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Li SC, Rabinovich CE, Becker ML, Torok KS, Ferguson PJ, Dedeoglu F, Hong S, Sivaraman V, Laxer RM, Stewart K, Ibarra MF, Mason T, Higgins G, Pope E, Li X, Lozy T, Fuhlbrigge RC. Capturing the Range of Disease Involvement in Localized Scleroderma: The Localized Scleroderma Total Severity Scale. Arthritis Care Res (Hoboken) 2024; 76:616-626. [PMID: 38148547 DOI: 10.1002/acr.25281] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Juvenile localized scleroderma (jLS) is a chronic autoimmune disease commonly associated with poor outcomes, including contractures, hemiatrophy, uveitis, and seizures. Despite improvements in treatment, >25% of patients with jLS have functional impairment. To improve patient evaluation, our workgroup developed the Localized scleroderma Total Severity Scale (LoTSS), an overall disease severity measure. METHODS LoTSS was developed as a weighted measure by a consensus process involving literature review, surveys, case vignettes, and multicriteria decision analysis. Feasibility was assessed in larger Childhood Arthritis and Rheumatology Research Alliance groups. Construct validity with physician assessment and inter-rater reliability was assessed using case vignettes. Additional evaluation was performed in a prospective patient cohort initiating treatment. RESULTS LoTSS severity items were organized into modules that reflect jLS disease patterns, with modules for skin, extracutaneous, and craniofacial manifestations. Construct validity of LoTSS was supported by a strong positive correlation with the Physician Global Assessment (PGA) of severity and damage and weak positive correlation with PGA-Activity, as expected. LoTSS was responsive, with a small effect size identified. Moderate-to-excellent inter-rater reliability was demonstrated. LoTSS was able to discriminate between patient subsets, with higher scores identified in those with greater disease burden and functional limitation. CONCLUSION We developed a new LS measure for assessing cutaneous and extracutaneous severity and have shown it to be reliable, valid, and responsive. LoTSS is the first measure that assesses and scores all the major extracutaneous manifestations in LS. Our findings suggest LoTSS could aid assessment and management of patients and facilitate outcome evaluation in treatment studies.
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Affiliation(s)
- Suzanne C Li
- Joseph M. Sanzari Children's Hospital, Hackensack, and Hackensack Meridian School of Medicine, Nutley, New Jersey
| | | | - Mara L Becker
- Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Sandy Hong
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Vidya Sivaraman
- The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Ronald M Laxer
- Temerty Faculty of Medicine, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katie Stewart
- Texas Children's Hospital and Baylor College of Medicine, Austin, Texas
| | | | | | - Gloria Higgins
- The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Elena Pope
- Temerty Faculty of Medicine, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Xiaohu Li
- Stevens Institute of Technology, Hoboken, New Jersey
| | - Tara Lozy
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey
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Charras A, Hofmann SR, Cox A, Schulze F, Russ S, Northey S, Liu X, Fang Y, Haldenby S, Hartmann H, Bassuk AG, Carvalho A, Sposito F, Grinstein L, Rösen-Wolff A, Meyer-Bahlburg A, Beresford MW, Lainka E, Foell D, Wittkowski H, Girschick HJ, Morbach H, Uebe S, Hüffmeier U, Ferguson PJ, Hedrich CM. P2RX7 gene variants associate with altered inflammasome assembly and reduced pyroptosis in chronic nonbacterial osteomyelitis (CNO). J Autoimmun 2024; 144:103183. [PMID: 38401466 DOI: 10.1016/j.jaut.2024.103183] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
Chronic nonbacterial osteomyelitis (CNO), an autoinflammatory bone disease primarily affecting children, can cause pain, hyperostosis and fractures, affecting quality-of-life and psychomotor development. This study investigated CNO-associated variants in P2RX7, encoding for the ATP-dependent trans-membrane K+ channel P2X7, and their effects on NLRP3 inflammasome assembly. Whole exome sequencing in two related transgenerational CNO patients, and target sequencing of P2RX7 in a large CNO cohort (N = 190) were conducted. Results were compared with publicly available datasets and regional controls (N = 1873). Findings were integrated with demographic and clinical data. Patient-derived monocytes and genetically modified THP-1 cells were used to investigate potassium flux, inflammasome assembly, pyroptosis, and cytokine release. Rare presumably damaging P2RX7 variants were identified in two related CNO patients. Targeted P2RX7 sequencing identified 62 CNO patients with rare variants (32.4%), 11 of which (5.8%) carried presumably damaging variants (MAF <1%, SIFT "deleterious", Polyphen "probably damaging", CADD >20). This compared to 83 of 1873 controls (4.4%), 36 with rare and presumably damaging variants (1.9%). Across the CNO cohort, rare variants unique to one (Median: 42 versus 3.7) or more (≤11 patients) participants were over-represented when compared to 190 randomly selected controls. Patients with rare damaging variants more frequently experienced gastrointestinal symptoms and lymphadenopathy while having less spinal, joint and skin involvement (psoriasis). Monocyte-derived macrophages from patients, and genetically modified THP-1-derived macrophages reconstituted with CNO-associated P2RX7 variants exhibited altered potassium flux, inflammasome assembly, IL-1β and IL-18 release, and pyroptosis. Damaging P2RX7 variants occur in a small subset of CNO patients, and rare P2RX7 variants may represent a CNO risk factor. Observations argue for inflammasome inhibition and/or cytokine blockade and may allow future patient stratification and individualized care.
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Affiliation(s)
- Amandine Charras
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Sigrun R Hofmann
- Department of Pediatrics, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Allison Cox
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Felix Schulze
- Department of Pediatrics, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Susanne Russ
- Department of Pediatrics, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Sarah Northey
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Xuan Liu
- Centre of Genome Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK
| | - Yongxiang Fang
- Centre of Genome Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK
| | - Sam Haldenby
- Centre of Genome Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK
| | - Hella Hartmann
- Light Microscopy Facility, Centre for Regenerative Therapies, Technische Universität Dresden, Germany
| | - Alexander G Bassuk
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Ana Carvalho
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Francesca Sposito
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Lev Grinstein
- Department of Pediatrics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Rösen-Wolff
- Department of Pediatrics, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Almut Meyer-Bahlburg
- Pediatric Rheumatology and Immunology, Department of Pediatrics, University Medicine Greifswald, Greifswald, Germany
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Elke Lainka
- Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Essen, Germany on behalf of the German Autoinflammatory Disease Network (AID Net), Germany
| | - Dirk Foell
- Department for Pediatric Rheumatology & Immunology, University Hospital Münster, Germany on behalf of the German Autoinflammatory Disease Network (AID Net), Germany
| | - Helmut Wittkowski
- Department for Pediatric Rheumatology & Immunology, University Hospital Münster, Germany on behalf of the German Autoinflammatory Disease Network (AID Net), Germany
| | | | - Henner Morbach
- Department of Pediatrics, University Hospital Würzburg, Germany
| | - Steffen Uebe
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrike Hüffmeier
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Polly J Ferguson
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Christian M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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3
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Wu EY, Oliver M, Scheck J, Lapidus S, Akca UK, Yasin S, Stern SM, Insalaco A, Pardeo M, Simonini G, Marrani E, Wang X, Huang B, Kovalick LK, Rosenwasser N, Casselman G, Liau A, Shao Y, Yang C, Mosa DM, Tucker L, Girschick H, Laxer RM, Akikusa JD, Hedrich CM, Onel K, Dedeoglu F, Twilt M, Ferguson PJ, Ozen S, Zhao Y. Feasibility of Conducting Comparative Effectiveness Research and Validation of a Clinical Disease Activity Score for Chronic Nonbacterial Osteomyelitis. J Rheumatol 2023; 50:1333-1340. [PMID: 37399459 PMCID: PMC10543471 DOI: 10.3899/jrheum.2022-1323] [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] [Accepted: 06/02/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Prospective comparative effectiveness research (CER) in chronic nonbacterial osteomyelitis (CNO) is lacking. Our objectives were to (1) determine the use and safety of each consensus treatment plan (CTP) regimen for CNO, (2) assess the feasibility of using the Chronic Nonbacterial Osteomyelitis International Registry (CHOIR) data for CER, and (3) develop and validate a CNO clinical disease activity score (CDAS) using CHOIR. METHODS Consenting children or young adults with CNO were enrolled into CHOIR. Demographic, clinical, and imaging data were prospectively collected. The CNO CDAS was developed through a Delphi survey and nominal group technique. External validation surveys were administered to CHOIR participants. RESULTS One hundred forty (78.2%) CHOIR participants enrolled between August 2018 and September 2020 received at least 1 CTP regimen. Baseline characteristics from different CTP groups were well matched. Patient pain, patient global assessment, and clinical CNO lesion count were key variables included in the CNO CDAS. The CDAS showed a strong correlation with patient/parent report of difficulty using a limb, back, or jaw and patient/parent report of disease severity, but a weak correlation with patient/parent report of fatigue, sadness, and worry. The change in CDAS was significant in patients reporting disease worsening or improvement (P < 0.001). The CDAS significantly decreased after initiating second-line treatments from median 12.0 (IQR 8.0-15.5) to 5.0 (IQR 3.0-12.0; P = 0.002). Although second-line treatments were well tolerated, psoriasis was the most common adverse event. CONCLUSION The CNO CDAS was developed and validated for disease monitoring and assessment of treatment effectiveness. CHOIR provided a comprehensive framework for future CER.
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Affiliation(s)
- Eveline Y Wu
- E.Y. Wu, MD, MSCR, L.K. Kovalick, PNP, Division of Rheumatology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Oliver
- M. Oliver, MD, MS, Division of Pediatric Rheumatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joshua Scheck
- J. Scheck, BS, N. Rosenwasser, MD, G. Casselman, BS, A. Liau, BS, Y. Shao, BS, C. Yang, BS, Y. Zhao, MD, PhD, Division of Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Sivia Lapidus
- S. Lapidus, MD, Division of Rheumatology, Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Ummusen Kaya Akca
- U. Kaya Akca, MD, S. Ozen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Shima Yasin
- S. Yasin, MD, MSc, P.J. Ferguson, MD, Division of Rheumatology, Allergy and Immunology, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Sara M Stern
- S.M. Stern, MD, Division of Rheumatology, Department of Pediatrics, The University of Utah, Salt Lake City, Utah, USA
| | - Antonella Insalaco
- A. Insalaco, MD, M. Pardeo, MD, Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Manuela Pardeo
- A. Insalaco, MD, M. Pardeo, MD, Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Gabriele Simonini
- G. Simonini, MD, E. Marrani, MD, Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Edoardo Marrani
- G. Simonini, MD, E. Marrani, MD, Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Xing Wang
- X. Wang, PhD, Biostatistics Epidemiology and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Bin Huang
- B. Huang, PhD, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Leonard K Kovalick
- E.Y. Wu, MD, MSCR, L.K. Kovalick, PNP, Division of Rheumatology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Natalie Rosenwasser
- J. Scheck, BS, N. Rosenwasser, MD, G. Casselman, BS, A. Liau, BS, Y. Shao, BS, C. Yang, BS, Y. Zhao, MD, PhD, Division of Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Gabriel Casselman
- J. Scheck, BS, N. Rosenwasser, MD, G. Casselman, BS, A. Liau, BS, Y. Shao, BS, C. Yang, BS, Y. Zhao, MD, PhD, Division of Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Adriel Liau
- J. Scheck, BS, N. Rosenwasser, MD, G. Casselman, BS, A. Liau, BS, Y. Shao, BS, C. Yang, BS, Y. Zhao, MD, PhD, Division of Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Yurong Shao
- J. Scheck, BS, N. Rosenwasser, MD, G. Casselman, BS, A. Liau, BS, Y. Shao, BS, C. Yang, BS, Y. Zhao, MD, PhD, Division of Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Claire Yang
- J. Scheck, BS, N. Rosenwasser, MD, G. Casselman, BS, A. Liau, BS, Y. Shao, BS, C. Yang, BS, Y. Zhao, MD, PhD, Division of Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Doaa Mosad Mosa
- D.M. Mosa, MD, Rheumatology and Rehabilitation Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
| | - Lori Tucker
- L. Tucker, MD, Division of Rheumatology, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hermann Girschick
- H. Girschick, Department of Pediatrics, Vivantes Clinic Friedrichshain, Berlin, Germany
| | - Ronald M Laxer
- R.M. Laxer, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | - Christian M Hedrich
- C.M. Hedrich, MD, PhD, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, UK
| | - Karen Onel
- K. Onel, MD, Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Fatma Dedeoglu
- F. Dedeoglu, MD, Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marinka Twilt
- M. Twilt, MD, Division of Rheumatology, Department of Paediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Polly J Ferguson
- S. Yasin, MD, MSc, P.J. Ferguson, MD, Division of Rheumatology, Allergy and Immunology, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Seza Ozen
- U. Kaya Akca, MD, S. Ozen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Yongdong Zhao
- J. Scheck, BS, N. Rosenwasser, MD, G. Casselman, BS, A. Liau, BS, Y. Shao, BS, C. Yang, BS, Y. Zhao, MD, PhD, Division of Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA;
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Sato TS, Ferguson PJ. Importance of recognizing spinal involvement in pediatric patients with chronic recurrent multifocal osteomyelitis. Pediatr Radiol 2023; 53:2104-2105. [PMID: 37246191 DOI: 10.1007/s00247-023-05691-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Affiliation(s)
- T Shawn Sato
- Department of Radiology, University of Iowa and Stead Family Children's Hospital, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
- Department of Pediatrics, University of Iowa and Stead Family Children's Hospital, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa and Stead Family Children's Hospital, 200 Hawkins Dr., Iowa City, IA, 52242, USA
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Todd BP, Luo Z, Gilkes N, Chimenti MS, Peterson Z, Mix MR, Harty JT, Nickl-Jockschat T, Ferguson PJ, Bassuk AG, Newell EA. Selective neuroimmune modulation by type I interferon drives neuropathology and neurologic dysfunction following traumatic brain injury. Acta Neuropathol Commun 2023; 11:134. [PMID: 37596685 PMCID: PMC10436463 DOI: 10.1186/s40478-023-01635-5] [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: 06/08/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
Accumulating evidence suggests that type I interferon (IFN-I) signaling is a key contributor to immune cell-mediated neuropathology in neurodegenerative diseases. Recently, we demonstrated a robust upregulation of type I interferon-stimulated genes in microglia and astrocytes following experimental traumatic brain injury (TBI). The specific molecular and cellular mechanisms by which IFN-I signaling impacts the neuroimmune response and neuropathology following TBI remains unknown. Using the lateral fluid percussion injury model (FPI) in adult male mice, we demonstrated that IFN α/β receptor (IFNAR) deficiency resulted in selective and sustained blockade of type I interferon-stimulated genes following TBI as well as decreased microgliosis and monocyte infiltration. Molecular alteration of reactive microglia also occurred with diminished expression of genes needed for MHC class I antigen processing and presentation following TBI. This was associated with decreased accumulation of cytotoxic T cells in the brain. The IFNAR-dependent modulation of the neuroimmune response was accompanied by protection from secondary neuronal death, white matter disruption, and neurobehavioral dysfunction. These data support further efforts to leverage the IFN-I pathway for novel, targeted therapy of TBI.
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Affiliation(s)
- Brittany P Todd
- Medical Scientist Training Program, University of Iowa, Iowa City, IA, USA
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, USA
| | - Zili Luo
- Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Noah Gilkes
- Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Michael S Chimenti
- Bioinformatics Division, Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | - Zeru Peterson
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, USA
| | - Madison R Mix
- Medical Scientist Training Program, University of Iowa, Iowa City, IA, USA
- Department of Pathology and Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa City, IA, USA
| | - John T Harty
- Department of Pathology and Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa City, IA, USA
| | - Thomas Nickl-Jockschat
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Alexander G Bassuk
- Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Elizabeth A Newell
- Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Ramachandran S, Zhao Y, Ferguson PJ. Update on treatment responses and outcome measure development in chronic nonbacterial osteomyelitis (CNO). Curr Opin Rheumatol 2023:00002281-990000000-00062. [PMID: 37433220 DOI: 10.1097/bor.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
PURPOSE OF REVIEW To review recent trends in treatment and recent progress in developing outcome measures needed for chronic nonbacterial osteomyelitis (CNO) clinical trials. RECENT FINDINGS CNO is an autoinflammatory bone disease. In a minority of patients, the disease is genetically driven, and diagnosis can be made by DNA sequencing. However, for nonsyndromic CNO there is no diagnostic test. The number of children with CNO appears to be increasing and damage is common. Increases in CNO diagnosis is due to raised awareness, increased availability of whole-body magnetic resonance imaging and rising incidence. Treatment remains empiric and it is unclear which second line treatment is superior. Tumor necrosis factor inhibitors (TNFi) and bisphosphonates continue to be used as second line agents for nonsteroidal anti-inflammatory drugs (NSAID) refractory CNO; newer immune modulatory medications are used if this fails. Validated classification criteria, clinical outcome measures and imaging scoring standards are needed for successful clinical trials. SUMMARY Best treatment for NSAID refractory CNO remains unclear. Classification criteria, clinical outcomes measures and standardized imaging scoring have been developed or are near completion. This will facilitate robust clinical trials in CNO with the goal of having approved medications for this painful disease.
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Affiliation(s)
- Shwetha Ramachandran
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Yongdong Zhao
- Department of Pediatrics, Seattle Children's Hospital. Seattle, Washington, USA
| | - Polly J Ferguson
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Mohanna M, Roberts E, Whitty L, Gritzfeld JF, Pain CE, Girschick HJ, Preston J, Hadjittofi M, Anderson C, Ferguson PJ, Theos A, Hedrich CM. Priorities in Chronic nonbacterial osteomyelitis (CNO) - results from an international survey and roundtable discussions. Pediatr Rheumatol Online J 2023; 21:65. [PMID: 37391782 DOI: 10.1186/s12969-023-00851-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder that predominantly affects children and young people. The pathophysiology and molecular mechanisms of CNO remain poorly understood, and diagnostic criteria and biomarkers are lacking. As a result, treatment is empiric and follows personal experience, case series and expert consensus plans. METHODS A survey was designed to gain insight on clinician and patient experiences of diagnosing and treating CNO and to collate opinions on research priorities. A version containing 24 questions was circulated among international expert clinicians and clinical academics (27 contacted, 21 responses). An equivalent questionnaire containing 20 questions was shared to explore the experience and priorities of CNO patients and family members (93 responses). RESULTS Responses were used to select topics for four moderated roundtable discussions at the "International Conference on CNO and autoinflammatory bone disease" (Liverpool, United Kingdom, May 25-26th, 2022). The group identified deciphering the pathophysiology of CNO to be the highest priority, followed by clinical trials, necessary outcome measures and classification criteria. Surprisingly, mental wellbeing scored behind these items. CONCLUSIONS Agreement exists among clinicians, academics, patients and families that deciphering the pathophysiology of CNO is of highest priority to inform clinical trials that will allow for the approval of medications for the treatment of CNO by regulatory agencies.
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Affiliation(s)
- M Mohanna
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Roberts
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - L Whitty
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J F Gritzfeld
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - C E Pain
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - H J Girschick
- Klinik Für Kinder- Und Jugendmedizin, Vivantes Netzwerk Für Gesundheit GmbH, Klinikum Im Friedrichshain, Berlin, Germany
| | - J Preston
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - M Hadjittofi
- Clinical Health Psychology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - C Anderson
- Royal Hospital for Children and Young People, Edinburgh, UK
| | - P J Ferguson
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - A Theos
- Department of Human Science, CRMO Patient/Parent Partner, Georgetown University, Washington, DC, USA
| | - C M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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Todd BP, Luo Z, Gilkes N, Chimenti MS, Peterson Z, Mix M, Harty JT, Nickl-Jockschat T, Ferguson PJ, Bassuk AG, Newell EA. Selective neuroimmune modulation by type I interferon drives neuropathology and neurologic dysfunction following traumatic brain injury. bioRxiv 2023:2023.06.06.543774. [PMID: 37333385 PMCID: PMC10274693 DOI: 10.1101/2023.06.06.543774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Accumulating evidence suggests that type I interferon (IFN-I) signaling is a key contributor to immune cell-mediated neuropathology in neurodegenerative diseases. Recently, we demonstrated a robust upregulation of type I interferon-stimulated genes in microglia and astrocytes following experimental traumatic brain injury (TBI). The specific molecular and cellular mechanisms by which IFN-I signaling impacts the neuroimmune response and neuropathology following TBI remains unknown. Using the lateral fluid percussion injury model (FPI) in adult male mice, we demonstrated that IFN α/β receptor (IFNAR) deficiency resulted in selective and sustained blockade of type I interferon-stimulated genes following TBI as well as decreased microgliosis and monocyte infiltration. Phenotypic alteration of reactive microglia also occurred with diminished expression of molecules needed for MHC class I antigen processing and presentation following TBI. This was associated with decreased accumulation of cytotoxic T cells in the brain. The IFNAR-dependent modulation of the neuroimmune response was accompanied by protection from secondary neuronal death, white matter disruption, and neurobehavioral dysfunction. These data support further efforts to leverage the IFN-I pathway for novel, targeted therapy of TBI.
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9
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Hedrich CM, Beresford MW, Dedeoglu F, Hahn G, Hofmann SR, Jansson AF, Laxer RM, Miettunen P, Morbach H, Pain CE, Ramanan AV, Roberts E, Schnabel A, Theos A, Whitty L, Zhao Y, Ferguson PJ, Girschick HJ. Gathering expert consensus to inform a proposed trial in chronic nonbacterial osteomyelitis (CNO). Clin Immunol 2023; 251:109344. [PMID: 37098355 DOI: 10.1016/j.clim.2023.109344] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/23/2022] [Accepted: 04/07/2023] [Indexed: 04/27/2023]
Abstract
Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease that primarily affects children and adolescents. CNO is associated with pain, bone swelling, deformity, and fractures. Its pathophysiology is characterized by increased inflammasome assembly and imbalanced expression of cytokines. Treatment is currently based on personal experience, case series and resulting expert recommendations. Randomized controlled trials (RCTs) have not been initiated because of the rarity of CNO, expired patent protection of some medications, and the absence of agreed outcome measures. An international group of fourteen CNO experts and two patient/parent representatives was assembled to generate consensus to inform and conduct future RCTs. The exercise delivered consensus inclusion and exclusion criteria, patent protected (excludes TNF inhibitors) treatments of immediate interest (biological DMARDs targeting IL-1 and IL-17), primary (improvement of pain; physician global assessment) and secondary endpoints (improved MRI; improved PedCNO score which includes physician and patient global scores) for future RCTs in CNO.
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Affiliation(s)
- C M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
| | - M W Beresford
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - F Dedeoglu
- Boston Children's Hospital & Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - G Hahn
- Department of Radiology, University Medical Center Carl Gustav Carus, TU Dresden, Germany
| | - S R Hofmann
- Department of Paediatrics, University Medical Center Carl Gustav Carus, TU Dresden, Germany
| | - A F Jansson
- Department of Pediatrics, Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - R M Laxer
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - P Miettunen
- University of Calgary, Calgary, Alberta, Canada
| | - H Morbach
- Pediatric Immunology, University Childrens' Hospital Würzburg, Würzburg, Germany
| | - C E Pain
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - A V Ramanan
- Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol and Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - E Roberts
- CNO/CRMO Patient Partner, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - A Schnabel
- Department of Paediatrics, University Medical Center Carl Gustav Carus, TU Dresden, Germany
| | - A Theos
- CNO/CRMO Patient/parent Partner, Department of Human Science, Georgetown University, Washington, DC, USA
| | - L Whitty
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Y Zhao
- Seattle Children's Hospital, University of Washington, Seattle, United States of America
| | - P J Ferguson
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - H J Girschick
- Vivantes Children's Hospital in Friedrichshain, Berlin, Germany
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10
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Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC, Johnson SR, Imundo LF, Winthrop KL, Arasaratnam RJ, Baden LR, Berard R, Bridges SL, Cheah JTL, Curtis JR, Ferguson PJ, Hakkarinen I, Onel KB, Schultz G, Sivaraman V, Smith BJ, Sparks JA, Vogel TP, Williams EA, Calabrese C, Cunha JS, Fontanarosa J, Gillispie-Taylor MC, Gkrouzman E, Iyer P, Lakin KS, Legge A, Lo MS, Lockwood MM, Sadun RE, Singh N, Sullivan N, Tam H, Turgunbaev M, Turner AS, Reston J. 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol 2023; 75:333-348. [PMID: 36597810 DOI: 10.1002/art.42386.10.1002/art.42386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs). METHODS This guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers, infectious diseases specialists, and patient representatives. Consensus required ≥70% agreement on both the direction and strength of each recommendation. RESULTS This guideline includes expanded indications for some vaccines in patients with RMDs, as well as guidance on whether to hold immunosuppressive medications or delay vaccination to maximize vaccine immunogenicity and efficacy. Safe approaches to the use of live attenuated vaccines in patients taking immunosuppressive medications are also addressed. Most recommendations are conditional and had low quality of supporting evidence. CONCLUSION Application of these recommendations should consider patients' individual risk for vaccine-preventable illness and for disease flares, particularly if immunosuppressive medications are held for vaccination. Shared decision-making with patients is encouraged in clinical settings.
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Affiliation(s)
- Anne R Bass
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Elie A Akl
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Lisa F Imundo
- Columbia University Irving Medical Center, New York, New York
| | | | - Reuben J Arasaratnam
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas
| | - Lindsey R Baden
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Roberta Berard
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - S Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Karen B Onel
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Vidya Sivaraman
- The Ohio State University and Nationwide Children's Hospital, Columbus
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Joanne S Cunha
- Brown University, Brown Physicians Inc., and Providence Veterans Affairs Medical Center, East Providence, Rhode Island
| | | | | | | | - Priyanka Iyer
- University of California Irvine Medical Center, Orange
| | - Kimberly S Lakin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Alexandra Legge
- Dalhousie University and QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mindy S Lo
- Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Herman Tam
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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11
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Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC, Johnson SR, Imundo LF, Winthrop KL, Arasaratnam RJ, Baden LR, Berard R, Bridges SL, Cheah JTL, Curtis JR, Ferguson PJ, Hakkarinen I, Onel KB, Schultz G, Sivaraman V, Smith BJ, Sparks JA, Vogel TP, Williams EA, Calabrese C, Cunha JS, Fontanarosa J, Gillispie-Taylor MC, Gkrouzman E, Iyer P, Lakin KS, Legge A, Lo MS, Lockwood MM, Sadun RE, Singh N, Sullivan N, Tam H, Turgunbaev M, Turner AS, Reston J. 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol 2023; 75:333-348. [PMID: 36597810 DOI: 10.1002/art.42386] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs). METHODS This guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers, infectious diseases specialists, and patient representatives. Consensus required ≥70% agreement on both the direction and strength of each recommendation. RESULTS This guideline includes expanded indications for some vaccines in patients with RMDs, as well as guidance on whether to hold immunosuppressive medications or delay vaccination to maximize vaccine immunogenicity and efficacy. Safe approaches to the use of live attenuated vaccines in patients taking immunosuppressive medications are also addressed. Most recommendations are conditional and had low quality of supporting evidence. CONCLUSION Application of these recommendations should consider patients' individual risk for vaccine-preventable illness and for disease flares, particularly if immunosuppressive medications are held for vaccination. Shared decision-making with patients is encouraged in clinical settings.
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Affiliation(s)
- Anne R Bass
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Elie A Akl
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Lisa F Imundo
- Columbia University Irving Medical Center, New York, New York
| | | | - Reuben J Arasaratnam
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas
| | - Lindsey R Baden
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Roberta Berard
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - S Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Karen B Onel
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Vidya Sivaraman
- The Ohio State University and Nationwide Children's Hospital, Columbus
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Joanne S Cunha
- Brown University, Brown Physicians Inc., and Providence Veterans Affairs Medical Center, East Providence, Rhode Island
| | | | | | | | - Priyanka Iyer
- University of California Irvine Medical Center, Orange
| | - Kimberly S Lakin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Alexandra Legge
- Dalhousie University and QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mindy S Lo
- Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Herman Tam
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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12
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Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC, Johnson SR, Imundo LF, Winthrop KL, Arasaratnam RJ, Baden LR, Berard R, Bridges SL, Cheah JTL, Curtis JR, Ferguson PJ, Hakkarinen I, Onel KB, Schultz G, Sivaraman V, Smith BJ, Sparks JA, Vogel TP, Williams EA, Calabrese C, Cunha JS, Fontanarosa J, Gillispie-Taylor MC, Gkrouzman E, Iyer P, Lakin KS, Legge A, Lo MS, Lockwood MM, Sadun RE, Singh N, Sullivan N, Tam H, Turgunbaev M, Turner AS, Reston J. 2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases. Arthritis Care Res (Hoboken) 2023; 75:449-464. [PMID: 36597813 DOI: 10.1002/acr.25045] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs). METHODS This guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers, infectious diseases specialists, and patient representatives. Consensus required ≥70% agreement on both the direction and strength of each recommendation. RESULTS This guideline includes expanded indications for some vaccines in patients with RMDs, as well as guidance on whether to hold immunosuppressive medications or delay vaccination to maximize vaccine immunogenicity and efficacy. Safe approaches to the use of live attenuated vaccines in patients taking immunosuppressive medications are also addressed. Most recommendations are conditional and had low quality of supporting evidence. CONCLUSION Application of these recommendations should consider patients' individual risk for vaccine-preventable illness and for disease flares, particularly if immunosuppressive medications are held for vaccination. Shared decision-making with patients is encouraged in clinical settings.
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Affiliation(s)
- Anne R Bass
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Elie A Akl
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Lisa F Imundo
- Columbia University Irving Medical Center, New York, New York
| | | | - Reuben J Arasaratnam
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas
| | - Lindsey R Baden
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Roberta Berard
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - S Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Karen B Onel
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Vidya Sivaraman
- The Ohio State University and Nationwide Children's Hospital, Columbus
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Joanne S Cunha
- Brown University, Brown Physicians Inc., and Providence Veterans Affairs Medical Center, East Providence, Rhode Island
| | | | | | | | - Priyanka Iyer
- University of California Irvine Medical Center, Orange
| | - Kimberly S Lakin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Alexandra Legge
- Dalhousie University and QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mindy S Lo
- Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Herman Tam
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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13
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging. Arthritis Care Res (Hoboken) 2022; 74:505-520. [PMID: 35233989 DOI: 10.1002/acr.24839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Recommendations in this guideline include the use of physical therapy and occupational therapy interventions; a healthy, well-balanced, age-appropriate diet; specific laboratory monitoring for medications; widespread use of immunizations; and shared decision-making with patients/caregivers. Disease management for all patients with JIA is addressed with respect to nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis, and a concurrent 2021 guideline on oligoarthritis, temporomandibular arthritis, and systemic JIA. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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14
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging. Arthritis Rheumatol 2022; 74:570-585. [PMID: 35233961 PMCID: PMC10127939 DOI: 10.1002/art.42036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Recommendations in this guideline include the use of physical therapy and occupational therapy interventions; a healthy, well-balanced, age-appropriate diet; specific laboratory monitoring for medications; widespread use of immunizations; and shared decision-making with patients/caregivers. Disease management for all patients with JIA is addressed with respect to nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis, and a concurrent 2021 guideline on oligoarthritis, temporomandibular arthritis, and systemic JIA. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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15
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2022; 74:521-537. [PMID: 35233986 PMCID: PMC10124899 DOI: 10.1002/acr.24853] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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16
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2022; 74:553-569. [PMID: 35233993 PMCID: PMC10161784 DOI: 10.1002/art.42037] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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17
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Abstract
Chronic nonbacterial osteomyelitis, or its most severe form, chronic recurrent multifocal osteomyelitis, is an autoinflammatory bone disease that causes skeletal inflammation characterized by bone pain and swelling that primarily affects children. It is a diagnosis of exclusion and its clinical presentation may mimic underlying infectious processes and malignancy. Clinical suspicion for this diagnosis and timely referral to pediatric rheumatology is crucial to achieve earlier diagnosis, appropriate treatment, and improved quality of life of affected patients and families. This article focuses on recent insights into the pathogenesis of chronic nonbacterial osteomyelitis and outlines recent advances and ongoing research.
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Affiliation(s)
- Farzana Nuruzzaman
- Pediatric Rheumatology, Stony Brook Children's Hospital, Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, Health Sciences Tower T11-060, Stony Brook, NY 11794, USA.
| | - Yongdong Zhao
- Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, MA.7.110 - Rheumatology, Seattle, WA 98105, USA
| | - Polly J Ferguson
- Pediatrics - Rheumatology, Allergy and Immunology, University of Iowa Carver College of Medicine, Med Labs, 25 South Grand, Iowa City, IA 52242, USA
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18
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Todd BP, Chimenti MS, Luo Z, Ferguson PJ, Bassuk AG, Newell EA. Traumatic brain injury results in unique microglial and astrocyte transcriptomes enriched for type I interferon response. J Neuroinflammation 2021; 18:151. [PMID: 34225752 PMCID: PMC8259035 DOI: 10.1186/s12974-021-02197-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 03/01/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background Traumatic brain injury (TBI) is a leading cause of death and disability that lacks neuroprotective therapies. Following a TBI, secondary injury response pathways are activated and contribute to ongoing neurodegeneration. Microglia and astrocytes are critical neuroimmune modulators with early and persistent reactivity following a TBI. Although histologic glial reactivity is well established, a precise understanding of microglia and astrocyte function following trauma remains unknown. Methods Adult male C57BL/6J mice underwent either fluid percussion or sham injury. RNA sequencing of concurrently isolated microglia and astrocytes was conducted 7 days post-injury to evaluate cell-type-specific transcriptional responses to TBI. Dual in situ hybridization and immunofluorescence were used to validate the TBI-induced gene expression changes in microglia and astrocytes and to identify spatial orientation of cells expressing these genes. Comparative analysis was performed between our glial transcriptomes and those from prior reports in mild TBI and other neurologic diseases to determine if severe TBI induces unique states of microglial and astrocyte activation. Results Our findings revealed sustained, lineage-specific transcriptional changes in both microglia and astrocytes, with microglia showing a greater transcriptional response than astrocytes at this subacute time point. Microglia and astrocytes showed overlapping enrichment for genes related to type I interferon signaling and MHC class I antigen presentation. The microglia and astrocyte transcriptional response to severe TBI was distinct from prior reports in mild TBI and other neurodegenerative and neuroinflammatory diseases. Conclusion Concurrent lineage-specific analysis revealed novel TBI-specific transcriptional changes; these findings highlight the importance of cell-type-specific analysis of glial reactivity following TBI and may assist with the identification of novel, targeted therapies.
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Affiliation(s)
- Brittany P Todd
- Medical Scientist Training Program, University of Iowa, Iowa City, IA, USA
| | - Michael S Chimenti
- Iowa Institute of Human Genetics, Bioinformatics Division, University of Iowa, Iowa City, IA, USA
| | - Zili Luo
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
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19
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Bhuyan F, de Jesus AA, Mitchell J, Leikina E, VanTries R, Herzog R, Onel KB, Oler A, Montealegre Sanchez GA, Johnson KA, Bichell L, Marrero B, De Castro LF, Huang Y, Calvo KR, Collins MT, Ganesan S, Chernomordik LV, Ferguson PJ, Goldbach-Mansky R. Novel Majeed Syndrome-Causing LPIN2 Mutations Link Bone Inflammation to Inflammatory M2 Macrophages and Accelerated Osteoclastogenesis. Arthritis Rheumatol 2021; 73:1021-1032. [PMID: 33314777 PMCID: PMC8252456 DOI: 10.1002/art.41624] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022]
Abstract
Objective To identify novel heterozygous LPIN2 mutations in a patient with Majeed syndrome and characterize the pathomechanisms that lead to the development of sterile osteomyelitis. Methods Targeted genetic analysis and functional studies assessing monocyte responses, macrophage differentiation, and osteoclastogenesis were conducted to compare the pathogenesis of Majeed syndrome to interleukin‐1 (IL‐1)–mediated diseases including neonatal‐onset multisystem inflammatory disease (NOMID) and deficiency of the IL‐1 receptor antagonist (DIRA). Results A 4‐year‐old girl of mixed ethnic background presented with sterile osteomyelitis and elevated acute‐phase reactants. She had a 17.8‐kb deletion on the maternal LPIN2 allele and a splice site mutation, p.R517H, that variably spliced out exons 10 and 11 on the paternal LPIN2 allele. The patient achieved long‐lasting remission receiving IL‐1 blockade with canakinumab. Compared to controls, monocytes and monocyte‐derived M1‐like macrophages from the patient with Majeed syndrome and those with NOMID or DIRA had elevated caspase 1 activity and IL‐1β secretion. In contrast, lipopolysaccharide‐stimulated, monocyte‐derived, M2‐like macrophages from the patient with Majeed syndrome released higher levels of osteoclastogenic mediators (IL‐8, IL‐6, tumor necrosis factor, CCL2, macrophage inflammatory protein 1α/β, CXCL8, and CXCL1) compared to NOMID patients and healthy controls. Accelerated osteoclastogenesis in the patient with Majeed syndrome was associated with higher NFATc1 levels, enhanced JNK/MAPK, and reduced Src kinase activation, and partially responded to JNK inhibition and IL‐1 (but not IL‐6) blockade. Conclusion We report 2 novel compound heterozygous disease‐causing mutations in LPIN2 in an American patient with Majeed syndrome. LPIN2 deficiency drives differentiation of proinflammatory M2‐like macrophages and enhances intrinsic osteoclastogenesis. This provides a model for the pathogenesis of sterile osteomyelitis which differentiates Majeed syndrome from other IL‐1–mediated autoinflammatory diseases.
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Affiliation(s)
- Farzana Bhuyan
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Adriana A de Jesus
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Jacob Mitchell
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Evgenia Leikina
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Rachel VanTries
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | | | | | - Andrew Oler
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | | | - Kim A Johnson
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Lena Bichell
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Bernadette Marrero
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | | | - Yan Huang
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | | | - Michael T Collins
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, Maryland
| | - Sundar Ganesan
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Leonid V Chernomordik
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
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20
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Evans LP, Boehme N, Wu S, Burghardt EL, Akurathi A, Todd BP, Newell EA, Ferguson PJ, Mahajan VB, Dutca LM, Harper MM, Bassuk AG. Sex Does Not Influence Visual Outcomes After Blast-Mediated Traumatic Brain Injury but IL-1 Pathway Mutations Confer Partial Rescue. Invest Ophthalmol Vis Sci 2021; 61:7. [PMID: 33030508 PMCID: PMC7582458 DOI: 10.1167/iovs.61.12.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose In a mouse model of blast-mediated traumatic brain injury (bTBI), interleukin-1 (IL-1)-pathway components were tested as potential therapeutic targets for bTBI-mediated retinal ganglion cell (RGC) dysfunction. Sex was also evaluated as a variable for RGC outcomes post-bTBI. Methods Male and female mice with null mutations in genes encoding IL-1α, IL-1β, or IL-1RI were compared to C57BL/6J wild-type (WT) mice after exposure to three 20-psi blast waves given at an interblast interval of 1 hour or to mice receiving sham injury. To determine if genetic blockade of IL-1α, IL-1β, or IL-1RI could prevent damage to RGCs, the function and structure of these cells were evaluated by pattern electroretinogram and optical coherence tomography, respectively, 5 weeks following blast or sham exposure. RGC survival was also quantitatively assessed via immunohistochemical staining of BRN3A at the completion of the study. Results Our results showed that male and female WT mice had a similar response to blast-induced retinal injury. Generally, constitutive deletion of IL-1α, IL-1β, or IL-1RI did not provide full protection from the effects of bTBI on visual outcomes; however, injured WT mice had significantly worse visual outcomes compared to the injured genetic knockout mice. Conclusions Sex does not affect RGC outcomes after bTBI. The genetic studies suggest that deletion of these IL-1 pathway components confers some protection, but global deletion from birth did not result in a complete rescue.
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Affiliation(s)
- Lucy P Evans
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States.,Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, United States
| | - Nickolas Boehme
- Iowa City VA Health Care System Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Shu Wu
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
| | - Elliot L Burghardt
- Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, United States.,Department of Biostatistics, University of Iowa, Iowa City, Iowa, United States
| | - Abhigna Akurathi
- Iowa City VA Health Care System Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Brittany P Todd
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States.,Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, United States
| | - Elizabeth A Newell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
| | - Vinit B Mahajan
- Omics Laboratory, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States
| | - Laura M Dutca
- Iowa City VA Health Care System Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Matthew M Harper
- Iowa City VA Health Care System Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Alexander G Bassuk
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
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21
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Sato TS, Ferguson PJ. Whole-body MRI Imaging Is an Essential Tool in Diagnosing and Monitoring Patients With Sterile Osteomyelitis. J Rheumatol 2021; 48:635-637. [PMID: 33649064 DOI: 10.3899/jrheum.201507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Takashi Shawn Sato
- T.S. Sato, Clinical Assistant Professor, Divisions of Pediatric Radiology and Neuroradiology, Department of Radiology, Carver College of Medicine, University of Iowa
| | - Polly J Ferguson
- P.J. Ferguson, Professor, Division of Pediatric Rheumatology, Allergy and Immunology, Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
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22
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Li AS, Velez G, Darbro B, Toral MA, Yang J, Tsang SH, Ferguson PJ, Folk JC, Bassuk AG, Mahajan VB. Whole-Exome Sequencing of Patients With Posterior Segment Uveitis. Am J Ophthalmol 2021; 221:246-259. [PMID: 32707200 DOI: 10.1016/j.ajo.2020.07.021] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To elucidate molecular risk factors for posterior segment uveitis using a functional genomics approach. DESIGN Genetic association cohort study. METHODS Setting: Single-center study at an academic referral center. STUDY POPULATION 164 patients with clinically diagnosed uveitis of the posterior segment. MAIN OUTCOME MEASURES Exome sequencing was used to detect variants identified in 164 patients with posterior segment uveitis. A phenotype-driven analysis, protein structural modeling, and in silico calculations were then used to rank and predict the functional consequences of key variants. RESULTS A total of 203 single nucleotide variants, in 23 genes across 164 patients, were included in this study. Both known and novel variants were identified in genes previously implicated in specific types of syndromic uveitis-such as NOD2 (Blau syndrome) and CAPN5 NIV (neovascular inflammatory vitreoretinopathy)-as well as variants in genes not previously linked to posterior segment uveitis. Based on a ranked list and protein-protein-interaction network, missense variants in NOD-like receptor family genes (NOD2, NLRC4, NLRP3, and NLRP1), CAPN5, and TYK2 were characterized via structural modeling and in silico calculations to predict how specific variants might alter protein structure and function. The majority of analyzed variants were notably different from wild type. CONCLUSIONS This study implicates new pathways and immune signaling proteins that may be associated with posterior segment uveitis susceptibility. A larger cohort and functional studies will help validate the pathogenicity of the mutations identified. In specific cases, whole-exome sequencing can help diagnose nonsyndromic uveitis in patients harboring known variants for syndromic inflammatory diseases.
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Affiliation(s)
- Angela S Li
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California, USA; Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Gabriel Velez
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California, USA; Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA; Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, USA
| | - Benjamin Darbro
- Department of Pediatrics, Medical Genetics and Genomics, University of Iowa, Iowa City, Iowa, USA
| | - Marcus A Toral
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California, USA; Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA; Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, USA
| | - Jing Yang
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California, USA; Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Stephen H Tsang
- Barbara and Donald Jonas Laboratory of Stem Cells and Regenerative Medicine and Bernard & Shirlee Brown Glaucoma Laboratory, Edward S. Harkness Eye Institute, Columbia University, New York, New York, USA; Department of Pathology & Cell Biology, College of Physicians & Surgeons (S.H.T.), Columbia University, New York, New York, USA
| | - Polly J Ferguson
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Iowa, Iowa City, Iowa, USA
| | - James C Folk
- Department of Ophthalmology, University of Iowa, Iowa City, Iowa, USA
| | - Alexander G Bassuk
- Department of Neurology and Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Vinit B Mahajan
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California, USA; Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA; Veterans Affairs, Palo Alto HCS, Palo Alto, California, USA.
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23
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Perkins A, Stevens AM, Ferguson PJ, Zhao Y. Urinary N-telopeptide as a Biomarker of Disease Activity in Patients with Chronic Nonbacterial Osteomyelitis Who Have Not Received Bisphosphonates. J Rheumatol 2020; 47:1842-1844. [PMID: 33004538 DOI: 10.3899/jrheum.191098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Anne M Stevens
- Seattle Children's Hospital, Seattle, Washington, and Janssen Research & Development, LLC, Spring House, Pennsylvania
| | | | - Yongdong Zhao
- Seattle Children's Hospital and Clinical and Translational Research Center, Seattle, Washington, USA.
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24
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Abstract
An alarming increase in children presenting with fever, hyperinflammation, and multiorgan dysfunction frequently requiring intensive care has been observed after severe acute respiratory syndrome coronavirus 2 infection. The illness resembles Kawasaki disease (KD), with coronary dilatation and aneurysm occurring in some. However, the cardiovascular manifestations were typically on the severe end of the KD spectrum, with cardiogenic shock a common presentation together with other features. This led to defining a unique syndrome named multisystem inflammatory syndrome in children (MIS-C). In this issue of the JCI, Lee and Day-Lewis et al. and Diorio et al. explored the clinical profiles associated with coronavirus disease 2019 in children. We posit that while splitting MIS-C into a separate disease may aid clinical management decisions, lumping it into the KD pot may better serve to understand pathobiology.
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Affiliation(s)
- Rae Sm Yeung
- Department of Paediatrics, Immunology and Medical Science, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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25
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Lynton JJ, Mersch A, Ferguson PJ. Multidisciplinary practice advancement: Role of a clinical pharmacy specialist in a pediatric specialty clinic. Am J Health Syst Pharm 2020; 77:1771-1777. [DOI: 10.1093/ajhp/zxaa246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AbstractPurposeTo describe clinical pharmacy specialists’ role in improving the use of specialty medications within a pediatric outpatient setting.SummaryThe outpatient pediatric specialty clinic (PSC) at the University of Iowa added a clinical pharmacy specialist to multidisciplinary teams within the PSC to focus on patient education, providing clinical recommendations, coordinating insurance approval, addressing barriers to adherence, and performing follow-up monitoring. Supplemental activities include coordinating between the electronic health record–integrated on-site specialty pharmacy and the PSC, assisting with quality improvement projects, developing policy revisions, negotiating access to specialty products, and answering medication information questions. Benefits in workflow efficiency, documentation, and revenue generation resulting from implementation of the pharmacist within the PSC have been identified by the clinic and the specialty pharmacy. The specialty pharmacy identified an increase in the rate of specialty prescription capture from 14% to 50%, leading to an increase in revenue for the health system. Within 12 months of the addition of the pharmacist to the team, an improvement in the rate of 13-valent pneumococcal conjugate vaccine administration to pediatric patients of 25.7 percentage points, medication adherence of >90%, and a 75% relative increase in appropriate hydroxychloroquine dosing were recognized. Due to the pharmacist’s impact on the PSC, a full-time pharmacist was added to the pediatric team to cover additional clinics, and 2 benefits investigation technicians were hired and funded by the PSC.ConclusionAn interdisciplinary team with an integrated pharmacist has facilitated sustainable improvements in medication access and adherence and clinical and quality measures, benefiting patients, the pediatric clinic, the specialty pharmacy, and the hospital organization.
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Affiliation(s)
- Jessica J Lynton
- Specialty Pharmacy Services, University of Iowa Health Care, Iowa City, IA
| | - Alex Mersch
- Specialty Pharmacy Services, University of Iowa Health Care, Iowa City, IA
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa Health Care, Iowa City, IA
- University of Iowa Carver College of Medicine, Iowa City, IA
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26
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Zhao Y, Ferguson PJ. Chronic non-bacterial osteomyelitis and autoinflammatory bone diseases. Clin Immunol 2020; 216:108458. [PMID: 32389739 PMCID: PMC7338233 DOI: 10.1016/j.clim.2020.108458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Yongdong Zhao
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - Polly J Ferguson
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America.
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27
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Manthiram K, Preite S, Dedeoglu F, Demir S, Ozen S, Edwards KM, Lapidus S, Katz AE, Feder HM, Lawton M, Licameli GR, Wright PF, Le J, Barron KS, Ombrello AK, Barham B, Romeo T, Jones A, Srinivasalu H, Mudd PA, DeBiasi RL, Gül A, Marshall GS, Jones OY, Chandrasekharappa SC, Stepanovskiy Y, Ferguson PJ, Schwartzberg PL, Remmers EF, Kastner DL. Common genetic susceptibility loci link PFAPA syndrome, Behçet's disease, and recurrent aphthous stomatitis. Proc Natl Acad Sci U S A 2020; 117:14405-14411. [PMID: 32518111 PMCID: PMC7322016 DOI: 10.1073/pnas.2002051117] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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] [Indexed: 12/12/2022] Open
Abstract
Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome in children. The disease appears to cluster in families, but the pathogenesis is unknown. We queried two European-American cohorts and one Turkish cohort (total n = 231) of individuals with PFAPA for common variants previously associated with two other oropharyngeal ulcerative disorders, Behçet's disease and recurrent aphthous stomatitis. In a metaanalysis, we found that a variant upstream of IL12A (rs17753641) is strongly associated with PFAPA (OR 2.13, P = 6 × 10-9). We demonstrated that monocytes from individuals who are heterozygous or homozygous for this risk allele produce significantly higher levels of IL-12p70 upon IFN-γ and LPS stimulation than those from individuals without the risk allele. We also found that variants near STAT4, IL10, and CCR1-CCR3 were significant susceptibility loci for PFAPA, suggesting that the pathogenesis of PFAPA involves abnormal antigen-presenting cell function and T cell activity and polarization, thereby implicating both innate and adaptive immune responses at the oropharyngeal mucosa. Our results illustrate genetic similarities among recurrent aphthous stomatitis, PFAPA, and Behçet's disease, placing these disorders on a common spectrum, with recurrent aphthous stomatitis on the mild end, Behçet's disease on the severe end, and PFAPA intermediate. We propose naming these disorders Behçet's spectrum disorders to highlight their relationship. HLA alleles may be factors that influence phenotypes along this spectrum as we found new class I and II HLA associations for PFAPA distinct from Behçet's disease and recurrent aphthous stomatitis.
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Affiliation(s)
- Kalpana Manthiram
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892;
| | - Silvia Preite
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Fatma Dedeoglu
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115
| | - Selcan Demir
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232
| | - Sivia Lapidus
- Division of Pediatric Rheumatology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Health, Hackensack, NJ 07601
| | - Alexander E Katz
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
| | - Henry M Feder
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT 06106
| | - Maranda Lawton
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115
| | - Greg R Licameli
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115
| | - Peter F Wright
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756
| | - Julie Le
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
| | - Karyl S Barron
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Amanda K Ombrello
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
| | - Beverly Barham
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
| | - Tina Romeo
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
| | - Anne Jones
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
| | - Hemalatha Srinivasalu
- Division of Pediatric Rheumatology, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010
| | - Pamela A Mudd
- Division of Pediatric Otolaryngology, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010
| | - Roberta L DeBiasi
- Division of Pediatric Infectious Diseases, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010
| | - Ahmet Gül
- Department of Internal Medicine, Division of Rheumatology, Istanbul Faculty of Medicine, Istanbul University, 34093 Istanbul, Turkey
| | - Gary S Marshall
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202
| | - Olcay Y Jones
- Division of Pediatric Rheumatology, Walter Reed National Military Medical Center, Bethesda, MD 20889
| | | | - Yuriy Stepanovskiy
- Department of Pediatric Infectious Diseases and Pediatric Immunology, Shupyk National Medical Academy of Postgraduate Education, 04112 Kiev, Ukraine
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52242
| | - Pamela L Schwartzberg
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Elaine F Remmers
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
| | - Daniel L Kastner
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892;
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28
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Hildebrand JM, Kauppi M, Majewski IJ, Liu Z, Cox AJ, Miyake S, Petrie EJ, Silk MA, Li Z, Tanzer MC, Brumatti G, Young SN, Hall C, Garnish SE, Corbin J, Stutz MD, Di Rago L, Gangatirkar P, Josefsson EC, Rigbye K, Anderton H, Rickard JA, Tripaydonis A, Sheridan J, Scerri TS, Jackson VE, Czabotar PE, Zhang JG, Varghese L, Allison CC, Pellegrini M, Tannahill GM, Hatchell EC, Willson TA, Stockwell D, de Graaf CA, Collinge J, Hilton A, Silke N, Spall SK, Chau D, Athanasopoulos V, Metcalf D, Laxer RM, Bassuk AG, Darbro BW, Fiatarone Singh MA, Vlahovich N, Hughes D, Kozlovskaia M, Ascher DB, Warnatz K, Venhoff N, Thiel J, Biben C, Blum S, Reveille J, Hildebrand MS, Vinuesa CG, McCombe P, Brown MA, Kile BT, McLean C, Bahlo M, Masters SL, Nakano H, Ferguson PJ, Murphy JM, Alexander WS, Silke J. A missense mutation in the MLKL brace region promotes lethal neonatal inflammation and hematopoietic dysfunction. Nat Commun 2020; 11:3150. [PMID: 32561755 PMCID: PMC7305203 DOI: 10.1038/s41467-020-16819-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/27/2020] [Indexed: 12/13/2022] Open
Abstract
MLKL is the essential effector of necroptosis, a form of programmed lytic cell death. We have isolated a mouse strain with a single missense mutation, MlklD139V, that alters the two-helix 'brace' that connects the killer four-helix bundle and regulatory pseudokinase domains. This confers constitutive, RIPK3 independent killing activity to MLKL. Homozygous mutant mice develop lethal postnatal inflammation of the salivary glands and mediastinum. The normal embryonic development of MlklD139V homozygotes until birth, and the absence of any overt phenotype in heterozygotes provides important in vivo precedent for the capacity of cells to clear activated MLKL. These observations offer an important insight into the potential disease-modulating roles of three common human MLKL polymorphisms that encode amino acid substitutions within or adjacent to the brace region. Compound heterozygosity of these variants is found at up to 12-fold the expected frequency in patients that suffer from a pediatric autoinflammatory disease, chronic recurrent multifocal osteomyelitis (CRMO).
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Affiliation(s)
- Joanne M Hildebrand
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Maria Kauppi
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Ian J Majewski
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Zikou Liu
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Allison J Cox
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Sanae Miyake
- Department of Biochemistry, Toho University School of Medicine, Ota-ku, Tokyo, 143-8540, Japan
| | - Emma J Petrie
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Michael A Silk
- Department of Biochemistry and Molecular Biology, Bio21 Institute, University of Melbourne, Melbourne, VIC, 3052, Australia.,Computational Biology and Clinical Informatics, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Zhixiu Li
- Translational Genomics Group, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT) at Translational Research Institute, Brisbane, Australia
| | - Maria C Tanzer
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.,Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, 82152, Germany
| | - Gabriela Brumatti
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Samuel N Young
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Cathrine Hall
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Sarah E Garnish
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Jason Corbin
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Michael D Stutz
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.,Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, OR, 97006, USA
| | - Ladina Di Rago
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Pradnya Gangatirkar
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Emma C Josefsson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Kristin Rigbye
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Holly Anderton
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - James A Rickard
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.,The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia
| | - Anne Tripaydonis
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.,The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia
| | - Julie Sheridan
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Thomas S Scerri
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Victoria E Jackson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Peter E Czabotar
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Jian-Guo Zhang
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Leila Varghese
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.,Ludwig Institute for Cancer Research and de Duve Institute, Brussels, Belgium
| | - Cody C Allison
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Marc Pellegrini
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Gillian M Tannahill
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.,GSK Medicines Research Centre, Stevenage, UK
| | - Esme C Hatchell
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Tracy A Willson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Dina Stockwell
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Carolyn A de Graaf
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Janelle Collinge
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Adrienne Hilton
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
| | - Natasha Silke
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Sukhdeep K Spall
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Diep Chau
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.,CSL Limited, Parkville, VIC, 3052, Australia
| | - Vicki Athanasopoulos
- Department of Immunology and Infectious Disease and Centre for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Centre for Personalised Immunology (CACPI), Shanghai Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Donald Metcalf
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Alexander G Bassuk
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA.,Department of Neurology, University of Iowa Carver College of Medicine and the Iowa Neuroscience Institute, Iowa City, IA, USA
| | - Benjamin W Darbro
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Maria A Fiatarone Singh
- Faculty of Health Sciences and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nicole Vlahovich
- Department of Sports Medicine, Australian Institute of Sport, Bruce, ACT, Australia
| | - David Hughes
- Department of Sports Medicine, Australian Institute of Sport, Bruce, ACT, Australia
| | - Maria Kozlovskaia
- Department of Sports Medicine, Australian Institute of Sport, Bruce, ACT, Australia.,Faculty of Health, University of Canberra, Canberra, Australia
| | - David B Ascher
- Department of Biochemistry and Molecular Biology, Bio21 Institute, University of Melbourne, Melbourne, VIC, 3052, Australia.,Computational Biology and Clinical Informatics, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Klaus Warnatz
- Department of Internal Medicine, Clinic for Rheumatology and Clinical Immunology, Medical Center -University of Freiburg, Faculty of Medicine, Freiburg, 79106, Germany.,Center for Chronic Immunodeficiency, Medical Center -University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Nils Venhoff
- Department of Internal Medicine, Clinic for Rheumatology and Clinical Immunology, Medical Center -University of Freiburg, Faculty of Medicine, Freiburg, 79106, Germany
| | - Jens Thiel
- Department of Internal Medicine, Clinic for Rheumatology and Clinical Immunology, Medical Center -University of Freiburg, Faculty of Medicine, Freiburg, 79106, Germany
| | - Christine Biben
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Stefan Blum
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - John Reveille
- Memorial Hermann Texas Medical Centre, Houston, TX, USA
| | - Michael S Hildebrand
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, VIC, 3084, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Carola G Vinuesa
- Department of Immunology and Infectious Disease and Centre for Personalised Immunology (NHMRC Centre for Research Excellence), John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Centre for Personalised Immunology (CACPI), Shanghai Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Pamela McCombe
- The University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Matthew A Brown
- Translational Genomics Group, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT) at Translational Research Institute, Brisbane, Australia.,NIHR Biomedical Research Centre, Kings College, London, UK
| | - Benjamin T Kile
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, The Alfred Hospital, Prahran, VIC, 3181, Australia
| | - Melanie Bahlo
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Seth L Masters
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Hiroyasu Nakano
- Department of Biochemistry, Toho University School of Medicine, Ota-ku, Tokyo, 143-8540, Japan
| | - Polly J Ferguson
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - James M Murphy
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Warren S Alexander
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.
| | - John Silke
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia.
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29
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Amarilyo G, Rothman D, Manthiram K, Edwards KM, Li SC, Marshall GS, Yildirim-Toruner C, Haines K, Ferguson PJ, Lionetti G, Cherian J, Zhao Y, DeLaMora P, Syverson G, Nativ S, Twilt M, Michelow IC, Stepanovskiy Y, Thatayatikom A, Harel L, Akoghlanian S, Tucker L, Marques MC, Srinivasalu H, Propst EJ, Licameli GR, Dedeoglu F, Lapidus S. Consensus treatment plans for periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome (PFAPA): a framework to evaluate treatment responses from the childhood arthritis and rheumatology research alliance (CARRA) PFAPA work group. Pediatr Rheumatol Online J 2020; 18:31. [PMID: 32293478 PMCID: PMC7157990 DOI: 10.1186/s12969-020-00424-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/03/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome in children. There is considerable heterogeneity in management strategies and a lack of evidence-based treatment guidelines. Consensus treatment plans (CTPs) are standardized treatment regimens that are derived based upon best available evidence and current treatment practices that are a way to enable comparative effectiveness studies to identify optimal therapy and are less costly to execute than randomized, double blind placebo controlled trials. The purpose of this project was to develop CTPs and response criteria for PFAPA. METHODS The CARRA PFAPA Working Group is composed of pediatric rheumatologists, infectious disease specialists, allergists/immunologists and otolaryngologists. An extensive literature review was conducted followed by a survey to assess physician practice patterns. This was followed by virtual and in-person meetings between 2014 and 2018. Nominal group technique (NGT) was employed to develop CTPs, as well as inclusion criteria for entry into future treatment studies, and response criteria. Consensus required 80% agreement. RESULTS The PFAPA working group developed CTPs resulting in 4 different treatment arms: 1. Antipyretic, 2. Abortive (corticosteroids), 3. Prophylaxis (colchicine or cimetidine) and 4. Surgical (tonsillectomy). Consensus was obtained among CARRA members for those defining patient characteristics who qualify for participation in the CTP PFAPA study. CONCLUSION The goal is for the CTPs developed by our group to lead to future comparative effectiveness studies that will generate evidence-driven therapeutic guidelines for this periodic inflammatory disease.
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Affiliation(s)
- Gil Amarilyo
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | - Kalpana Manthiram
- grid.280128.10000 0001 2233 9230National Human Genome Research Institute, National Institutes of Health, Bethesda, MD USA
| | - Kathryn M. Edwards
- grid.152326.10000 0001 2264 7217Vanderbilt University School of Medicine, Nashville, TN USA
| | - Suzanne C. Li
- Joseph M Sanzari Children’s Hospital, Hackensack Meridian Health, Hackensack, NJ USA
| | - Gary S. Marshall
- grid.266623.50000 0001 2113 1622Department of Pediatrics, University of Louisville, Louisville, KY USA
| | | | - Kathleen Haines
- Joseph M Sanzari Children’s Hospital, Hackensack Meridian Health, Hackensack, NJ USA
| | - Polly J. Ferguson
- grid.214572.70000 0004 1936 8294Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Geraldina Lionetti
- grid.414016.60000 0004 0433 7727UCSF Benioff Children’s Hospital Oakland, Oakland, CA USA
| | - Julie Cherian
- grid.412695.d0000 0004 0437 5731Stony Brook University Hospital, Stony Brook, NY USA
| | - Yongdong Zhao
- grid.34477.330000000122986657Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - Patricia DeLaMora
- grid.5386.8000000041936877XWeill Cornell Medical College, New York, NY USA
| | - Grant Syverson
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Wauwatosa, WI USA
| | - Simona Nativ
- grid.429583.1Goryeb Children’s Hospital, Morristown, NJ USA
| | - Marinka Twilt
- grid.22072.350000 0004 1936 7697Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta Canada
| | - Ian C. Michelow
- grid.40263.330000 0004 1936 9094Alpert Medical School of Brown University, Providence, RI USA
| | - Yuriy Stepanovskiy
- grid.415616.10000 0004 0399 7926Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Akaluck Thatayatikom
- grid.15276.370000 0004 1936 8091Department of Pediatrics, University of Florida, Gainesville, FL USA
| | - Liora Harel
- grid.12136.370000 0004 1937 0546Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shoghik Akoghlanian
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA
| | - Lori Tucker
- grid.414137.40000 0001 0684 7788BC Children’s Hospital, Vancouver, BC Canada
| | - Mariana Correia Marques
- grid.38142.3c000000041936754XBoston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Hemalatha Srinivasalu
- grid.239560.b0000 0004 0482 1586Children’s National Medical Center, Washington, DC USA
| | - Evan J. Propst
- grid.17063.330000 0001 2157 2938Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Greg R. Licameli
- grid.38142.3c000000041936754XBoston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Fatma Dedeoglu
- grid.38142.3c000000041936754XBoston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Sivia Lapidus
- Joseph M Sanzari Children’s Hospital, Hackensack Meridian Health, Hackensack, NJ USA
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Evans LP, Woll AW, Wu S, Todd BP, Hehr N, Hedberg-Buenz A, Anderson MG, Newell EA, Ferguson PJ, Mahajan VB, Harper MM, Bassuk AG. Modulation of Post-Traumatic Immune Response Using the IL-1 Receptor Antagonist Anakinra for Improved Visual Outcomes. J Neurotrauma 2020; 37:1463-1480. [PMID: 32056479 PMCID: PMC7249480 DOI: 10.1089/neu.2019.6725] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to characterize acute changes in inflammatory pathways in the mouse eye after blast-mediated traumatic brain injury (bTBI) and to determine whether modulation of these pathways could protect the structure and function of retinal ganglion cells (RGC). The bTBI was induced in C57BL/6J male mice by exposure to three 20 psi blast waves directed toward the head with the body shielded, with an inter-blast interval of one hour. Acute cytokine expression in retinal tissue was measured through reverse transcription-quantitative polymerase chain reaction (RT-qPCR) four hours post-blast. Increased retinal expression of interleukin (lL)-1β, IL-1α, IL-6, and tumor necrosis factor (TNF)α was observed in bTBI mice exposed to blast when compared with shams, which was associated with activation of microglia and macroglia reactivity, assessed via immunohistochemistry with ionized calcium binding adaptor molecule 1 and glial fibrillary acidic protein, respectively, one week post-blast. Blockade of the IL-1 pathway was accomplished using anakinra, an IL-1RI antagonist, administered intra-peritoneally for one week before injury and continuing for three weeks post-injury. Retinal function and RGC layer thickness were evaluated four weeks post-injury using pattern electroretinogram (PERG) and optical coherence tomography (OCT), respectively. After bTBI, anakinra treatment resulted in a preservation of RGC function and RGC structure when compared with saline treated bTBI mice. Optic nerve integrity analysis demonstrated a trend of decreased damage suggesting that IL-1 blockade also prevents axonal damage after blast. Blast exposure results in increased retinal inflammation including upregulation of pro-inflammatory cytokines and activation of resident microglia and macroglia. This may explain partially the RGC loss we observed in this model, as blockade of the acute inflammatory response after injury with the IL-1R1 antagonist anakinra resulted in preservation of RGC function and RGC layer thickness.
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Affiliation(s)
- Lucy P Evans
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.,Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, USA
| | - Addison W Woll
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
| | - Shu Wu
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Brittany P Todd
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Nicole Hehr
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Adam Hedberg-Buenz
- The Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, USA.,Department of Molecular Physiology and Biophysics, and University of Iowa, Iowa City, Iowa, USA
| | - Michael G Anderson
- The Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, USA.,Department of Molecular Physiology and Biophysics, and University of Iowa, Iowa City, Iowa, USA.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | | | - Polly J Ferguson
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Vinit B Mahajan
- Omics Laboratory, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Matthew M Harper
- The Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, USA.,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
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Newell EA, Todd BP, Luo Z, Evans LP, Ferguson PJ, Bassuk AG. A Mouse Model for Juvenile, Lateral Fluid Percussion Brain Injury Reveals Sex-Dependent Differences in Neuroinflammation and Functional Recovery. J Neurotrauma 2019; 37:635-646. [PMID: 31621484 PMCID: PMC7045348 DOI: 10.1089/neu.2019.6675] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 01/01/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability that lacks targeted therapies. Successful translation of promising neuroprotective therapies will likely require more precise identification of target populations through greater study of crucial biological factors like age and sex. A growing body of work supports the impact of these factors on response to and recovery from TBI. However, age and sex are understudied in TBI animal models. The first aim of this study was to demonstrate the feasibility of lateral fluid percussion injury (FPI) in juvenile mice as a model of pediatric TBI. Subsequently, we were interested in examining the impact of young age and sex on TBI outcome. After adapting the lateral FPI model to 21-day-old male and female mice, we characterized the molecular, histological, and functional outcomes. Whereas similar tissue injury was observed in male and female juvenile mice exposed to TBI, we observed differences in neuroinflammation and neurobehavioral function. Overall, our findings revealed less acute inflammatory cytokine expression, greater subacute microglial/macrophage accumulation, and greater neurological recovery in juvenile male mice after TBI. Given that ongoing brain development may affect progression of and recovery from TBI, juvenile models are of critical importance. The sex-dependent differences we discovered after FPI support the necessity of also including this biological variable in future TBI studies. Understanding the mechanisms underlying age- and sex-dependent differences may result in the discovery of novel therapeutic targets for TBI.
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Affiliation(s)
| | - Brittany P Todd
- Department of Pediatrics and University of Iowa, Iowa City, Iowa
| | - Zili Luo
- Department of Pediatrics and University of Iowa, Iowa City, Iowa
| | - Lucy P Evans
- Department of Pediatrics and University of Iowa, Iowa City, Iowa.,Medical Scientist Training Program, University of Iowa, Iowa City, Iowa
| | - Polly J Ferguson
- Department of Pediatrics and University of Iowa, Iowa City, Iowa
| | - Alexander G Bassuk
- Department of Pediatrics and University of Iowa, Iowa City, Iowa.,Medical Scientist Training Program, University of Iowa, Iowa City, Iowa
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Li SC, Torok KS, Rabinovich CE, Dedeoglu F, Becker ML, Ferguson PJ, Hong SD, Ibarra MF, Stewart K, Pope E, Higgins GC, Laxer RM, Mason T, Fuhlbrigge RC, Andrews T. Initial Results from a Pilot Comparative Effectiveness Study of 3 Methotrexate-based Consensus Treatment Plans for Juvenile Localized Scleroderma. J Rheumatol 2019; 47:1242-1252. [DOI: 10.3899/jrheum.190311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/27/2022]
Abstract
Objective.To perform a comparative effectiveness feasibility study in juvenile localized scleroderma (LS), using standardized treatment regimens (consensus treatment plans; CTP).Methods.A prospective, multicenter 1-year pilot observational cohort study was performed by Childhood Arthritis and Rheumatology Research Alliance (CARRA) LS workgroup members. Patients with active, moderate to severe juvenile LS were treated with one of 3 CTP: methotrexate alone, or in combination with intravenous (30 mg/kg/dose for 3 mos) or oral corticosteroids (2 mg/kg/day tapered by 48 weeks).Results.Fifty patients, with demographics typical for juvenile LS, were enrolled, and 44 (88%) completed the study. Most had extracutaneous involvement. Patients improved in all 3 CTP, with > 75% having a major or moderate level of improvement compared to baseline. Damage accrued in some patients. Major deviations from prescribed regimen resulted from medication intolerance (n = 6; 14%) or treatment failure (n = 11; 25%); failures occurred in all 3 CTP. Significant responses to treatment were demonstrated by LS skin scoring measures and overall physician assessments, with differences in response level identified in some patient subsets. Response differences were associated with baseline disease activity level, LS subtype, skin disease extent, and extracutaneous involvement.Conclusion.This study demonstrates the feasibility of conducting juvenile LS comparative effectiveness studies. The CTP were found to be safe, effective, and tolerable. Our assessments performed well. Because damage is common and may progress despite effective control of activity, we recommend initial treatment efficacy be evaluated primarily by activity measures. Potential confounders for response were identified that warrant further study.
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Zhao Y, Sato TS, Nielsen SM, Beer M, Huang M, Iyer RS, McGuire M, Ngo AV, Otjen JP, Panwar J, Stimec J, Thapa M, Toma P, Taneja A, Gove NE, Ferguson PJ. Development of a Scoring Tool for Chronic Nonbacterial Osteomyelitis Magnetic Resonance Imaging and Evaluation of its Interrater Reliability. J Rheumatol 2019; 47:739-747. [PMID: 31575701 DOI: 10.3899/jrheum.190186] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Serial magnetic resonance imaging (MRI) examinations are often needed in chronic nonbacterial osteomyelitis (CNO) to determine the objective response to treatment. Our objectives in this study were (1) to develop a consensus-based MRI scoring tool for clinical and research use in CNO; and (2) to evaluate interrater reliability and agreement using whole-body (WB)-MRI from children with CNO. METHODS Eleven pediatric radiologists discussed definitions and grading of signal intensity, size of signal abnormality within bone marrow, and associated features on MRI through monthly conference calls and a consensus meeting, using a nominal group technique in July 2017. WB-MRI scans from children with CNO were deidentified for training reading and an interrater reliability study. The reading by each radiologist was conducted in a randomized order. Interrater reliability for abnormal signal and severity were assessed using free-marginal κ statistics. RESULTS Radiologists reached a consensus on grading CNO-specific MRI findings and on describing bone units based on anatomy. A total of 45 sets of WB-MRI scans, including 4 sets of non-CNO MRI examinations, were selected for the final reading. The mean κ of each category of bones was > 0.7 with majority > 0.9 demonstrating substantial/almost perfect interrater reliability of readings among radiologists. The agreement on signal intensity and the size of signal abnormality within the most commonly affected bones (femur and tibia) were lower than those of other bones. CONCLUSION The chronic nonbacterial osteomyelitis magnetic resonance imaging scoring (CROMRIS) tool is a comprehensive standardized scoring tool for MRI in children with CNO. Our interrater study demonstrated good interrater reliability and agreement of readings.
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Affiliation(s)
- Yongdong Zhao
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. .,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine.
| | - T Shawn Sato
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Sabrina M Nielsen
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Meinrad Beer
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Mingqian Huang
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Ramesh S Iyer
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Michael McGuire
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Anh-Vu Ngo
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Jeffrey P Otjen
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Jyoti Panwar
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Jennifer Stimec
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Mahesh Thapa
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Paolo Toma
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Angela Taneja
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Nancy E Gove
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
| | - Polly J Ferguson
- From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Y. Zhao, MD, PhD, Seattle Children's Hospital, Department of Pediatrics, University of Washington, and Center for Clinical and Translational Research, Seattle Children's Research Institute; T.S. Sato, MD, Department of Radiology, University of Iowa Carver College of Medicine; S.M. Nielsen, MSc, Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, and The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark; M. Beer, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm; M. Huang, MD, Department of Radiology, Stony Brook University Hospital; R.S. Iyer, MD, MBA, Department of Radiology, Seattle Children's Hospital, University of Washington; M. McGuire, MD, Department of Radiology, Hackensack University Medical Center; A.V. Ngo, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J.P. Otjen, MD, Department of Radiology, Seattle Children's Hospital, University of Washington; J. Panwar, MD, FRCR, Department of Medical Imaging, Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College and Hospital;J. Stimec, MD, Department of Medical Imaging, Hospital for Sick Children, University of Toronto; M. Thapa, MD, MEd, Department of Radiology, Seattle Children's Hospital, University of Washington; P. Toma, MD, Department of Imaging, Bambino Gesù Children's Hospital; A. Taneja, MD, Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University; N.E. Gove, PhD, Center for Clinical and Translational Research, Seattle Children's Research Institute; P.J. Ferguson, MD, Department of Pediatrics, University of Iowa Carver College of Medicine
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Li SC, Fuhlbrigge RC, Laxer RM, Pope E, Ibarra MF, Stewart K, Mason T, Becker ML, Hong S, Dedeoglu F, Torok KS, Rabinovich CE, Ferguson PJ, Punaro M, Feldman BM, Andrews T, Higgins GC. Developing comparative effectiveness studies for a rare, understudied pediatric disease: lessons learned from the CARRA juvenile localized scleroderma consensus treatment plan pilot study. Pediatr Rheumatol Online J 2019; 17:43. [PMID: 31307476 PMCID: PMC6632199 DOI: 10.1186/s12969-019-0350-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/08/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We designed and initiated a pilot comparative effectiveness study for juvenile localized scleroderma (jLS), for which there is limited evidence on best therapy. We evaluated the process we used, in relation to the specific protocol and to the general task of identifying strategies for implementing studies in rare pediatric diseases. METHODS This was a prospective, multi-center, observational cohort study of 50 jLS patients initiating treatment, designed and conducted by the jLS group of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) from 2012 to 2015. A series of virtual and physical meetings were held to design the study, standardize clinical assessments, generate and refine disease activity and damage measures, and monitor the study. Patients were initiated on one of three standardized methotrexate-based treatment regimens (consensus treatment plans, CTPs) and monitored for 1 year. An optional bio-banking sub-study was included. RESULTS The target enrollment of 50 patients was achieved over 26 months at 10 sites, with patients enrolled into all CTPs. Enrolled patients were typical for jLS. Study eligibility criteria were found to perform well, capturing patients thought appropriate for treatment studies. Minor modifications to the eligibility criteria, primarily to facilitate recruitment for future studies, were discussed with consensus agreement reached on them by the jLS group. There were marked differences in site preferences for specific CTPs, with half the sites treating all their patients with the same CTP. Most patients (88%) completed the study, and 68% participated in the bio-banking substudy. CONCLUSIONS We demonstrate the feasibility of our approach for conducting comparative effectiveness research in a rare pediatric disease. Multi-center collaboration by dedicated investigators who met regularly was a key factor in the success of this project. Other factors that facilitate these studies include having a sufficient number of investigators to enroll in each regimen, and streamlining study approval and management.
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Affiliation(s)
- Suzanne C. Li
- Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, Imus PC337, 30 Prospect Ave, Hackensack, NJ 07061 USA
- Hackensack Meridian School of Medicine at Seton Hall University, Clifton, NJ USA
| | | | - Ronald M. Laxer
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Elena Pope
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | | | - Katie Stewart
- Texas Scottish Rite Hospital and UT Southwestern, Dallas, TX USA
| | | | | | - Sandy Hong
- University of Iowa Stead Family Children’s Hospital, Iowa City, IA USA
| | | | | | | | | | - Marilynn Punaro
- Texas Scottish Rite Hospital and UT Southwestern, Dallas, TX USA
| | - Brian M. Feldman
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Tracy Andrews
- Rutgers School of Public Health, Rutgers University, Newark, NJ USA
| | - Gloria C. Higgins
- The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
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Cox AJ, Grady F, Velez G, Mahajan VB, Ferguson PJ, Kitchen A, Darbro BW, Bassuk AG. In trans variant calling reveals enrichment for compound heterozygous variants in genes involved in neuronal development and growth. Genet Res (Camb) 2019; 101:e8. [PMID: 31190668 PMCID: PMC7045018 DOI: 10.1017/s0016672319000065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 01/09/2023] Open
Abstract
Compound heterozygotes occur when different variants at the same locus on both maternal and paternal chromosomes produce a recessive trait. Here we present the tool VarCount for the quantification of variants at the individual level. We used VarCount to characterize compound heterozygous coding variants in patients with epileptic encephalopathy and in the 1000 Genomes Project participants. The Epi4k data contains variants identified by whole exome sequencing in patients with either Lennox-Gastaut Syndrome (LGS) or infantile spasms (IS), as well as their parents. We queried the Epi4k dataset (264 trios) and the phased 1000 Genomes Project data (2504 participants) for recessive variants. To assess enrichment, transcript counts were compared between the Epi4k and 1000 Genomes Project participants using minor allele frequency (MAF) cutoffs of 0.5 and 1.0%, and including all ancestries or only probands of European ancestry. In the Epi4k participants, we found enrichment for rare, compound heterozygous variants in six genes, including three involved in neuronal growth and development - PRTG (p = 0.00086, 1% MAF, combined ancestries), TNC (p = 0.022, 1% MAF, combined ancestries) and MACF1 (p = 0.0245, 0.5% MAF, EU ancestry). Due to the total number of transcripts considered in these analyses, the enrichment detected was not significant after correction for multiple testing and higher powered or prospective studies are necessary to validate the candidacy of these genes. However, PRTG, TNC and MACF1 are potential novel recessive epilepsy genes and our results highlight that compound heterozygous variants should be considered in sporadic epilepsy.
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Affiliation(s)
- Allison J. Cox
- Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
- Interdisciplinary Graduate Program in Genetics, The University of Iowa, Iowa City, IA, USA
| | - Fillan Grady
- Medical Scientist Training Program, University of Iowa, Iowa City, IA, USA
| | - Gabriel Velez
- Medical Scientist Training Program, University of Iowa, Iowa City, IA, USA
- Omics Laboratory, Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Vinit B. Mahajan
- Omics Laboratory, Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Palo Alto Veterans Administration, Palo Alto, CA, USA
| | - Polly J. Ferguson
- Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
| | - Andrew Kitchen
- Department of Anthropology, The University of Iowa, Iowa City, IA, USA
| | | | - Alexander G. Bassuk
- Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
- Interdisciplinary Graduate Program in Genetics, The University of Iowa, Iowa City, IA, USA
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Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Holland GN, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Sen HN, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care Res (Hoboken) 2019; 71:703-716. [PMID: 31021540 DOI: 10.1002/acr.23871] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. CONCLUSION This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.
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Affiliation(s)
- Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gary N Holland
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Rayfel Schneider
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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37
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Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Rheumatol 2019; 71:846-863. [PMID: 31021537 DOI: 10.1002/art.40884] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
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Affiliation(s)
| | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Rayfel Schneider
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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38
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Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Holland GN, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Sen HN, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Rheumatol 2019; 71:864-877. [PMID: 31021511 DOI: 10.1002/art.40885] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. CONCLUSION This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.
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Affiliation(s)
- Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gary N Holland
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Rayfel Schneider
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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39
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Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken) 2019; 71:717-734. [PMID: 31021516 DOI: 10.1002/acr.23870] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
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Affiliation(s)
| | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Rayfel Schneider
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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40
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Farmer JR, Foldvari Z, Ujhazi B, De Ravin SS, Chen K, Bleesing JJH, Schuetz C, Al-Herz W, Abraham RS, Joshi AY, Costa-Carvalho BT, Buchbinder D, Booth C, Reiff A, Ferguson PJ, Aghamohammadi A, Abolhassani H, Puck JM, Adeli M, Cancrini C, Palma P, Bertaina A, Locatelli F, Di Matteo G, Geha RS, Kanariou MG, Lycopoulou L, Tzanoudaki M, Sleasman JW, Parikh S, Pinero G, Fischer BM, Dbaibo G, Unal E, Patiroglu T, Karakukcu M, Al-Saad KK, Dilley MA, Pai SY, Dutmer CM, Gelfand EW, Geier CB, Eibl MM, Wolf HM, Henderson LA, Hazen MM, Bonfim C, Wolska-Kuśnierz B, Butte MJ, Hernandez JD, Nicholas SK, Stepensky P, Chandrakasan S, Miano M, Westermann-Clark E, Goda V, Kriván G, Holland SM, Fadugba O, Henrickson SE, Ozen A, Karakoc-Aydiner E, Baris S, Kiykim A, Bredius R, Hoeger B, Boztug K, Pashchenko O, Neven B, Moshous D, Villartay JPD, Bousfiha AA, Hill HR, Notarangelo LD, Walter JE. Outcomes and Treatment Strategies for Autoimmunity and Hyperinflammation in Patients with RAG Deficiency. J Allergy Clin Immunol Pract 2019; 7:1970-1985.e4. [PMID: 30877075 DOI: 10.1016/j.jaip.2019.02.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although autoimmunity and hyperinflammation secondary to recombination activating gene (RAG) deficiency have been associated with delayed diagnosis and even death, our current understanding is limited primarily to small case series. OBJECTIVE Understand the frequency, severity, and treatment responsiveness of autoimmunity and hyperinflammation in RAG deficiency. METHODS In reviewing the literature and our own database, we identified 85 patients with RAG deficiency, reported between 2001 and 2016, and compiled the largest case series to date of 63 patients with prominent autoimmune and/or hyperinflammatory pathology. RESULTS Diagnosis of RAG deficiency was delayed a median of 5 years from the first clinical signs of immune dysregulation. Most patients (55.6%) presented with more than 1 autoimmune or hyperinflammatory complication, with the most common etiologies being cytopenias (84.1%), granulomas (23.8%), and inflammatory skin disorders (19.0%). Infections, including live viral vaccinations, closely preceded the onset of autoimmunity in 28.6% of cases. Autoimmune cytopenias had early onset (median, 1.9, 2.1, and 2.6 years for autoimmune hemolytic anemia, immune thrombocytopenia, and autoimmune neutropenia, respectively) and were refractory to intravenous immunoglobulin, steroids, and rituximab in most cases (64.7%, 73.7%, and 71.4% for autoimmune hemolytic anemia, immune thrombocytopenia, and autoimmune neutropenia, respectively). Evans syndrome specifically was associated with lack of response to first-line therapy. Treatment-refractory autoimmunity/hyperinflammation prompted hematopoietic stem cell transplantation in 20 patients. CONCLUSIONS Autoimmunity/hyperinflammation can be a presenting sign of RAG deficiency and should prompt further evaluation. Multilineage cytopenias are often refractory to immunosuppressive treatment and may require hematopoietic cell transplantation for definitive management.
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Affiliation(s)
- Jocelyn R Farmer
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Zsofia Foldvari
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Boglarka Ujhazi
- University of South Florida and Johns Hopkins All Children's Hospital, Saint Petersburg, Fla
| | - Suk See De Ravin
- Laboratory of Host Defenses, National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, Md
| | - Karin Chen
- Division of Allergy and Immunology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jack J H Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Catharina Schuetz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Waleed Al-Herz
- Faculty of Medicine, Pediatrics Department, Kuwait University, Kuwait City, Kuwait; Allergy and Clinical Immunology Unit, Pediatrics Department, Alsabah Hospital, Kuwait City, Kuwait
| | - Roshini S Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Avni Y Joshi
- Division of Pediatric Allergy/Immunology, Mayo Clinic Children's Center Rochester, Rochester, Minn
| | | | - David Buchbinder
- Pediatrics/Hematology, CHOC Children's Hospital - UC Irvine, Irvine, Calif
| | - Claire Booth
- Department of Paediatric Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Andreas Reiff
- Division of Rheumatology, Children's Hospital Los Angeles, Keck School of Medicine, USC, Los Angeles, Calif
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jennifer M Puck
- Department of Pediatrics, University of California San Francisco and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Mehdi Adeli
- Sidra Medicine, Weill Cornell Medicine, and Hamad Medical Corporation, Doha, Qatar
| | - Caterina Cancrini
- Academic Department of Pediatrics (DPUO), Unit of Immune and Infectious Diseases, Childrens' Hospital Bambino Gesù, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Palma
- Academic Department of Pediatrics (DPUO), Research Unit in Congenital and Perinatal Infection, Children's Hospital Bambino Gesù, Rome, Italy
| | - Alice Bertaina
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, IRCCS, Ospedale Bambino Gesù, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, IRCCS, Ospedale Bambino Gesù, Rome, Italy; Department of Pediatrics, Sapienza, University of Rome, Rome, Italy
| | - Gigliola Di Matteo
- Academic Department of Pediatrics (DPUO), Unit of Immune and Infectious Diseases, Childrens' Hospital Bambino Gesù, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Raif S Geha
- Immunology Division, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Maria G Kanariou
- Department of Immunology - Histocompatibility, Specialized Center & Referral Center for Primary Immunodeficiencies - Paediatric Immunology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Lilia Lycopoulou
- 1st Department of Pediatrics, University of Athens, Aghia Sofia Children's Hospital, Athens, Greece
| | - Marianna Tzanoudaki
- Department of Immunology - Histocompatibility, Specialized Center & Referral Center for Primary Immunodeficiencies - Paediatric Immunology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - John W Sleasman
- Division of Allergy, Immunology and Pulmonary Medicine, Duke University School of Medicine, Durham, NC
| | - Suhag Parikh
- Division of Pediatric Blood and Marrow Transplantation, Duke University School of Medicine, Durham, NC
| | - Gloria Pinero
- Division of Allergy, Immunology and Pulmonary Medicine, Duke University School of Medicine, Durham, NC
| | - Bernard M Fischer
- Division of Allergy, Immunology and Pulmonary Medicine, Duke University School of Medicine, Durham, NC
| | - Ghassan Dbaibo
- Department of Pediatrics and Adolescent Medicine, Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | - Ekrem Unal
- Division of Pediatric Hematology and Oncology & HCST Unit, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Turkan Patiroglu
- Division of Pediatric Hematology and Oncology & HCST Unit, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey; Division of Pediatric Immunology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Musa Karakukcu
- Division of Pediatric Hematology and Oncology & HCST Unit, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Khulood Khalifa Al-Saad
- Salmanyia Medical Complex, Department of Pediatrics, Division of Pediatric Hematology and Oncology, Manama, Bahrain
| | - Meredith A Dilley
- Department of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, Mass; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Cullen M Dutmer
- Division of Allergy & Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Erwin W Gelfand
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | | | - Martha M Eibl
- Immunology Outpatient Clinic, Vienna, Austria; Biomedizinische Forschungs GmbH, Vienna, Austria
| | - Hermann M Wolf
- Immunology Outpatient Clinic, Vienna, Austria; Sigmund Freud Private University-Medical School, Vienna, Austria
| | - Lauren A Henderson
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Melissa M Hazen
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Carmem Bonfim
- Hospital Infantil Pequeno Principe, Curitiba, Brazil
| | | | - Manish J Butte
- Division of Immunology, Allergy, and Rheumatology, Department of Pediatrics and Jeffrey Modell Diagnostic and Research Center, University of California, Los Angeles, Los Angeles, Calif
| | - Joseph D Hernandez
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, Calif
| | - Sarah K Nicholas
- Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Polina Stepensky
- Department of Bone Marrow Transplantation, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Shanmuganathan Chandrakasan
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Maurizio Miano
- Haematology Unit, Department of Pediatric Haematology-Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Emma Westermann-Clark
- Department of Internal Medicine, Division of Allergy/Immunology, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Vera Goda
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation, Central Hospital of Southern Pest- National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Gergely Kriván
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation, Central Hospital of Southern Pest- National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Steven M Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Md
| | - Olajumoke Fadugba
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Sarah E Henrickson
- Allergy Immunology Division, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa; Institute for Immunology, the University of Pennsylvania, Philadelphia, Pa
| | - Ahmet Ozen
- Marmara University School of Medicine, Division of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Elif Karakoc-Aydiner
- Marmara University School of Medicine, Division of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Safa Baris
- Marmara University School of Medicine, Division of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Ayca Kiykim
- Ministry of Health, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Robbert Bredius
- Department of Pediatrics, Section Pediatric Immunology, Infections and Stem Cell Transplantation, Leiden University Medical Center, Leiden, the Netherlands
| | - Birgit Hoeger
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria; CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria; CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria; St Anna Kinderspital and Children's Cancer Research Institute, Department of Pediatrics, Medical University of Vienna, Vienna, Austria; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Olga Pashchenko
- Department of Immunology, Pirogov Russian National Research Medical University, Russian Clinical Children's Hospital, Moscow, Russia
| | - Benedicte Neven
- Paris Descartes Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory "Immunogenetics of Pediatric Autoimmune Diseases", INSERM UMR1163, Université Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Despina Moshous
- Paris Descartes Sorbonne Paris Cité University, Imagine Institute, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory "Genome Dynamics in The Immune System", INSERM UMR1163, Université Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Jean-Pierre de Villartay
- Laboratory "Genome Dynamics in The Immune System", INSERM UMR1163, Université Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Ahmed Aziz Bousfiha
- Laboratoire d'Immunologie Clinique, d'Inflammation et d'Allergie LICIA, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco; Clinical Immunology Unit, Casablanca Children's Hospital, Ibn Rochd Medical School, Hassan II University, Casablanca, Morocco
| | - Harry R Hill
- Division of Clinical Immunology, Departments of Pathology, Pediatrics and Medicine, University of Utah, Salt Lake City, Utah
| | - Luigi D Notarangelo
- Haematology Unit, Department of Pediatric Haematology-Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Jolan E Walter
- University of South Florida and Johns Hopkins All Children's Hospital, Saint Petersburg, Fla; Division of Allergy and Immunology, Massachusetts General Hospital for Children, Boston, Mass.
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Nichols-Vinueza DX, Su HC, Rao VK, Bayer DK, Ferguson PJ, Parker R, Uzel G. Granulomatosis with Polyangiitis and Severe Systemic Eosinophilia Due to a Novel PIK3CD mutation. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Chronic nonbacterial osteomyelitis (CNO) is an innate immune system disorder that predominantly affects children. It can present as part of a syndrome or in isolation. It presents as bone pain with or without fever or objective swelling at the site. It is difficult to diagnose. Laboratory studies can be normal, whereas a biopsy reveals sterile osteomyelitis. Osteolytic or sclerotic bone changes may be seen on radiographs. However, MRI is more sensitive for detecting CNO and is considered the gold standard for monitoring the disease. Treatment depends on disease severity and includes nonsteroidal antiinflammatory drugs, bisphosphonates, and cytokine inhibitors.
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Affiliation(s)
- Yongdong Zhao
- Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, MA 7.110, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 4038 Boyd Tower, Iowa City, IA 52242, USA.
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Zhao Y, Wu EY, Oliver MS, Cooper AM, Basiaga ML, Vora SS, Lee TC, Fox E, Amarilyo G, Stern SM, Dvergsten JA, Haines KA, Rouster-Stevens KA, Onel KB, Cherian J, Hausmann JS, Miettunen P, Cellucci T, Nuruzzaman F, Taneja A, Barron KS, Hollander MC, Lapidus SK, Li SC, Ozen S, Girschick H, Laxer RM, Dedeoglu F, Hedrich CM, Ferguson PJ. Consensus Treatment Plans for Chronic Nonbacterial Osteomyelitis Refractory to Nonsteroidal Antiinflammatory Drugs and/or With Active Spinal Lesions. Arthritis Care Res (Hoboken) 2018; 70:1228-1237. [PMID: 29112802 DOI: 10.1002/acr.23462] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/31/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To develop standardized treatment regimens for chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis (CRMO), to enable comparative effectiveness treatment studies. METHODS Virtual and face-to-face discussions and meetings were held within the CNO/CRMO subgroup of the Childhood Arthritis and Rheumatology Research Alliance (CARRA). A literature search was conducted, and CARRA membership was surveyed to evaluate available treatment data and identify current treatment practices. Nominal group technique was used to achieve consensus on treatment plans for CNO refractory to nonsteroidal antiinflammatory drug (NSAID) monotherapy and/or with active spinal lesions. RESULTS Three consensus treatment plans (CTPs) were developed for the first 12 months of therapy for CNO patients refractory to NSAID monotherapy and/or with active spinal lesions. The 3 CTPs are methotrexate or sulfasalazine, tumor necrosis factor inhibitors with optional methotrexate, and bisphosphonates. Short courses of glucocorticoids and continuation of NSAIDs are permitted for all regimens. Consensus was achieved on these CTPs among CARRA members. Consensus was also reached on subject eligibility criteria, initial evaluations that should be conducted prior to the initiation of CTPs, and data items to collect to assess treatment response. CONCLUSION Three consensus treatment plans were developed for pediatric patients with CNO refractory to NSAIDs and/or with active spinal lesions. Use of these CTPs will provide additional information on efficacy and will generate meaningful data for comparative effectiveness research in CNO.
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Affiliation(s)
- Yongdong Zhao
- Seattle Children's Hospital, University of Washington, Seattle
| | | | - Melissa S Oliver
- Stanford Children's Health, Stanford University, Palo Alto, California
| | | | | | | | - Tzielan C Lee
- Stanford Children's Health, Stanford University, Palo Alto, California
| | - Emily Fox
- Children's Mercy, Kansas City, Missouri
| | - Gil Amarilyo
- Schneider Children's Medical Center of Israel, Petach Tikva Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Kathleen A Haines
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
| | | | - Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Julie Cherian
- Stony Brook Children's Hospital, Stony Brook, New York
| | - Jonathan S Hausmann
- Boston Children's Hospital and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Angela Taneja
- Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Karyl S Barron
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | - Suzanne C Li
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
| | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | | | - Ronald M Laxer
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Christian M Hedrich
- Children's Hospital Dresden, University Medical Center Carl Gustav Carus, TU Dresden, Dresden, Germany, and Institute of Translational Medicine, University of Liverpool, and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
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Velez G, Bassuk AG, Schaefer KA, Brooks B, Gakhar L, Mahajan M, Kahn P, Tsang SH, Ferguson PJ, Mahajan VB. A novel de novo CAPN5 mutation in a patient with inflammatory vitreoretinopathy, hearing loss, and developmental delay. Cold Spring Harb Mol Case Stud 2018; 4:mcs.a002519. [PMID: 29472286 PMCID: PMC5983175 DOI: 10.1101/mcs.a002519] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/29/2017] [Accepted: 02/16/2018] [Indexed: 12/05/2022] Open
Abstract
Mutations that activate the protease calpain-5 (CAPN5) cause a nonsyndromic adult-onset autoinflammatory eye disease characterized by uveitis, altered synaptic signaling, retinal degeneration, neovascularization, and intraocular fibrosis. We describe a pediatric patient with severe inflammatory vitreoretinopathy accompanied by hearing loss and developmental delay associated with a novel, de novo CAPN5 missense mutation (c.865C>T, p.Arg289Trp) that shows greater hyperactivation of the calpain protease, indicating a genotype–phenotype correlation that links mutation severity to proteolytic activity and the possibility of earlier onset syndromic disease with auditory and neurological abnormalities.
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Affiliation(s)
- Gabriel Velez
- Omics Laboratory, Stanford University, Palo Alto, California 94304, USA.,Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California 94304, USA.,Medical Scientist Training Program, University of Iowa, Iowa City, Iowa 52242, USA
| | - Alexander G Bassuk
- Department of Pediatrics, University of Iowa, Iowa City, Iowa 52242, USA
| | - Kellie A Schaefer
- Omics Laboratory, Stanford University, Palo Alto, California 94304, USA.,Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California 94304, USA
| | - Brian Brooks
- Pediatric, Developmental, and Genetic Eye Disease Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Lokesh Gakhar
- Department of Biochemistry, University of Iowa, Iowa City, Iowa 52242, USA.,Protein Crystallography Facility, University of Iowa, Iowa City, Iowa 52242, USA
| | - MaryAnn Mahajan
- Omics Laboratory, Stanford University, Palo Alto, California 94304, USA.,Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California 94304, USA
| | - Philip Kahn
- Department of Pediatrics, Division of Pediatric Rheumatology, New York University, New York, New York 10016, USA
| | - Stephen H Tsang
- Barbara and Donald Jonas Laboratory of Stem Cells and Regenerative Medicine and Bernard & Shirlee Brown Glaucoma Laboratory, Edward S. Harkness Eye Institute, Columbia University, New York, New York 10016, USA.,Department of Pathology & Cell Biology, College of Physicians & Surgeons, Columbia University, New York, New York 10032, USA
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa, Iowa City, Iowa 52242, USA
| | - Vinit B Mahajan
- Omics Laboratory, Stanford University, Palo Alto, California 94304, USA.,Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California 94304, USA.,Palo Alto Veterans Administration, Palo Alto, California 94538, USA
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45
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Evans LP, Newell EA, Mahajan M, Tsang SH, Ferguson PJ, Mahoney J, Hue CD, Vogel EW, Morrison B, Arancio O, Nichols R, Bassuk AG, Mahajan VB. Acute vitreoretinal trauma and inflammation after traumatic brain injury in mice. Ann Clin Transl Neurol 2018; 5:240-251. [PMID: 29560370 PMCID: PMC5846452 DOI: 10.1002/acn3.523] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/16/2022] Open
Abstract
Objective Limited attention has been given to ocular injuries associated with traumatic brain injury (TBI). The retina is an extension of the central nervous system and evaluation of ocular damage may offer a less‐invasive approach to gauge TBI severity and response to treatment. We aim to characterize acute changes in the mouse eye after exposure to two different models of TBI to assess the utility of eye damage as a surrogate to brain injury. Methods A model of blast TBI (bTBI) using a shock tube was compared to a lateral fluid percussion injury model (LFPI) using fluid pressure applied directly to the brain. Whole eyes were collected from mice 3 days post LFPI and 24 days post bTBI and were evaluated histologically using a hematoxylin and eosin stain. Results bTBI mice showed evidence of vitreous detachment in the posterior chamber in addition to vitreous hemorrhage with inflammatory cells. Subretinal hemorrhage, photoreceptor degeneration, and decreased cellularity in the retinal ganglion cell layer was also seen in bTBI mice. In contrast, eyes of LFPI mice showed evidence of anterior uveitis and subcapsular cataracts. Interpretation We demonstrated that variations in the type of TBI can result in drastically different phenotypic changes within the eye. As such, molecular and phenotypic changes in the eye following TBI may provide valuable information regarding the mechanism, severity, and ongoing pathophysiology of brain injury. Because vitreous samples are easily obtained, molecular changes within the eye could be utilized as biomarkers of TBI in human patients.
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Affiliation(s)
- Lucy P Evans
- Medical Scientist Training Program University of Iowa Iowa City Iowa.,Department of Pediatrics University of Iowa Iowa City Iowa
| | | | - MaryAnn Mahajan
- Omics Laboratory Department of Ophthalmology Stanford University Palo Alto California
| | - Stephen H Tsang
- Bernard and Shirlee Brown Glaucoma Laboratory and Barbara Donald Jonas Laboratory of Regenerative Medicine Columbia University New York New York.,Edward S. Harkness Eye Institute Columbia University New York New York.,Departments of Ophthalmology, Pathology & Cell Biology Institute of Human Nutrition Columbia University New York New York
| | | | | | - Christopher D Hue
- Department of Biomedical Engineering Columbia University New York New York
| | - Edward W Vogel
- Department of Biomedical Engineering Columbia University New York New York
| | - Barclay Morrison
- Department of Biomedical Engineering Columbia University New York New York
| | - Ottavio Arancio
- Department of Pathology & Cell Biology Taub Institute Columbia University New York New York
| | - Russell Nichols
- Department of Pathology & Cell Biology Taub Institute Columbia University New York New York
| | | | - Vinit B Mahajan
- Omics Laboratory Department of Ophthalmology Stanford University Palo Alto California.,Palo Alto Veterans Administration Palo Alto California
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Affiliation(s)
| | | | - Xinyu Bing
- University of Iowa, Iowa City, Iowa, USA
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Abstract
PURPOSE OF REVIEW Chronic non-bacterial osteomyelitis (CNO) with its most severe form chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder. We summarize the clinical presentation, diagnostic approaches, most recent advances in understanding the pathophysiology, and available treatment options and outcomes in CNO/CRMO. RECENT FINDINGS Though the exact molecular pathophysiology of CNO/CRMO remains somewhat elusive, it appears likely that variable defects in the TLR4/MAPK/inflammasome signaling cascade result in an imbalance between pro- and anti-inflammatory cytokine expressions in monocytes from CNO/CRMO patients. In this context, we present previously unpublished data on cytokine and chemokine expression in monocytes and tissues. CNO/CRMO is an autoinflammatory bone disorder resulting from imbalanced cytokine expression from innate immune cells. Though the exact molecular pathophysiology remains unclear, variable molecular defects appear to result in inflammasome activation and pro-inflammatory cytokine expression in monocytes from CNO/CRMO patients. Recent advances suggest signaling pathways and single molecules as biomarkers for CNO/CRMO as well as future treatment targets.
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Affiliation(s)
- Sigrun R Hofmann
- Pediatric Rheumatology and Immunology, Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Franz Kapplusch
- Pediatric Rheumatology and Immunology, Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Henner Morbach
- Pediatric Rheumatology and Immunology, Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Jessica Pablik
- Division of Pathology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Polly J Ferguson
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Christian M Hedrich
- Pediatric Rheumatology and Immunology, Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Department of Women's and Children's Health, Institute of Translational Medicine (Child Health), University of Liverpool, East Prescott Road, Liverpool, L14 5AB, UK.
- Department of Pediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
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48
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Moorthy LN, Muscal E, Riebschleger M, Klein-Gitelman M, Nigrovic LE, Horon JR, Rouster-Stevens K, Ferguson PJ, Eberhard BA, Brunner HI, Prahalad S, Schneider R, Nigrovic PA. Efficacy of an Interinstitutional Mentoring Program Within Pediatric Rheumatology. Arthritis Care Res (Hoboken) 2017; 68:645-51. [PMID: 26414673 DOI: 10.1002/acr.22732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/08/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The small size of many pediatric rheumatology programs translates into limited mentoring options for early career physicians. To address this problem, the American College of Rheumatology (ACR) and the Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed a subspecialty-wide interinstitutional mentoring program, the ACR/CARRA Mentoring Interest Group (AMIGO). We sought to assess the impact of this program on mentoring within pediatric rheumatology. METHODS In a longitudinal 3-year study, participant ratings from the AMIGO pilot program were compared with those after the program was opened to general enrollment. Access to mentoring as a function of career stage was assessed by surveys of the US and Canadian pediatric rheumatologists in 2011 and 2014, before and after implementation of AMIGO. RESULTS Participants in the pilot phase (19 dyads) and the general implementation phase (112 dyads) reported comparable success in establishing mentor contact, suitability of mentor-mentee pairing, and benefit with respect to career development, scholarship, and work-life balance. Community surveys showed that AMIGO participation as mentee was high among fellows (86%) and modest among junior faculty (31%). Implementation correlated with significant gains in breadth of mentorship and in overall satisfaction with mentoring for fellows but not junior faculty. CONCLUSION AMIGO is a career mentoring program that serves most fellows and many junior faculty in pediatric rheumatology across the US and Canada. Program evaluation data confirm that a subspecialty-wide interinstitutional mentoring program is feasible and can translate into concrete improvement in mentoring, measurable at the level of the whole professional community.
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Affiliation(s)
| | - Eyal Muscal
- Texas Children's Hospital, Baylor University College of Medicine, Houston
| | | | | | | | | | | | | | - B Anne Eberhard
- Hofstra-North Shore-Long Island Jewish School of Medicine, North Shore, New York
| | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sampath Prahalad
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Rayfel Schneider
- University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
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Cox AJ, Darbro BW, Laxer RM, Velez G, Bing X, Finer AL, Erives A, Mahajan VB, Bassuk AG, Ferguson PJ. Correction: Recessive coding and regulatory mutations in FBLIM1 underlie the pathogenesis of chronic recurrent multifocal osteomyelitis (CRMO). PLoS One 2017; 12:e0181222. [PMID: 28686717 PMCID: PMC5501673 DOI: 10.1371/journal.pone.0181222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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50
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Abstract
PURPOSE OF REVIEW We focus on recent advances in the understanding of the genetic, molecular, immunologic, and environmental factors implicated in the pathogenesis of autoinflammatory bone diseases including the syndromic and non-syndromic forms of chronic recurrent multifocal osteomyelitis (CRMO). RECENT FINDINGS Evidence implicating the IL-1 pathway in the pathogenesis of the Mendelian forms of CRMO is growing. LIPIN2 can regulate the NLRP3 inflammasome by affecting P2X7 receptor activation, and intracellular cholesterol can modulate P2X7R currents. Work in a mouse model of CRMO demonstrates that dietary manipulation can alter the microbiome and protect these mice from the development of sterile osteomyelitis in vivo. Although the genetic and immunologic basis of non-syndromic CRMO remains only partially understood, the IL-1 pathway is central to the pathogenesis in the syndromic autoinflammatory bone disorders. Recent work implicates lipids and the microbiome in sterile osteomyelitis.
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Affiliation(s)
- Allison J Cox
- Department of Pediatrics and the Inflammation Program, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Yongdong Zhao
- Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Polly J Ferguson
- Department of Pediatrics and the Inflammation Program, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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