1
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Eggenhuizen PJ, Cheong RMY, Lo C, Chang J, Ng BH, Ting YT, Monk JA, Loh KL, Broury A, Tay ESV, Shen C, Zhong Y, Lim S, Chung JX, Kandane-Rathnayake R, Koelmeyer R, Hoi A, Chaudhry A, Manzanillo P, Snelgrove SL, Morand EF, Ooi JD. Smith-specific regulatory T cells halt the progression of lupus nephritis. Nat Commun 2024; 15:899. [PMID: 38321013 PMCID: PMC10847119 DOI: 10.1038/s41467-024-45056-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024] Open
Abstract
Antigen-specific regulatory T cells (Tregs) suppress pathogenic autoreactivity and are potential therapeutic candidates for autoimmune diseases such as systemic lupus erythematosus (SLE). Lupus nephritis is associated with autoreactivity to the Smith (Sm) autoantigen and the human leucocyte antigen (HLA)-DR15 haplotype; hence, we investigated the potential of Sm-specific Tregs (Sm-Tregs) to suppress disease. Here we identify a HLA-DR15 restricted immunodominant Sm T cell epitope using biophysical affinity binding assays, then identify high-affinity Sm-specific T cell receptors (TCRs) using high-throughput single-cell sequencing. Using lentiviral vectors, we transduce our lead Sm-specific TCR into Tregs derived from patients with SLE who are anti-Sm and HLA-DR15 positive. Compared with polyclonal mock-transduced Tregs, Sm-Tregs potently suppress Sm-specific pro-inflammatory responses in vitro and suppress disease progression in a humanized mouse model of lupus nephritis. These results show that Sm-Tregs are a promising therapy for SLE.
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Affiliation(s)
- Peter J Eggenhuizen
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Rachel M Y Cheong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Cecilia Lo
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Janet Chang
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Boaz H Ng
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Yi Tian Ting
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Julie A Monk
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Khai L Loh
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Ashraf Broury
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Elean S V Tay
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Chanjuan Shen
- Department of Hematology, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
| | - Yong Zhong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Steven Lim
- Alfred Research Alliance Flow Cytometry Core Facility, Melbourne, VIC, Australia
| | - Jia Xi Chung
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Rangi Kandane-Rathnayake
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Alberta Hoi
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | | | | | - Sarah L Snelgrove
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | - Joshua D Ooi
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
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2
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Yeo AL, Kandane-Rathnayake R, Koelmeyer R, Golder V, Louthrenoo W, Chen YH, Cho J, Lateef A, Hamijoyo L, Luo SF, Wu YJJ, Navarra SV, Zamora L, Li Z, An Y, Sockalingam S, Katsumata Y, Harigai M, Hao Y, Zhang Z, Basnayake BMDB, Chan M, Kikuchi J, Takeuchi T, Bae SC, Oon S, O'Neill S, Goldblatt F, Ng KPL, Law A, Tugnet N, Kumar S, Tee C, Tee M, Ohkubo N, Tanaka Y, Lau CS, Nikpour M, Hoi A, Leech M, Morand EF. SMART-SLE: serology monitoring and repeat testing in systemic lupus erythematosus-an analysis of anti-double-stranded DNA monitoring. Rheumatology (Oxford) 2024; 63:525-533. [PMID: 37208196 PMCID: PMC10836977 DOI: 10.1093/rheumatology/kead231] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE Disease activity monitoring in SLE includes serial measurement of anti-double stranded-DNA (dsDNA) antibodies, but in patients who are persistently anti-dsDNA positive, the utility of repeated measurement is unclear. We investigated the usefulness of serial anti-dsDNA testing in predicting flare in SLE patients who are persistently anti-dsDNA positive. METHODS Data were analysed from patients in a multinational longitudinal cohort with known anti-dsDNA results from 2013 to 2021. Patients were categorized based on their anti-dsDNA results as persistently negative, fluctuating or persistently positive. Cox regression models were used to examine longitudinal associations of anti-dsDNA results with flare. RESULTS Data from 37 582 visits of 3484 patients were analysed. Of the patients 1029 (29.5%) had persistently positive anti-dsDNA and 1195 (34.3%) had fluctuating results. Anti-dsDNA expressed as a ratio to the normal cut-off was associated with the risk of subsequent flare, including in the persistently positive cohort (adjusted hazard ratio [HR] 1.56; 95% CI: 1.30, 1.87; P < 0.001) and fluctuating cohort (adjusted HR 1.46; 95% CI: 1.28, 1.66), both for a ratio >3. Both increases and decreases in anti-dsDNA more than 2-fold compared with the previous visit were associated with increased risk of flare in the fluctuating cohort (adjusted HR 1.33; 95% CI: 1.08, 1.65; P = 0.008) and the persistently positive cohort (adjusted HR 1.36; 95% CI: 1.08, 1.71; P = 0.009). CONCLUSION Absolute value and change in anti-dsDNA titres predict flares, including in persistently anti-dsDNA positive patients. This indicates that repeat monitoring of dsDNA has value in routine testing.
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Affiliation(s)
- Ai Li Yeo
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Rachel Koelmeyer
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Vera Golder
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Worawit Louthrenoo
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiacai Cho
- Rheumatology Divsion, National University Hospital, Singapore
| | - Aisha Lateef
- Rheumatology Divsion, National University Hospital, Singapore
| | - Laniyati Hamijoyo
- Department of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Shue-Fen Luo
- Department of Rheumatology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Yeong-Jian J Wu
- Department of Rheumatology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Sandra V Navarra
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Leonid Zamora
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Zhanguo Li
- Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
| | - Yuan An
- Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
| | | | - Yasuhiro Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yanjie Hao
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | | | - Madelynn Chan
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital, Singapore
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases and Hanyang University Institute for Rheumatology Research and Hanyang University Institute of Bioscience and Biotechnology, Seoul, South Korea
| | - Shereen Oon
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Sean O'Neill
- Rheumatology Department, Level 1 Liverpool Hospital, Liverpool, NSW, Australia
| | - Fiona Goldblatt
- Rheumatology Unit, Royal Adelaide Hospital and Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | - Annie Law
- Singapore General Hospital, Singapore
| | - Nicola Tugnet
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Sunil Kumar
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | - Cherica Tee
- University of the Philippines, Quezon City, Philippines
| | - Michael Tee
- University of the Philippines, Quezon City, Philippines
| | - Naoaki Ohkubo
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong, Hong Kong, China
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Alberta Hoi
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle Leech
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Eric F Morand
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
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3
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Connelly K, Eades LE, Koelmeyer R, Ayton D, Golder V, Kandane-Rathnayake R, Gregory K, Brunner H, Burke L, Arnaud L, Askanase A, Aranow C, Vital E, Pons-Estel G, Dantata K, Andersen J, Cornet A, Buie J, Sun Y, Tanaka Y, Simon L, Lahoud Y, Friedman A, Kalunian K, Zuraw Q, Werth V, Garces S, Morand EF. Towards a novel clinical outcome assessment for systemic lupus erythematosus: first outcomes of an international taskforce. Nat Rev Rheumatol 2023; 19:592-602. [PMID: 37433880 DOI: 10.1038/s41584-023-00993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/13/2023]
Abstract
Systemic lupus erythematosus (SLE) is a disease of high unmet therapeutic need. The challenge of accurately measuring clinically meaningful responses to treatment has hindered progress towards positive outcomes in SLE trials, impeding the approval of potential new therapies. Current primary end points used in SLE trials are based on legacy disease activity measures that were neither specifically designed for the clinical trial context, nor developed according to contemporary recommendations for clinical outcome assessments (COAs), such as that substantial patient input should be incorporated into their design. The Treatment Response Measure for SLE (TRM-SLE) Taskforce is a global collaboration of SLE clinician-academics, patients and patient representatives, industry partners and regulatory experts, established to realize the goal of developing a new COA for SLE clinical trials. The aim of this project is a novel COA designed specifically to measure treatment effects that are clinically meaningful to patients and clinicians, and intended for implementation in a trial end point that supports regulatory approval of novel therapeutic agents in SLE. This Consensus Statement reports the first outcomes of the TRM-SLE project, including a structured process for TRM-SLE development.
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Affiliation(s)
- Kathryn Connelly
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| | - Laura E Eades
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rachel Koelmeyer
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Vera Golder
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | | | - Kate Gregory
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Hermine Brunner
- Division of Rheumatology, Cincinnati Children's Hospital, University of Cincinnati, Cincinatti, OH, USA
| | | | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Autoimmune Diseases (RESO), Hopitaux Universitaires de Strasbourg, Strasbourg, Alsace, France
| | - Anca Askanase
- Lupus Center, Columbia University Medical Center, New York City, NY, USA
| | - Cynthia Aranow
- Lupus Centre of Excellence, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Ed Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Guillermo Pons-Estel
- Departamento de Medicina Interna, Centro Regional de Enfermedades Autoinmunes y Reumáticas de Grupo Oroño (GO CREAR), Rosario, Argentina
| | | | | | | | - Joy Buie
- Lupus Foundation of America, Washington, DC, USA
| | - Ying Sun
- Merck Healthcare KGaA, Darmstadt, Hesse, Germany
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan
| | | | | | | | - Kenneth Kalunian
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, CA, USA
| | - Qing Zuraw
- Janssen Research and Development, Spring House, PA, USA
| | - Victoria Werth
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Eric F Morand
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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4
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Tan BCH, Tang I, Bonin J, Koelmeyer R, Hoi A. The performance of different classification criteria for systemic lupus erythematosus in a real-world rheumatology department. Rheumatology (Oxford) 2022; 61:4509-4513. [PMID: 35348630 PMCID: PMC9629341 DOI: 10.1093/rheumatology/keac120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/17/2022] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE New classification criteria have been proposed to improve classification of systemic lupus erythematosus (SLE). We aimed to evaluate their performance by determining their sensitivity, specificity and accuracy in a real-world rheumatology department. METHODS SLE patients who were enrolled in the Australian Lupus Registry and Biobank were included and compared with controls recruited from other rheumatology clinics. Clinical and immunological features were reviewed, according to ACR 1997, SLICC 2012, EULAR/ACR 2019, or Systemic Lupus Erythematosus Risk Probability Index (SLERPI). Performance of each set of criteria was evaluated for the overall cohort and in a subgroup of patients with early SLE. RESULTS The study included 394 SLE and 123 control patients with other rheumatological conditions. Sensitivity was highest using SLICC 2012 or SLERPI 2020 criteria. Specificity was highest using ACR 1997 criteria. The SLICC 2012 criteria had the highest overall accuracy at 94.4% (95% CI: 91.7, 97.1%). In the subgroup analysis of SLE patients with early disease, SLICC 2012 performed similarly well. CONCLUSIONS The sensitivity and specificity of each set of classification criteria vary slightly, with SLICC 2012 and SLERPI 2020 having the highest sensitivities and the ACR 1997 criteria having the highest specificity in our patient cohort. All classification criteria serve as good instructional aids for clinicians to understand SLE manifestations. For the Australian Lupus Registry and Biobank, we will continue to use the ACR 1997 and/or SLICC 2012 as entry to the observational cohort.
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Affiliation(s)
- Brandon C H Tan
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University
| | - Isaac Tang
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University
| | - Julie Bonin
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University
| | - Alberta Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia
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Ko T, Koelmeyer R, Li N, Yap K, Yeo AL, Kent J, Pellicano R, Golder V, Kitching AR, Morand E, Hoi A. Predictors of infection requiring hospitalization in patients with systemic lupus erythematosus: a time-to-event analysis. Semin Arthritis Rheum 2022; 57:152099. [PMID: 36155969 DOI: 10.1016/j.semarthrit.2022.152099] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the predictors of serious infection in patients with systemic lupus erythematosus (SLE). METHODS Serious infections were identified in SLE patients in a prospectively-followed single centre cohort. Associations of serious infection with disease-related variables and medication use were analysed using Cox and related regression models. RESULTS 346 patients were followed for a mean (SD) of 6.6 (3.7) years. 86 episodes of serious infection were observed, with an incidence rate of 3.8 episodes per 100 person-years. Patients who had serious infection had higher baseline SLE Damage Index (SDI) and Charlston Comorbidity Index (CCI); they were also more likely to have high disease activity status (HDAS), and higher disease activity in multiple clinical domains, higher flare rates, higher time-adjusted prednisolone dose exposure, and less time in lupus low disease activity state (LLDAS). Patients who have received cyclophosphamide, rituximab and mycophenolate were more likely to have experienced serious infection. After multivariable adjustment in Cox regression analysis, cyclophosphamide, higher SDI score, and higher disease activity were associated with an increased hazard of first serious infection. History of previous serious infection conferred the highest risk. Lymphopenia was also a modest but statistically significant predictor of serious infection. CONCLUSION History of previous serious infection was the strongest predictor of serious infection in our SLE cohort. This study also suggests that clinical factors such as damage accrual, disease activity, and choice of immunosuppressant, can each have an independent risk in predicting serious infection particularly the first episode.
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Affiliation(s)
- Tina Ko
- Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
| | - Ning Li
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
| | - Kristy Yap
- Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
| | - Ai Li Yeo
- Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
| | - Joanna Kent
- Department of Nephrology, Monash Health, Clayton VIC 3168, Australia
| | - Rebecca Pellicano
- Department of Nephrology, Monash Health, Clayton VIC 3168, Australia
| | - Vera Golder
- Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia; Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
| | - A Richard Kitching
- Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia; Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
| | - Eric Morand
- Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia; Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
| | - Alberta Hoi
- Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia; Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.
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6
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Northcott M, Gearing LJ, Bonin J, Koelmeyer R, Hoi A, Hertzog PJ, Morand EF. Immunosuppressant exposure confounds gene expression analysis in systemic lupus erythematosus. Front Immunol 2022; 13:964263. [PMID: 36059457 PMCID: PMC9430375 DOI: 10.3389/fimmu.2022.964263] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe analysis of gene module expression in SLE is emerging as a tool to identify active biological pathways, with the aim of developing targeted therapies for subsets of patients. Detailed information on the effect of immunosuppressants on gene module expression is lacking. We aimed to examine the impact of medication exposure on gene module expression.MethodsA set of commercially available disease-relevant gene modules were measured in 730 whole blood samples from a dedicated lupus clinic on whom prospectively collected, contemporaneous clinical data including medication exposure were available.ResultsCompared to heathy controls, SLE patients showed over-expression of IFN and under-expression of B cell, T cell and pDC modules. Neutrophil module over-expression and under-expression of B and T cell modules were observed in patients with active lupus nephritis or highly active disease (SLEDAI-2K > 8), while Lupus Low Disease Activity State (LLDAS) had inverse associations. Disease activity in other organ domains was not associated with specific gene modules. In contrast, medications were associated with multiple effects. Glucocorticoid use was associated with under-expression of T cell, B cell and plasmablast modules, and over-expression of neutrophil modules. Mycophenolate and azathioprine exposure were associated with plasmablast module and B cell module under-expression respectively. Disease activity associations with neutrophil over-expression and lymphocyte module under-expression were attenuated by multivariable adjustment for medication exposure.ConclusionMedications have significant effect on gene module expression in SLE patients. These findings emphasize the need to control for medications in studies of gene expression in SLE.
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Affiliation(s)
- Melissa Northcott
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Linden J. Gearing
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia
| | - Julie Bonin
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Alberta Hoi
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Paul J. Hertzog
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia
| | - Eric F. Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
- *Correspondence: Eric F. Morand,
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7
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Hoi A, Toor S, Monk J, Chang J, Koelmeyer R, Papadaki A, Peters J, Vincent F, Ooi J, Morand EF. POS0774 ANTI-Sm AUTOANTIBODIES IDENTIFY A PHENOTYPE OF SEVERE SLE WITH AN ASSOCIATED SERUM BIOMARKER PROFILE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAntibodies to Smith (Sm) have been described as one of the most specific autoantibodies for systemic lupus erythematosus (SLE). Other than its association with lupus nephritis, there is, however, limited understanding of its clinical significance1,2.ObjectivesTo describe clinical associations and serum protein profiles of anti-Sm positivity in SLE.MethodsPatients fulfilling SLE classification criteria who were followed longitudinally in a prospective multicentre cohort were studied according to their baseline anti-Sm antibody status. Comparison between Sm+ and Sm- patients was made using descriptive statistics. Clinical associations of Sm positivity with patient disease characteristics were studied using logistic regression. In a subset, 211 serum analytes were measured using Quantibody, Luminex and ELISA assays. Associations between serum proteins and Sm positivity were studied using Least Absolute Shrinkage and Selection Operator (LASSO) penalised regression, adjusting for demographics (age, sex, ethnicity) and medication useResults383 patients were studied with median (IQR) follow-up of 4.9 (2,9) years; 65 (17%) had positive anti-Sm antibodies. Sm+ patients were significantly more likely to be of non-European ancestry (OR 2.73, 95% CI 1.55-4.82, p<0.001), and to be positive for anti-dsDNA antibodies (OR 2.8, 95% CI 2.3-3.4, p<0.001), anti-RNP antibodies (OR 15.7, 95% CI 13.9-17.8, p<0.001), direct anti-globulin test (OR 2.36, 95% CI 2.07-2.7, p<0.001) and hypocomplementemia (OR 7.73, 95% CI 5.1-11.7, p<0.001). Sm+ patients were significantly more likely to have active disease during the observation period in a range of organ domains, including mucocutaneous, renal, vasculitis and fever.More Sm+ patients had episodes of High Disease Activity Status (HDAS, SLEDAI-2K ≧10)3 (OR 3.07, 95% CI 1.70-5.54, p<0.001) and persistent active disease (time-adjusted mean SLEDAI-2K > 4) (OR 3.23. 95% CI 1.84-5.70, p<0.001). Conversely, fewer Sm+ patients attained LLDAS for ≥50% observed time (19.7% vs 41.8%, p=0.002). Sm+ patients were more likely to be treated with glucocorticoids, immunosuppressants, and rituximab. There was no significant difference in damage accrual between Sm + and Sm - patients.In serum protein analysis (n=197, 29 Sm+), LASSO modelling retained 3 proteins associated with Sm+ status, CXCL13, IL1RL1 and FLT1, along with Asian ethnicity and age. In analysis including pairwise interaction between predictors, 28 Sm+ associated proteins were identified, including CCL4, VCAM1, IL1RL1, Fcg R IIB/C, TDGF1, CEACAM1, TIMP1, BMP5, GDF15, and TNFRSF17.ConclusionAnti-Sm autoantibodies, present in 17% of SLE patients, were strongly associated with classical disease manifestations, more severe disease activity, and a specific serological and proteomic profile. These findings suggest anti-Sm+ SLE as a specific disease subset.References[1]Barada, FA., B.S. Andrews, J.S. Davis, R.P. Taylor, Antibodies to Sm in patients with systemic lupus erythematosus. Correlation of Sm antibody titers with disease activity and other laboratory parameters. Arthritis Rheum, 1981. 24:1236-1244[2]Arroyo-Avilla, M, Y. Santiago-Casas, G.McGwin, R.S. Cantor, M. Petri, R. Ramsey-Goldman, J.D. Reveille, R.P.Kimberly, G.S. Alarcon, L.M.Vila, E.E. Brown. Clinical Associations of anti-Smith antibodies in PROFILE: a multi-ethnic lupus cohort. 2015. 34:1217-1223[3]Koelmeyer, R., H.T. Nim, M. Nikpour, Y.B. Sun, A. Kao, O. Guenther, E. Morand, and A. Hoi, High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus. Lupus Sci Med, 2020. 7(1).AcknowledgementsI would like to acknowledge participants and clinicians involved with the Australian Lupus Registry & BiobankDisclosure of InterestsNone declared
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Northcott M, Jones S, Koelmeyer R, Bonin J, Vincent F, Kandane-Rathnayake R, Hoi A, Morand E. Type 1 interferon status in systemic lupus erythematosus: a longitudinal analysis. Lupus Sci Med 2022; 9:9/1/e000625. [PMID: 35197305 PMCID: PMC8867321 DOI: 10.1136/lupus-2021-000625] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/04/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Type 1 interferon (IFN) is key to the pathogenesis of SLE, evidenced by the expression of IFN-stimulated genes (ISGs) in most patients, but the clinical utility of serial ISG assessment remains unknown. With the emergence of IFN-blocking drugs, we aimed to examine IFN status in relation to clinical findings longitudinally to provide insights into the value of testing ISG levels over time. METHODS Clinical data and whole blood were collected prospectively on adult patients with SLE from a single tertiary lupus centre. IFN status was measured using a panel of ISGs. FINDINGS 729 samples were analysed from 205 patients. At baseline, 62.9% of patients were IFN high, 30.2% IFN low and 6.8% borderline. 142 patients had multiple samples collected, and 87.3% of these demonstrated stable ISG status over time. In longitudinal follow-up, IFN high patients had higher activity in multiple organ domains and spent less time in Lupus Low Disease Activity State, but IFN score did not correlate with SLE Disease Activity Index in individual patients. In the small subset of patients who had large fluctuations in ISG across the observation period, most had high-dose glucocorticoids that correlated with ISG suppression. However, low-moderate-dose glucocorticoids did not suppress ISG expression. CONCLUSION Although IFN high status is associated with indicators of more severe SLE, in the majority of patients, ISGs are stable across time and do not correlate with disease activity. Changes in ISG expression may be seen with high-dose, but not routine dose, glucocorticoid exposure. These findings suggest baseline but not serial ISG measurement may be of value in the management of SLE.
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Affiliation(s)
- Melissa Northcott
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Sarah Jones
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Julie Bonin
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Fabien Vincent
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Alberta Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Eric Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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Hoi A, Koelmeyer R, Bonin J, Sun Y, Kao A, Gunther O, Nim HT, Morand E. Disease course following High Disease Activity Status revealed patterns in SLE. Arthritis Res Ther 2021; 23:191. [PMID: 34261522 PMCID: PMC8278658 DOI: 10.1186/s13075-021-02572-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We sought to examine the disease course of High Disease Activity Status (HDAS) patients and their different disease patterns in a real-world longitudinal cohort. Disease resolution till Lupus Low Disease Activity State (LLDAS) has been a general treatment goal, but there is limited information on this subset of patients who achieve this. METHODS All consenting patients of the Monash Lupus Cohort who had at least 12 months of observation were included. HDAS was defined as SLEDAI-2K ≥ 10 ever, and HDAS episode as the period from the first HDAS clinic visit until attainment of LLDAS. We examined the associations of different HDAS patterns with the likelihood of damage accrual. RESULTS Of 342 SLE patients, 151 experienced HDAS at least once, accounting for 298 HDAS episodes. The majority of HDAS patients (76.2%) experienced Recurrent HDAS (> 1 HDAS visit), and a smaller subset (47.7%) had Persistent HDAS (consecutive HDAS visits for longer than 2 months). Recurrent or Persistent HDAS patients were younger at diagnosis and more likely to experience renal or serositis manifestations; persistent HDAS patients were also more likely to experience neurological manifestations. Baseline SLEDAI greater than 10 was associated with longer HDAS episodes. Recurrent and Persistent HDAS were both associated with an increased likelihood of damage accrual. The total duration of HDAS episode greater than 2 years and experiencing multiple HDAS episodes (≥4) was also associated with an increased likelihood of damage accrual (OR 1.80, 95% CI 1.08-2.97, p = 0.02, and OR 3.31, 95% CI 1.66-13.26, p = 0.01, respectively). CONCLUSION HDAS episodes have a highly variable course. Recurrent and Persistent HDAS, and longer duration of HDAS episodes, increased the risk of damage accrual. In addition to a major signifier of severity in SLE, its resolution to LLDAS can determine the subsequent outcome in SLE patients.
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Affiliation(s)
- Alberta Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.
- Department of Rheumatology, Monash Health, Clayton, VIC, 3168, Australia.
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Julie Bonin
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Ying Sun
- Merck Healthcare KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Amy Kao
- EMD Serono, EMD Serono Research & Development Institute, Inc, a business of Merck KGaA, Darmstadt, Germany
| | - Oliver Gunther
- Merck Healthcare KGaA, Frankfurter Strasse 250, 64293, Darmstadt, Germany
| | - Hieu T Nim
- Faculty of Information Technology, Monash University, Clayton, VIC, 3168, Australia
| | - Eric Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Department of Rheumatology, Monash Health, Clayton, VIC, 3168, Australia
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Koelmeyer R, Nim HT, Nikpour M, Sun YB, Kao A, Guenther O, Morand E, Hoi A. High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus. Lupus Sci Med 2021; 7:7/1/e000372. [PMID: 32467293 PMCID: PMC7259842 DOI: 10.1136/lupus-2019-000372] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Disease severity in SLE is an important concept related to disease activity, treatment burden and prognosis. We set out to evaluate if high disease activity status (HDAS), based on ever attainment of a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) disease activity score of ≥10, is an indicator for disease severity in SLE. METHODS Using prospectively collected data, we assessed the association of HDAS with sociodemographic and disease characteristics and adverse clinical outcomes using logistic regression or generalised estimating equations. RESULTS Of 286 patients with SLE, who were observed for a median (range) of 5.1 years (1-10.8 years), 43.7% experienced HDAS at least once during the observational period. Autoantibody positivity, particularly anti-dsDNA and anti-Sm positivity, were associated with increased likelihood of HDAS. Age ≥45 years at diagnosis was associated with reduced likelihood of HDAS (p=0.002). Patients with HDAS had higher Physician Global Assessment score (>1: OR 8.1, p<0.001) and were more likely to meet criteria for flare (mild/moderate flare: OR 4.4, p<0.001; severe flare: OR 17.2, p<0.001) at the time of experiencing HDAS. They were also more likely to have overall higher disease activity, as defined by time-adjusted mean SLEDAI-2K score in the highest quartile (OR 11.7, 95% CI 5.1 to 26.6; p>0.001), higher corticosteroid exposure (corticosteroid dose in highest quartile: OR 7.7, 95% CI 3.9 to 15.3; p<0.001) and damage accrual (OR 2.3, 95% CI 1.3 to 3.9; p=0.003) when compared with non-HDAS patients. CONCLUSIONS HDAS is associated with more severe disease, as measured by higher disease activity across time, corticosteroid exposure and damage accrual. The occurrence of HDAS may be a useful prognostic marker in the management of SLE.
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Affiliation(s)
- Rachel Koelmeyer
- Monash Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Hieu Tri Nim
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Mandana Nikpour
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia.,Rheumatology, St Vincent Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ying B Sun
- Global Evidence & Value Development, Merck Healthcare KGaA, Darmstadt, Germany
| | - Amy Kao
- Global Clinical Development, EMD Serono Research and Development Institute, Darmstadt, Germany
| | - Oliver Guenther
- Global Evidence & Value Development, Merck Healthcare KGaA, Darmstadt, Germany
| | - Eric Morand
- Monash Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Department of Rheumatology, Monash Health, Clayton, Victoria, Australia
| | - Alberta Hoi
- Monash Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia .,Department of Rheumatology, Monash Health, Clayton, Victoria, Australia
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Vincent FB, Kandane-Rathnayake R, Koelmeyer R, Harris J, Hoi AY, Mackay F, Morand EF. Associations of serum soluble Fas and Fas ligand (FasL) with outcomes in systemic lupus erythematosus. Lupus Sci Med 2021; 7:7/1/e000375. [PMID: 32546562 PMCID: PMC7299016 DOI: 10.1136/lupus-2019-000375] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/18/2019] [Revised: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 01/11/2023]
Abstract
Objective Fas/Fas ligand (FasL) and B cell-activating factor (BAFF) signalling have pivotal roles in SLE pathogenesis. We investigated the clinical associations of serum concentrations of soluble Fas (sFas) and soluble FasL (sFasL) in SLE and their relationship with BAFF. Methods Serum sFas and sFasL were quantified by multiplex assay, and BAFF by ELISA, in 118 patients with SLE and 17 healthy controls (HC). SLE disease activity and organ damage were assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics Damage Index. Results sFas, sFasL and BAFF were detectable in all samples. Serum sFas and sFasL were significantly higher in SLE compared with HC. In univariable regression analyses, patients with active renal disease and those with flare had significantly higher levels of sFas compared with those without. High serum BAFF in patients with SLE was associated with increased sFas but not sFasL. The association between sFas and renal disease remained significant after adjusting for BAFF, but the association with flare attenuated. High sFas levels were associated with increased time-adjusted mean SLEDAI-2K, even after adjusting for BAFF, and with higher odds of flare over time. In contrast, high sFasL was associated with reduced organ damage over time. Serum sFasL/sFas ratio was negatively associated with active overall disease, flare and organ damage. Conclusions Serum sFas is associated with active renal SLE, and active disease and flare over time, while sFasL/sFas ratio is negatively associated with disease activity and organ damage accrual. Treatments correcting abnormal levels of sFas/FasL may be worthy of evaluation in SLE.
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Affiliation(s)
- Fabien B Vincent
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - James Harris
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Alberta Y Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Fabienne Mackay
- Department of Immunology and Pathology, Monash University, Central Clinical School, Alfred Medical Research and Education Precinct (AMREP), Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Hoi A, Nim HT, Koelmeyer R, Sun Y, Kao A, Gunther O, Morand E. Algorithm for calculating high disease activity in SLE. Rheumatology (Oxford) 2021; 60:4291-4297. [PMID: 33493337 DOI: 10.1093/rheumatology/keab003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/19/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The ability to identify lupus patients in High Disease Activity Status (HDAS) without knowledge of the SLEDAI could have application in selection of patients for treatment escalation or enrolment in trials. We sought to generate an algorithm that could calculate via model fitting the presence of HDAS using simple demographic and laboratory values. METHODS We examined the association of High Disease Activity (HDA) with demographic and laboratory parameters using prospectively collected data. An HDA visit is recorded when SLEDAI-2K ≥10. We utilised the use of combinatorial search to find algorithms to build a mathematical model predictive of HDA. Performance of each algorithm was evaluated using multi-class area under receiver operating characteristics (mAUROC) and the final model was compared with the Naïve Bayes Classifier, and analysed using the confusion matrix for accuracy and misclassification rate. RESULTS Data on 286 patients, followed for a median of 5.1 years were studied for a total of 5,680 visits. Sixteen laboratory parameters were found to be significantly associated with HDA. A total of 216 algorithms were evaluated and final algorithm chosen was based on 7 pathology measures and 3 demographic variables. It has an accuracy of 88.6% and misclassification rate of 11.4%. When compared with the Naïve Bayes Classifier (AUC = 0.663), our algorithm has a better accuracy with AUC = 0.829. CONCLUSION This study shows that building an accurate model to calculate HDA using routinely available clinical parameters is feasible. Future studies to independently validate the algorithm will be needed to confirm its predictive performance.
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Affiliation(s)
- Alberta Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia.,Department of Rheumatology, Monash Health, Clayton, VIC, 3168, Australia
| | - Hieu T Nim
- Faculty of Information Technology, Monash University, Clayton, VIC, 3168, Australia; and Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Ying Sun
- Merck KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany
| | - Amy Kao
- EMD Serono, EMD Serono Research & Development Institute, Inc, a business of Merck KGaA, Darmstadt, Germany
| | - Oliver Gunther
- Merck KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany
| | - Eric Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia.,Department of Rheumatology, Monash Health, Clayton, VIC, 3168, Australia
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Yeo AL, Koelmeyer R, Kandane‐Rathnayake R, Golder V, Hoi A, Huq M, Hammond E, Nab H, Nikpour M, Morand EF. Lupus Low Disease Activity State and Reduced Direct Health Care Costs in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72:1289-1295. [DOI: 10.1002/acr.24023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/02/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Ai Li Yeo
- Monash University and Monash Health Clayton Victoria Australia
| | | | | | - Vera Golder
- Monash University and Monash Health Clayton Victoria Australia
| | - Alberta Hoi
- Monash University and Monash Health Clayton Victoria Australia
| | - Molla Huq
- University of Melbourne, Parkville, Monash University, Clayton, and St Vincent’s Hospital Melbourne Fitzroy Victoria Australia
| | - Edward Hammond
- AstraZeneca, Gaithersburg, Maryland, and AstraZeneca Cambridge UK
| | - Henk Nab
- AstraZeneca, Gaithersburg, Maryland, and AstraZeneca Cambridge UK
| | - Mandana Nikpour
- University of Melbourne, Parkville, and St Vincent’s Hospital Melbourne Fitzroy Victoria Australia
| | - Eric F. Morand
- Monash University and Monash Health Clayton Victoria Australia
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Nim HT, Connelly K, Vincent FB, Petitjean F, Hoi A, Koelmeyer R, Boyd SE, Morand EF. Novel Methods of Incorporating Time in Longitudinal Multivariate Analysis Reveals Hidden Associations With Disease Activity in Systemic Lupus Erythematosus. Front Immunol 2019; 10:1649. [PMID: 31379847 PMCID: PMC6653068 DOI: 10.3389/fimmu.2019.01649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 04/10/2019] [Accepted: 07/02/2019] [Indexed: 12/27/2022] Open
Abstract
Objective: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. SLE is characterized by high inter-patient variability, including fluctuations over time, a factor which most biomarker studies omit from consideration. We investigated relationships between disease activity and biomarker expression in SLE, using novel methods to control for time-dependent variability, in a proof-of-concept study to evaluate whether doing so revealed additional information. Methods: We measured 4 serum biomarkers (MIF, CCL2, CCL19, and CXCL10) and 13 routine clinical laboratory parameters, alongside disease activity measured by the SLE disease activity index-2k (SLEDAI-2k), collected longitudinally. We analyzed these data with unsupervised learning methods via ensemble clustering, incorporating temporal relationships using dynamic time warping for distance metric calculation. Results: Data from 843 visits in 110 patients (median age 47, 83% female) demonstrated highly heterogeneous time-dependent relationships between disease activity and biomarkers. Unbiased magnitude-based hierarchical clustering of biomarker expression levels isolated a patient subset (n = 9) with distinctively heterogeneous expression of the 17 biological parameters, and who had MIF, CCL2, CCL19, and CXCL10 levels that were higher and more strongly associated with disease activity, based on leave-one-out cross-validated regression analysis. In the remaining subgroup, a time-dependent regression model revealed significantly stronger predictive power of biomarkers for disease activity, compared to a time-agnostic regression model. Despite no significant difference in simple magnitude, using dynamic time warping analysis to align longitudinal profiles revealed a large subset (n = 69) with significantly stronger associations between biological parameters and disease activity. This subgroup had significantly lower flare rates, disease activity and damage scores, suggesting this clustering is clinically meaningful. Conclusions: These results suggest associations between biological parameters and disease activity in SLE exist in a multi-dimensional time-dependent pattern, with implications for the analysis of biomarkers in SLE often used to identify therapeutic targets. Novel methods to analyse high-dimensional data and control for time-dependent variability may have broad utility in the study complex relationships between clinical and biological parameters.
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Affiliation(s)
- Hieu T Nim
- Data Science & AI, Faculty of Information Technology, Monash University, Clayton, VIC, Australia.,Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Kathryn Connelly
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Fabien B Vincent
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - François Petitjean
- Data Science & AI, Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Alberta Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Sarah E Boyd
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
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Vincent FB, Kandane-Rathnayake R, Koelmeyer R, Hoi AY, Harris J, Mackay F, Morand EF. Analysis of serum B cell-activating factor from the tumor necrosis factor family (BAFF) and its soluble receptors in systemic lupus erythematosus. Clin Transl Immunology 2019; 8:e01047. [PMID: 31024730 PMCID: PMC6475618 DOI: 10.1002/cti2.1047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/28/2022] Open
Abstract
Objectives To determine the presence and clinical associations of the soluble receptors of B cell-activating factor from the tumor necrosis factor family (BAFF) in serum of patients with systemic lupus erythematosus (SLE). Methods Serum BAFF and soluble BAFF receptor (sBAFF-R) were quantified using ELISA, and soluble B cell maturation antigen (sBCMA) and transmembrane activator and cyclophilin ligand interactor (sTACI) by Luminex, in 87 SLE patients and 17 healthy controls (HC). Disease activity and organ damage were assessed using SLE Disease Activity Index 2000 (SLEDAI-2K) and Systemic Lupus International Collaborating Clinics (SLICC) SLE Damage Index (SDI), respectively. Results BAFF and all receptors were detectable in all serum samples. Serum sBCMA and sTACI, but not sBAFF-R, were significantly higher in SLE than in HC. Serum BAFF was also increased in SLE, but this association was attenuated after adjusting for age and ethnicity. Increased serum BAFF was associated with flare and organ damage. Increased serum sBCMA was associated with the presence of anti-dsDNA, but not with overall or organ-specific disease activity, flare or organ damage. Neither sTACI nor sBAFF-R was associated with any SLE clinical parameters in multivariable analysis. While serum BAFF correlated negatively with sBAFF-R in HC, no statistically significant correlations were observed between BAFF and its receptors in SLE patients. Conclusion Serum BAFF was associated with flare and organ damage independent of the presence of its soluble receptors. While sBCMA was associated with anti-dsDNA positivity, other soluble BAFF receptors were not associated with SLE clinical indicators.
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Affiliation(s)
- Fabien B Vincent
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Rangi Kandane-Rathnayake
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Rachel Koelmeyer
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Alberta Y Hoi
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - James Harris
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Fabienne Mackay
- Department of Immunology and Pathology Central Clinical School Alfred Medical Research and Education Precinct (AMREP) Monash University Melbourne VIC Australia.,Department of Microbiology and Immunology School of Biomedical Sciences Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne VIC Australia
| | - Eric F Morand
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
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16
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Anania JC, Trist HM, Palmer CS, Tan PS, Kouskousis BP, Chenoweth AM, Kent SJ, Mackay GA, Hoi A, Koelmeyer R, Slade C, Bryant VL, Hodgkin PD, Aui PM, van Zelm MC, Wines BD, Hogarth PM. The Rare Anaphylaxis-Associated FcγRIIa3 Exhibits Distinct Characteristics From the Canonical FcγRIIa1. Front Immunol 2018; 9:1809. [PMID: 30177930 PMCID: PMC6109644 DOI: 10.3389/fimmu.2018.01809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 05/23/2018] [Accepted: 07/23/2018] [Indexed: 02/04/2023] Open
Abstract
FcγRIIa is an activating FcγR, unique to humans and non-human primates. It induces antibody-dependent proinflammatory responses and exists predominantly as FcγRIIa1. A unique splice variant, we designated FcγRIIa3, has been reported to be associated with anaphylactic reactions to intravenous immunoglobulins (IVIg) therapy. We aim to define the functional consequences of this FcγRIIa variant associated with adverse responses to IVIg therapy and evaluate the frequency of associated SNPs. FcγRIIa forms from macaque and human PBMCs were investigated for IgG-subclass specificity, biochemistry, membrane localization, and functional activity. Disease-associated SNPs were analyzed by sequencing genomic DNA from 224 individuals with immunodeficiency or autoimmune disease. FcγRIIa3 was identified in macaque and human PBMC. The FcγRIIa3 is distinguished from the canonical FcγRIIa1 by a unique 19-amino acid cytoplasmic insertion and these two FcγRIIa forms responded distinctly to antibody ligation. Whereas FcγRIIa1 was rapidly internalized, FcγRIIa3 was retained longer at the membrane, inducing greater calcium mobilization and cell degranulation. Four FCGR2A SNPs were identified including the previously reported intronic SNP associated with anaphylaxis, but in only 1 of 224 individuals. The unique cytoplasmic element of FcγRIIa3 delays internalization and is associated with enhanced cellular activation. The frequency of the immunodeficiency-associated SNP varies between disease populations but interestingly occurred at a lower frequency than previously reported. None-the-less enhanced FcγRIIa3 function may promote a proinflammatory environment and predispose to pathological inflammatory responses.
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Affiliation(s)
- Jessica C Anania
- Immune Therapies Group, Burnet Institute, Melbourne, VIC, Australia.,Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Halina M Trist
- Immune Therapies Group, Burnet Institute, Melbourne, VIC, Australia
| | - Catherine S Palmer
- Immune Therapies Group, Burnet Institute, Melbourne, VIC, Australia.,Monash Micro Imaging, Monash University, Clayton, VIC, Australia
| | - Peck Szee Tan
- Immune Therapies Group, Burnet Institute, Melbourne, VIC, Australia
| | - Betty P Kouskousis
- Immune Therapies Group, Burnet Institute, Melbourne, VIC, Australia.,Monash Micro Imaging, Monash University, Clayton, VIC, Australia
| | - Alicia M Chenoweth
- Immune Therapies Group, Burnet Institute, Melbourne, VIC, Australia.,Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC, Australia.,Melbourne Sexual Health Centre, Central Clinical School, Monash University, Melbourne, VIC, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Parkville, VIC, Australia
| | - Graham A Mackay
- Department of Pharmacology & Therapeutics, The University of Melbourne, Parkville, VIC, Australia
| | - Alberta Hoi
- Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
| | - Rachel Koelmeyer
- Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
| | - Charlotte Slade
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.,Walter and Eliza Hall Institute for Medical Research, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, VIC, Australia.,The Jeffrey Modell Diagnostic and Research Centre for Primary Immunodeficiencies, Melbourne, VIC, Australia
| | - Vanessa L Bryant
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.,Walter and Eliza Hall Institute for Medical Research, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, VIC, Australia.,The Jeffrey Modell Diagnostic and Research Centre for Primary Immunodeficiencies, Melbourne, VIC, Australia
| | - Philip D Hodgkin
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.,Walter and Eliza Hall Institute for Medical Research, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Pei Mun Aui
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia.,The Jeffrey Modell Diagnostic and Research Centre for Primary Immunodeficiencies, Melbourne, VIC, Australia
| | - Menno C van Zelm
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia.,The Jeffrey Modell Diagnostic and Research Centre for Primary Immunodeficiencies, Melbourne, VIC, Australia
| | - Bruce D Wines
- Immune Therapies Group, Burnet Institute, Melbourne, VIC, Australia.,Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Pathology, The University of Melbourne, Parkville, VIC, Australia
| | - P Mark Hogarth
- Immune Therapies Group, Burnet Institute, Melbourne, VIC, Australia.,Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Pathology, The University of Melbourne, Parkville, VIC, Australia
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17
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Mende R, Vincent FB, Kandane-Rathnayake R, Koelmeyer R, Lin E, Chang J, Hoi AY, Morand EF, Harris J, Lang T. Analysis of Serum Interleukin (IL)-1β and IL-18 in Systemic Lupus Erythematosus. Front Immunol 2018; 9:1250. [PMID: 29930551 PMCID: PMC5999794 DOI: 10.3389/fimmu.2018.01250] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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] [Received: 04/02/2018] [Accepted: 05/18/2018] [Indexed: 12/13/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by biological and clinical heterogeneity. The interleukin (IL)-1 superfamily is a group of innate cytokines that contribute to pathogenesis in many autoimmune diseases. IL-1β and IL-18 are two members that have been shown to play a role in murine lupus-like models, but their role in human SLE remains poorly understood. Here, IL-1β and IL-18 were quantified by enzyme-linked immunosorbent assay in the serum of healthy controls (HCs) and SLE patients from a prospectively followed cohort. Disease activity and organ damage were assessed using SLE disease activity index 2000 (SLEDAI-2K) and SLE damage index scores (SDI), respectively. 184 SLE patients (mean age 44.9 years, 91% female, 56% double-stranded deoxyribonucleic acid positive) were compared to 52 HC. SLE patients had median [IQR] SLEDAI-2K of 4 [2,6], and SDI of 1 [0–2]. Serum IL-18 levels were statistically significantly higher in SLE patients compared to HCs. Univariable linear regression analyses showed that patients with active renal disease or irreversible organ damage had statistically significantly elevated serum IL-18 levels. The association between serum IL-18 and active renal disease was confirmed in multivariable analysis after adjusting for ethnicity and organ damage. High baseline serum IL-18 levels were associated with organ damage at the subsequent visit. Serum IL-1β levels were not significantly elevated in SLE patients when compared to HCs and had no association with overall or organ-specific disease activity or organ damage in cross-sectional and longitudinal analyses. Our data suggest that serum IL-18 and IL-1β have different clinical implications in SLE, with IL-18 being potentially associated with active renal disease.
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Affiliation(s)
- Rachel Mende
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Fabien B Vincent
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Rangi Kandane-Rathnayake
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Rachel Koelmeyer
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Emily Lin
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Janet Chang
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Alberta Y Hoi
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - James Harris
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Tali Lang
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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18
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Currier D, Pirkis J, Carlin J, Degenhardt L, Dharmage SC, Giles-Corti B, Gordon I, Gurrin L, Hocking J, Kavanagh A, Keogh LA, Koelmeyer R, LaMontagne AD, Schlichthorst M, Patton G, Sanci L, Spittal MJ, Studdert DM, Williams J, English DR. The Australian longitudinal study on male health-methods. BMC Public Health 2016; 16:1030. [PMID: 28185550 PMCID: PMC5103246 DOI: 10.1186/s12889-016-3698-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development. METHODS Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use. RESULTS A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %. CONCLUSION Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects.
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Affiliation(s)
- Dianne Currier
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - John Carlin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, 2031, Australia
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Billie Giles-Corti
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Ian Gordon
- Statistical Consulting Centre, School of Mathematics and Statistics, The University of Melbourne, Melbourne, 3010, Australia
| | - Lyle Gurrin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Anne Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Rachel Koelmeyer
- School of Clinical Sciences, Monash University, Clayton, 3168, Australia
| | - Anthony D LaMontagne
- School of Health & Social Development, Deakin University, Burwood, 3125, Australia
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - George Patton
- Centre for Adolescent Health, Murdoch Childrens Research Institute, University of Melbourne, Melbourne, 3010, Australia
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, 3010, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - David M Studdert
- Centre for Health Policy/PCOR, Stanford University School of Medicine, Stanford, 94305, USA.,Stanford Law School, Stanford, 94305, USA
| | - Joanne Williams
- School of Health & Social Development, Deakin University, Burwood, 3125, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
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19
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Pirkis J, Currier D, Carlin J, Degenhardt L, Dharmage SC, Giles-Corti B, Gordon IR, Gurrin LC, Hocking JS, Kavanagh A, Keogh L, Koelmeyer R, LaMontagne AD, Patton G, Sanci L, Spittal MJ, Schlichthorst M, Studdert D, Williams J, English DR. Cohort Profile:Ten to Men(the Australian Longitudinal Study on Male Health). Int J Epidemiol 2016; 46:793-794i. [DOI: 10.1093/ije/dyw055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/13/2022] Open
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20
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Koelmeyer R, Currier D, Spittal MJ, Schlichthorst M, Pirkis JE, English DR. Age Matters: Exploring Correlates of Self-Rated Health Across Four Generations of Australian Males. Behav Med 2016; 42:132-42. [PMID: 27337617 DOI: 10.1080/08964289.2015.1121132] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The importance of addressing health disparities experienced by boys and men reached tangible prominence in Australia with adoption of the 2010 National Male Health Policy and the establishment of a national longitudinal study on male health-Ten to Men. Ten to Men is based on a holistic model of health with a strong focus on social determinants and health and well-being over the life course. Given the life course focus, we set out to assess if health-related characteristics and the correlates of self-rated health differ across the life course among four sociologically defined generations of Australian males. While some differences in the correlates of good or excellent health were observed across generations, addressing obesity and depression appear to be important for improving the health of Australian males of all ages.
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21
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Boulos D, Koelmeyer R, Morand E, Hoi A. THU0320 Cardiovascular Risk Profiles in A Lupus Cohort: Those That Are Missed. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Koelmeyer R, English DR, Smith A, Grierson J. Association of social determinants of health with self-rated health among Australian gay and bisexual men living with HIV. AIDS Care 2013; 26:65-74. [DOI: 10.1080/09540121.2013.793273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Pitts M, Grierson J, Koelmeyer R. Drivers of treatment change in PLHIV- psycho-social factors are more important than considerations of adherence. Retrovirology 2012. [PMCID: PMC3360351 DOI: 10.1186/1742-4690-9-s1-p65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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24
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Paquet-Fifield S, Schlüter H, Li A, Aitken T, Gangatirkar P, Blashki D, Koelmeyer R, Pouliot N, Palatsides M, Ellis S, Brouard N, Zannettino A, Saunders N, Thompson N, Li J, Kaur P. A role for pericytes as microenvironmental regulators of human skin tissue regeneration. J Clin Invest 2009; 119:2795-806. [PMID: 19652362 DOI: 10.1172/jci38535] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 06/17/2009] [Indexed: 12/19/2022] Open
Abstract
The cellular and molecular microenvironment of epithelial stem and progenitor cells is poorly characterized despite well-documented roles in homeostatic tissue renewal, wound healing, and cancer progression. Here, we demonstrate that, in organotypic cocultures, dermal pericytes substantially enhanced the intrinsically low tissue-regenerative capacity of human epidermal cells that have committed to differentiate and that this enhancement was independent of angiogenesis. We used microarray analysis to identify genes expressed by human dermal pericytes that could potentially promote epidermal regeneration. Using this approach, we identified as a candidate the gene LAMA5, which encodes laminin alpha5, a subunit of the ECM component laminin-511/521 (LM-511/521). LAMA5 was of particular interest as we had previously shown that it promotes skin regeneration both in vitro and in vivo. Analysis using immunogold localization revealed that pericytes synthesized and secreted LAMA5 in human skin. Consistent with this observation, coculture with pericytes enhanced LM-511/521 deposition in the dermal-epidermal junction of organotypic cultures. We further showed that skin pericytes could also act as mesenchymal stem cells, exhibiting the capacity to differentiate into bone, fat, and cartilage lineages in vitro. This study suggests that pericytes represent a potent stem cell population in the skin that is capable of modifying the ECM microenvironment and promoting epidermal tissue renewal from non-stem cells, a previously unsuspected role for pericytes.
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Affiliation(s)
- Sophie Paquet-Fifield
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, Melbourne, Victoria, Australia
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Branford S, Hughes T, Milner A, Koelmeyer R, Schwarer A, Arthur C, Filshie R, Moreton S, Lynch K, Taylor K. Efficacy and safety of imatinib in patients with chronic myeloid leukemia and complete or near-complete cytogenetic response to interferon-alpha. Cancer 2007; 110:801-8. [PMID: 17607681 DOI: 10.1002/cncr.22842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Interferon-alpha (IFN-alpha) confers a survival advantage for the minority of patients with chronic myeloid leukemia (CML) who achieve a complete cytogenetic response. The question of whether IFN-alpha-responsive patients can experience further improvements with imatinib has not been answered. Imatinib offers clear quality of life advantages. Furthermore, patients who achieve a major molecular response (MMR) while receiving imatinib are likely to remain progression free. METHODS A total of 23 patients treated for a median of 4.5 years with IFN-alpha (range, 1.6-14.3 years) who had achieved a complete (Philadelphia chromosome [Ph] negative, n = 15 patients) or near-complete (1-10% Ph, n = 8 patients) cytogenetic response were studied. The primary objective was to determine whether ceasing therapy with IFN-alpha and switching to 12 months of imatinib treatment at a dose of 400 mg/day could improve the molecular response as assessed by real-time quantitative polymerase chain reaction of BCR-ABL transcript levels. Safety was also assessed. RESULTS Every patient who had not achieved an MMR while receiving IFN-alpha (n = 16 patients) achieved an MMR after a median of 3 months of imatinib treatment. Significant BCR-ABL reductions (median, 63-fold; range, 18-425-fold) occurred in 15 of these patients. Every patient who had already achieved an MMR while receiving IFN-alpha (n = 7 patients) maintained an MMR while receiving imatinib. No patients discontinued imatinib due to toxicity, but 1 patient withdrew consent. CONCLUSIONS These data suggest that switching IFN-alpha-responsive patients to imatinib leads to a rapid improvement in achieving an MMR, a response with established prognostic value, and is well tolerated. The study should help patients and their physicians make evidence-based decisions regarding the potential benefits and risks of switching to imatinib.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Benzamides
- Diarrhea/chemically induced
- Follow-Up Studies
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Imatinib Mesylate
- Interferon-alpha/administration & dosage
- Interferon-alpha/adverse effects
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Neutropenia/chemically induced
- Patient Dropouts
- Piperazines/administration & dosage
- Piperazines/adverse effects
- Prospective Studies
- Pyrimidines/administration & dosage
- Pyrimidines/adverse effects
- Time Factors
- Transcription, Genetic/drug effects
- Treatment Outcome
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Affiliation(s)
- Susan Branford
- Division of Molecular Pathology, Institute of Medical and Veterinary Science, Adelaide, SA, Australia.
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26
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Edmondson SR, Thumiger SP, Kaur P, Loh B, Koelmeyer R, Li A, Silha JV, Murphy LJ, Wraight CJ, Werther GA. Insulin-like growth factor binding protein-3 (IGFBP-3) localizes to and modulates proliferative epidermal keratinocytes in vivo. Br J Dermatol 2005; 152:225-30. [PMID: 15727632 DOI: 10.1111/j.1365-2133.2004.06350.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The colocalization of insulin-like growth factor binding protein-3 (IGFBP-3) and IGF-I receptor (IGF-IR) in the basal/germinative layer of the epidermis suggests a key role in modulating epidermal homeostasis. OBJECTIVES We aimed to clarify both the specific cellular localization and the effect of excess epidermal IGFBP-3 on keratinocyte proliferation. METHODS (i) Total RNA was isolated from fluorescence-activated cell sorted basal human keratinocyte subtypes [keratinocyte stem cells, transit amplifying keratinocytes (TA), postmitotic differentiating keratinocytes (PMD)], and real-time polymerase chain reaction analysis was used to determine the abundance of IGFBP-3 and IGF-IR mRNAs. (ii) An IGFBP-3 transgenic mouse model was then used to assess the effect of excess epidermal IGFBP-3 on keratinocyte proliferation. Excess epidermal IGFBP-3 mRNA and protein was determined by in situ hybridization and immunohistochemistry, respectively. RESULTS (i) The highest levels of IGFBP-3 mRNA were detected in TA keratinocytes, in contrast to IGF-IR mRNA levels which were highest in PMD keratinocytes. (ii) Elevated human IGFBP-3 mRNA and protein was confirmed in the epidermis of skin derived from transgenic mice. Excess IGFBP-3 reduced the relative percentage of proliferative keratinocytes (Ki67 positive) irrespective of skin location (belly, back and tail). Thus, in the epidermis, IGFBP-3 mRNA is highly expressed by proliferative keratinocytes (TA) and overexpression of IGFBP-3 inhibits keratinocyte proliferation. CONCLUSIONS We conclude that in vivo IGFBP-3 ensures epidermal homeostasis via downregulation of keratinocyte proliferation, and thus modulates the early stages of keratinocyte differentiation.
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Affiliation(s)
- S R Edmondson
- Epithelial Stem Cell Biology Laboratory, Peter MacCallum Cancer Institute, East Melbourne, 3002 Victoria, Australia
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