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Sieiro Santos C, Calleja Antolin S, Moriano Morales C, Garcia Herrero J, Diez Alvarez E, Ramos Ortega F, Ruiz de Morales JG. Immune responses to mRNA vaccines against SARS-CoV-2 in patients with immune-mediated inflammatory rheumatic diseases. RMD Open 2022; 8:e001898. [PMID: 34987093 PMCID: PMC9065768 DOI: 10.1136/rmdopen-2021-001898] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 08/25/2021] [Accepted: 12/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with immune-mediated rheumatic diseases (IMRDs) are commonly treated with immunosuppressors and prone to infections. Recently introduced mRNA SARS-CoV-2 vaccines have demonstrated extraordinary efficacy across all ages. Immunosuppressed patients were excluded from phase III trials with SARS-CoV-2 mRNA vaccines. AIMS To fully characterise B-cell and T-cell immune responses elicited by mRNA SARS-CoV-2 vaccines in patients with rheumatic diseases under immunotherapies, and to identify which drugs reduce vaccine's immunogenicity. METHODS Humoral, CD4 and CD8 immune responses were investigated in 100 naïve patients with SARS-CoV-2 with selected rheumatic diseases under immunosuppression after a two-dose regimen of SARS-CoV-2 mRNA vaccine. Responses were compared with age, gender and disease-matched patients with IMRD not receiving immunosuppressors and with healthy controls. RESULTS Patients with IMRD showed decreased seroconversion rates (80% vs 100%, p=0.03) and cellular immune responses (75% vs 100%, p=0.02). Patients on methotrexate achieved seroconversion in 62% of cases and cellular responses in 80% of cases. Abatacept decreased humoral and cellular responses. Rituximab (31% responders) and belimumab (50% responders) showed impaired humoral responses, but cellular responses were often preserved. Antibody titres were reduced with mycophenolate and azathioprine but preserved with leflunomide and anticytokines. CONCLUSIONS Patients with IMRD exhibit impaired SARS-CoV-2 vaccine immunogenicity, variably reduced with immunosuppressors. Among commonly used therapies, abatacept and B-cell depleting therapies show deleterious effects, while anticytokines preserved immunogenicity. The effects of cumulative methotrexate and glucocorticoid doses on immunogenicity should be considered. Humoral and cellular responses are weakly correlated, but CD4 and CD8 tightly correlate. Seroconversion alone might not reflect the vaccine's immunogenicity.
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Ruiz de Morales JG, Cordero-Coma M, Rovira M, Calleja-Antolin S, Espinosa G, de Las Heras N. Autologous Hematopoietic Stem Cell Transplantation for Susac Syndrome. Ann Intern Med 2020; 173:315-317. [PMID: 32628529 DOI: 10.7326/l20-0055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jose G Ruiz de Morales
- Complejo Hospitalario Universitario de León and Instituto de Biomedicina, University of León, León, Spain (J.G.R., M.C.)
| | - Miguel Cordero-Coma
- Complejo Hospitalario Universitario de León and Instituto de Biomedicina, University of León, León, Spain (J.G.R., M.C.)
| | - Montserrat Rovira
- Stem Cell Transplantation Unit, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain (M.R.)
| | | | - Gerard Espinosa
- Hospital Clinic, University of Barcelona, Barcelona, Spain (G.E.)
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Puig L, Ruiz de Morales JG, Dauden E, Andreu JL, Cervera R, Adán A, Marsal S, Escobar C, Hinojosa J, Palau J, Arraiza A, Casado P, Codesido M, Pascual C, Saldaña R, Gil Á. [Prevalence of ten Immune-mediated inflammatory diseases (IMID) in Spain]. Rev Esp Salud Publica 2019; 93:e201903013. [PMID: 30907380] [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: 10/15/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE Immune-mediated inflammatory diseases (IMID) are chronic and highly disabling diseases that share inflammatory sequences and immunological dysregulations. Considered as a disease in itself, the prevalence of IMID is virtually unknown. The aim of this study was to assess the prevalence of 10 selected UDI, including rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, Crohn's disease, systemic lupus erythematosus, hidradenitis suppurativa, sarcoidosis and uveitis in Spain. METHODS cross-sectional epidemiological study of point prevalence was made. This study was carried out through a series of computerized interviews in households chosen at random in 17 autonomous communities in Spain. A structured questionnaire was used to determine the frequency of diagnosis and the concurrence of 10 IMID in the respondents and other individuals belonging to the same family nucleus. The point prevalence estimates were used and compared with the objective of determining the frequency of IMID by age, sex and communities. The data were processed using Excel 2016 (Microsoft, Redmond, WA, USA) and the SPSS V.019 system (IBM Corp. Armonk, NY, USA) for statistical analysis using the usual statistical tests in this type of studies. RESULTS Of the 7,980 respondents, 510 were diagnosed with an IMID, representing a cross-sectional study of 6.39% (95% CI: 6.02-6.76). One, two, three or more members of the family were affected in 87.2%, 7.8% and 5% of positive relatives in IMID, respectively. The most recurrent diseases were psoriasis (2.69% [95% CI: 2.32-3.06]) and rheumatic arthritis (1.07% [95% CI: 0.70-1.44]). There were differences in prevalence due to sex (p = 0.004) and age (p = 0.000). No significant differences were identified related to geographic location (p = 0.819). Attendance of at least 2 IMID was reported in 8.9% of respondents. CONCLUSIONS The overall prevalence was of the IMID studied was 6.39%, psoriasis being the most frequent with 2.69%. This study constitutes an initial step to consider IMID as an independent disease within the health system..
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Affiliation(s)
- Lluís Puig
- Servicio de Dermatología. Hospital de la Santa Creu i Sant Pau. Barcelona. España
| | | | - Esteban Dauden
- Servicio de Dermatología. Hospital Universitario de La Princesa. Madrid. España
| | - José Luís Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro-Majadahonda. Madrid. España
| | - Ricard Cervera
- Servicio de Enfermedades Autoinmunes. Hospital Clínic de Barcelona. Barcelona. España
| | - Alfredo Adán
- Instituto de Oftalmología. Hospital Clinic de Barcelona. Barcelona. España
| | - Sara Marsal
- Grupo de Investigación de Reumatología. Institut de Recerca. Hospital Universitari Vall d'Hebron. Barcelona. España
| | - Carina Escobar
- UNIMID (Asociación de Personas con Enfermedades Crónicas Inflamatorias Inmunomediadas). Madrid. España
| | - Joaquín Hinojosa
- Servicio de Medicina Digestiva. Hospital de Manises. Valencia. España
| | - Javier Palau
- Departamento de Salud de La Ribera. Valencia. España
| | - Antonio Arraiza
- Asistencia Sanitaria. Dirección General. Osakidetza. Vitoria-Gasteiz. España
| | - Paloma Casado
- Calidad y Cohesión. Ministerio de Sanidad, Servicios Sociales e Igualdad. Madrid. España
| | - María Codesido
- Calidad y Cohesión. Ministerio de Sanidad, Servicios Sociales e Igualdad. Madrid. España
| | | | - Roberto Saldaña
- Confederación ACCU (Confederación de afectados por Crohn y Colitis Ulcerosa). Madrid. España
| | - Ángel Gil
- Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain
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Duffy D, Rouilly V, Braudeau C, Corbière V, Djebali R, Ungeheuer MN, Josien R, LaBrie ST, Lantz O, Louis D, Martinez-Caceres E, Mascart F, Ruiz de Morales JG, Ottone C, Redjah L, Guen NSL, Savenay A, Schmolz M, Toubert A, Albert ML. Standardized whole blood stimulation improves immunomonitoring of induced immune responses in multi-center study. Clin Immunol 2017; 183:325-335. [PMID: 28943400 DOI: 10.1016/j.clim.2017.09.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
Functional immune responses are increasingly important for clinical studies, providing in depth biomarker information to assess immunotherapy or vaccination. Incorporating functional immune assays into routine clinical practice has remained limited due to challenges in standardizing sample preparation. We recently described the use of a whole blood syringe-based system, TruCulture®, which permits point-of-care standardized immune stimulation. Here, we report on a multi-center clinical study in seven FOCIS Centers of Excellence to directly compare TruCulture to conventional PBMC methods. Whole blood and PBMCs from healthy donors were exposed to LPS, anti-CD3 anti-CD28 antibodies, or media alone. 55 protein analytes were analyzed centrally by Luminex multi-analyte profiling in a CLIA-certified laboratory. TruCulture responses showed greater reproducibility and improved the statistical power for monitoring differential immune response activation. The use of TruCulture addresses a major unmet need through a robust and flexible method for immunomonitoring that can be reproducibly applied in multi-center clinical studies. ONE SENTENCE SUMMARY A multi-center study revealed greater reproducibility from whole blood stimulation systems as compared to PBMC stimulation for studying induced immune responses.
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Affiliation(s)
- Darragh Duffy
- Center for Translational Research, Institut Pasteur, Paris, France; Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France; INSERM U1223, Institut Pasteur, Paris, France.
| | - Vincent Rouilly
- Center for Translational Research, Institut Pasteur, Paris, France
| | - Cecile Braudeau
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, Inserm, Université de Nantes, Nantes, France
| | - Véronique Corbière
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Raouf Djebali
- Center for Translational Research, Institut Pasteur, Paris, France
| | - Marie-Noelle Ungeheuer
- Center for Translational Research, Institut Pasteur, Paris, France; ICAReB Platform, Center for Translational Research, Institut Pasteur, Paris, France
| | - Regis Josien
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, Inserm, Université de Nantes, Nantes, France; LabEx IGO Immunotherapy Graf-Oncology, Nantes, France
| | | | - Olivier Lantz
- Laboratoire d'Immunologie clinique, CIC-4218 et Unité Inserm 932 Institut Curie, Paris, France
| | - Delphine Louis
- Laboratoire d'Immunologie clinique, CIC-4218 et Unité Inserm 932 Institut Curie, Paris, France
| | - Eva Martinez-Caceres
- Germans Trias i Pujol Hospital, Dept Cellular Biology, Physiology, Immunology, UAB, Barcelona, Spain
| | - Francoise Mascart
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles (ULB), Brussels, Belgium; Immunobiology Clinic, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Catherine Ottone
- Center for Translational Research, Institut Pasteur, Paris, France; ICAReB Platform, Center for Translational Research, Institut Pasteur, Paris, France
| | - Lydia Redjah
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nina Salabert-Le Guen
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR 1064, Inserm, Université de Nantes, Nantes, France; LabEx IGO Immunotherapy Graf-Oncology, Nantes, France
| | - Alain Savenay
- INSERM UMR1160, Université Paris Diderot, AP-HP, Hopital St Louis, Paris, France
| | | | - Antoine Toubert
- INSERM UMR1160, Université Paris Diderot, AP-HP, Hopital St Louis, Paris, France
| | - Matthew L Albert
- Center for Translational Research, Institut Pasteur, Paris, France; Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France; INSERM U1223, Institut Pasteur, Paris, France; Department of Cancer Immunology, Genentech Inc., San Francisco, CA 94080, USA.
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Ruiz de Morales JG, Muñoz F, Hernando M. Successful Treatment of Common Variable Immunodeficiency-associated Inflammatory Bowel Disease With Ustekinumab. J Crohns Colitis 2017; 11:1154-1155. [PMID: 28333242 DOI: 10.1093/ecco-jcc/jjx024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/16/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Jose G Ruiz de Morales
- Department of Clinical Immunology, Complejo Hospitalario Universitario de León, León, Spain
| | - Fernando Muñoz
- Department of Gastroenterology, Complejo Hospitalario Universitario de León, León, Spain
| | - Mercedes Hernando
- Department of Pathology, Complejo Hospitalario Universitario de León, León, Spain
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Cordero-Coma M, Calleja-Antolín S, Garzo-García I, Nuñez-Garnés AM, Álvarez-Castro C, Franco-Benito M, Ruiz de Morales JG. Adalimumab for Treatment of Noninfectious Uveitis: Immunogenicity and Clinical Relevance of Measuring Serum Drug Levels and Antidrug Antibodies. Ophthalmology 2016; 123:2618-2625. [PMID: 27692527 DOI: 10.1016/j.ophtha.2016.08.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the rate of immunogenicity induced by adalimumab and its relationship with drug serum levels and clinical responses in patients with noninfectious uveitis. DESIGN Prospective observational study. PARTICIPANTS Consecutive patients from 1 referral center who initiated treatment with adalimumab for active noninfectious uveitis resistant to conventional therapy. METHODS All patients received 40 mg adalimumab every other week. Patients were evaluated clinically and immunologically before and after 4, 8, and 24 weeks of treatment. MAIN OUTCOME MEASURES Clinical evaluation included assessment of changes in visual acuity, degree of inflammation in the anterior chamber and vitreous cavity, central macular thickness, and retinal angiographic leakage. Immunologic evaluation included assessment of serum trough adalimumab and antibodies against adalimumab (AAA) levels and class II HLA typing. RESULTS Twenty-five patients were enrolled. Overall, 18 of 25 patients (72%) showed a favorable clinical response to adalimumab therapy. Eleven patients (44%) achieved a complete response and 7 (28%) achieved a partial response. However, 7 of 25 patients (28%) were considered nonresponders. Median trough adalimumab serum levels were higher in responders than in nonresponders (P < 0.001). We observed AAA positivity (AAA+) at least 1 time point in 8 of 25 patients (32%), including 4 with transitory AAA and 4 with permanent AAA. In all patients with permanent AAA+, trough adalimumab levels became undetectable (P < 0.001). However, in patients who demonstrated transitory AAA+, no correlation was observed between AAA titers and adalimumab trough levels (P = 0.2).Concomitant immunosuppression did not show any protective effect on adalimumab immunogenicity in our cohort. An association between the presence of AAA+ and a worse uveitis outcome was observed only in patients with permanent AAA+, which correlated with undetectable adalimumab trough levels (P = 0.014). CONCLUSIONS Treatment of noninfectious uveitis with adalimumab is associated with high rates of favorable clinical response. Overall, adalimumab trough levels were higher in responder patients. Development of permanent AAA was associated with undetectable trough adalimumab levels and worse uveitis outcome. Immunogenicity was more common in patients in whom uveitis was associated with a systemic disease and was not influenced by concomitant immunosuppressors.
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Affiliation(s)
- Miguel Cordero-Coma
- Uveitis Unit, Department of Ophthalmology, University Hospital of León, León, Spain; Instituto de Biomedicina (IBIOMED), University of León, León, Spain
| | | | - Irene Garzo-García
- Uveitis Unit, Department of Ophthalmology, University Hospital of León, León, Spain
| | - Ana M Nuñez-Garnés
- Immunology Service and Uveitis Unit, University Hospital of León, León, Spain
| | | | - Manuel Franco-Benito
- Uveitis Unit, Department of Ophthalmology, University Hospital of León, León, Spain
| | - Jose G Ruiz de Morales
- Instituto de Biomedicina (IBIOMED), University of León, León, Spain; Immunology Service and Uveitis Unit, University Hospital of León, León, Spain.
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Cordero-Coma M, Calleja S, Llorente M, Rodriguez E, Franco M, Ruiz de Morales JG. Serum cytokine profile in adalimumab-treated refractory uveitis patients: decreased IL-22 correlates with clinical responses. Ocul Immunol Inflamm 2013; 21:212-9. [PMID: 23617852 DOI: 10.3109/09273948.2013.770888] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To report the effect of adalimumab on serum cytokines in chronic refractory uveitis. METHODS Prospective study on the effects of adalimumab on serum cytokine levels at different time points in a cohort of 12 refractory chronic uveitis patients. Results were analyzed according to clinical outcomes and compared with systemic steroid-treated recurrent uveitis patients. RESULTS Before treatment, patients exhibited significantly increased IL-1β, IL-6, TNFα, IL-12 p70, IL-10, and IL-22. Adalimumab significantly decreased IL-6, and IL-12p70 at early time points (after 1 month of treatment). Adalimumab effects on IL-10 and IL-22 appeared later (after 6 months of treatment). IL-1β, IL-17A, and TNFα were not modified at any time point. Only decreased IL-22 serum levels correlated with disease activity (p = 0.011). These effects were not observed in steroid-treated patients. CONCLUSIONS Adalimumab induced drug-specific and time-dependent declines in serum levels of particular cytokines, although only IL-22 correlated with disease activity in 10 out 12 patients.
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Affiliation(s)
- Miguel Cordero-Coma
- Ophthalmology Department, Complejo Hospitalario Universitario de León, León, Spain
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Vivas S, Ruiz de Morales JG, Riestra S, Arias L, Fuentes D, Alvarez N, Calleja S, Hernando M, Herrero B, Casqueiro J, Rodrigo L. Duodenal biopsy may be avoided when high transglutaminase antibody titers are present. World J Gastroenterol 2009; 15:4775-80. [PMID: 19824110 PMCID: PMC2761554 DOI: 10.3748/wjg.15.4775] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the predictive value of tissue transglutaminase (tTG) antibodies for villous atrophy in adult and pediatric populations to determine if duodenal biopsy can be avoided.
METHODS: A total of 324 patients with celiac disease (CD; 97 children and 227 adults) were recruited prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet (GFD) and with normal tTG levels.
RESULTS: Adults showed less severe histopathology (26% vs 63%, P < 0.0001) and lower tTG antibody titers than children. Levels of tTG antibody correlated with Marsh type in both populations (r = 0.661, P < 0.0001). Multiple logistic regression revealed that only tTG antibody was an independent predictor for Marsh type 3 lesions, but clinical presentation type and age were not. A cut-off point of 30 U tTG antibody yielded the highest area under the receiver operating characteristic curve (0.854). Based on the predictive value of this cut-off point, up to 95% of children and 53% of adults would be correctly diagnosed without biopsy. Despite GFDs and decreased tTG antibody levels, 25% of the adults did not recover from villous atrophy during the second year after diagnosis.
CONCLUSION: Strongly positive tTG antibody titers might be sufficient for CD diagnosis in children. However, duodenal biopsy cannot be avoided in adults because disease presentation and monitoring are different.
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