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Howley L, Eyerly-Webb S, Killen SAS, Paul E, Krishnan A, Gropler MRF, Drewes B, Dion E, Lund A, Buyon JP, Cuneo BF. Variation in prenatal surveillance and management of anti-SSA/Ro autoantibody positive pregnancies. J Matern Fetal Neonatal Med 2024; 37:2323623. [PMID: 38443062 PMCID: PMC11005667 DOI: 10.1080/14767058.2024.2323623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To describe international surveillance and treatment strategies for managing anti-SSA/Ro autoantibody positive pregnancies. STUDY DESIGN An electronic REDCap questionnaire was distributed to Fetal Heart Society and North American Fetal Therapy Network members which queried institution-based risk stratification, surveillance methods/frequency, conduction abnormality treatments, and postnatal anti-SSA/Ro pregnancy assessment. RESULTS 101 responses from 59 centers (59% US, 17% international) were collected. Most (79%) do not risk stratify pregnancies by anti-SSA/Ro titer; those that do use varied cutoff values. Many pregnant rheumatology patients are monitored for cardiac abnormalities regardless of maternal anti-SSA/Ro status. Surveillance strategies were based on maternal factors (anti-SSA/Ro status 85%, titer 25%, prior affected child 79%) and monitoring durations varied. Most respondents treat 2° and 3° fetal atrioventricular block, commonly with dexamethasone and/or IVIG. CONCLUSIONS Wide variation exists in current fetal cardiac surveillance and treatment for anti-SSA/Ro autoantibody positive pregnancies, highlighting the need for evidence-based protocols to optimize care.
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Affiliation(s)
- Lisa Howley
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN, USA
- The Children’s Heart Clinic, Children’s Minnesota, Minneapolis, MN USA
| | | | - Stacy A. S. Killen
- Vanderbilt University Medical Center, Monroe Carell Jr. Children’s Hospital, Nashville, TN, USA
| | - Erin Paul
- Icahn School of Medicine, Mount Sinai Children’s Heart Center, New York, NY, USA
| | | | | | - Bailey Drewes
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Eric Dion
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN, USA
| | - Amy Lund
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN, USA
- The Children’s Heart Clinic, Children’s Minnesota, Minneapolis, MN USA
| | - Jill P. Buyon
- New York University Grossman School of Medicine, NYU Langone Medical Center, New York, NY, USA
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Abheiden CNH, Blomjous BS, Slaager C, Landman AJEMC, Ket JCF, Salmon JE, Buyon JP, Heymans MW, de Vries JIP, Bultink IEM, de Boer MA. Systemic lupus erythematosus is associated with an increased frequency of spontaneous preterm births: systematic review and meta-analysis. Am J Obstet Gynecol 2024:S0002-9378(24)00439-3. [PMID: 38492714 DOI: 10.1016/j.ajog.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Preterm birth is one of the most frequent complications of pregnancy in women with systemic lupus erythematosus. The high indicated preterm birth proportion due to hypertensive disorders of pregnancy and/or fetal growth restriction is well known, and preventive measures and screening for early detection are performed. The risk of spontaneous preterm birth is less well recognized. This study aimed to determine the proportions of spontaneous and indicated preterm birth in pregnancies of women with systemic lupus erythematosus. DATA SOURCES A systematic literature search using Pubmed, Embase, Web of Science, and Google Scholar was performed in June 2021. STUDY ELIGIBILITY CRITERIA Studies in pregnant women with systemic lupus erythematosus reporting spontaneous and indicated preterm birth rates were selected. Original research articles published from 1995 to June 2021 were included. METHODS Quality and risk of bias of the included studies were assessed using the Newcastle-Ottawa quality assessment scale. To estimate the pooled event rates and 95% confidence intervals, meta-analysis of single proportions with a random-effects model was performed. RESULTS We included 21 articles, containing data of 8157 pregnancies in women with systemic lupus erythematosus. On average, 31% (95% prediction interval, 0.14-0.50) of the pregnancies resulted in preterm birth, including 14% (95% prediction interval, 0.04-0.27) spontaneous and 16% (95% prediction interval, 0.03-0.35) indicated preterm birth. CONCLUSION In pregnant women with systemic lupus erythematosus, spontaneous and indicated preterm birth proportions are high. This information should be applied in (prepregnancy) counseling and management in pregnancy. The knowledge obtained by this meta-analysis paves the way for further research of associated risk factors and development of interventions to reduce spontaneous preterm birth in systemic lupus erythematosus pregnancies.
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Affiliation(s)
- Carolien N H Abheiden
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Birgit S Blomjous
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands
| | - Ciska Slaager
- Department of Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anadeijda J E M C Landman
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| | - Jill P Buyon
- NYU Grossman School of Medicine, New York University, New York, NY
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Irene E M Bultink
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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Horisberger A, Griffith A, Keegan J, Arazi A, Pulford J, Murzin E, Howard K, Hancock B, Fava A, Sasaki T, Ghosh T, Inamo J, Beuschel R, Cao Y, Preisinger K, Gutierrez-Arcelus M, Eisenhaure TM, Guthridge J, Hoover PJ, Dall'Era M, Wofsy D, Kamen DL, Kalunian KC, Furie R, Belmont M, Izmirly P, Clancy R, Hildeman D, Woodle ES, Apruzzese W, McMahon MA, Grossman J, Barnas JL, Payan-Schober F, Ishimori M, Weisman M, Kretzler M, Berthier CC, Hodgin JB, Demeke DS, Putterman C, Brenner MB, Anolik JH, Raychaudhuri S, Hacohen N, James JA, Davidson A, Petri MA, Buyon JP, Diamond B, Zhang F, Lederer JA, Rao DA. Blood immunophenotyping identifies distinct kidney histopathology and outcomes in patients with lupus nephritis. bioRxiv 2024:2024.01.14.575609. [PMID: 38293222 PMCID: PMC10827101 DOI: 10.1101/2024.01.14.575609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Lupus nephritis (LN) is a frequent manifestation of systemic lupus erythematosus, and fewer than half of patients achieve complete renal response with standard immunosuppressants. Identifying non-invasive, blood-based pathologic immune alterations associated with renal injury could aid therapeutic decisions. Here, we used mass cytometry immunophenotyping of peripheral blood mononuclear cells in 145 patients with biopsy-proven LN and 40 healthy controls to evaluate the heterogeneity of immune activation in patients with LN and to identify correlates of renal parameters and treatment response. Unbiased analysis identified 3 immunologically distinct groups of patients with LN that were associated with different patterns of histopathology, renal cell infiltrates, urine proteomic profiles, and treatment response at one year. Patients with enriched circulating granzyme B+ T cells at baseline showed more severe disease and increased numbers of activated CD8 T cells in the kidney, yet they had the highest likelihood of treatment response. A second group characterized primarily by a high type I interferon signature had a lower likelihood of response to therapy, while a third group appeared immunologically inactive by immunophenotyping at enrollment but with chronic renal injuries. Main immune profiles could be distilled down to 5 simple cytometric parameters that recapitulate several of the associations, highlighting the potential for blood immune profiling to translate to clinically useful non-invasive metrics to assess immune-mediated disease in LN.
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Denvir B, Carlucci PM, Corbitt K, Buyon JP, Belmont HM, Gold HT, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Barbour KE, Helmick CG, Parton H, Izmirly PM. Prevalence of concomitant rheumatologic diseases and autoantibody specificities among racial and ethnic groups in SLE patients. Front Epidemiol 2024; 4:1334859. [PMID: 38516120 PMCID: PMC10956350 DOI: 10.3389/fepid.2024.1334859] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
Objective Leveraging the Manhattan Lupus Surveillance Program (MLSP), a population-based registry of cases of systemic lupus erythematosus (SLE) and related diseases, we investigated the proportion of SLE with concomitant rheumatic diseases, including Sjögren's disease (SjD), antiphospholipid syndrome (APLS), and fibromyalgia (FM), as well as the prevalence of autoantibodies in SLE by sex and race/ethnicity. Methods Prevalent SLE cases fulfilled one of three sets of classification criteria. Additional rheumatic diseases were defined using modified criteria based on data available in the MLSP: SjD (anti-SSA/Ro positive and evidence of keratoconjunctivitis sicca and/or xerostomia), APLS (antiphospholipid antibody positive and evidence of a blood clot), and FM (diagnosis in the chart). Results 1,342 patients fulfilled SLE classification criteria. Of these, SjD was identified in 147 (11.0%, 95% CI 9.2-12.7%) patients with women and non-Latino Asian patients being the most highly represented. APLS was diagnosed in 119 (8.9%, 95% CI 7.3-10.5%) patients with the highest frequency in Latino patients. FM was present in 120 (8.9%, 95% CI 7.3-10.5) patients with non-Latino White and Latino patients having the highest frequency. Anti-dsDNA antibodies were most prevalent in non-Latino Asian, Black, and Latino patients while anti-Sm antibodies showed the highest proportion in non-Latino Black and Asian patients. Anti-SSA/Ro and anti-SSB/La antibodies were most prevalent in non-Latino Asian patients and least prevalent in non-Latino White patients. Men were more likely to be anti-Sm positive. Conclusion Data from the MLSP revealed differences among patients classified as SLE in the prevalence of concomitant rheumatic diseases and autoantibody profiles by sex and race/ethnicity underscoring comorbidities associated with SLE.
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Affiliation(s)
- Brendan Denvir
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Philip M. Carlucci
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Kelly Corbitt
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Heather T. Gold
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Jane E. Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Joan M. Bathon
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Yousaf Ali
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ellen M. Ginzler
- Division of Rheumatology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | | | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kamil E. Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Charles G. Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hilary Parton
- Division of Disease Control, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
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5
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Buyon JP, Masson M, Izmirly CG, Phoon C, Acherman R, Sinkovskaya E, Abuhamad A, Makhoul M, Satou G, Hogan W, Pinto N, Moon-Grady A, Howley L, Donofrio M, Krishnan A, Ahmadzia H, Levasseur S, Paul E, Owens S, Cumbermack K, Matta J, Joffe G, Lindblade C, Haxel C, Kohari K, Copel J, Strainic J, Doan T, Bermudez-Wagner K, Holloman C, Sheth SS, Killen S, Tacy T, Kaplinski M, Hornberger L, Carlucci PM, Izmirly P, Fraser N, Clancy RM, Cuneo BF. Prospective Evaluation of High Titer Autoantibodies and Fetal Home Monitoring in the Detection of Atrioventricular Block Among Anti-SSA/Ro Pregnancies. Arthritis Rheumatol 2024; 76:411-420. [PMID: 37947364 DOI: 10.1002/art.42733] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This prospective study of pregnant patients, Surveillance To Prevent AV Block Likely to Occur Quickly (STOP BLOQ), addresses the impact of anti-SSA/Ro titers and utility of ambulatory monitoring in the detection of fetal second-degree atrioventricular block (AVB). METHODS Women with anti-SSA/Ro autoantibodies by commercial testing were stratified into high and low anti-52-kD and/or 60-kD SSA/Ro titers applying at-risk thresholds defined by previous evaluation of AVB pregnancies. The high-titer group performed fetal heart rate and rhythm monitoring (FHRM) thrice daily and weekly/biweekly echocardiography from 17-26 weeks. Abnormal FHRM prompted urgent echocardiography to identify AVB. RESULTS Anti-52-kD and/or 60-kD SSA/Ro met thresholds for monitoring in 261 of 413 participants (63%); for those, AVB frequency was 3.8%. No cases occurred with low titers. The incidence of AVB increased with higher levels, reaching 7.7% for those in the top quartile for anti-60-kD SSA/Ro, which increased to 27.3% in those with a previous child who had AVB. Based on levels from 15 participants with paired samples from both an AVB and a non-AVB pregnancy, healthy pregnancies were not explained by decreased titers. FHRM was considered abnormal in 45 of 30,920 recordings, 10 confirmed AVB by urgent echocardiogram, 7 being second-degree AVB, all <12 hours from normal FHRM and within another 0.75 to 4 hours to echocardiogram. The one participant with second/third-degree and two participants with third-degree AVB were diagnosed by urgent echocardiogram >17 to 72 hours from an FHRM. Surveillance echocardiograms detected no AVB when the preceding interval FHRM recordings were normal. CONCLUSION High-titer antibodies are associated with an increased incidence of AVB. Anti-SSA/Ro titers remain stable over time and do not explain the discordant recurrence rates, suggesting that other factors are required. Fetal heart rate and rhythm (FHRM) with results confirmed by a pediatric cardiologist reliably detects conduction abnormalities, which may reduce the need for serial echocardiograms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gary Satou
- University of California, Los Angeles, California
| | | | | | | | - Lisa Howley
- Midwest Fetal Care Center, Children's Minnesota/Allina Health, Minneapolis, Minnesota
| | | | | | | | | | - Erin Paul
- Mount Sinai Hospital, New York City, New York
| | | | | | | | - Gary Joffe
- Perinatal Associates of New Mexico, Rio Rancho, New Mexico
| | | | - Caitlin Haxel
- University of Vermont Children's Hospital, Burlington, Vermont
| | | | | | - James Strainic
- UH Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Tam Doan
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Conisha Holloman
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Shreya S Sheth
- Baylor School of Medicine, Baylor College of Medicine, Houston, Texas
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6
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Griffin MM, Engel A, Mehta-Lee SS, Nusbaum J, Golpanian M, Izmirly P, Belmont HM, Buyon JP. Risk Assessment Model for Postpartum Venous Thromboembolism Prevention in Patients with Systemic Lupus Erythematosus. Am J Perinatol 2023; 40:1732-1737. [PMID: 37494484 DOI: 10.1055/s-0043-1771049] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This article assesses the application of the Royal College of Obstetricians and Gynaecologists (RCOG) venous thromboembolism (VTE) risk model on a cohort of postpartum patients with a history of systemic lupus erythematosus (SLE). STUDY DESIGN This is a secondary analysis of an ongoing patient registry of women with SLE from 2016 to 2022. There were 49 SLE patients with 55 pregnancies using the Definitions of Remission in SLE (DORIS) criteria to determine SLE disease activity. RCOG risk assessment model scoring was calculated for each patient prior to and after delivery. The primary outcome was the qualification of "active SLE" by standard rheumatologic criteria and assessment of recommendations for VTE prophylaxis based on RCOG VTE risk assessment scoring. Data were analyzed using Fisher's exact test, chi-square test, and Mann-Whitney U test with significance defined as p < 0.05. RESULTS In the study cohort, 34 pregnancies (61.8%) were in DORIS remission at delivery. Twenty-one pregnancies (38.2%) were not and scored 3 points on the RCOG VTE risk model. Of these pregnancies, only 19% (n = 4) were recommended for VTE prophylaxis by the obstetrical provider despite RCOG score ≥3. Only 35.7% (n = 5) of pregnancies in DORIS remission, but with 3 points for non-SLE-related VTE risk factors (n = 14), were recommended for VTE prophylaxis. Of the 20 pregnancies in remission with an RCOG score < 3 after assessing all risk factors, 15% (n = 3) were nevertheless recommended for VTE prophylaxis. No patients had a postpartum VTE regardless of therapy. CONCLUSION These data reveal a need to improve upon providing postpartum VTE prophylaxis to SLE patients not in remission while also recognizing a diagnosis of SLE alone should not equate with active disease. Moreover, SLE patients in remission may still warrant VTE prophylaxis if other non-SLE-related risk factors are present. KEY POINTS · Those with SLE are at increased risk for VTE postpartum.. · VTE prophylaxis should be instituted when clinically appropriate.. · Caution should be exercised in broadly assigning disease activity for SLE diagnosis only.. · This study supports VTE prophylaxis use in postpartum patients with SLE..
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Affiliation(s)
- Myah M Griffin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York
| | - Alexis Engel
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - Shilpi S Mehta-Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York
| | - Julie Nusbaum
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - Michael Golpanian
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - Peter Izmirly
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - H Michael Belmont
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
| | - Jill P Buyon
- Department of Rheumatology, NYU Langone Health/New York University Grossman School of Medicine, New York, New York
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7
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Lee JYE, Mendel A, Askanase A, Bae SC, Buyon JP, Clarke AE, Costedoat-Chalumeau N, Fortin PR, Gladman DD, Ramsey-Goldman R, Hanly JG, Inanç M, Isenberg DA, Mak A, Mosca M, Petri M, Rahman A, Sanchez-Guerrero J, Urowitz M, Wallace DJ, Bernatsky S, Vinet É. Systemic Lupus Erythematosus Women with Lupus Nephritis in Pregnancy Therapeutic Challenge (SWITCH): The Systemic Lupus International Collaborating Clinics experience. Ann Rheum Dis 2023; 82:1496-1497. [PMID: 37208152 DOI: 10.1136/ard-2023-224197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Joo-Young E Lee
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Arielle Mendel
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anca Askanase
- Department of Rheumatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology and Hanyang University Institute of Bioscience and Biotechnology, Seoul, South Korea
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Ann Elaine Clarke
- Division of Rheumatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nathalie Costedoat-Chalumeau
- APHP, Centre de Reference Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Paul R Fortin
- Division of Rheumatology, Department of Medicine, Centre ARThrite, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
| | - Dafna D Gladman
- Lupus Program, Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murat Inanç
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Anselm Mak
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Michelle Petri
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anisur Rahman
- Department of Rheumatology, University College London, London, UK
| | - Jorge Sanchez-Guerrero
- Lupus Program, Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Murray Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Professor Emeritus Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Wallace
- Division of Rheumatology, Department of Medicine, Cedars-Sinai/David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sasha Bernatsky
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Évelyne Vinet
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
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8
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Zaminski D, Saxena A, Izmirly P, Buyon JP, Belmont HM. Clinical implications of discordance between anti-dsDNA antibodies by multiplex flow immunoassay and Crithidia luciliae assay in a multiethnic racial cohort of patients with SLE. Lupus Sci Med 2023; 10:e001012. [PMID: 37963669 PMCID: PMC10649789 DOI: 10.1136/lupus-2023-001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE Anti-dsDNA antibodies (anti-dsDNA) are a component of all classification schemes in SLE and comprise one of the domains in validated activity indices. Anti-dsDNA is frequently measured commercially by an enzyme immunoassay (EIA) or Crithidia luciliae immunofluorescence test (CLIFT). To address the clinical impact of measuring these antibodies by two different assays, this study leveraged a well-phenotyped multiethnic/racial cohort. METHODS All patients fulfilled the classification criteria for SLE by at least one of the validated schemes: American College of Rheumatology, Systemic Lupus Erythematosus International Collaborating Clinics and/or American College of Rheumatology/European League Against Rheumatism classification criteria. Patients with one or more simultaneously paired anti-dsDNA by multiplex EIA and CLIFT were identified. Analysis of concordance or discordance, titre comparability of assays and association with hybrid SLE Disease Activity Index score, prevalence of lupus nephritis (LN), ability to predict a flare and classification criteria was performed. RESULTS 207 patients were simultaneously tested by EIA and CLIFT at least once for anti-dsDNA, generating 586 paired results. 377 pairs were concordant and 209 were discordant. 41 of 207 patients always had discordant paired results and 39 patients always had results with titre discordance. In 100 patients with LN, 60 were positive by EIA and 72 by CLIFT. Sensitivities and specificities for patients with LN versus patients without LN were EIA 60% and 47%, and CLIFT 72% and 37%, respectively. 42 patients had flare assessment within 90 days of their paired result. Six of seven patients with mild flares and all four patients with severe flares had concordant positive results. CONCLUSION Our data demonstrate that discordance of positivity between both assays for anti-dsDNA is relatively common, occurring in a fifth of patients overall and a third of visits. EIA positivity is associated with LN less often than CLIFT positivity. With the significant discordance of results between anti-dsDNA assays, obtaining both CLIFT and EIA assays may be beneficial for classification and routine monitoring of SLE.
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Affiliation(s)
- Devyn Zaminski
- NYU Grossman School of Medicine, New York City, New York, USA
| | - Amit Saxena
- Rheumatology, NYU Grossman School of Medicine, New York City, New York, USA
| | - Peter Izmirly
- Rheumatology, NYU Grossman School of Medicine, New York City, New York, USA
| | - Jill P Buyon
- Rheumatology, NYU Grossman School of Medicine, New York City, New York, USA
| | - H Michael Belmont
- Rheumatology, NYU Grossman School of Medicine, New York City, New York, USA
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Azzouz DF, Chen Z, Izmirly PM, Chen LA, Li Z, Zhang C, Mieles D, Trujillo K, Heguy A, Pironti A, Putzel GG, Schwudke D, Fenyo D, Buyon JP, Alekseyenko AV, Gisch N, Silverman GJ. Longitudinal gut microbiome analyses and blooms of pathogenic strains during lupus disease flares. Ann Rheum Dis 2023; 82:1315-1327. [PMID: 37365013 PMCID: PMC10511964 DOI: 10.1136/ard-2023-223929] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Whereas genetic susceptibility for systemic lupus erythematosus (SLE) has been well explored, the triggers for clinical disease flares remain elusive. To investigate relationships between microbiota community resilience and disease activity, we performed the first longitudinal analyses of lupus gut-microbiota communities. METHODS In an observational study, taxononomic analyses, including multivariate analysis of ß-diversity, assessed time-dependent alterations in faecal communities from patients and healthy controls. From gut blooms, strains were isolated, with genomes and associated glycans analysed. RESULTS Multivariate analyses documented that, unlike healthy controls, significant temporal community-wide ecological microbiota instability was common in SLE patients, and transient intestinal growth spikes of several pathogenic species were documented. Expansions of only the anaerobic commensal, Ruminococcus (blautia) gnavus (RG) occurred at times of high-disease activity, and were detected in almost half of patients during lupus nephritis (LN) disease flares. Whole genome sequence analysis of RG strains isolated during these flares documented 34 genes postulated to aid adaptation and expansion within a host with an inflammatory condition. Yet, the most specific feature of strains found during lupus flares was the common expression of a novel type of cell membrane-associated lipoglycan. These lipoglycans share conserved structural features documented by mass spectroscopy, and highly immunogenic repetitive antigenic-determinants, recognised by high-level serum IgG2 antibodies, that spontaneously arose, concurrent with RG blooms and lupus flares. CONCLUSIONS Our findings rationalise how blooms of the RG pathobiont may be common drivers of clinical flares of often remitting-relapsing lupus disease, and highlight the potential pathogenic properties of specific strains isolated from active LN patients.
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Affiliation(s)
- Doua F Azzouz
- Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Ze Chen
- Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, New York, USA
| | - Peter M Izmirly
- Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Lea Ann Chen
- Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Zhi Li
- Institute of Systems Genetics, NYU Grossman School of Medicine, New York, New York, USA
| | - Chongda Zhang
- Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, New York, USA
| | - David Mieles
- Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Kate Trujillo
- Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Adriana Heguy
- Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Alejandro Pironti
- Microbiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Greg G Putzel
- Microbiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Dominik Schwudke
- Division of Bioanalytical Chemsitry, Forschungszentrum Borstel Leibniz Lungenzentrum, Borstel, Germany
- German Center for Infection Research (DZIF), Partner Site: Hamburg-Lübeck, Borstel, Germany
- Airway Research Center North, Member of the German Center for Lung Research (DZL), Partner Site: Research Center Borstel, Borstel, Germany
| | - David Fenyo
- Institute of Systems Genetics, NYU Grossman School of Medicine, New York, New York, USA
| | - Jill P Buyon
- Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Alexander V Alekseyenko
- Department of Public Health Sciences, Biomedical Informatics Center, Program for Microbiome Research, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicolas Gisch
- Division of Bioanalytical Chemistry, Priority Area Infections, Forschungszentrum Borstel Leibniz Lungenzentrum, Borstel, Germany
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10
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Cuneo BF, Buyon JP, Sammaritano L, Jaeggi E, Arya B, Behrendt N, Carvalho J, Cohen J, Cumbermack K, DeVore G, Doan T, Donofrio MT, Freud L, Galan HL, Gropler MRF, Haxel C, Hornberger LK, Howley LW, Izmirly P, Killen SS, Kaplinski M, Krishnan A, Lavasseur S, Lindblade C, Matta J, Makhoul M, Miller J, Morris S, Paul E, Perrone E, Phoon C, Pinto N, Rychik J, Satou G, Saxena A, Sklansky M, Stranic J, Strasburger JF, Srivastava S, Srinivasan S, Tacy T, Tworetzky W, Uzun O, Yagel S, Zaretsky MV, Moon-Grady AJ. Knowledge is power: regarding SMFM Consult Series #64: Systemic lupus erythematosus in pregnancy. Am J Obstet Gynecol 2023; 229:361-363. [PMID: 37394327 DOI: 10.1016/j.ajog.2023.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Bettina F Cuneo
- University of Colorado School of Medicine, Children's Hospital Colorado and University Hospital, Aurora, CO.
| | - Jill P Buyon
- NYU Grossman School of Medicine, NYU Langone Medical Center, New York, NY
| | | | | | - Bhawna Arya
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Nicholas Behrendt
- University of Colorado School of Medicine, Children's Hospital Colorado and University Hospital, Aurora, CO
| | - Julene Carvalho
- Royal College of Obstetrics and Gynecology, Royal Brompton Hospital, London, United Kingdom
| | - Jennifer Cohen
- Icahn School of Medicine, Mt Sinai Hospital, New York, NY
| | - Kristopher Cumbermack
- University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, KY
| | - Greggory DeVore
- David Geffen School of Medicine, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA
| | - Tam Doan
- Baylor University College of Medicine, Texas Children's Hospital, Houston, TX
| | - Mary T Donofrio
- George Washington School of Medicine, Children's National Hospital, Washington, DC
| | | | - Henry L Galan
- University of Colorado School of Medicine, Children's Hospital Colorado and University Hospital, Aurora, CO
| | - Melanie R F Gropler
- Case Western Reserve School of Medicine, University Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Caitlin Haxel
- University of Vermont School of Medicine, University of Vermont Medical Center, Burlington, VT
| | - Lisa K Hornberger
- Stollery Children's Hospital, University of Alberta Medical School, Edmonton, Alberta, Canada
| | | | - Peter Izmirly
- NYU Grossman School of Medicine, NYU Langone Medical Center, New York, NY
| | - Stacy S Killen
- Vanderbilt University Medical School, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Michelle Kaplinski
- Stanford University Medical School, Lucille Packard Children's Hospital, Palo Alto, CA
| | - Anita Krishnan
- George Washington School of Medicine, Children's National Hospital, Washington, DC
| | - Stephanie Lavasseur
- New York-Presbyterian Medical School, Morgan Stanley Children's Hospital, New York, NY
| | | | - Jyothi Matta
- University of Kentucky School of Medicine, Norton Children's Hospital, Louisville, KY
| | | | - Jena Miller
- Johns Hopkins School of Medicine, Johns Hopkins Medicine, Baltimore, MD
| | - Shaine Morris
- Baylor University College of Medicine, Texas Children's Hospital, Houston, TX
| | - Erin Paul
- Icahn School of Medicine, Mt Sinai Hospital, New York, NY
| | - Erin Perrone
- University of Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Colin Phoon
- NYU Grossman School of Medicine, NYU Langone Medical Center, New York, NY
| | - Nelangi Pinto
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Jack Rychik
- University of Pennsylvania Medical School, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gary Satou
- David Geffen School of Medicine, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA
| | - Amit Saxena
- NYU Grossman School of Medicine, NYU Langone Medical Center, New York, NY
| | - Mark Sklansky
- David Geffen School of Medicine, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA
| | - James Stranic
- Case Western Reserve School of Medicine, University Rainbow Babies and Children's Hospital, Cleveland, OH
| | | | | | - Sharda Srinivasan
- University of Wisconsin School of Medicine, American Children's Hospital, Madison, WI
| | - Theresa Tacy
- Stanford University Medical School, Lucille Packard Children's Hospital, Palo Alto, CA
| | - Wayne Tworetzky
- Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Orhan Uzun
- University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Simcha Yagel
- Hadassah Medical School, Hadassah-Hebrew Medical Center, Jerusalem, Israel
| | - Michael V Zaretsky
- University of Colorado School of Medicine, Children's Hospital Colorado and University Hospital, Aurora, CO
| | - Anita J Moon-Grady
- University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, CA
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11
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Hasan G, Ferucci ED, Buyon JP, Belmont HM, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H, Izmirly PM. Population-based prevalence and incidence estimates of mixed connective tissue disease from the Manhattan Lupus Surveillance Program. Rheumatology (Oxford) 2023; 62:2845-2849. [PMID: 36538873 DOI: 10.1093/rheumatology/keac703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE Epidemiological data for MCTD are limited. Leveraging data from the Manhattan Lupus Surveillance Program (MLSP), a racially/ethnically diverse population-based registry of cases with SLE and related diseases including MCTD, we provide estimates of the prevalence and incidence of MCTD. METHODS MLSP cases were identified from rheumatologists, hospitals and population databases using a variety of International Classification of Diseases, Ninth Revision codes. MCTD was defined as one of the following: fulfilment of our modified Alarcon-Segovia and Kahn criteria, which required a positive RNP antibody and the presence of synovitis, myositis and RP; a diagnosis of MCTD and no other diagnosis of another CTD; and a diagnosis of MCTD regardless of another CTD diagnosis. RESULTS Overall, 258 (7.7%) cases met a definition of MCTD. Using our modified Alarcon-Segovia and Kahn criteria for MCTD, the age-adjusted prevalence was 1.28 (95% CI 0.72, 2.09) per 100 000. Using our definition of a diagnosis of MCTD and no other diagnosis of another CTD yielded an age-adjusted prevalence and incidence of MCTD of 2.98 (95% CI 2.10, 4.11) per 100 000 and 0.39 (95% CI 0.22, 0.64) per 100 000, respectively. The age-adjusted prevalence and incidence were highest using a diagnosis of MCTD regardless of other CTD diagnoses and were 16.22 (95% CI 14.00, 18.43) per 100 000 and 1.90 (95% CI 1.49, 2.39) per 100 000, respectively. CONCLUSIONS The MLSP provided estimates for the prevalence and incidence of MCTD in a diverse population. The variation in estimates using different case definitions is reflective of the challenge of defining MCTD in epidemiologic studies.
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Affiliation(s)
- Ghadeer Hasan
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Elizabeth D Ferucci
- Division of Community Health Services, Department of Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Jane E Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Joan M Bathon
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yousaf Ali
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ellen M Ginzler
- Division of Rheumatology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Chaim Putterman
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hilary Parton
- Division of Disease Control, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, USA
| | - Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
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12
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Choi MY, Chen I, Clarke AE, Fritzler MJ, Buhler KA, Urowitz M, Hanly J, St-Pierre Y, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, Alarcón GS, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Lim S, Inanc M, Kalunian K, Jacobsen S, Peschken C, Kamen DL, Askanase A, Buyon JP, Sontag D, Costenbader KH. Machine learning identifies clusters of longitudinal autoantibody profiles predictive of systemic lupus erythematosus disease outcomes. Ann Rheum Dis 2023:ard-2022-223808. [PMID: 37085289 DOI: 10.1136/ard-2022-223808] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES A novel longitudinal clustering technique was applied to comprehensive autoantibody data from a large, well-characterised, multinational inception systemic lupus erythematosus (SLE) cohort to determine profiles predictive of clinical outcomes. METHODS Demographic, clinical and serological data from 805 patients with SLE obtained within 15 months of diagnosis and at 3-year and 5-year follow-up were included. For each visit, sera were assessed for 29 antinuclear antibodies (ANA) immunofluorescence patterns and 20 autoantibodies. K-means clustering on principal component analysis-transformed longitudinal autoantibody profiles identified discrete phenotypic clusters. One-way analysis of variance compared cluster enrolment demographics and clinical outcomes at 10-year follow-up. Cox proportional hazards model estimated the HR for survival adjusting for age of disease onset. RESULTS Cluster 1 (n=137, high frequency of anti-Smith, anti-U1RNP, AC-5 (large nuclear speckled pattern) and high ANA titres) had the highest cumulative disease activity and immunosuppressants/biologics use at year 10. Cluster 2 (n=376, low anti-double stranded DNA (dsDNA) and ANA titres) had the lowest disease activity, frequency of lupus nephritis and immunosuppressants/biologics use. Cluster 3 (n=80, highest frequency of all five antiphospholipid antibodies) had the highest frequency of seizures and hypocomplementaemia. Cluster 4 (n=212) also had high disease activity and was characterised by multiple autoantibody reactivity including to antihistone, anti-dsDNA, antiribosomal P, anti-Sjögren syndrome antigen A or Ro60, anti-Sjögren syndrome antigen B or La, anti-Ro52/Tripartite Motif Protein 21, antiproliferating cell nuclear antigen and anticentromere B). Clusters 1 (adjusted HR 2.60 (95% CI 1.12 to 6.05), p=0.03) and 3 (adjusted HR 2.87 (95% CI 1.22 to 6.74), p=0.02) had lower survival compared with cluster 2. CONCLUSION Four discrete SLE patient longitudinal autoantibody clusters were predictive of long-term disease activity, organ involvement, treatment requirements and mortality risk.
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Affiliation(s)
- May Yee Choi
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Irene Chen
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Ann Elaine Clarke
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Marvin J Fritzler
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Katherine A Buhler
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Murray Urowitz
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Lupus Clinic, Toronto, Ontario, Canada
| | - John Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yvan St-Pierre
- Medicine, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Birmingham University Medical School, Birmingham, West Midlands, UK
| | - Sang-Cheol Bae
- Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology and Hanyang University Institute of Bioscience and Biotechnology, Seoul, The Republic of Korea
| | - Juanita Romero-Diaz
- Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
| | - Jorge Sanchez-Guerrero
- Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Daniel J Wallace
- Division of Rheumatology, Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David Alan Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Anisur Rahman
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Paul R Fortin
- Division of Rheumatology, CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Lupus Clinic, Toronto, Ontario, Canada
| | - Ian N Bruce
- Epidemiology Unit, University of Manchester, Manchester, UK
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Mary Anne Dooley
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rosalind Ramsey-Goldman
- Department of Medicine, Division of Rheumatology, Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susan Manzi
- Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | | | - Graciela S Alarcón
- Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | | | - Cynthia Aranow
- Division of Autoimmune and Musculoskeletal Disease, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Meggan Mackay
- Division of Autoimmune and Musculoskeletal Disease, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Sam Lim
- Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Murat Inanc
- Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Kenneth Kalunian
- Department of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, California, USA
| | - Søren Jacobsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Diane L Kamen
- Division of Rheumatology & Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anca Askanase
- Hospital for Joint Diseases, New York University, Seligman Centre for Advanced Therapeutics, New York, New York, USA
| | - Jill P Buyon
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - David Sontag
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Karen H Costenbader
- Department of Medicine, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Medicine, Harvard Medical School, Boston, Massachusetts, USA
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13
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Cornwell MG, Bannoudi HE, Luttrell-Williams E, Engel A, Barrett TJ, Myndzar K, Izmirly P, Belmont HM, Clancy R, Ruggles KV, Buyon JP, Berger JS. Modeling of clinical phenotypes in systemic lupus erythematosus based on the platelet transcriptome and FCGR2a genotype. J Transl Med 2023; 21:247. [PMID: 37029410 PMCID: PMC10082503 DOI: 10.1186/s12967-023-04059-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/12/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND The clinical heterogeneity of SLE with its complex pathogenesis remains challenging as we strive to provide optimal management. The contribution of platelets to endovascular homeostasis, inflammation and immune regulation highlights their potential importance in SLE. Prior work from our group showed that the Fcγ receptor type IIa (FcγRIIa)-R/H131 biallelic polymorphism is associated with increased platelet activity and cardiovascular risk in SLE. The study was initiated to investigate the platelet transcriptome in patients with SLE and evaluate its association across FcγRIIa genotypes and distinct clinical features. METHODS Fifty-one patients fulfilling established criteria for SLE (mean age = 41.1 ± 12.3, 100% female, 45% Hispanic, 24% black, 22% Asian, 51% white, mean SLEDAI = 4.4 ± 4.2 at baseline) were enrolled and compared with 18 demographically matched control samples. The FCGR2a receptor was genotyped for each sample, and RNA-seq was performed on isolated, leukocyte-depleted platelets. Transcriptomic data were used to create a modular landscape to explore the differences between SLE patients and controls and various clinical parameters in the context of FCGR2a genotypes. RESULTS There were 2290 differentially expressed genes enriched for pathways involved in interferon signaling, immune activation, and coagulation when comparing SLE samples vs controls. When analyzing patients with proteinuria, modules associated with oxidative phosphorylation and platelet activity were unexpectedly decreased. Furthermore, genes that were increased in SLE and in patients with proteinuria were enriched for immune effector processes, while genes increased in SLE but decreased in proteinuria were enriched for coagulation and cell adhesion. A low-binding FCG2Ra allele (R131) was associated with decreases in FCR activation, which further correlated with increases in platelet and immune activation pathways. Finally, we were able to create a transcriptomic signature of clinically active disease that performed significantly well in discerning SLE patients with active clinical disease form those with inactive clinical disease. CONCLUSIONS In aggregate, these data demonstrate the platelet transcriptome provides insight into lupus pathogenesis and disease activity, and shows potential use as means of assessing this complex disease using a liquid biopsy.
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Affiliation(s)
- MacIntosh G Cornwell
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY, USA
| | - Hanane El Bannoudi
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Elliot Luttrell-Williams
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Alexis Engel
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Grossman School of Medicine, Medical Science Building 593, 530 First Avenue, New York, NY, 10016, USA
| | - Tessa J Barrett
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA
| | - Khrystyna Myndzar
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Grossman School of Medicine, Medical Science Building 593, 530 First Avenue, New York, NY, 10016, USA
| | - Peter Izmirly
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Grossman School of Medicine, Medical Science Building 593, 530 First Avenue, New York, NY, 10016, USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Grossman School of Medicine, Medical Science Building 593, 530 First Avenue, New York, NY, 10016, USA
| | - Robert Clancy
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Grossman School of Medicine, Medical Science Building 593, 530 First Avenue, New York, NY, 10016, USA
| | - Kelly V Ruggles
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY, USA.
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Grossman School of Medicine, Medical Science Building 593, 530 First Avenue, New York, NY, 10016, USA.
| | - Jeffrey S Berger
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
- Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA.
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14
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Makadia L, Izmirly P, Buyon JP, Phoon CKL. Autoimmune Congenital Complete Heart Block: How Late Can It Occur? AJP Rep 2023; 13:e29-e34. [PMID: 37168107 PMCID: PMC10166639 DOI: 10.1055/s-0043-1768708] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/14/2023] [Indexed: 05/13/2023] Open
Abstract
Objective Maternal anti-Ro (SSA) and/or anti-La (SSB) antibodies are a risk factor for congenital complete heart block (CHB). Because detailed analysis of the incidence of CHB after 24 weeks of gestational age (GA) is lacking, we aimed to ascertain the risk of "later-onset" CHB among offspring of SSA/SSB-positive mothers in the published literature. Study Design Using search terms "neonatal lupus heart block" and "autoimmune congenital heart block" on PubMed and Ovid, we gathered prospective studies of SSA/SSB-positive mothers with fetal echo surveillance starting from before CHB diagnosis and retrospective cases of fetal CHB diagnosis after 24 weeks of GA (if there was prior normal heart rate) or after birth. Results Ten prospective studies included 1,248 SSA/SSB-positive pregnancies with 24 cases of CHB diagnosed during pregnancy (1.9%). Among these, three (12.5%) were after 24 weeks-at weeks 25, 26, and 28. Our retrospective studies revealed 50 patients with CHB diagnosis in late fetal life and neonatal period and 34 in the nonneonatal childhood period. An additional four cases were diagnosed after age 18 years. Conclusion Later-onset autoimmune CHB in offspring of SSA/SSB-positive mothers does occur. Our analysis suggests that prenatal surveillance should continue beyond 24 weeks of GA but is limited by inconsistent published surveillance data.
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Affiliation(s)
- Luv Makadia
- Division of Pediatric Cardiology, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone and NYU Grossman School of Medicine, New York, New York
| | - Peter Izmirly
- Division of Rheumatology, Department of Medicine, NYU Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, NYU Langone Health and NYU Grossman School of Medicine, New York, New York
| | - Colin K. L. Phoon
- Division of Pediatric Cardiology, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone and NYU Grossman School of Medicine, New York, New York
- Address for correspondence Colin K. L. Phoon, MPhil, MD Division of Pediatric Cardiology, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone and NYU Grossman School of Medicine150-160 East 32nd Street, New York, NY 10016
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15
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Kleitsch J, Mazori DR, Masson M, Izmirly PM, Saxena A, Buyon JP, Glick SA. Cutaneous Neonatal Lupus in Patients with Skin of Color: A Retrospective Cohort Study from a National Registry. J Am Acad Dermatol 2023:S0190-9622(23)00513-3. [PMID: 36997071 DOI: 10.1016/j.jaad.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
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16
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Clancy RM, Guthridge CJ, Marion MC, Guthridge J, Howard TD, Izmirly PM, Masson M, Buyon JP, James J, Langefeld CD. The modifying influence of HLA class II DQB1*06:02 on the Streptococcus and clinical phenotype correlation among anti-Ro+ mothers of children with neonatal lupus. Genes Dis 2022. [DOI: 10.1016/j.gendis.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Carlucci PM, Li J, Fava A, Deonaraine KK, Wofsy D, James JA, Putterman C, Diamond B, Davidson A, Fine DM, Monroy-Trujillo J, Atta MG, DeJager W, Guthridge JM, Haag K, Rao DA, Brenner MB, Lederer JA, Apruzzese W, Belmont HM, Izmirly PM, Zaminski D, Wu M, Connery S, Payan-Schober F, Furie R, Dall'Era M, Cho K, Kamen D, Kalunian K, Anolik J, Barnas J, Ishimori M, Weisman MH, Buyon JP, Petri M. High incidence of proliferative and membranous nephritis in SLE patients with low proteinuria in the Accelerating Medicines Partnership. Rheumatology (Oxford) 2022; 61:4335-4343. [PMID: 35212719 PMCID: PMC9629353 DOI: 10.1093/rheumatology/keac067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Delayed detection of LN associates with worse outcomes. There are conflicting recommendations regarding a threshold level of proteinuria at which biopsy will likely yield actionable management. This study addressed the association of urine protein:creatinine ratios (UPCR) with clinical characteristics and investigated the incidence of proliferative and membranous histology in patients with a UPCR between 0.5 and 1. METHODS A total of 275 SLE patients (113 first biopsy, 162 repeat) were enrolled in the multicentre multi-ethnic/racial Accelerating Medicines Partnership across 15 US sites at the time of a clinically indicated renal biopsy. Patients were followed for 1 year. RESULTS At biopsy, 54 patients had UPCR <1 and 221 had UPCR ≥1. Independent of UPCR or biopsy number, a majority (92%) of patients had class III, IV, V or mixed histology. Moreover, patients with UPCR <1 and class III, IV, V, or mixed had a median activity index of 4.5 and chronicity index of 3, yet 39% of these patients had an inactive sediment. Neither anti-dsDNA nor low complement distinguished class I or II from III, IV, V or mixed in patients with UPCR <1. Of 29 patients with baseline UPCR <1 and class III, IV, V or mixed, 23 (79%) had a UPCR <0.5 at 1 year. CONCLUSION In this prospective study, three-quarters of patients with UPCR <1 had histology showing class III, IV, V or mixed with accompanying activity and chronicity despite an inactive sediment or normal serologies. These data support renal biopsy at thresholds lower than a UPCR of 1.
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Affiliation(s)
- Philip M Carlucci
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Jessica Li
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Andrea Fava
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - David Wofsy
- Rheumatology Division, Department of Medicine, Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA
| | - Judith A James
- Department of Medicine, Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Chaim Putterman
- Division of Rheumatology, Department of Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Betty Diamond
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Anne Davidson
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Derek M Fine
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Jose Monroy-Trujillo
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Mohamed G Atta
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Wade DeJager
- Department of Medicine, Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Joel M Guthridge
- Department of Medicine, Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Kristin Haag
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael B Brenner
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James A Lederer
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William Apruzzese
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - H Michael Belmont
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Peter M Izmirly
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Devyn Zaminski
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Ming Wu
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Sean Connery
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Fernanda Payan-Schober
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Richard Furie
- Division of Rheumatology, Department of Medicine, Northwell Health, Great Neck, NY
| | - Maria Dall'Era
- Rheumatology Division, Department of Medicine, Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA
| | - Kerry Cho
- Nephrology Division, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Kenneth Kalunian
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA
| | - Jennifer Anolik
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
| | - Jennifer Barnas
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
| | - Mariko Ishimori
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jill P Buyon
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Michelle Petri
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Kaizer AM, Lindblade C, Clancy R, Tebo AE, Drewes B, Masson M, Chang M, Fraser N, Buyon JP, Cuneo BF. Reducing the burden of surveillance in pregnant women with no history of fetal atrioventricular block using the negative predictive value of anti-Ro/SSA antibody titers. Am J Obstet Gynecol 2022; 227:761.e1-761.e10. [PMID: 35690080 PMCID: PMC10871557 DOI: 10.1016/j.ajog.2022.05.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The risk of fetal atrioventricular block in anti-Ro/SSA antibody-exposed pregnancies with no previous affected offspring is approximately 2%. A high antibody titer is necessary but not sufficient for atrioventricular block, and specific antibody titers do not predict risk. However, there are no data on the negative predictive value of antibody titer to identify pregnancies at low risk of fetal atrioventricular block, and may not require surveillance. OBJECTIVE This study aimed to define anti-Ro52 and anti-Ro60 antibody thresholds for the identification of fetuses unlikely to develop atrioventricular block using clinically validated and research laboratory tests. STUDY DESIGN This study performed a multicenter review of pregnant subjects who tested positive in their local commercial laboratories for anti-Ro/SSA antibodies at the University of Colorado Children's Hospital (2014-2021) and Phoenix Children's Hospital (2014-2021) and enrolled in the Research Registry for Neonatal Lupus (RRNL) at New York University Langone Medical Center (2002-2021). The subjects were referred on the basis of rheumatologic symptoms or history of atrioventricular block in a previous pregnancy and were retrospectively grouped on the basis of pregnancy outcome. Group 1 indicated no fetal atrioventricular block in current or past pregnancies; group 2 indicated fetal atrioventricular block in the current pregnancy; and group 3 indicated normal current pregnancy but with fetal atrioventricular block in a previous pregnancy. Maternal sera were analyzed for anti-Ro52 and anti-Ro60 antibodies using a clinically validated multiplex bead assay (Associated Regional and University Pathologists Laboratories, Salt Lake City, UT) and a research enzyme-linked immunosorbent immunoassay (New York University). This study calculated the negative predictive value separately for anti-Ro52 and anti-Ro60 antibodies and for the 2 combined using a logistic regression model and a parallel testing strategy. RESULTS This study recruited 270 subjects (141 in group 1, 66 in group 2, and 63 in group 3). Of note, 89 subjects in group 1 had data on hydroxychloroquine treatment: anti-Ro/SSA antibody titers were no different between those treated (n=46) and untreated (n=43). Mean anti-Ro52 and anti-Ro60 titers were the lowest in group 1 and not different between groups 2 and 3. No case of fetal atrioventricular block developed among subjects with anti-Ro52 and anti-Ro60 titers of <110 arbitrary units per milliliter using the multiplex bead assay of the Associated Regional and University Pathologists Laboratories (n=141). No case of fetal atrioventricular block developed among subjects with research laboratory anti-Ro52 titers of <650 and anti-Ro60 of <4060 enzyme-linked immunosorbent immunoassay units (n=94). Using these 100% negative predictive value thresholds, more than 50% of the anti-Ro/SSA antibody pregnancies that ultimately had no fetal atrioventricular block could be excluded from surveillance based on clinical and research titers, respectively. CONCLUSION Study data suggested that there is a clinical immunoassay level of maternal anti-Ro/SSA antibodies below which the pregnancy is at low risk of fetal atrioventricular block. This study speculated that prospectively applying these data may avert the costly serial echocardiograms currently recommended for all anti-Ro/SSA-antibody positive pregnancies and guide future management.
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Affiliation(s)
- Alexander M Kaizer
- Department of Biostatistics and Informatics, University of Colorado Boulder, Aurora, CO
| | | | - Robert Clancy
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Anne E Tebo
- Department of Pathology, Associated Regional University Pathologists, Institute for Clinical and Experimental Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | - Bailey Drewes
- Division of Cardiology, Department of Pediatrics and Obstetrics, University of Colorado School of Medicine, Aurora, CO
| | - Mala Masson
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Miao Chang
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Nicola Fraser
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Bettina F Cuneo
- Division of Cardiology, Department of Pediatrics and Obstetrics, University of Colorado School of Medicine, Aurora, CO.
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Blazer A, Qian Y, Schlegel MP, Algasas H, Buyon JP, Cadwell K, Cammer M, Heffron SP, Liang FX, Mehta-Lee S, Niewold T, Rasmussen SE, Clancy RM. APOL1 variant-expressing endothelial cells exhibit autophagic dysfunction and mitochondrial stress. Front Genet 2022; 13:769936. [PMID: 36238153 PMCID: PMC9551299 DOI: 10.3389/fgene.2022.769936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 08/16/2022] [Indexed: 12/09/2022] Open
Abstract
Polymorphisms in the Apolipoprotein L1 (APOL1) gene are common in ancestrally African populations, and associate with kidney injury and cardiovascular disease. These risk variants (RV) provide an advantage in resisting Trypanosoma brucei, the causal agent of African trypanosomiasis, and are largely absent from non-African genomes. Clinical associations between the APOL1 high risk genotype (HRG) and disease are stronger in those with comorbid infectious or immune disease. To understand the interaction between cytokine exposure and APOL1 cytotoxicity, we established human umbilical vein endothelial cell (HUVEC) cultures representing each APOL1 genotype. Untreated HUVECs were compared to IFNɣ-exposed; and APOL1 expression, mitochondrial function, lysosome integrity, and autophagic flux were measured. IFNɣ increased median APOL1 expression across all genotypes 22.1 (8.3 to 29.8) fold (p=0.02). Compared to zero risk variant-carrying HUVECs (0RV), HUVECs carrying 2 risk variant copies (2RV) showed both depressed baseline and maximum mitochondrial oxygen consumption (p<0.01), and impaired mitochondrial networking on MitoTracker assays. These cells also demonstrated a contracted lysosomal compartment, and an accumulation of autophagosomes suggesting a defect in autophagic flux. Upon blocking autophagy with non-selective lysosome inhibitor, hydroxychloroquine, autophagosome accumulation between 0RV HUVECs and untreated 2RV HUVECs was similar, implicating lysosomal dysfunction in the HRG-associated autophagy defect. Compared to 0RV and 2RV HUVECs, HUVECs carrying 1 risk variant copy (1RV) demonstrated intermediate mitochondrial respiration and autophagic flux phenotypes, which were exacerbated with IFNɣ exposure. Taken together, our data reveal that IFNɣ induces APOL1 expression, and that each additional RV associates with mitochondrial dysfunction and autophagy inhibition. IFNɣ amplifies this phenotype even in 1RV HUVECs, representing the first description of APOL1 pathobiology in variant heterozygous cell cultures.
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Affiliation(s)
- Ashira Blazer
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Yingzhi Qian
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Martin Paul Schlegel
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Huda Algasas
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Ken Cadwell
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Michael Cammer
- DART Microscopy Laboratory, New York University Grossman School of Medicine, New York University School of Medicine, New York, NY, United States
| | - Sean P. Heffron
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Feng-Xia Liang
- DART Microscopy Laboratory, New York University Grossman School of Medicine, New York University School of Medicine, New York, NY, United States
| | - Shilpi Mehta-Lee
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, United States
| | - Timothy Niewold
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Sara E. Rasmussen
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Robert M. Clancy
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
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Conklin J, Golpanian M, Engel A, Izmirly P, Belmont HM, Dervieux T, Buyon JP, Alexander RV. Erythrocyte complement receptor 1 (ECR1) and erythrocyte-bound C4d (EC4d) in the prediction of poor pregnancy outcomes in systemic lupus erythematosus (SLE). Lupus Sci Med 2022; 9:9/1/e000754. [PMID: 36755365 PMCID: PMC9445792 DOI: 10.1136/lupus-2022-000754] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Complement activation has been associated with adverse pregnancy outcomes (APO) in SLE. Pregnant women with SLE were studied to evaluate whether complement dysregulation within the first two pregnancy trimesters predicts APO. METHODS Pregnant women fulfilled classification criteria for SLE. APO included neonatal death, preterm delivery before 36 weeks and small for gestational age newborn. Pre-eclampsia was also evaluated. Erythrocyte complement receptor 1 (ECR1) and erythrocyte-bound C4d (EC4d) were measured by flow cytometry. Complement proteins C3 and C4 were measured by immunoturbidimetry and anti-double-stranded DNA by ELISA in serum. Statistical analysis consisted of t-test, confusion matrix-derived diagnostic analysis, and multivariate logistic regression. RESULTS Fifty-one women had 57 pregnancies and 169 visits during the study. Baseline visits occurred mainly in the first (n=32) and second trimester (n=21). Fourteen (24.6%) pregnancies resulted in 21 APO with preterm delivery being the most common (n=10). ECR1 <5.5 net mean fluorescence intensity in the first trimester predicted APO with a diagnostic OR (DOR) of 18.33 (95% CI: 2.39 to 140.4; t-test p=0.04). Other individual biomarkers did not reach statistical significance. To estimate the likelihood of APO, we developed an algorithm that included the week of pregnancy, ECR1 and EC4d. From this algorithm, a Pregnancy Adversity Index (PAI) was calculated, and a PAI >0 indicated an elevated likelihood of pregnancy complications (DOR: 20.0 (95% CI: 3.64 to 109.97)). CONCLUSIONS Low levels of ECR1 in early or mid-pregnancy are predictive of an APO. Incorporating the weeks of gestation and both ECR1 and EC4d generated a PAI, which further predicted serious pregnancy complications.
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Affiliation(s)
| | - Michael Golpanian
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Alexis Engel
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Peter Izmirly
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - H Michael Belmont
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Thierry Dervieux
- Research and Development, Prometheus Laboratories, San Diego, California, USA
| | - Jill P Buyon
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
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Choi MY, Clarke AE, Urowitz M, Hanly J, St-Pierre Y, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Wallace DJ, Isenberg D, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, Alarcón GS, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Lim S, Inanc M, Kalunian K, Jacobsen S, Peschken C, Kamen DL, Askanase A, Buyon JP, Costenbader KH, Fritzler MJ. Longitudinal analysis of ANA in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Ann Rheum Dis 2022; 81:1143-1150. [PMID: 35338033 PMCID: PMC10066935 DOI: 10.1136/annrheumdis-2022-222168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/12/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES A perception derived from cross-sectional studies of small systemic lupus erythematosus (SLE) cohorts is that there is a marked discrepancy between antinuclear antibody (ANA) assays, which impacts on clinicians' approach to diagnosis and follow-up. We compared three ANA assays in a longitudinal analysis of a large international incident SLE cohort retested regularly and followed for 5 years. METHODS Demographic, clinical and serological data was from 805 SLE patients at enrolment, year 3 and 5. Two HEp-2 indirect immunofluorescence assays (IFA1, IFA2), an ANA ELISA, and SLE-related autoantibodies were performed in one laboratory. Frequencies of positivity, titres or absorbance units (AU), and IFA patterns were compared using McNemar, Wilcoxon and kappa statistics, respectively. RESULTS At enrolment, ANA positivity (≥1:80) was 96.1% by IFA1 (median titre 1:1280 (IQR 1:640-1:5120)), 98.3% by IFA2 (1:2560 (IQR 1:640-1:5120)) and 96.6% by ELISA (176.3 AU (IQR 106.4 AU-203.5 AU)). At least one ANA assay was positive for 99.6% of patients at enrolment. At year 5, ANA positivity by IFAs (IFA1 95.2%; IFA2 98.9%) remained high, while there was a decrease in ELISA positivity (91.3%, p<0.001). Overall, there was >91% agreement in ANA positivity at all time points and ≥71% agreement in IFA patterns between IFA1 and IFA2. CONCLUSION In recent-onset SLE, three ANA assays demonstrated commutability with a high proportion of positivity and titres or AU. However, over 5 years follow-up, there was modest variation in ANA assay performance. In clinical situations where the SLE diagnosis is being considered, a negative test by either the ELISA or HEp-2 IFA may require reflex testing.
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Affiliation(s)
- May Yee Choi
- Medicine, Division of Rheumatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ann Elaine Clarke
- Medicine, Division of Rheumatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Murray Urowitz
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - John Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yvan St-Pierre
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea (the Republic of)
| | | | - Jorge Sanchez-Guerrero
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Sasha Bernatsky
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | | | | | - Joan T Merrill
- Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Paul R Fortin
- CHU de Québec, Universite Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, the University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ellen M Ginzler
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Mary Anne Dooley
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Susan Manzi
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Guillermo Ruiz-Irastorza
- BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Sam Lim
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Ken Kalunian
- University of California Los Angeles School of Medicine, La Jolla, California, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anca Askanase
- Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York, USA
| | - Jill P Buyon
- New York University School of Medicine, New York, New York, USA
| | - Karen H Costenbader
- Department of Medicine, Div of Rheuamtology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Marvin J Fritzler
- Medicine, Division of Rheumatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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22
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Clancy RM, Marion MC, Ainsworth HC, Chang M, Howard TD, Izmirly PM, Masson M, Buyon JP, Langefeld CD. Gut dysbiosis and the clinical spectrum in anti-Ro positive mothers of children with neonatal lupus. Gut Microbes 2022; 14:2081474. [PMID: 35704681 PMCID: PMC9225419 DOI: 10.1080/19490976.2022.2081474] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Anti-SSA/Ro antibodies, while strongly linked to fetal cardiac injury and neonatal rash, can associate with a spectrum of disease in the mother, ranging from completely asymptomatic to overt Systemic Lupus Erythematosus (SLE) or Sjögren's Syndrome (SS). This study was initiated to test the hypothesis that the microbiome, influenced in part by genetics, contributes to disease state. The stool microbiome of healthy controls (HC) was compared to that of anti-SSA/Ro positive women whose children had neonatal lupus. At the time of sampling, these women were either asymptomatic (Asym), had minor rheumatic symptoms or signs considered as an undifferentiated autoimmune syndrome (UAS), or were diagnosed with SLE or SS. Differences in microbial relative abundances among these three groups were tested assuming an ordering in clinical severity (HC<Asym/UAS<SS/SLE) and then again without the ordinal assumption. Those taxa that showed differential relative abundances were then tested for whether the effect size differed depending on the women's HLA SLE-risk allele genotype (DRB1*03:01, DRB1*15:01, DQB1*02:01 and DQB1*06:02) or anti-SSA/Ro autoantibody levels. Multiple genera within the families Ruminococcaceae and Lachnospiraceae showed evidence of an HLA-by-genus interaction (P < .05). Four genera exhibited evidence of an interaction with anti-Ro52 IgA: Lachnoclostridium, Romboutsia, Bacteroides and Actinomyces (P < .01). In addition to documenting differences in microbial relative abundances across clinical severity of disease, these data provide a first-time demonstration that microbial differences are correlated with HLA SLE-risk alleles. Taken together, these data suggest that the clinical spectrum from benign to overt clinical autoimmunity may partially result from or trigger a complex interplay among specific microbial profiles, anti-Ro autoantibodies, and genetics.
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Affiliation(s)
- Robert M. Clancy
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA,CONTACT Robert M. Clancy Division of Rheumatology, NYU Grossman School of Medicine, New York, NY10016, USA
| | - Miranda C. Marion
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA,Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hannah C. Ainsworth
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA,Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Miao Chang
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Timothy D. Howard
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA,Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Peter M. Izmirly
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Mala Masson
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jill P. Buyon
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Carl D. Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA,Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Guttmann A, Denvir B, Aringer M, Buyon JP, Belmont HM, Sahl S, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H, Izmirly PM. Evaluation of the EULAR/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus in a Population-Based Registry. Arthritis Care Res (Hoboken) 2022; 75:1007-1016. [PMID: 35638708 DOI: 10.1002/acr.24960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/04/2022] [Accepted: 05/24/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Using the Manhattan Lupus Surveillance Program, a multiracial/ethnic population-based registry, we aimed to compare 3 commonly used classification criteria for systemic lupus erythematosus (SLE) to identify unique cases and determine the incidence and prevalence of SLE using the EULAR/American College of Rheumatology (ACR) criteria. METHODS SLE cases were defined as fulfilling the 1997 ACR, the Systemic Lupus International Collaborating Clinics (SLICC), or the EULAR/ACR classification criteria. We quantified the number of cases uniquely associated with each and the number fulfilling all 3 criteria. Prevalence and incidence using the EULAR/ACR classification criteria and associated 95% confidence intervals (95% CIs) were calculated. RESULTS A total of 1,497 cases fulfilled at least 1 of the 3 classification criteria, with 1,008 (67.3%) meeting all 3 classifications, 138 (9.2%) fulfilling only the SLICC criteria, 35 (2.3%) fulfilling only the 1997 ACR criteria, and 34 (2.3%) uniquely fulfilling the EULAR/ACR criteria. Patients solely satisfying the EULAR/ACR criteria had <4 manifestations. The majority classified only by the 1997 ACR criteria did not meet any of the defined immunologic criteria. Patients fulfilling only the SLICC criteria did so based on the presence of features unique to this system. Using the EULAR/ACR classification criteria, age-adjusted overall prevalence and incidence rates of SLE in Manhattan were 59.6 (95% CI 55.9-63.4) and 4.9 (95% CI 4.3-5.5) per 100,000 population, with age-adjusted prevalence and incidence rates highest among non-Hispanic Black female patients. CONCLUSION Applying the 3 commonly used classification criteria to a population-based registry identified patients with SLE fulfilling only 1 validated definition. The most recently developed EULAR/ACR classification criteria revealed prevalence and incidence estimates similar to those previously established for the ACR and SLICC classification schemes.
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Affiliation(s)
| | - Brendan Denvir
- New York University School of Medicine, New York, New York
| | - Martin Aringer
- University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jill P Buyon
- New York University School of Medicine, New York, New York
| | | | - Sara Sahl
- Harbor-University of California Medical Center, Los Angeles
| | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Anca Askanase
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Joan M Bathon
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Yousaf Ali
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ellen M Ginzler
- State University of New York Downstate Health Sciences University, Brooklyn
| | | | | | | | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Long Island City, New York
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24
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Iwamoto T, Dorschner JM, Selvaraj S, Mezzano V, Jensen MA, Vsetecka D, Amin S, Makol A, Osborn T, Moder K, Chowdhary VR, Izmirly P, Belmont HM, Clancy RM, Buyon JP, Wu M, Loomis CA, Niewold TB. High Systemic Type I Interferon Activity is Associated with Active Class III/IV Lupus Nephritis. J Rheumatol 2021; 49:388-397. [PMID: 34782453 DOI: 10.3899/jrheum.210391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Previous studies suggest a link between high serum type I interferon (IFN) and lupus nephritis (LN). We determined whether serum IFN activity is associated with subtypes of LN and studied renal tissues and cells to understand the impact of IFN in LN. METHODS 221 systemic lupus erythematosus (SLE) patients were studied. Serum IFN activity was measured by WISH bioassay. mRNA in-situ hybridization was used in renal tissue to measure expression of the representative IFN-induced gene, interferon-induced protein with tetratricopeptide repeats-1 (IFIT1), and the plasmacytoid dendritic cell (pDC) marker gene C-type lectin domain family-4 member C (CLEC4C or BDCA2). Podocyte cell line gene expression was measured by real-time PCR. RESULTS Class III/IV LN prevalence was significantly increased in patients with high serum IFN compared with those with low IFN (OR=5.48, p=4.0x10-7). In multivariate regression models, type I IFN was a stronger predictor of class III/IV LN than complement C3 or anti-dsDNA antibody, and could account for the association of these variables with LN. IFIT1 expression was increased in all classes of LN, but most in the glomerular areas of active class III/IV LN kidneys. IFIT1 expression was not closely co-localized with pDCs. IFN directly activated podocyte cell lines to induce chemokines and proapoptotic molecules. CONCLUSION Systemic high IFN is involved in the pathogenesis of severe LN. We do not find co-localization of pDCs with IFN signature in renal tissue, and instead observe the greatest intensity of IFN signature in glomerular areas, which could suggest a blood source of IFN.
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Affiliation(s)
- Taro Iwamoto
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Jessica M Dorschner
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Shanmugapriya Selvaraj
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Valeria Mezzano
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Mark A Jensen
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Danielle Vsetecka
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Shreyasee Amin
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Ashima Makol
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Thomas Osborn
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Kevin Moder
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Vaidehi R Chowdhary
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Peter Izmirly
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - H Michael Belmont
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Robert M Clancy
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Jill P Buyon
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Ming Wu
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Cynthia A Loomis
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
| | - Timothy B Niewold
- Colton Center for Autoimmunity, New York University, USA; Allergy and Clinical Immunology, Chiba University, Japan; Mayo Clinic College of Medicine, USA; Department of Pathology, New York University, USA; Division of Rheumatology, New York University, USA. Funding: TBN: Grants from the Colton Center for Autoimmunity, NIH (AR060861, AR057781, AR065964), the Lupus Research Foundation, and the Lupus Research Alliance Disclosures of Competing Interests: TBN has received research grants from EMD Serono and Janssen, and has consulted for Thermo Fisher, Progentec, and Inova, all unrelated to the current manuscript. Corresponding author: Timothy B. Niewold, MD, Colton Center for Autoimmunity, NYU Grossman School of Medicine, 550 1st Ave., New York, NY 10016,
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Petri M, Goldman DW, Alarcón GS, Gordon C, Merrill JT, Fortin PR, Bruce IN, Isenberg D, Wallace D, Nived O, Ramsey-Goldman R, Bae SC, Hanly JG, Sanchez-Guerrero J, Clarke AE, Aranow C, Manzi S, Urowitz M, Gladman DD, Kalunian K, Werth VP, Zoma A, Bernatsky S, Khamashta M, Jacobsen S, Buyon JP, Dooley MA, van Vollenhoven R, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim S, Inanç M, Kamen DL, Rahman A, Steinsson K, Franks AG, Magder LS. Comparison of the 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology Systemic Lupus Erythematosus Classification Criteria With Two Sets of Earlier Systemic Lupus Erythematosus Classification Criteria. Arthritis Care Res (Hoboken) 2021; 73:1231-1235. [PMID: 32433832 PMCID: PMC10711744 DOI: 10.1002/acr.24263] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2023]
Abstract
OBJECTIVE The Systemic Lupus International Collaborating Clinics (SLICC) 2012 systemic lupus erythematosus (SLE) classification criteria and the revised American College of Rheumatology (ACR) 1997 criteria are list based, counting each SLE manifestation equally. We derived a classification rule based on giving variable weights to the SLICC criteria and compared its performance to the revised ACR 1997, the unweighted SLICC 2012, and the newly reported European Alliance of Associations for Rheumatology (EULAR)/ACR 2019 criteria sets. METHODS The physician-rated patient scenarios used to develop the SLICC 2012 classification criteria were reemployed to devise a new weighted classification rule using multiple linear regression. The performance of the rule was evaluated on an independent set of expert-diagnosed patient scenarios and compared to the performance of the previously reported classification rules. RESULTS The weighted SLICC criteria and the EULAR/ACR 2019 criteria had less sensitivity but better specificity compared to the list-based revised ACR 1997 and SLICC 2012 classification criteria. There were no statistically significant differences between any pair of rules with respect to overall agreement with the physician diagnosis. CONCLUSION The 2 new weighted classification rules did not perform better than the existing list-based rules in terms of overall agreement on a data set originally generated to assess the SLICC criteria. Given the added complexity of summing weights, researchers may prefer the unweighted SLICC criteria. However, the performance of a classification rule will always depend on the populations from which the cases and non-cases are derived and whether the goal is to prioritize sensitivity or specificity.
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Affiliation(s)
| | | | | | | | | | - Paul R. Fortin
- CHU de Québec – Université Laval, Quebec City, Quebec, Canada
| | - Ian N. Bruce
- The University of Manchester and Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, UK
| | | | | | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - John G. Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jorge Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Murray Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Dafna D. Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Victoria P. Werth
- Hospital of the University of Pennsylvania and Department of Veterans Affairs Medical Center, Philadelphia
| | - Asad Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
| | | | - Munther Khamashta
- The Rayne Institute, St Thomas’ Hospital, King’s College London, London, UK
| | - Søren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Ronald van Vollenhoven
- Amsterdam University Medical Centres, University of Amsterdam, Free University, and Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Ellen Ginzler
- State University of New York Downstate Medical Center, Brooklyn
| | | | | | - Joseph L. Jorizzo
- Wake Forest University, Winston-Salem, North Carolina, and Weill Cornell Medicine, New York, New York
| | | | - Sam Lim
- Emory University, Atlanta, Georgia
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Deonaraine KK, Carlucci PM, Fava A, Li J, Wofsy D, James JA, Putterman C, Diamond B, Davidson A, Fine DM, Monroy-Trujillo J, Atta MG, Haag K, Rao DA, Apruzzese W, Belmont HM, Izmirly PM, Wu M, Connery S, Payan-Schober F, Furie RA, Berthier CC, Dall'Era M, Cho K, Kamen DL, Kalunian K, Anolik J, Ishimori M, Weisman MH, Petri MA, Buyon JP. Safety of procuring research tissue during a clinically indicated kidney biopsy from patients with lupus: data from the Accelerating Medicines Partnership RA/SLE Network. Lupus Sci Med 2021; 8:8/1/e000522. [PMID: 34389634 PMCID: PMC8354250 DOI: 10.1136/lupus-2021-000522] [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: 05/19/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022]
Abstract
Objectives In lupus nephritis the pathological diagnosis from tissue retrieved during kidney biopsy drives treatment and management. Despite recent approval of new drugs, complete remission rates remain well under aspirational levels, necessitating identification of new therapeutic targets by greater dissection of the pathways to tissue inflammation and injury. This study assessed the safety of kidney biopsies in patients with SLE enrolled in the Accelerating Medicines Partnership, a consortium formed to molecularly deconstruct nephritis. Methods 475 patients with SLE across 15 clinical sites in the USA consented to obtain tissue for research purposes during a clinically indicated kidney biopsy. Adverse events (AEs) were documented for 30 days following the procedure and were determined to be related or unrelated by all site investigators. Serious AEs were defined according to the National Institutes of Health reporting guidelines. Results 34 patients (7.2%) experienced a procedure-related AE: 30 with haematoma, 2 with jets, 1 with pain and 1 with an arteriovenous fistula. Eighteen (3.8%) experienced a serious AE requiring hospitalisation; four patients (0.8%) required a blood transfusion related to the kidney biopsy. At one site where the number of cores retrieved during the biopsy was recorded, the mean was 3.4 for those who experienced a related AE (n=9) and 3.07 for those who did not experience any AE (n=140). All related AEs resolved. Conclusions Procurement of research tissue should be considered feasible, accompanied by a complication risk likely no greater than that incurred for standard clinical purposes. In the quest for targeted treatments personalised based on molecular findings, enhanced diagnostics beyond histology will likely be required.
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Affiliation(s)
- Kristina K Deonaraine
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Philip M Carlucci
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Andrea Fava
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Li
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - David Wofsy
- Rheumatology Division and Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Chaim Putterman
- Division of Rheumatology and Department of Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Betty Diamond
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Anne Davidson
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Derek M Fine
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Mohamed G Atta
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin Haag
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William Apruzzese
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - H Michael Belmont
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Peter M Izmirly
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ming Wu
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sean Connery
- Department of Internal Medicine, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Fernanda Payan-Schober
- Department of Internal Medicine, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Richard A Furie
- Division of Rheumatology, Northwell Health, Great Neck, NY, USA
| | - Celine C Berthier
- Internal Medicine, Department of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Maria Dall'Era
- Rheumatology Division and Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Kerry Cho
- Nephrology Division, University of California San Francisco, San Francisco, CA, USA
| | - Diane L Kamen
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth Kalunian
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jennifer Anolik
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mariko Ishimori
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Jill P Buyon
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
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Izmirly PM, Kim MY, Samanovic M, Fernandez-Ruiz R, Ohana S, Deonaraine KK, Engel AJ, Masson M, Xie X, Cornelius AR, Herati RS, Haberman RH, Scher JU, Guttmann A, Blank RB, Plotz B, Haj-Ali M, Banbury B, Stream S, Hasan G, Ho G, Rackoff P, Blazer AD, Tseng CE, Belmont HM, Saxena A, Mulligan MJ, Clancy RM, Buyon JP. Evaluation of Immune Response and Disease Status in SLE Patients Following SARS-CoV-2 Vaccination. Arthritis Rheumatol 2021; 74:284-294. [PMID: 34347939 PMCID: PMC8426963 DOI: 10.1002/art.41937] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [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: 06/04/2021] [Revised: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate seroreactivity and disease flares after COVID-19 vaccination in a multi-ethnic/racial cohort of patients with systemic lupus erythematosus (SLE). METHODS 90 SLE patients and 20 healthy controls receiving a complete COVID-19 vaccine regimen were included. IgG seroreactivity to the SARS-CoV-2 spike receptor-binding domain (RBD) and SARS-CoV-2 microneutralization were used to evaluate B cell responses; IFN-γ production to assess T cell responses was measured by ELISpot. Disease activity was measured by the hybrid SLE disease activity index (SLEDAI) and flares were assigned by the SELENA/SLEDAI flare index. RESULTS Overall, fully vaccinated SLE patients produced significantly lower IgG antibodies against SARS-CoV-2 spike RBD than controls. Twenty-six SLE patients (28.8%) generated an IgG response below that of the lowest control (<100 units/ml). In logistic regression analyses, the use of any immunosuppressant or prednisone and a normal anti-dsDNA level prior to vaccination associated with decreased vaccine responses. IgG seroreactivity to the SARS-CoV-2 Spike RBD strongly correlated with the SARS-CoV-2 microneutralization titers and antigen-specific IFN-γ production determined by ELISpot. In a subset of patients with poor antibody responses, IFN-γ production was likewise diminished. Pre-/post-vaccination SLEDAI scores were similar. Only 11.4% of patients had a post-vaccination flare; 1.3% were severe. CONCLUSION In a multi-ethnic/racial study of SLE patients 29% had a low response to the COVID-19 vaccine which was associated with being on immunosuppression. Reassuringly, disease flares were rare. While minimal protective levels remain unknown, these data suggest protocol development is needed to assess efficacy of booster vaccination.
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Affiliation(s)
- Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Mimi Y Kim
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, New York, NY, 10461, USA
| | - Marie Samanovic
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Vaccine Center, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Ruth Fernandez-Ruiz
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Sharon Ohana
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Kristina K Deonaraine
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Alexis J Engel
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Mala Masson
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Xianhong Xie
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, New York, NY, 10461, USA
| | - Amber R Cornelius
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Vaccine Center, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Ramin S Herati
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Vaccine Center, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Rebecca H Haberman
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Jose U Scher
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Allison Guttmann
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Rebecca B Blank
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Benjamin Plotz
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Mayce Haj-Ali
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Brittany Banbury
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Sara Stream
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Ghadeer Hasan
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Gary Ho
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Paula Rackoff
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Ashira D Blazer
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Chung-E Tseng
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Amit Saxena
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Mark J Mulligan
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Vaccine Center, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Robert M Clancy
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
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Smilowitz NR, Luttrell-Williams E, Golpanian M, Engel A, Buyon JP, Katz SD, Berger JS. Microvascular endothelial glycocalyx thickness is associated with brachial artery flow-mediated dilation. Vasc Med 2021; 26:563-565. [PMID: 34278881 DOI: 10.1177/1358863x211026765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nathaniel R Smilowitz
- Department of Medicine, Leon H Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA.,Department of Medicine, VA New York Harbor Healthcare System, New York, NY, USA
| | - Elliot Luttrell-Williams
- Department of Medicine, Leon H Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Michael Golpanian
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Alexis Engel
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Jill P Buyon
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Stuart D Katz
- Department of Medicine, Leon H Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Jeffrey S Berger
- Department of Medicine, Leon H Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA.,Department of Surgery, New York University School of Medicine, New York, NY, USA
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29
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Saxena A, Guttmann A, Masson M, Kim MY, Haberman RH, Castillo R, Scher JU, Deonaraine KK, Engel AJ, Belmont HM, Blazer AD, Buyon JP, Fernandez-Ruiz R, Izmirly PM. Evaluation of SARS-CoV-2 IgG antibody reactivity in patients with systemic lupus erythematosus: analysis of a multi-racial and multi-ethnic cohort. Lancet Rheumatol 2021; 3:e585-e594. [PMID: 34075358 PMCID: PMC8159192 DOI: 10.1016/s2665-9913(21)00114-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Patients with systemic lupus erythematosus (SLE) are at risk of developing COVID-19 due to underlying immune abnormalities and regular use of immunosuppressant medications. We aimed to evaluate the presence of SARS-CoV-2 IgG antibodies in patients with SLE with or without previous COVID-19-related symptoms or RT-PCR-confirmed SARS-CoV-2 infection. Methods For this analysis, we included patients with SLE from two cohorts based in New York City: the Web-based Assessment of Autoimmune, Immune-Mediated and Rheumatic Patients during the COVID-19 pandemic (WARCOV) study; and the NYU Lupus Cohort (a prospective registry of patients at NYU Langone Health and NYC Health + Hospitals/Bellevue). Patients in both cohorts were tested for SARS-CoV-2 IgG antibodies via commercially available immunoassays, processed through hospital or outpatient laboratories. Patients recruited from the NYU Lupus Cohort, referred from affiliated providers, or admitted to hospital with COVID-19 were tested for SARS-CoV-2 IgG antibodies as part of routine surveillance during follow-up clinical visits. Findings 329 patients with SLE were included in this analysis, 146 from the WARCOV study and 183 from the NYU Lupus Cohort, and were tested for SARS-CoV-2 antibodies between April 29, 2020, and Feb 9, 2021. 309 (94%) were women and 91 (28%) were of Hispanic ethnicity. 51 (16%) of 329 patients had a positive SARS-CoV-2 IgG antibody test. Seropositive patients were more likely than seronegative patients to be Hispanic (24 [47%] of 51 vsz 67 [24%] of 278). Other demographic variables, SLE-specific factors, and immunosuppressant use were not associated with SARS-CoV-2 positivity. Of the 29 patients with COVID-19 previously confirmed by RT-PCR, 18 (62%) were on immunosuppressants; 24 (83%) of 29 patients tested positive for SARS-CoV-2 IgG antibodies. Of 17 patients who had symptoms of COVID-19 but negative concurrent RT-PCR testing, one (6%) developed an antibody response. Of 26 patients who had COVID-19-related symptoms but did not undergo RT-PCR testing, six (23%) developed an antibody response. Of 83 patients who had no symptoms of COVID-19 and no RT-PCR testing, four (5%) developed an antibody response. Among 36 patients who were initially SARS-CoV-2 IgG positive, the majority maintained reactivity serially (88% up to 10 weeks, 83% up to 20 weeks, and 80% up to 30 weeks). Seven (70%) of ten patients with confirmed COVID-19 had antibody positivity beyond 30 weeks from disease onset. Interpretation Most patients with SLE and confirmed COVID-19 were able to produce and maintain a serological response despite the use of a variety of immunosuppressants, providing reassurance about the efficacy and durability of humoral immunity and possible protection against re-infection with SARS-CoV-2. Funding National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, and Bloomberg Philanthropies COVID-19 Response Initiative Grant.
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Affiliation(s)
- Amit Saxena
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Allison Guttmann
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Mala Masson
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Mimi Y Kim
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, The Bronx, New York, NY, USA
| | - Rebecca H Haberman
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Rochelle Castillo
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Jose U Scher
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Kristina K Deonaraine
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Alexis J Engel
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Ashira D Blazer
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Ruth Fernandez-Ruiz
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
| | - Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY USA
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30
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Arriens C, Alexander RV, Narain S, Saxena A, Collins CE, Wallace DJ, Massarotti E, Conklin J, Kalunian KC, Putterman C, Ramsey-Goldman R, Buyon JP, Askanase A, Furie RA, James JA, Bello GA, Manzi S, Ahearn J, O'Malley T, Weinstein A, Dervieux T. Cell-bound complement activation products associate with lupus severity in SLE. Lupus Sci Med 2021; 7:7/1/e000377. [PMID: 32371480 PMCID: PMC7228655 DOI: 10.1136/lupus-2019-000377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 11/11/2022]
Abstract
Objectives To evaluate the association between lupus severity and cell-bound complement activation products (CB-CAPs) or low complement proteins C3 and C4. Methods All subjects (n=495) fulfilled the American College of Rheumatology (ACR) classification criteria for SLE. Abnormal CB-CAPs (erythrocyte-bound C4d or B-lymphocyte-bound C4d levels >99th percentile of healthy) and complement proteins C3 and C4 were determined using flow cytometry and turbidimetry, respectively. Lupus severity was estimated using the Lupus Severity Index (LSI). Statistical analysis consisted of multivariable linear regression and groups comparisons. Results Abnormal CB-CAPs were more prevalent than low complement values irrespective of LSI levels (62% vs 38%, respectively, p<0.0001). LSI was low (median 5.44, IQR: 4.77–6.93) in patients with no complement abnormality, intermediate in patients with abnormal CB-CAPs (median 6.09, IQR: 5.31–8.20) and high in the group presenting with both abnormal CB-CAPs and low C3 and/or C4 (median 7.85, IQR: 5.51–8.37). Odds of immunosuppressant use was higher in subjects with LSI ≥5.95 compared with subjects with LSI <5.95 (1.60 vs 0.53, p<0.0001 for both). Multivariable regression analysis revealed that higher LSI scores associated with abnormal CB-CAPs—but not low C3/C4—after adjusting for younger age, race and longer disease duration (p=0.0001), which were also independent predictors of disease severity (global R2=0.145). Conclusion Abnormalities in complement activation as measured by CB-CAPs are associated with increased LSI.
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Affiliation(s)
- Cristina Arriens
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Sonali Narain
- Rheumatology, Northwell Health, Great Neck, New York, USA
| | - Amit Saxena
- Center for Musculoskeletal Care, New York University, New York, New York, USA
| | | | | | | | | | - Kenneth C Kalunian
- Rheumatology, University iof California San Diego, La Jolla, California, USA
| | - Chaim Putterman
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, New York, USA.,Azrieli Faculty of Medicine, Bar Ilan University, Zefat, Israel.,Research Institute, Galilee Medical Center, Nahariya, Israel
| | | | - Jill P Buyon
- New York University School of Medicine, New York, New York, USA
| | - Anca Askanase
- Rheumatology, Columbia University Medical Center, New York, New York, USA
| | | | - Judith A James
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ghalib A Bello
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Joseph Ahearn
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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31
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Elkhalifa M, Orbai AM, Magder LS, Petri M, Alarcón GS, Gordon C, Merrill J, Fortin PR, Bruce IN, Isenberg D, Wallace D, Nived O, Ramsey-Goldman R, Bae SC, Hanly JG, Sanchez-Guerrero J, Clarke AE, Aranow C, Manzi S, Urowitz M, Gladman DD, Kalunian K, Werth VP, Zoma A, Bernatsky S, Khamashta M, Jacobsen SØ, Buyon JP, Dooley MA, Vollenhoven RV, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim S, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks AG. Anti-beta 2 glycoprotein I IgA in the SLICC classification criteria dataset. Lupus 2021; 30:1283-1288. [PMID: 33957797 PMCID: PMC10140618 DOI: 10.1177/09612033211014248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Anti-beta 2 glycoprotein I IgA is a common isotype of anti-beta 2 glycoprotein I in SLE. Anti-beta 2 glycoprotein I was not included in the American College of Rheumatology (ACR) SLE classification criteria, but was included in the Systemic Lupus International Collaborating Clinics (SLICC) criteria. We aimed to evaluate the prevalence of anti-beta 2-glycoprotein I IgA in SLE versus other rheumatic diseases. In addition, we examined the association between anti-beta 2 glycoprotein I IgA and disease manifestations in SLE. METHODS The dataset consisted of 1384 patients, 657 with a consensus physician diagnosis of SLE and 727 controls with other rheumatic diseases. Anti-beta 2 glycoprotein I isotypes were measured by ELISA. Patients with a consensus diagnosis of SLE were compared to controls with respect to presence of anti-beta 2 glycoprotein I. Among patients with SLE, we assessed the association between anti-beta 2 glycoprotein I IgA and clinical manifestations. RESULTS The prevalence of anti-beta 2 glycoprotein I IgA was 14% in SLE patients and 7% in rheumatic disease controls (odds ratio, OR 2.3, 95% CI: 1.6, 3.3). It was more common in SLE patients who were younger patients and of African descent (p = 0.019). Eleven percent of SLE patients had anti-beta 2 glycoprotein I IgA alone (no anti-beta 2 glycoprotein I IgG or IgM). There was a significant association between anti-beta 2 glycoprotein I IgA and anti-dsDNA (p = 0.001) and the other antiphospholipid antibodies (p = 0.0004). There was no significant correlation of anti-beta 2 glycoprotein I IgA with any of the other ACR or SLICC clinical criteria for SLE. Those with anti-beta 2 glycoprotein I IgA tended to have a history of thrombosis (12% vs 6%, p = 0.071), but the difference was not statistically significant. CONCLUSION We found the anti-beta 2 glycoprotein I IgA isotype to be more common in patients with SLE and in particular, with African descent. It could occur alone without other isotypes.
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Affiliation(s)
- Marwa Elkhalifa
- Department of Medicine, Alexandria University, Alexandria, Egypt.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ana-Maria Orbai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laurence S Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Graciela S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caroline Gordon
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Joan Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Paul R Fortin
- Division of Rheumatology, CHU de Québec - Université Laval, Quebec City, Canada
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, UK
| | - David Isenberg
- Centre for Rheumatology Research, University College, London, UK
| | - Daniel Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ola Nived
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jorge Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Susan Manzi
- Autoimmunity Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Murray Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Victoria P Werth
- Division of Dermatology, Hospital of the University of Pennsylvania and the Veteran's Administration Medical Center, Philadelphia, PA, USA
| | - Asad Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, Scotland, UK
| | - Sasha Bernatsky
- Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Munther Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK
| | - SØren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Mary Anne Dooley
- Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ronald van Vollenhoven
- Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands.,Free University (VU) Amsterdam, Amsterdam, Netherlands.,Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Ellen Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Thomas Stoll
- Department of Rheumatology, Kantonsspital, Schaffhausen, Switzerland
| | - Christine Peschken
- Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph L Jorizzo
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Jeffery P Callen
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Sam Lim
- Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Diane L Kamen
- Division of Rheumatology, Medical University of South Carolina, Charleston, SC, USA
| | - Anisur Rahman
- Centre for Rheumatology Research, University College, London, UK
| | - Kristjan Steinsson
- Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland
| | - Andrew G Franks
- Division of Rheumatology, Department of Medicine and The Department of Dermatology, New York University School of Medicine, New York, NY, USA
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Hartl J, Serpas L, Wang Y, Rashidfarrokhi A, Perez OA, Sally B, Sisirak V, Soni C, Khodadadi-Jamayran A, Tsirigos A, Caiello I, Bracaglia C, Volpi S, Ghiggeri GM, Chida AS, Sanz I, Kim MY, Belmont HM, Silverman GJ, Clancy RM, Izmirly PM, Buyon JP, Reizis B. Autoantibody-mediated impairment of DNASE1L3 activity in sporadic systemic lupus erythematosus. J Exp Med 2021; 218:e20201138. [PMID: 33783474 PMCID: PMC8020718 DOI: 10.1084/jem.20201138] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/18/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
Antibodies to double-stranded DNA (dsDNA) are prevalent in systemic lupus erythematosus (SLE), particularly in patients with lupus nephritis, yet the nature and regulation of antigenic cell-free DNA (cfDNA) are poorly understood. Null mutations in the secreted DNase DNASE1L3 cause human monogenic SLE with anti-dsDNA autoreactivity. We report that >50% of sporadic SLE patients with nephritis manifested reduced DNASE1L3 activity in circulation, which was associated with neutralizing autoantibodies to DNASE1L3. These patients had normal total plasma cfDNA levels but showed accumulation of cfDNA in circulating microparticles. Microparticle-associated cfDNA contained a higher fraction of longer polynucleosomal cfDNA fragments, which bound autoantibodies with higher affinity than mononucleosomal fragments. Autoantibodies to DNASE1L3-sensitive antigens on microparticles were prevalent in SLE nephritis patients and correlated with the accumulation of cfDNA in microparticles and with disease severity. DNASE1L3-sensitive antigens included DNA-associated proteins such as HMGB1. Our results reveal autoantibody-mediated impairment of DNASE1L3 activity as a common nongenetic mechanism facilitating anti-dsDNA autoreactivity in patients with severe sporadic SLE.
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Affiliation(s)
- Johannes Hartl
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Lee Serpas
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Yueyang Wang
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Ali Rashidfarrokhi
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Oriana A. Perez
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Benjamin Sally
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Vanja Sisirak
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Le Centre national de la recherche scientifique - unité mixte de recherche 5164, ImmunoConcEpt, Universite ´de Bordeaux, Bordeaux, France
| | - Chetna Soni
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Alireza Khodadadi-Jamayran
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY
| | - Aristotelis Tsirigos
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY
| | - Ivan Caiello
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Stefano Volpi
- Centro per le Malattie Autoinfiammatorie e Immunodeficienze, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Giannina Gaslini, Genoa, Italy
| | - Asiya Seema Chida
- Division of Rheumatology, Department of Medicine, Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | - Ignacio Sanz
- Division of Rheumatology, Department of Medicine, Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | - Mimi Y. Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Gregg J. Silverman
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Robert M. Clancy
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Boris Reizis
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
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Cornwell MG, Luttrell-Williams ES, Golpanian M, El Bannoudi H, Myndzar K, Izmirly P, Belmont HM, Katz S, Smilowitz NR, Engel A, Clancy R, Ruggles K, Buyon JP, Berger JS. Hydroxychloroquine is associated with lower platelet activity and improved vascular health in systemic lupus erythematosus. Lupus Sci Med 2021; 8:e000475. [PMID: 33737451 PMCID: PMC7978255 DOI: 10.1136/lupus-2021-000475] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/10/2021] [Accepted: 02/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Hydroxychloroquine (HCQ) is a mainstay of therapy in the treatment of SLE. The effect of HCQ on platelets and vascular health is uncertain. We investigated the relationship between HCQ use and dose with platelet activity, platelet transcriptomics and vascular health in patients with SLE. METHODS Platelet aggregation, platelet mRNA expression and vascular health (sublingual capillary perfused boundary region (PBR), red blood cell filling (RBCF) and brachial artery reactivity testing) were analysed by HCQ use and dose. RESULTS Among 132 subjects with SLE (age: 39.7±12.9 years, 97% female), 108 were on HCQ. SLE disease activity was similar between subjects on and off HCQ. Platelet aggregation in response to multiple agonists was significantly lower in patients on HCQ. There were inverse relationships between HCQ dose and gene expression pathways of platelet activity. Gene expression of P-selectin (SELP) was inversely correlated with HCQ dose (r=-0.41, p=0.003), which was validated at the protein level. Subjects on HCQ had improved vascular function correlating with HCQ dose as measured by lower PBR (r=-0.52, p=0.007), higher RBCF (r=0.55, p=0.004) and greater brachial artery reactivity (r=0.43, p=0.056). CONCLUSION HCQ use was associated with decreased platelet activation and activation-related transcripts and improved vascular health in SLE.
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Affiliation(s)
- MacIntosh Grant Cornwell
- Institute for Systems Genetics, NYU Langone Health, New York City, New York, USA
- Division of Translational Medicine, New York University School of Medicine, New York City, New York, USA
| | - Elliot S Luttrell-Williams
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Michael Golpanian
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Hanane El Bannoudi
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Khrystyna Myndzar
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Peter Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Stuart Katz
- Division of Translational Medicine, New York University School of Medicine, New York City, New York, USA
| | - Nathaniel R Smilowitz
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Alexis Engel
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Robert Clancy
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Kelly Ruggles
- Institute for Systems Genetics, NYU Langone Health, New York City, New York, USA
- Division of Translational Medicine, New York University School of Medicine, New York City, New York, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Jeffrey S Berger
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
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Suryawanshi H, Clancy R, Morozov P, Halushka MK, Buyon JP, Tuschl T. Cell atlas of the foetal human heart and implications for autoimmune-mediated congenital heart block. Cardiovasc Res 2021; 116:1446-1457. [PMID: 31589297 PMCID: PMC7314636 DOI: 10.1093/cvr/cvz257] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/09/2019] [Accepted: 10/01/2019] [Indexed: 01/01/2023] Open
Abstract
Aims Investigating human heart development and applying this to deviations resulting in disease is incomplete without molecular characterization of the cell types required for normal functioning. We investigated foetal human heart single-cell transcriptomes from mid-gestational healthy and anti-SSA/Ro associated congenital heart block (CHB) samples. Methods and results Three healthy foetal human hearts (19th to 22nd week of gestation) and one foetal heart affected by autoimmune-associated CHB (21st week of gestation) were subjected to enzymatic dissociation using the Langendorff preparation to obtain single-cell suspensions followed by 10× Genomics- and Illumina-based single-cell RNA-sequencing (scRNA-seq). In addition to the myocytes, fibroblasts, immune cells, and other minor cell types, previously uncharacterized diverse sub-populations of endothelial cells were identified in the human heart. Differential gene expression analysis revealed increased and heterogeneous interferon responses in varied cell types of the CHB heart compared with the healthy controls. In addition, we also identified matrisome transcripts enriched in CHB stromal cells that potentially contribute to extracellular matrix deposition and subsequent fibrosis. Conclusion These data provide an information-rich resource to further our understanding of human heart development, which, as illustrated by comparison to a heart exposed to a maternal autoimmune environment, can be leveraged to provide insight into the pathogenesis of disease.
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Affiliation(s)
- Hemant Suryawanshi
- Laboratory of RNA Molecular Biology, The Rockefeller University, 1230 York Avenue, Box 186, New York, NY 10065, USA
| | - Robert Clancy
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Pavel Morozov
- Laboratory of RNA Molecular Biology, The Rockefeller University, 1230 York Avenue, Box 186, New York, NY 10065, USA
| | - Marc K Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Thomas Tuschl
- Laboratory of RNA Molecular Biology, The Rockefeller University, 1230 York Avenue, Box 186, New York, NY 10065, USA
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Izmirly P, Kim M, Friedman DM, Costedoat-Chalumeau N, Clancy R, Copel JA, Phoon CKL, Cuneo BF, Cohen RE, Robins K, Masson M, Wainwright BJ, Zahr N, Saxena A, Buyon JP. Hydroxychloroquine to Prevent Recurrent Congenital Heart Block in Fetuses of Anti-SSA/Ro-Positive Mothers. J Am Coll Cardiol 2021; 76:292-302. [PMID: 32674792 DOI: 10.1016/j.jacc.2020.05.045] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Experimental and clinical evidence support the role of macrophage Toll-like receptor signaling in maternal anti-SSA/Ro-mediated congenital heart block (CHB). OBJECTIVES Hydroxychloroquine (HCQ), an orally administered Toll-like receptor antagonist widely used in lupus including during pregnancy, was evaluated for efficacy in reducing the historical 18% recurrence rate of CHB. METHODS This multicenter, open-label, single-arm, 2-stage clinical trial was designed using Simon's optimal approach. Anti-SSA/Ro-positive mothers with a previous pregnancy complicated by CHB were recruited (n = 19 Stage 1; n = 35 Stage 2). Patients received 400 mg daily of HCQ prior to completion of gestational week 10, which was maintained through pregnancy. The primary outcome was 2° or 3° CHB any time during pregnancy, and secondary outcomes included isolated endocardial fibroelastosis, 1° CHB at birth and skin rash. RESULTS By intention-to-treat (ITT) analysis, 4 of 54 evaluable pregnancies resulted in a primary outcome (7.4%; 90% confidence interval: 3.4% to 15.9%). Because 9 mothers took potentially confounding medications (fluorinated glucocorticoids and/or intravenous immunoglobulin) after enrollment but prior to a primary outcome, to evaluate HCQ alone, 9 additional mothers were recruited and followed the identical protocol. In the per-protocol analysis restricted to pregnancies exposed to HCQ alone, 4 of 54 (7.4%) fetuses developed a primary outcome as in the ITT. Secondary outcomes included mild endocardial fibroelastosis (n = 1) and cutaneous neonatal lupus (n = 4). CONCLUSIONS These prospective data support that HCQ significantly reduces the recurrence of CHB below the historical rate by >50%, suggesting that this drug should be prescribed for secondary prevention of fetal cardiac disease in anti-SSA/Ro-exposed pregnancies. (Preventive Approach to Congenital Heart Block With Hydroxychloroquine [PATCH]; NCT01379573).
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Affiliation(s)
- Peter Izmirly
- New York University School of Medicine, New York, New York.
| | - Mimi Kim
- Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Robert Clancy
- New York University School of Medicine, New York, New York
| | | | | | | | | | | | - Mala Masson
- New York University School of Medicine, New York, New York
| | | | - Noel Zahr
- Pitié-Salpêtrière University Hospital, Paris, France
| | - Amit Saxena
- New York University School of Medicine, New York, New York
| | - Jill P Buyon
- New York University School of Medicine, New York, New York. https://twitter.com/JillBuyonMD
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Fernandez-Ruiz R, Masson M, Kim MY, Myers B, Haberman RH, Castillo R, Scher JU, Guttmann A, Carlucci PM, Deonaraine KK, Golpanian M, Robins K, Chang M, Belmont HM, Buyon JP, Blazer AD, Saxena A, Izmirly PM. Leveraging the United States Epicenter to Provide Insights on COVID-19 in Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2020; 72:1971-1980. [PMID: 32715660 PMCID: PMC7941257 DOI: 10.1002/art.41450] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To characterize patients with systemic lupus erythematosus (SLE) affected by coronavirus disease 2019 (COVID-19) and to analyze associations of comorbidities and medications on infection outcomes. METHODS Patients with SLE and reverse transcriptase-polymerase chain reaction-confirmed COVID-19 were identified through an established New York University lupus cohort, query of 2 hospital systems, and referrals from rheumatologists. Data were prospectively collected via a web-based questionnaire and review of medical records. Data on baseline characteristics were obtained for all patients with COVID-19 to analyze risk factors for hospitalization. Data were also collected on asymptomatic patients and those with COVID-19-like symptoms who tested negative or were not tested. Statistical analyses were limited to confirmed COVID-19-positive patients. RESULTS A total of 226 SLE patients were included: 41 with confirmed COVID-19, 19 who tested negative for COVID-19, 42 with COVID-19-like symptoms who did not get tested, and 124 who remained asymptomatic without testing. Of the SLE patients with confirmed COVID-19, hospitalization was required in 24 (59%) and intensive care unit-level of care in 4, and 4 died. Hospitalized patients tended to be older, nonwhite, Hispanic, have higher body mas index (BMI), history of nephritis, and at least 1 comorbidity. An exploratory (due to limited sample size) logistic regression analysis identified race, presence of at least 1 comorbidity, and BMI as independent predictors of hospitalization. CONCLUSION In general, the variables predictive of hospitalization in our SLE patients were similar to those identified in the general population. Further studies are needed to understand additional risk factors for poor COVID-19 outcomes in patients with SLE.
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Affiliation(s)
- Ruth Fernandez-Ruiz
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Mala Masson
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Mimi Y. Kim
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY
| | | | - Rebecca H. Haberman
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Rochelle Castillo
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Jose U. Scher
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Allison Guttmann
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Philip M. Carlucci
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Kristina K. Deonaraine
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Michael Golpanian
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Kimberly Robins
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Miao Chang
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Ashira D. Blazer
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Amit Saxena
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
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Friedman DM, Kim M, Costedoat-Chalumeau N, Clancy R, Copel J, Phoon CK, Cuneo BF, Cohen R, Masson M, Wainwright BJ, Zahr N, Saxena A, Izmirly PM, Buyon JP. Electrocardiographic QT Intervals in Infants Exposed to Hydroxychloroquine Throughout Gestation. Circ Arrhythm Electrophysiol 2020; 13:e008686. [PMID: 32907357 DOI: 10.1161/circep.120.008686] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Based on inhibition of viral replication and limited reports on clinical efficacy, hydroxychloroquine is being considered as prophylaxis and treatment of coronavirus disease-19 (COVID-19). Although hydroxychloroquine is generally considered safe during pregnancy based on studies in patients with systemic lupus erythematosus and other rheumatic conditions, there may still be reluctance to institute this antimalarial during pregnancy for the sole purpose of antiviral therapy. METHODS To provide data regarding any potential fetal/neonatal cardiotoxicity, we leveraged a unique opportunity in which neonatal ECGs and hydroxychloroquine blood levels were available in a recently completed study evaluating the efficacy of hydroxychloroquine 400 mg daily to prevent the recurrence of congenital heart block associated with anti-SSA/Ro (anti-Sjögren's Syndrome A/Ro) antibodies. RESULTS Forty-five ECGs were available for corrected QT interval (QTc) measurement, and levels of hydroxychloroquine were assessed during each trimester of pregnancy and in the cord blood, providing unambiguous assurance of drug exposure. Overall, there was no correlation between cord blood levels of hydroxychloroquine and the neonatal QTc (R=0.02, P=0.86) or the mean of hydroxychloroquine values obtained throughout each individual pregnancy and the QTc (R=0.04, P=0.80). In total 5 (11% [95% CI, 4%-24%]) neonates had prolongation of the QTc >2 SD above historical healthy controls (2 markedly and 3 marginally) but ECGs were otherwise normal. CONCLUSIONS In aggregate, these data provide reassurances that the maternal use of hydroxychloroquine is associated with a low incidence of infant QTc prolongation. However, if included in clinical COVID-19 studies, early postnatal ECGs should be considered. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01379573.
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Affiliation(s)
| | - Mimi Kim
- Albert Einstein College of Medicine, Bronx, NY (M.K.)
| | | | - Robert Clancy
- New York University School of Medicine, New York, NY (R. Clancy, C.K.P., R. Cohen, M.M., B.J.W., A.S., P.M.I., J.P.B.)
| | | | - Colin K Phoon
- New York University School of Medicine, New York, NY (R. Clancy, C.K.P., R. Cohen, M.M., B.J.W., A.S., P.M.I., J.P.B.)
| | - Bettina F Cuneo
- University of Colorado School of Medicine, Aurora, CO (B.F.C.)
| | - Rebecca Cohen
- New York University School of Medicine, New York, NY (R. Clancy, C.K.P., R. Cohen, M.M., B.J.W., A.S., P.M.I., J.P.B.)
| | - Mala Masson
- New York University School of Medicine, New York, NY (R. Clancy, C.K.P., R. Cohen, M.M., B.J.W., A.S., P.M.I., J.P.B.)
| | - Benjamin J Wainwright
- New York University School of Medicine, New York, NY (R. Clancy, C.K.P., R. Cohen, M.M., B.J.W., A.S., P.M.I., J.P.B.)
| | - Noel Zahr
- Pitié-Salpêtrière University Hospital, Paris, France (N.Z.)
| | - Amit Saxena
- New York University School of Medicine, New York, NY (R. Clancy, C.K.P., R. Cohen, M.M., B.J.W., A.S., P.M.I., J.P.B.)
| | - Peter M Izmirly
- New York University School of Medicine, New York, NY (R. Clancy, C.K.P., R. Cohen, M.M., B.J.W., A.S., P.M.I., J.P.B.)
| | - Jill P Buyon
- New York University School of Medicine, New York, NY (R. Clancy, C.K.P., R. Cohen, M.M., B.J.W., A.S., P.M.I., J.P.B.)
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Fernandez-Ruiz R, Bornkamp N, Kim MY, Askanase A, Zezon A, Tseng CE, Belmont HM, Saxena A, Salmon JE, Lockshin M, Buyon JP, Izmirly PM. Discontinuation of hydroxychloroquine in older patients with systemic lupus erythematosus: a multicenter retrospective study. Arthritis Res Ther 2020; 22:191. [PMID: 32807233 PMCID: PMC7430013 DOI: 10.1186/s13075-020-02282-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/01/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background Although hydroxychloroquine (HCQ) is a mainstay of treatment for patients with systemic lupus erythematosus (SLE), ocular toxicity can result from accumulated exposure. As the longevity of patients with SLE improves, data are needed to balance the risk of ocular toxicity and the risk of disease flare, especially in older patients with quiescent disease. Accordingly, this study was initiated to examine the safety of HCQ withdrawal in older SLE patients. Methods Data were obtained by retrospective chart review at three major lupus centers in New York City. Twenty-six patients who discontinued HCQ and thirty-two patients on HCQ matched for gender, race/ethnicity, and age were included in this study. The primary outcome was the occurrence of a lupus flare classified by the revised version of the Safety of Estrogens in Lupus Erythematosus: National Assessment version of the Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) Flare composite index, within 1 year of HCQ withdrawal or matched time of continuation. Results Five patients (19.2%) in the HCQ withdrawal group compared to five (15.6%) in the HCQ continuation group experienced a flare of any severity (odds ratio [OR] = 1.28; 95% CI 0.31, 5.30; p = 0.73). There were no severe flares in either group. The results were similar after adjusting for length of SLE, number of American College of Rheumatology criteria, low complement levels, and SELENA-SLEDAI score, and in a propensity score analysis (OR = 1.18; 95% CI 0.23, 6.16; p = 0.84). The analysis of time to any flare revealed a non-significant earlier time to flare in the HCQ withdrawal group (log-rank p = 0.67). Most flares were in the cutaneous and musculoskeletal systems, but one patient in the continuation group developed pericarditis. The most common reason for HCQ withdrawal was retinal toxicity (42.3%), followed by patient’s preference (34.6%), other confirmed or suspected adverse effects (15.4%), ophthalmologist recommendation for macular degeneration (3.8%), and rheumatologist recommendation for quiescent SLE (3.8%). Conclusions In this retrospective study of older stable patients with SLE on long-term HCQ, withdrawal did not significantly increase the risk of flares.
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Affiliation(s)
- Ruth Fernandez-Ruiz
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
| | - Nicole Bornkamp
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Mimi Y Kim
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Anna Zezon
- Division of Rheumatology, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Chung-E Tseng
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Amit Saxena
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Jane E Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Michael Lockshin
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
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39
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Limaye MA, Buyon JP, Cuneo BF, Mehta-Lee SS. A review of fetal and neonatal consequences of maternal systemic lupus erythematosus. Prenat Diagn 2020; 40:1066-1076. [PMID: 32282083 DOI: 10.1002/pd.5709] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and is commonly seen in pregnancy. The physiologic and immunologic changes of pregnancy may alter the course of SLE and impact maternal, fetal, and neonatal health. Multidisciplinary counseling before and during pregnancy from rheumatology, maternal fetal medicine, obstetrics, and pediatric cardiology is critical. Transplacental passage of autoantibodies, present in about 40% of women with SLE, can result in neonatal lupus (NL). NL can consist of usually permanent cardiac manifestations, including conduction system and myocardial disease, as well as transient cutaneous, hematologic, and hepatic manifestations. Additionally, women with SLE are more likely to develop adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, and preterm birth, perhaps due to an underlying effect on placentation. This review describes the impact of SLE on maternal and fetal health by trimester, beginning with prepregnancy optimization of maternal health. This is followed by a discussion of NL and the current understanding of the epidemiology and pathophysiology of anti-Ro/La mediated cardiac disease, as well as screening, treatment, and methods for prevention. Finally discussed is the known increase in preeclampsia and fetal growth issues in women with SLE that can lead to iatrogenic preterm delivery.
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Affiliation(s)
- Meghana A Limaye
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, NYU Langone Medical Center, New York, New York, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Bettina F Cuneo
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Shilpi S Mehta-Lee
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, NYU Langone Medical Center, New York, New York, USA
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40
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Abstract
Over the 2 months since coronavirus first appeared in China, cases have emerged on every continent, and it is clear that patients with autoimmune diseases might also be affected. Coronavirus disease 2019 (COVID-19) is a highly contagious viral illness with a mortality rate approaching 2%. Here we discuss the challenges that patients with autoimmune diseases might face and the information on using immunomodulatory therapies like chloroquine, tocilizumab and baricitinib to quench the cytokine storm in patients with very severe COVID-19 pneumonia.
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Affiliation(s)
- Anca D Askanase
- Department of Rheumatology, Columbia University Medical Center, New York, New York, USA
| | - Leila Khalili
- Department of Rheumatology, Columbia University Medical Center, New York, New York, USA
| | - Jill P Buyon
- Department of Rheumatology, NYU Langone Health, New York, New York, USA
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41
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Davis-Porada J, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, Sammaritano LR, Branch DW, Sawitzke A, Merrill JT, Buyon JP, Salmon JE. Low frequency of flares during pregnancy and post-partum in stable lupus patients. Arthritis Res Ther 2020; 22:52. [PMID: 32188491 PMCID: PMC7081564 DOI: 10.1186/s13075-020-2139-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Lupus patients are at risk for pregnancy loss, and it has been generally accepted that women with SLE should have low disease activity prior to conception. However, there are conflicting results regarding the effect of pregnancy on SLE flares. This study aims to identify predictors of flares during and after pregnancy in SLE patients with inactive or stable disease activity during the first trimester and to characterize and estimate the frequency of post-partum flares in these patients. Methods SLE patients in the multicenter, prospective PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study were evaluated for flares during and after pregnancy using the SELENA-SLEDAI Flare Index. Flares during pregnancy were assessed in all 384 patients and post-partum flares in 234 patients with study visits 2–6 months post-partum. Logistic regression models were fit to the data to identify independent risk factors for flare. Results During pregnancy, 20.8% of patients had mild/moderate flares and 6.25% had severe. Post-partum, 27.7% of patients had mild/moderate flares and 1.7% had severe. The mild flares rarely required treatment. Younger age, low C4 and higher PGA at baseline were independently associated with higher risk of having at least one mild/moderate or severe flare during pregnancy. Older patients were at decreased risk of flare, as well as those with quiescent disease at baseline. No variables evaluated at baseline or the visit most proximal to delivery was significantly associated with risk of flare post-partum. Medications were not associated with flare during or after pregnancy. Conclusion In patients with inactive or stable mild disease activity at the time of conception, lupus disease flares during and after pregnancy are typically mild and occur at similar rates. Flares during pregnancy are predicted by the patients’ age and clinical and serological activity at baseline.
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Affiliation(s)
- Julia Davis-Porada
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Mimi Y Kim
- Albert Einstein College of Medicine, New York, NY, USA
| | - Marta M Guerra
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Carl A Laskin
- Mount Sinai Hospital Toronto, Toronto, Ontario, Canada.,Trio Fertility, Toronto, Ontario, Canada
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael D Lockshin
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.,Weill Cornell Medicine, New York, NY, USA
| | - Lisa R Sammaritano
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.,Weill Cornell Medicine, New York, NY, USA
| | - D Ware Branch
- Intermountain Healthcare, Salt Lake City, UT, USA.,University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Allen Sawitzke
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Joan T Merrill
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Jill P Buyon
- New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
| | - Jane E Salmon
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA. .,Weill Cornell Medicine, New York, NY, USA.
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42
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Nusbaum JS, Mirza I, Shum J, Freilich RW, Cohen RE, Pillinger MH, Izmirly PM, Buyon JP. Sex Differences in Systemic Lupus Erythematosus: Epidemiology, Clinical Considerations, and Disease Pathogenesis. Mayo Clin Proc 2020; 95:384-394. [PMID: 32029091 DOI: 10.1016/j.mayocp.2019.09.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/17/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic, multiorgan, systemic autoimmune disease that is more common in women than men and is typically diagnosed during reproductive age, necessitating sex-specific considerations in care. In women there is no substantive evidence to suggest that SLE reduces fertility, but subfertility may occur as a result of active disease, immunosuppressive drugs, and age-related declines in fertility related to delays in childbearing. Although pregnancy outcomes have improved, SLE still poses risks in pregnancy that contribute to poorer maternal and fetal outcomes. Cyclophosphamide, an important agent for the treatment of severe or life-threatening lupus, may adversely affect fertility, particularly with increases in dose and patient age. Fertility preservation techniques are therefore an important consideration for women and men before cytotoxic treatment. There is mixed evidence as to whether exogenous estrogen in the form of oral contraceptive pills or hormone replacement therapy may increase the risk for the development of SLE, but among women with SLE already diagnosed, combined oral contraceptive pills and hormone replacement therapy do not confer risk for severe flare and remain important in reproductive care. The higher incidence of SLE in women may nonetheless be attributable to effects of endogenous estrogen, as well as failures in X chromosome inactivation, increased Toll-like receptor gene products, and changes in microRNA function. A greater appreciation of the biological underpinnings and consequences of sex differences in SLE may lead to more targeted treatments and improved outcomes for patients with SLE.
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Affiliation(s)
- Julie S Nusbaum
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York.
| | - Ibraheem Mirza
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York
| | - Justine Shum
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York
| | - Robert W Freilich
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York
| | - Rebecca E Cohen
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York
| | - Michael H Pillinger
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York
| | - Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York
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43
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Affiliation(s)
- Bruce N Cronstein
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Jill P Buyon
- New York University School of Medicine, New York, New York, USA
| | - Steven B Abramson
- Rheumatology Research, NYU-Hospital for Joint Diseases, New York, New York, USA
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44
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Abramson SB, Anderson PJ, Buyon JP, Cronstein BN, Pederson T, Philips MR, Serhan CN. A tribute to Gerald Weissmann (1930-2019). J Clin Invest 2019; 129:4553-4555. [PMID: 31589163 DOI: 10.1172/jci133490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Steven B Abramson
- Department of Medicine, Division of Rheumatology, NYU School of Medicine, NYU Langone Health, New York, New York, USA
| | - Paul J Anderson
- Department of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jill P Buyon
- Division of Rheumatology, Departments of Medicine (Rheumatology) and Hospital for Joint Diseases, NYU Langone School of Medicine, New York, New York, USA
| | - Bruce N Cronstein
- Departments of Medicine, Biochemistry, and Molecular Pharmacology and Pathology, NYU School of Medicine, Clinical and Translational Science Institute, NYU Langone Health, New York, New York, USA
| | - Thoru Pederson
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Mark R Philips
- Departments of Medicine, Cell Biology, and Pharmacology, NYU Cancer Institute, Division of Rheumatology, NYU School of Medicine, New York, New York, USA
| | - Charles N Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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45
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Clancy RM, Marion MC, Ainsworth HC, Blaser MJ, Chang M, Howard TD, Izmirly PM, Lacher C, Masson M, Robins K, Buyon JP, Langefeld CD. Salivary dysbiosis and the clinical spectrum in anti-Ro positive mothers of children with neonatal lupus. J Autoimmun 2019; 107:102354. [PMID: 31677965 DOI: 10.1016/j.jaut.2019.102354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/15/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
Mothers giving birth to children with manifestations of neonatal lupus (NL) represent a unique population at risk for the development of clinically evident pathologic autoimmunity since many are asymptomatic and only become aware of anti-SSA/Ro positivity (anti-Ro+) based on heart block in their fetus. Accordingly, we hypothesized that the microbiome in saliva is associated with the development of autoreactivity and in some cases the progression in health status from benign to overt clinical disease including Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE). The study comprised a clinical spectrum of anti-Ro+ mothers, all of whom gave birth to a child with NL: 9 were asymptomatic or had an undifferentiated autoimmune disease (Asym/UAS) and 16 fulfilled criteria for SS and/or SLE. Microbial diversity was reduced across all levels from kingdom to species for the anti-Ro+ mothers vs healthy controls; however, there were no significant differences between Asym/UAS and SS/SLE mothers. Relative abundance of Proteobacteria and more specifically class Betaproteobacteria decreased with clinical severity (healthy controls < Asym/UAS < SS/SLE). These ordered differences were maintained through the taxonomic hierarchy to three genera (Lautropia, Comamonas, and Neisseria) and species within these genera (L. mirabilis, N. flavescens and N. oralis). Biometric analysis comparing von Willebrand Factor domains present in human Ro60 with L. mirabilis proteins support the hypothesis of molecular mimicry. These data position the microbiome in the development of anti-Ro reactivity and subsequent clinical spectrum of disease.
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Affiliation(s)
- R M Clancy
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA.
| | - M C Marion
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - H C Ainsworth
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - M J Blaser
- Rutgers University, Center for Advanced Biotechnology and Medicine, Piscataway, NJ, USA
| | - M Chang
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - T D Howard
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - P M Izmirly
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - C Lacher
- Rutgers University, Center for Advanced Biotechnology and Medicine, Piscataway, NJ, USA
| | - M Masson
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - K Robins
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - J P Buyon
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - C D Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
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46
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Saxena A, Izmirly PM, Bomar RP, Golpanian RS, Friedman DM, Eisenberg R, Kim MY, Buyon JP. Factors associated with long-term cardiac dysfunction in neonatal lupus. Ann Rheum Dis 2019; 79:217-224. [PMID: 31672776 DOI: 10.1136/annrheumdis-2019-215900] [Citation(s) in RCA: 5] [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: 06/16/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Cardiac manifestations of neonatal lupus (NL) have been associated with significant morbidity and mortality; however, there is minimal information on long-term outcomes of affected individuals. This study was initiated to evaluate the presence of and the risk factors associated with cardiac dysfunction in NL after birth in multiple age groups to improve counselling, to further understand pathogenesis and to provide potential preventative strategies. METHODS Echocardiogram reports were evaluated in 239 individuals with cardiac NL: 143 from age 0-1 year, 176 from age >1-17 years and 64 from age >17 years. Logistic regression analyses evaluated associations of cardiac dysfunction at each age group with demographic, fetal and postnatal factors, using imputation to address missing data. RESULTS Cardiac dysfunction was identified in 22.4% at age 0-1 year, 14.8% at age >1-17 years and 28.1% at age >17 years. Dysfunction in various age groups was significantly associated with male sex, black race, lower fetal heart rates, fetal extranodal cardiac disease and length of time paced. In 106 children with echocardiograms at ages 0-1 year and >1-17 years, 43.8% with dysfunction at age 0-1 year were also affected at age >1-17 years, while the others reverted to normal. Of children without dysfunction at age 0-1 year, 8.9% developed new dysfunction between ages >1 and 17 years. Among 34 with echocardiograms at ages >1-17 years and >17 years, 6.5% with normal function at age >1-17 years developed dysfunction in adulthood. CONCLUSIONS Risk factors in fetal life can influence cardiac morbidity into adulthood.Although limited by a small number of cases, cardiac dysfunction in the first year often normalises by later childhood. New-onset dysfunction, although rare, can occur de novo after the first year.
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Affiliation(s)
- Amit Saxena
- Medicine, NYU School of Medicine, New York, New York, United States
| | - Peter M Izmirly
- Medicine, NYU School of Medicine, New York, New York, United States
| | - Rebecca P Bomar
- Medicine, NYU School of Medicine, New York, New York, United States
| | | | | | - Ruth Eisenberg
- Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mimi Y Kim
- Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jill P Buyon
- Medicine, NYU School of Medicine, New York, New York, United States
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47
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Bocharnikov AV, Keegan J, Wacleche VS, Cao Y, Fonseka CY, Wang G, Muise ES, Zhang KX, Arazi A, Keras G, Li ZJ, Qu Y, Gurish MF, Petri M, Buyon JP, Putterman C, Wofsy D, James JA, Guthridge JM, Diamond B, Anolik JH, Mackey MF, Alves SE, Nigrovic PA, Costenbader KH, Brenner MB, Lederer JA, Rao DA. PD-1hiCXCR5- T peripheral helper cells promote B cell responses in lupus via MAF and IL-21. JCI Insight 2019; 4:130062. [PMID: 31536480 DOI: 10.1172/jci.insight.130062] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by pathologic T cell-B cell interactions and autoantibody production. Defining the T cell populations that drive B cell responses in SLE may enable design of therapies that specifically target pathologic cell subsets. Here, we evaluated the phenotypes of CD4+ T cells in the circulation of 52 SLE patients drawn from multiple cohorts and identified a highly expanded PD-1hiCXCR5-CD4+ T cell population. Cytometric, transcriptomic, and functional assays demonstrated that PD-1hiCXCR5-CD4+ T cells from SLE patients are T peripheral helper (Tph) cells, a CXCR5- T cell population that stimulates B cell responses via IL-21. The frequency of Tph cells, but not T follicular helper (Tfh) cells, correlated with both clinical disease activity and the frequency of CD11c+ B cells in SLE patients. PD-1hiCD4+ T cells were found within lupus nephritis kidneys and correlated with B cell numbers in the kidney. Both IL-21 neutralization and CRISPR-mediated deletion of MAF abrogated the ability of Tph cells to induce memory B cell differentiation into plasmablasts in vitro. These findings identify Tph cells as a highly expanded T cell population in SLE and suggest a key role for Tph cells in stimulating pathologic B cell responses.
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Affiliation(s)
| | | | | | - Ye Cao
- Division of Rheumatology, Immunology, and Allergy
| | - Chamith Y Fonseka
- Center for Data Sciences, and.,Division of Rheumatology and Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Broad Institute of Massachusetts Institute and Technology and Harvard University, Cambridge, Massachusetts, USA
| | | | - Eric S Muise
- Oncology & Immunology Discovery, and.,Genetics and Pharmacogenomics, Merck & Co. Inc., Boston, Massachusetts, USA
| | - Kelvin X Zhang
- Oncology & Immunology Discovery, and.,Genetics and Pharmacogenomics, Merck & Co. Inc., Boston, Massachusetts, USA
| | - Arnon Arazi
- Broad Institute of Massachusetts Institute and Technology and Harvard University, Cambridge, Massachusetts, USA
| | | | - Zhihan J Li
- Division of Rheumatology, Immunology, and Allergy
| | - Yujie Qu
- Oncology & Immunology Discovery, and
| | | | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jill P Buyon
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Chaim Putterman
- Department of Microbiology & Immunology and Division of Rheumatology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Wofsy
- Rheumatology Division and Russell/Engleman Research Center, UCSF, San Francisco, California, USA
| | - Judith A James
- Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Joel M Guthridge
- Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Betty Diamond
- Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jennifer H Anolik
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, New York, USA
| | | | | | - Peter A Nigrovic
- Division of Rheumatology, Immunology, and Allergy.,Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Deepak A Rao
- Division of Rheumatology, Immunology, and Allergy
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48
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Abramson SB, Cronstein B, Buyon JP. In Memoriam: Gerald Weissmann,
MD
, 1930–2019. Arthritis Rheumatol 2019. [DOI: 10.1002/art.41053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Jill P. Buyon
- NYU School of MedicineNYU Langone Health New York NY
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49
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Katz G, Smilowitz NR, Blazer A, Clancy R, Buyon JP, Berger JS. Systemic Lupus Erythematosus and Increased Prevalence of Atherosclerotic Cardiovascular Disease in Hospitalized Patients. Mayo Clin Proc 2019; 94:1436-1443. [PMID: 31303426 PMCID: PMC6711365 DOI: 10.1016/j.mayocp.2019.01.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/18/2018] [Accepted: 01/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its individual phenotypes of coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease by age and sex in a large US cohort of hospitalized patients with systemic lupus erythematosus (SLE). METHODS A nested case-control study of adults with and without SLE was conducted from the January 1, 2008, through December 31, 2014, National Inpatient Sample. Hospitalized patients with SLE were matched (1:3) by age, sex, race, and calendar year to hospitalized patients without SLE. The prevalences of CAD, PAD, and cerebrovascular disease were evaluated, and associations with SLE were determined after adjustment for common cardiovascular risk factors. RESULTS Among the 252,676 patients with SLE and 758,034 matched patients without SLE, the mean age was 51 years, 89% were women, and 49% were white. Patients with SLE had a higher prevalence of ASCVD vs those without SLE (25.6% vs 19.2%; OR, 1.45; 95% CI, 1.44-1.47; P<.001). After multivariable adjustment, SLE was associated with a greater odds of ASCVD (adjusted odds ratio [aOR], 1.46; 95% CI, 1.41-1.51). The association between SLE and ASCVD was observed in women and men and was attenuated with increasing age. Also, SLE was associated with increased odds of CAD (aOR, 1.42; 95% CI, 1.40-1.44), PAD (aOR, 1.25; 95% CI, 1.22-1.28), and cerebrovascular disease (aOR, 1.68; 95% CI, 1.65-1.71). CONCLUSION In hospitalized US patients, SLE was associated with increased ASCVD prevalence, which was observed in both sexes and was greatest in younger patients.
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Affiliation(s)
- Gregory Katz
- Division of Cardiology, Department of Medicine, Marc and Ruti Bell Program in Vascular Biology, New York University School of Medicine, New York, NY
| | - Nathaniel R Smilowitz
- Division of Cardiology, Department of Medicine, Marc and Ruti Bell Program in Vascular Biology, New York University School of Medicine, New York, NY
| | - Ashira Blazer
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Robert Clancy
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Jeffrey S Berger
- Division of Cardiology, Department of Medicine, Marc and Ruti Bell Program in Vascular Biology, New York University School of Medicine, New York, NY.
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Abstract
Linked Comment: Ultrasound Obstet Gynecol 2019; 54: 87-95.
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Affiliation(s)
- B F Cuneo
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - J P Buyon
- Division of Rheumatology, Department of Internal Medicine, New York University Langone School of Medicine, NYU Langone Health, New York, NY, USA
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