set of requirements for two types of systemic sclerosis centres in order to establish a nationwide structure for an optimal and transparent organization of care. Methods: A three-round Delphi study was conducted among a panel of rheumatologists working at university or regional hospitals across the Netherlands. Prior to the final consensus round, a session with a patient panel (N = 22) was held. The results of this meeting were described in the last round for rheumatologists. Criteria were divided into five categories: (1) medical care, (2) case load, (3) collaboration, (4) research, (5) training of staff, and (6) other. In the first round, criteria derived from literature were proposed and participants could add criteria that were missing. For every item, participants could indicate if they thought the item should be included for two types of systemic sclerosis centres: (1) systemic sclerosis expert centre or (2) systemic sclerosis treatment centres. Consensus was reached when more than 85% of the panel agreed. Results: In total, 47 rheumatologists participated in Delphi round 1, 35 in round 2 and 43 in round 3. Additional suggestions were added by the patient panel (n = 22). Consensus was reached for the requirements of systemic sclerosis expert centres (45 items) and systemic sclerosis treatment centres (29 items) including minimal caseloads of annual suspected systemic sclerosis cases and total patients in care. Conclusion: Requirements of centres for systemic sclerosis care in the Netherlands were established in this study. Feasibility of certification should be evaluated next. Our proposed list can serve as a model for other countries.
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Affiliation(s)
- Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rita Schriemer
- NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Sonja Dittmar
- NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Lian de Pundert
- Department of Rheumatology, Haga Ziekenhuis, The Hague, The Netherlands
| | | | - Els van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Madelon Vonk
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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13
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Greco R, Alexander T, Burman J, Del Papa N, de Vries-Bouwstra J, Farge D, Henes J, Kazmi M, Kirgizov K, Muraro PA, Ricart E, Rovira M, Saccardi R, Sharrack B, Snarski E, Withers B, Jessop H, Boglione C, Kramer E, Badoglio M, Labopin M, Orchard K, Corbacioglu S, Ljungman P, Mikulska M, De la Camara R, Snowden JA. Hematopoietic stem cell transplantation for autoimmune diseases in the time of COVID-19: EBMT guidelines and recommendations. Bone Marrow Transplant 2021; 56:1493-1508. [PMID: 34031556 PMCID: PMC8143059 DOI: 10.1038/s41409-021-01326-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 02/28/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
Coronavirus disease-19 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), represents one of the biggest challenges of 21st century, threatening public health around the globe. Increasing age and presence of co-morbidities are reported risk factors for severe disease and mortality, along with autoimmune diseases (ADs) and immunosuppressive treatments such as haematopoietic stem cell transplantation (HSCT), which are also associated with adverse outcomes. We review the impact of the pandemic on specific groups of patients with neurological, rheumatological, and gastroenterological indications, along with the challenges delivering HSCT in adult and pediatric populations. Moving forward, we developed consensus-based guidelines and recommendations for best practice and quality of patient care in order to support clinicians, scientists, and their multidisciplinary teams, as well as patients and their carers. These guidelines aim to support national and international organizations related to autoimmune diseases and local clinical teams delivering HSCT. Areas of unmet need and future research questions are also highlighted. The waves of the COVID-19 pandemic are predicted to be followed by an "endemic" phase and therefore an ongoing risk within a "new normality". These recommendations reflect currently available evidence, coupled with expert opinion, and will be revised according to necessary modifications in practice.
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Affiliation(s)
- Raffaella Greco
- grid.15496.3fUnit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Tobias Alexander
- grid.7468.d0000 0001 2248 7639Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Burman
- grid.8993.b0000 0004 1936 9457Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Jeska de Vries-Bouwstra
- grid.10419.3d0000000089452978Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dominique Farge
- Centre de Référence des Maladies Auto-Immunes Systémiques Rares d’Ile-de-France, Filière, Paris, France ,grid.508487.60000 0004 7885 7602EA 3518, Université Denis Diderot, Paris, France ,grid.14709.3b0000 0004 1936 8649Department of Internal Medicine, McGill University, Montreal, QC Canada
| | - Jörg Henes
- grid.411544.10000 0001 0196 8249Department for Internal Medicine II (Oncology, Hematology, Rheumatology and Immunology), University Hospital Tuebingen, Tübingen, Germany
| | - Majid Kazmi
- grid.239826.40000 0004 0391 895XKings Health Partners, Department of Haematology, Guys Hospital, London, UK
| | - Kirill Kirgizov
- N.N. Blokhin National Medical Center of Oncology, Institute of Pediatric Oncology and Hematology, Moscow, Russia
| | - Paolo A. Muraro
- grid.7445.20000 0001 2113 8111Department of Brain Sciences, Imperial College London, London, UK
| | - Elena Ricart
- grid.410458.c0000 0000 9635 9413Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain ,grid.10403.36Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Montserrat Rovira
- grid.10403.36BMT Unit, Department of Haematology, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Institute Josep Carreras, Barcelona, Spain
| | - Riccardo Saccardi
- grid.24704.350000 0004 1759 9494Department of Haematology, Careggi University Hospital, Florence, Italy
| | - Basil Sharrack
- grid.31410.370000 0000 9422 8284Department of Neuroscience, Sheffield Teaching Hospitals NHS, Foundation Trust, Sheffield, UK ,grid.11835.3e0000 0004 1936 9262NIHR Neurosciences Biomedical Research Centre, University of Sheffield, Sheffield, UK
| | - Emilian Snarski
- grid.13339.3b0000000113287408Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland ,LUX MED Oncology, Warsaw, Poland ,grid.499028.ePolish Stem Cells Bank (PBKM), Warsaw, Poland
| | - Barbara Withers
- Department of Haematology and Bone Marrow Transplant, Sydney, Australia
| | - Helen Jessop
- grid.31410.370000 0000 9422 8284Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Claudia Boglione
- grid.24704.350000 0004 1759 9494Department of Haematology, Careggi University Hospital, Florence, Italy
| | - Ellen Kramer
- Patient Advocacy Committee, EBMT Executive Office, Eddific Dr. Frederic, Duran i Jorda, Barcelona, Spain
| | - Manuela Badoglio
- grid.492743.fEBMT Paris study office/CEREST-TC—Department of Haematology, Saint Antoine Hospital—INSERM UMR 938—Université Pierre et Marie Curie, Paris, France
| | - Myriam Labopin
- grid.492743.fEBMT Paris study office/CEREST-TC—Department of Haematology, Saint Antoine Hospital—INSERM UMR 938—Université Pierre et Marie Curie, Paris, France
| | - Kim Orchard
- grid.123047.30000000103590315Department of Haematology, University Hospital Southampton and University of Southampton, Southampton, UK
| | - Selim Corbacioglu
- grid.7727.50000 0001 2190 5763Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Per Ljungman
- grid.24381.3c0000 0000 9241 5705Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge; Division of Hematology, Department of Medicine Huddinge Karolinska Institutet, Stockholm, Sweden
| | - Malgorzata Mikulska
- grid.410345.70000 0004 1756 7871Division of Infectious Diseases, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
| | - Rafael De la Camara
- grid.411251.20000 0004 1767 647XDepartment of Hematology, Hospital de la Princesa, Madrid, Spain
| | - John A. Snowden
- grid.31410.370000 0000 9422 8284Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK ,grid.11835.3e0000 0004 1936 9262Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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14
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van Bijnen S, de Vries-Bouwstra J, van den Ende CH, Boonstra M, Kroft L, Geurts B, Snoeren M, Schouffoer A, Spierings J, van Laar JM, Huizinga TW, Voskuyl A, Marijt E, van der Velden W, van den Hoogen FH, Vonk MC. Predictive factors for treatment-related mortality and major adverse events after autologous haematopoietic stem cell transplantation for systemic sclerosis: results of a long-term follow-up multicentre study. Ann Rheum Dis 2020; 79:1084-1089. [PMID: 32409324 DOI: 10.1136/annrheumdis-2020-217058] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/01/2020] [Accepted: 04/22/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Autologous haematopoietic stem cell transplantation (HSCT) improves survival in systemic sclerosis (SSc) with poor prognosis, but is hampered by treatment-related mortality (TRM). OBJECTIVE To evaluate event-free survival (EFS), TRM, response to treatment, disease progression and patient characteristics associated with events. METHODS All patients treated with HSCT for SSc in The Netherlands until 2017 (n=92) were included. Data on skin involvement (modified Rodnan skin score (mRSS), pulmonary function (forced vital capacity (FVC) and diffusion capacity of the lungs for carbon monoxide (DLCO)), extent of interstitial lung disease on high-resolution CT using Goh scores and left ventricular ejection fraction (LVEF) were collected at baseline, 1, 2 and 5 years. Occurrence of events, defined as death or major organ failure, were collected until 2019. As control, a comparison between patients treated with cyclophosphamide (CYC) and patients with HSCT who participated in the Autologous Stem Cell Transplantation International Scleroderma (ASTIS) trial was performed. RESULTS Median follow-up was 4.6 years. EFS estimates at 5, 10 and 15 years were 78%, 76% and 66%, respectively. Twenty deaths occurred. Mean FVC, DLCO, mRSS and Goh scores all improved significantly. Disease progression occurred in 22 patients. Frequency of TRM decreased over time and occurred more often in males. Events were independently associated with male sex, LVEF <50% and older age. In ASTIS, patients treated with HSCT (n=23) 7 events occurred versus 13 in the CYC group (n=22). CONCLUSION Our data confirm long-term efficacy of HSCT in improving survival, skin and lung involvement in SSc. Male sex, lower LVEF and older age at baseline were identified as risk factors for events.
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Affiliation(s)
- Sandra van Bijnen
- Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Maaike Boonstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Lucie Kroft
- Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Bram Geurts
- Radiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Miranda Snoeren
- Radiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Julia Spierings
- Rheumatology and Clinical Immunology, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Jacob M van Laar
- Rheumatology and Clinical Immunology, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Tom Wj Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology, Amsterdam UMC, Amsterdam, Noord-Holland, Netherlands
| | - Erik Marijt
- Haematology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Madelon C Vonk
- Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen, Netherlands
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15
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López-Isac E, Acosta-Herrera M, Kerick M, Assassi S, Satpathy AT, Granja J, Mumbach MR, Beretta L, Simeón CP, Carreira P, Ortego-Centeno N, Castellvi I, Bossini-Castillo L, Carmona FD, Orozco G, Hunzelmann N, Distler JHW, Franke A, Lunardi C, Moroncini G, Gabrielli A, de Vries-Bouwstra J, Wijmenga C, Koeleman BPC, Nordin A, Padyukov L, Hoffmann-Vold AM, Lie B, Proudman S, Stevens W, Nikpour M, Vyse T, Herrick AL, Worthington J, Denton CP, Allanore Y, Brown MA, Radstake TRDJ, Fonseca C, Chang HY, Mayes MD, Martin J. GWAS for systemic sclerosis identifies multiple risk loci and highlights fibrotic and vasculopathy pathways. Nat Commun 2019; 10:4955. [PMID: 31672989 PMCID: PMC6823490 DOI: 10.1038/s41467-019-12760-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune disease that shows one of the highest mortality rates among rheumatic diseases. We perform a large genome-wide association study (GWAS), and meta-analysis with previous GWASs, in 26,679 individuals and identify 27 independent genome-wide associated signals, including 13 new risk loci. The novel associations nearly double the number of genome-wide hits reported for SSc thus far. We define 95% credible sets of less than 5 likely causal variants in 12 loci. Additionally, we identify specific SSc subtype-associated signals. Functional analysis of high-priority variants shows the potential function of SSc signals, with the identification of 43 robust target genes through HiChIP. Our results point towards molecular pathways potentially involved in vasculopathy and fibrosis, two main hallmarks in SSc, and highlight the spectrum of critical cell types for the disease. This work supports a better understanding of the genetic basis of SSc and provides directions for future functional experiments.
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Affiliation(s)
- Elena López-Isac
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, Granada, Spain.
| | | | - Martin Kerick
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, Granada, Spain
| | - Shervin Assassi
- The University of Texas Health Science Center-Houston, Houston, USA
| | - Ansuman T Satpathy
- Center for Personal Dynamic Regulomes, Stanford University School of Medicine, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
| | - Jeffrey Granja
- Center for Personal Dynamic Regulomes, Stanford University School of Medicine, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
| | - Maxwell R Mumbach
- Center for Personal Dynamic Regulomes, Stanford University School of Medicine, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Carmen P Simeón
- Department of Internal Medicine, Valle de Hebrón Hospital, Barcelona, Spain
| | - Patricia Carreira
- Department of Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Ivan Castellvi
- Department of Rheumatology, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | | | - F David Carmona
- Department of Genetics and Institute of Biotechnology, University of Granada, Granada, Spain
| | - Gisela Orozco
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK
| | | | - Jörg H W Distler
- Department of Internal Medicine 3, Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Claudio Lunardi
- Department of Medicine, Università degli Studi di Verona, Verona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Department of Clinical and Molecular Science, Università Politecnica delle Marche and Ospedali Riuniti, Ancona, Italy
| | - Armando Gabrielli
- Clinica Medica, Department of Clinical and Molecular Science, Università Politecnica delle Marche and Ospedali Riuniti, Ancona, Italy
| | | | - Cisca Wijmenga
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Annika Nordin
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | | | - Benedicte Lie
- Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia
| | | | - Mandana Nikpour
- The University of Melbourne at St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Timothy Vyse
- Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Jane Worthington
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK
| | - Christopher P Denton
- Centre for Rheumatology, Royal Free and University College Medical School, London, United Kingdom
| | - Yannick Allanore
- Department of Rheumatology A, Cochin Hospital, INSERM U1016, Paris Descartes University, Paris, France
| | - Matthew A Brown
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Timothy R D J Radstake
- Department of Rheumatology & Clinical Immunology, Laboratory of Translational Immunology, department of Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carmen Fonseca
- Centre for Rheumatology, Royal Free and University College Medical School, London, United Kingdom
| | - Howard Y Chang
- Center for Personal Dynamic Regulomes, Stanford University School of Medicine, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
| | - Maureen D Mayes
- The University of Texas Health Science Center-Houston, Houston, USA
| | - Javier Martin
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, Granada, Spain.
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16
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Takata M, Pachera E, Frank-Bertoncelj M, Kozlova A, Jüngel A, Whitfield ML, Assassi S, Calcagni M, de Vries-Bouwstra J, Huizinga TW, Kurreeman F, Kania G, Distler O. OTUD6B-AS1 Might Be a Novel Regulator of Apoptosis in Systemic Sclerosis. Front Immunol 2019; 10:1100. [PMID: 31156645 PMCID: PMC6533854 DOI: 10.3389/fimmu.2019.01100] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/30/2018] [Accepted: 04/30/2019] [Indexed: 12/19/2022] Open
Abstract
Antisense long non-coding RNAs (AS lncRNAs) have increasingly been recognized as important regulators of gene expression and they have been found to play key roles in several diseases. However, very little is known about the role of AS lncRNAs in fibrotic diseases such as systemic sclerosis (SSc). Our recent screening experiments by RNA sequencing showed that ovarian tumor domain containing 6B antisense RNA1 (OTUD6B-AS1) and its sense gene OTUD6B were significantly downregulated in SSc skin biopsies. Therefore, we aimed to identify key regulators of OTUD6B-AS1 and to analyze the functional relevance of OTUD6B-AS1 in SSc. OTUD6B-AS1 and OTUD6B expression in SSc and healthy control (HC) dermal fibroblasts (Fb) after stimulation with transforming growth factor-β (TGFβ), Interleukin (IL)-4, IL-13, and platelet-derived growth factor (PDGF) was analyzed by qPCR. To identify the functional role of OTUD6B-AS1, dermal Fb or human pulmonary artery smooth muscle cells (HPASMC) were transfected with a locked nucleic acid antisense oligonucleotide (ASO) targeting OTUD6B-AS1. Proliferation was measured by BrdU and real-time proliferation assay. Apoptosis was measured by Caspase 3/7 assay and Western blot for cleaved caspase 3. While no difference was recorded at the basal level between HC and SSc dermal Fb, the expression of OTUD6B-AS1 and OTUD6B was significantly downregulated in both SSc and HC dermal Fb after PDGF stimulation in a time-dependent manner. Only mild and inconsistent effects were observed with TGFβ, IL-4, and IL-13. OTUD6B-AS1 knockdown in Fb and HPASMC did not affect extracellular matrix or pro-fibrotic/proinflammatory cytokine production. However, OTUD6B-AS1 knockdown significantly increased Cyclin D1 expression at the mRNA and protein level. Moreover, silencing of OTUD6B-AS1 significantly reduced proliferation and suppressed apoptosis in both dermal Fb and HPASMC. OTUD6B-AS1 knockdown did not affect OTUD6B expression at the mRNA level and protein level. Our data suggest that OTUD6B-AS1 regulates proliferation and apoptosis via cyclin D1 expression in a sense gene independent manner. This is the first report investigating the function of OTUD6B-AS1. Our data shed light on a novel apoptosis resistance mechanism in Fb and vascular smooth muscle cells that might be relevant for pathogenesis of SSc.
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Affiliation(s)
- Miki Takata
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zürich, Zurich, Switzerland
| | - Elena Pachera
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zürich, Zurich, Switzerland
| | - Mojca Frank-Bertoncelj
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zürich, Zurich, Switzerland
| | - Anastasiia Kozlova
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zürich, Zurich, Switzerland
| | - Astrid Jüngel
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zürich, Zurich, Switzerland
| | - Michael L Whitfield
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Shervin Assassi
- Department of Internal Medicine, Division of Rheumatology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, United States
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Zurich, Switzerland
| | | | - Tom W Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Fina Kurreeman
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Gabriela Kania
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zürich, Zurich, Switzerland
| | - Oliver Distler
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zürich, Zurich, Switzerland
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17
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Spierings J, van Rhijn- de Brouwer F, de Vries-Bouwstra J, de Bresser C, Vonk M, Voskuyl A, Pieterse A, Kars M, van Laar J. E070 Shared decision-making in progressive diffuse cutaneous systemic sclerosis: a patient’s perspective. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez110.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julia Spierings
- Clinical Immunology and Rheumatology, University Medical Center Utrecht, Utrecht, NETHERLANDS
| | - Femke van Rhijn- de Brouwer
- Clinical Immunology and Rheumatology, University Medical Center Utrecht, Utrecht, NETHERLANDS
- Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, NETHERLANDS
| | | | - Carolijn de Bresser
- Clinical Immunology and Rheumatology, University Medical Center Utrecht, Utrecht, NETHERLANDS
| | - Madelon Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, NETHERLANDS
| | - Alexandre Voskuyl
- Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Center, location VUmc, Amsterdam, NETHERLANDS
| | - Arwen Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, NETHERLANDS
| | - Marijke Kars
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, NETHERLANDS
| | - Jaap van Laar
- Clinical Immunology and Rheumatology, University Medical Center Utrecht, Utrecht, NETHERLANDS
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18
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Morrisroe K, Hudson M, Baron M, de Vries-Bouwstra J, Carreira PE, Wuttge DM, Wang M, Frech TM, Stevens W, Proudman SM, Nikpour M. Determinants of health-related quality of life in a multinational systemic sclerosis inception cohort. Clin Exp Rheumatol 2018; 36 Suppl 113:53-60. [PMID: 30183603] [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: 08/09/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate health-related quality of life (HRQoL) and its determinants in a systemic sclerosis (SSc) multinational inception cohort. We performed a meta-analysis of data from individual countries, and compared the meta-analysis to individual country results by pooling data from each of the countries. METHODS SSc patients within 2 years of disease onset were recruited from 5 countries participating in the International Systemic Sclerosis Inception Cohort (INSYNC). Data from each country's database were exported for analysis using a harmonised platform. HRQoL was assessed using the Medical Outcomes Short Form-36 (SF-36). Multivariate linear regression assessed associations between HRQoL and predictors in cohorts separately and meta-analyzed to generate pooled estimates. The analyses were repeated using individual patient data. RESULTS Of the 637 SSc patients recruited, the majority was female (80.2%-83.3%), aged between 52.4-56.7 years with limited cutaneous disease subtype (48.6%-66.7%). HRQoL scores were lower for SSc patients than the general population (SF-36 physical component summary (PCS) score (36.4-39.6), mental component summary (MCS) score (41.0-46.4)). Determinants of SF-36 PCS by meta-analysis included increasing age (β=-0.1, 95%CI -0.2, -0.01), diffuse cutaneous disease subtype (β=-8.4, 95%CI -10.6, -6.3), and pulmonary arterial hypertension (β=-10.9, 95%CI -16.6, -5.3). Increasing age (β=0.09, 95%CI 0.0, 0.18) was the only variable associated with SF-36 MCS. Analyses using individual patient data revealed similar results to those of the meta-analysis of cohort data. CONCLUSIONS Our study provides estimates of HRQoL in a large inception SSc cohort and provides evidence that individual patient data analysis is valid in the INSYNC dataset.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent's Hospital; and Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Marie Hudson
- Jewish General Hospital, Montreal; and Lady Davis Research Institute, Montreal, Canada
| | - Murray Baron
- Jewish General Hospital, Montreal; and Lady Davis Research Institute, Montreal, Canada
| | | | - Patricia E Carreira
- Rheumatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Dirk M Wuttge
- Lund University, Skane University Hospital, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - Mianbo Wang
- Jewish General Hospital, Montreal; and Lady Davis Research Institute, Montreal, Canada
| | - Tracy M Frech
- Division of Rheumatology, Department of Internal Medicine, University of Utah and Salt Lake Regional Veterans Affair Medical Center, USA
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Susanna M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Australia; and Discipline of Medicine, University of Adelaide, Australia
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López-Isac E, Martín JE, Assassi S, Simeón CP, Carreira P, Ortego-Centeno N, Freire M, Beltrán E, Narváez J, Alegre-Sancho JJ, Fernández-Gutiérrez B, Balsa A, Ortiz AM, González-Gay MA, Beretta L, Santaniello A, Bellocchi C, Lunardi C, Moroncini G, Gabrielli A, Witte T, Hunzelmann N, Distler JHW, Riekemasten G, van der Helm-van Mil AH, de Vries-Bouwstra J, Magro-Checa C, Voskuyl AE, Vonk MC, Molberg Ø, Merriman T, Hesselstrand R, Nordin A, Padyukov L, Herrick A, Eyre S, Koeleman BPC, Denton CP, Fonseca C, Radstake TRDJ, Worthington J, Mayes MD, Martín J. Brief Report: IRF4 Newly Identified as a Common Susceptibility Locus for Systemic Sclerosis and Rheumatoid Arthritis in a Cross-Disease Meta-Analysis of Genome-Wide Association Studies. Arthritis Rheumatol 2017; 68:2338-44. [PMID: 27111665 DOI: 10.1002/art.39730] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/19/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) and rheumatoid arthritis (RA) are autoimmune diseases that have similar clinical and immunologic characteristics. To date, several shared SSc-RA genetic loci have been identified independently. The aim of the current study was to systematically search for new common SSc-RA loci through an interdisease meta-genome-wide association (meta-GWAS) strategy. METHODS The study was designed as a meta-analysis combining GWAS data sets of patients with SSc and patients with RA, using a strategy that allowed identification of loci with both same-direction and opposite-direction allelic effects. The top single-nucleotide polymorphisms were followed up in independent SSc and RA case-control cohorts. This allowed an increase in the sample size to a total of 8,830 patients with SSc, 16,870 patients with RA, and 43,393 healthy controls. RESULTS This cross-disease meta-analysis of the GWAS data sets identified several loci with nominal association signals (P < 5 × 10(-6) ) that also showed evidence of association in the disease-specific GWAS scans. These loci included several genomic regions not previously reported as shared loci, as well as several risk factors that were previously found to be associated with both diseases. Follow-up analyses of the putatively new SSc-RA loci identified IRF4 as a shared risk factor for these 2 diseases (Pcombined = 3.29 × 10(-12) ). Analysis of the biologic relevance of the known SSc-RA shared loci identified the type I interferon and interleukin-12 signaling pathways as the main common etiologic factors. CONCLUSION This study identified a novel shared locus, IRF4, for the risk of SSc and RA, and highlighted the usefulness of a cross-disease GWAS meta-analysis strategy in the identification of common risk loci.
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Affiliation(s)
- Elena López-Isac
- Institute of Parasitology and Biomedicine López-Neyra CSIC, Granada, Spain
| | | | | | | | | | | | - Mayka Freire
- Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Emma Beltrán
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | | | | | - Alejandro Balsa
- Hospital Universitario La Paz, Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | - Ana M Ortiz
- Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | | | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alessandro Santaniello
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Chiara Bellocchi
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | | | - Armando Gabrielli
- Università Politecnica delle Marche and Ospedali Riuniti, Ancona, Italy
| | | | | | | | | | | | | | | | | | - Madelon C Vonk
- Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Øyvind Molberg
- Oslo University Hospital Rikshospitalet and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Annika Nordin
- Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Leonid Padyukov
- Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ariane Herrick
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Steve Eyre
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Christopher P Denton
- Centre for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Carmen Fonseca
- Centre for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Timothy R D J Radstake
- University Medical Center Utrecht, Utrecht, The Netherlands. Members of the Spanish Scleroderma Group are shown in Appendix A
| | - Jane Worthington
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Javier Martín
- Institute of Parasitology and Biomedicine López-Neyra CSIC, Granada, Spain
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Yiu KH, Ninaber MK, Kroft LJ, Schouffoer AA, Stolk J, Scherer HU, Meijs J, de Vries-Bouwstra J, Tse HF, Delgado V, Bax JJ, Huizinga TWJ, Marsan NA. Impact of pulmonary fibrosis and elevated pulmonary pressures on right ventricular function in patients with systemic sclerosis. Rheumatology (Oxford) 2015; 55:504-12. [DOI: 10.1093/rheumatology/kev342] [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] [Received: 05/14/2014] [Indexed: 11/12/2022] Open
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López-Isac E, Campillo-Davo D, Bossini-Castillo L, Guerra SG, Assassi S, Simeón CP, Carreira P, Ortego-Centeno N, García de la Peña P, Beretta L, Santaniello A, Bellocchi C, Lunardi C, Moroncini G, Gabrielli A, Riemekasten G, Witte T, Hunzelmann N, Kreuter A, Distler JH, Voskuyl AE, de Vries-Bouwstra J, Herrick A, Worthington J, Denton CP, Fonseca C, Radstake TR, Mayes MD, Martín J. Influence of TYK2 in systemic sclerosis susceptibility: a new locus in the IL-12 pathway. Ann Rheum Dis 2015; 75:1521-6. [PMID: 26338038 DOI: 10.1136/annrheumdis-2015-208154] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/13/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES TYK2 is a common genetic risk factor for several autoimmune diseases. This gene encodes a protein kinase involved in interleukin 12 (IL-12) pathway, which is a well-known player in the pathogenesis of systemic sclerosis (SSc). Therefore, we aimed to assess the possible role of this locus in SSc. METHODS This study comprised a total of 7103 patients with SSc and 12 220 healthy controls of European ancestry from Spain, USA, Germany, the Netherlands, Italy and the UK. Four TYK2 single-nucleotide polymorphisms (V362F (rs2304256), P1104A (rs34536443), I684S (rs12720356) and A928V (rs35018800)) were selected for follow-up based on the results of an Immunochip screening phase of the locus. Association and dependence analyses were performed by the means of logistic regression and conditional logistic regression. Meta-analyses were performed using the inverse variance method. RESULTS Genome-wide significance level was reached for TYK2 V362F common variant in our pooled analysis (p=3.08×10(-13), OR=0.83), while the association of P1104A, A928V and I684S rare and low-frequency missense variants remained significant with nominal signals (p=2.28×10(-3), OR=0.80; p=1.27×10(-3), OR=0.59; p=2.63×10(-5), OR=0.83, respectively). Interestingly, dependence and allelic combination analyses showed that the strong association observed for V362F with SSc, corresponded to a synthetic association dependent on the effect of the three previously mentioned TYK2 missense variants. CONCLUSIONS We report for the first time the association of TYK2 with SSc and reinforce the relevance of the IL-12 pathway in SSc pathophysiology.
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Affiliation(s)
- Elena López-Isac
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
| | - Diana Campillo-Davo
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
| | - Lara Bossini-Castillo
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
| | - Sandra G Guerra
- Centre for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Shervin Assassi
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center-Houston, Houston, USA
| | | | - Patricia Carreira
- Department of Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alessandro Santaniello
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Chiara Bellocchi
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Claudio Lunardi
- Department of Medicine, Università degli Studi di Verona, Verona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche and Ospedali Riuniti, Ancona, Italy
| | - Armando Gabrielli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche and Ospedali Riuniti, Ancona, Italy
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany German Rheumatism Research Center (DRFZ), a Leibniz Institute, Berlin, Germany
| | - Torsten Witte
- Department of Clinical Immunology, Hannover Medical School, Hannover, Germany
| | | | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St Elisabeth Hospital Oberhausen, Germany
| | - Jörg Hw Distler
- Department of Internal Medicine, Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexandre E Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Ariane Herrick
- Centre for Musculoskeletal Research and NIHR Manchester Musculoskeletal Biomedical Research Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jane Worthington
- Centre for Musculoskeletal Research and NIHR Manchester Musculoskeletal Biomedical Research Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christopher P Denton
- Centre for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Carmen Fonseca
- Centre for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Timothy Rdj Radstake
- Department of Rheumatology & Clinical Immunology, Laboratory of Translational Immunology, department of Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maureen D Mayes
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center-Houston, Houston, USA
| | - Javier Martín
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
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López-Isac E, Bossini-Castillo L, Guerra SG, Denton C, Fonseca C, Assassi S, Zhou X, Mayes MD, Simeón CP, Ortego-Centeno N, Castellví I, Carreira P, Gorlova O, Beretta L, Santaniello A, Lunardi C, Hesselstrand R, Nordin A, Riemekasten G, Witte T, Hunzelmann N, Kreuter A, Distler JHW, Voskuyl AE, de Vries-Bouwstra J, Koeleman BP, Herrick A, Worthington J, Radstake TRDJ, Martin J. Identification of IL12RB1 as a novel systemic sclerosis susceptibility locus. Arthritis Rheumatol 2015; 66:3521-3. [PMID: 25199642 DOI: 10.1002/art.38870] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Elena López-Isac
- Institute of Parasitology and Biomedicine, López-Neyra, Consejo Superior de Investigaciones Cientificas and Parque Tecnologico de la Salud, Granada, Spain
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de Vries-Bouwstra J, Le Cessie S, Allaart C, Breedveld F, Huizinga T. Using predicted disease outcome to provide differentiated treatment of early rheumatoid arthritis. J Rheumatol 2006; 33:1747-53. [PMID: 16845710] [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: 05/10/2023]
Abstract
OBJECTIVE To determine the usefulness of a prediction model for making treatment decisions in early rheumatoid arthritis (RA). METHODS In 152 patients with early RA, progression of radiological damage during the first year [Sharp-van der Heijde (SH) score > 0] was assessed and used to define actual disease outcome. Available variables at baseline were entered in a multivariate regression analysis with progression score as dependent variable. This model was used to predict disease outcome in every patient. Using the standard deviations of the predicted disease outcome, patients were divided into 3 groups: (1) severe disease: high probability (> or = 0.8) for progression > 0, (2) mild disease: high probability (> or =0.8) for progression < or = 0, and (3) not classified: no high probability for either option. It was determined how many patients could be classified by using this model. RESULTS One hundred nine patients (71.7%) showed joint damage progression during the first year. Baseline variables available were: age, sex, duration of symptoms, duration of morning stiffness, patient's global assessment of disease activity, Health Assessment Questionnaire score, swollen and painful joint count, bilateral compression pain in metatarsophalangeals, rheumatoid factor positivity, erythrocyte sedimentation rate, shared epitope positivity, SH-score, and the presence of erosions. The R2 value (approximately variation explained) of the prediction model was 0.36. By using this model 46.3% of patients could be classified as having severe disease, 0% as having mild disease, and 53.7% could not be classified. CONCLUSION To be able to make treatment decisions in early RA based on predicted disease outcome, a better prediction of disease outcome is needed, making the search for better prognostic variables urgent.
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