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Tansley SL, McMorrow F, Cotton CV, Adamali H, Barratt SL, Betteridge ZE, Perurena-Prieto J, Gibbons MA, Kular R, Loganathan A, Lamb JA, Lu H, New RP, Pratt D, Rivera-Ortega P, Sayers R, Steward M, Stranks L, Vital E, Spencer LG, McHugh NJ, Cooper RG. Identification of connective tissue disease autoantibodies and a novel autoantibody anti-annexin A11 in patients with "idiopathic" interstitial lung disease. Clin Immunol 2024; 262:110201. [PMID: 38575043 DOI: 10.1016/j.clim.2024.110201] [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: 01/17/2024] [Revised: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Autoantibodies are a hallmark feature of Connective Tissue Diseases (CTD). Their presence in patients with idiopathic interstitial lung disease (ILD) may suggest covert CTD. We aimed to determine the prevalence of CTD autoantibodies in patients diagnosed with idiopathic ILD. METHODS 499 patient sera were analysed: 251 idiopathic pulmonary fibrosis (IPF), 206 idiopathic non-specific interstitial pneumonia (iNSIP) and 42 cryptogenic organising pneumonia (COP). Autoantibody status was determined by immunoprecipitation. RESULTS 2.4% of IPF sera had a CTD-autoantibody compared to 10.2% of iNSIP and 7.3% of COP. 45% of autoantibodies were anti-synthetases. A novel autoantibody targeting an unknown 56 kDa protein was found in seven IPF patients (2.8%) and two NSIP (1%) patients. This was characterised as anti-annexin A11. CONCLUSION Specific guidance on autoantibody testing and interpretation in patients with ILD could improve diagnostic accuracy. Further work is required to determine the clinical significance of anti-annexin A11.
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Affiliation(s)
- Sarah L Tansley
- Department of Life Sciences, University of Bath, Bath, UK; Royal National Hospital for Rheumatic Diseases, Bath, UK.
| | | | | | - Huzaifa Adamali
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | - Shaney L Barratt
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | | | | | - Michael A Gibbons
- College of Medicine & Health, University of Exeter; Royal Devon University Hospitals Foundation NHS Trust
| | - Raman Kular
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Janine A Lamb
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Hui Lu
- Department of Life Sciences, University of Bath, Bath, UK
| | - Robert P New
- Division of Musculoskeletal and dermatological Sciences, University of Manchester, UK
| | - Diane Pratt
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | | | - Ross Sayers
- College of Medicine & Health, University of Exeter
| | | | | | - Edward 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
| | - Lisa G Spencer
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Neil J McHugh
- Department of Life Sciences, University of Bath, Bath, UK
| | - Robert G Cooper
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Tansley S, Cotton C, McMorrow FK, Lu H, New RP, Spencer LG, McHugh NJ, Cooper RG. P221 Autoantibodies are common in patients with idiopathic interstitial lung disease, suggesting a high prevalence of undiagnosed autoimmune connective tissue disease. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.220] [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: 11/14/2022] Open
Abstract
Abstract
Background/Aims
In some patients, interstitial lung disease (ILD) may be the dominant or even sole manifestation of an otherwise unrecognised autoimmune connective tissue disease (CTD). Accurate diagnosis can be challenging given considerable overlap of the clinical, radiological and histological disease features. Distinguishing CTD related ILD (CTD-ILD) from idiopathic ILD, enables appropriate immunosuppressive treatment, informs prognosis and facilitates monitoring for other CTD associated complications. Occasionally a lung biopsy may be necessary to ensure accurate diagnosis. Autoantibodies are a hallmark feature of CTD, are highly disease specific and their presence is strongly suggestive of covert CTD-ILD. We investigated patients with idiopathic ILD for the presence of autoantibodies that may suggest misdiagnosis.
Methods
The serum from three subgroups of patients recruited to UK Biomarkers of Interstitial Lung Disease (BILD) were analysed: 171 with a diagnosis of idiopathic ILD and non-specific organising pneumonia on HRCT and 27 with a diagnosis of idiopathic ILD and cryptogenic organising pneumonia on HRCT. Autoantibody status was determined by radio-immunoprecipitation.
Results
Results are summarised in Table 1. Overall CTD-autoantibodies were identified in 15.6% of patients with idiopathic ILD, and were more common in those with NSIP, see table. Autoantibodies identified included those readily detectable e.g. anti-Jo1, in addition to rarer antibodies not included in standard assays e.g. anti-EIF3. Nearly half of all autoantibodies detected were anti-synthetase autoantibodies.
Conclusion
Covert-CTD is likely to be common amongst patients diagnosed with idiopathic ILD, particularly idiopathic NSIP. More specific guidance on autoantibody testing could improve diagnosis and ensure patients receive appropriate immunosuppressive treatment.
Disclosure
S. Tansley: None. C. Cotton: None. F.K. McMorrow: None. H. Lu: None. R.P. New: None. L.G. Spencer: None. N.J. McHugh: None. R.G. Cooper: None.
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Affiliation(s)
- Sarah Tansley
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
| | - Caroline Cotton
- Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | | | - Hui Lu
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
| | - Robert P New
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UNITED KINGDOM
| | - Lisa G Spencer
- Respiratory Medicine, Aintree University Hospital, Liverpool, UNITED KINGDOM
| | - Neil J McHugh
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
| | - Robert G Cooper
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UNITED KINGDOM
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Tansley SL, Cotton CV, McMorrow FK, Lu H, Betteridge ZE, New RP, Spencer LG, McHugh NJ, Cooper RG. OA12 Autoantibodies are common in patients labelled as “idiopathic” interstitial lung disease suggesting a high prevalence of undiagnosed autoimmune connective tissue disease. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac132.011] [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: 11/14/2022] Open
Abstract
Abstract
Background/Aims
In some patients, interstitial lung disease (ILD) may be the dominant or even sole clinically overt manifestation of an otherwise unrecognised autoimmune connective tissue disease (CTD). Accurate diagnosis can be challenging given considerable overlap of the clinical, radiological and histological disease features. Distinguishing CTD-related ILD (CTD-ILD) from idiopathic ILD can avoid a lung biopsy, enables appropriate immunosuppressive treatment, informs prognosis and facilitates monitoring for other CTD-associated complications. Autoantibodies are a hallmark feature of CTD, are highly disease-specific and their presence is strongly suggestive of covert CTD-ILD. We investigated patients who had been labelled with “idiopathic” ILD by their local hospital teams for the presence of autoantibodies that may suggest misdiagnosis.
Methods
Serum from two groups of patients recruited to UK Biomarkers of Interstitial Lung Disease (BILD) were analysed: 183 with a local diagnosis of idiopathic non-specific interstitial pneumonia (iNSIP) and 34 with a local diagnosis of idiopathic or Cryptogenic Organising Pneumonia (COP). Autoantibody status was determined by radio-immunoprecipitation.
Results
Overall, CTD-autoantibodies were identified in 15% of patients with a prior label of “idiopathic” ILD. CTD autoantibodies were more common in those with a prior diagnosis of COP, where more than 1 in 5 patient samples contained a potentially relevant autoantibody, see table. The autoantibodies identified included those readily detectable e.g. anti-Jo1, in addition to rarer antibodies not included in standard assays e.g. anti-EIF2B. Nearly half of all autoantibodies detected were anti-synthetase autoantibodies.
Conclusion
Covert CTD-ILD is potentially being missed as a diagnosis in patients who have been labelled by local teams as having idiopathic forms of inflammatory ILD (COP or iNSIP). More specific guidance on autoantibody testing and the interpretation of these test results could improve diagnosis and ensure patients receive more appropriate management.
Disclosure
S.L. Tansley: None. C.V. Cotton: None. F.K. McMorrow: None. H. Lu: None. Z.E. Betteridge: None. R.P. New: None. L.G. Spencer: None. N.J. McHugh: None. R.G. Cooper: None.
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Affiliation(s)
- Sarah L Tansley
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UNITED KINGDOM
| | - Caroline V Cotton
- Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | | | - Hui Lu
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
| | - Zoe E Betteridge
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
| | - Robert P New
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UNITED KINGDOM
| | - Lisa G Spencer
- Respiratory Medicine, Aintree University Hospital, Liverpool, UNITED KINGDOM
| | - Neil J McHugh
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
| | - Robert G Cooper
- Insititute of Life Course and Medicial Sciences, University of Liverpool, Liverpool, UNITED KINGDOM
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4
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Bianchi M, Kozyrev SV, Notarnicola A, Hultin Rosenberg L, Karlsson Å, Pucholt P, Rothwell S, Alexsson A, Sandling JK, Andersson H, Cooper RG, Padyukov L, Tjärnlund A, Dastmalchi M, Meadows JRS, Pyndt Diederichsen L, Molberg Ø, Chinoy H, Lamb JA, Rönnblom L, Lindblad-Toh K, Lundberg IE. Contribution of Rare Genetic Variation to Disease Susceptibility in a Large Scandinavian Myositis Cohort. Arthritis Rheumatol 2022; 74:342-352. [PMID: 34279065 DOI: 10.1002/art.41929] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of complex autoimmune conditions characterized by inflammation in skeletal muscle and extramuscular compartments, and interferon (IFN) system activation. We undertook this study to examine the contribution of genetic variation to disease susceptibility and to identify novel avenues for research in IIMs. METHODS Targeted DNA sequencing was used to mine coding and potentially regulatory single nucleotide variants from ~1,900 immune-related genes in a Scandinavian case-control cohort of 454 IIM patients and 1,024 healthy controls. Gene-based aggregate testing, together with rare variant- and gene-level enrichment analyses, was implemented to explore genotype-phenotype relations. RESULTS Gene-based aggregate tests of all variants, including rare variants, identified IFI35 as a potential genetic risk locus for IIMs, suggesting a genetic signature of type I IFN pathway activation. Functional annotation of the IFI35 locus highlighted a regulatory network linked to the skeletal muscle-specific gene PTGES3L, as a potential candidate for IIM pathogenesis. Aggregate genetic associations with AGER and PSMB8 in the major histocompatibility complex locus were detected in the antisynthetase syndrome subgroup, which also showed a less marked genetic signature of the type I IFN pathway. Enrichment analyses indicated a burden of synonymous and noncoding rare variants in IIM patients, suggesting increased disease predisposition associated with these classes of rare variants. CONCLUSION Our study suggests the contribution of rare genetic variation to disease susceptibility in IIM and specific patient subgroups, and pinpoints genetic associations consistent with previous findings by gene expression profiling. These features highlight genetic profiles that are potentially relevant to disease pathogenesis.
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Affiliation(s)
- Matteo Bianchi
- Science for Life Laboratory and Uppsala University, Uppsala, Sweden
| | - Sergey V Kozyrev
- Science for Life Laboratory and Uppsala University, Uppsala, Sweden
| | | | | | - Åsa Karlsson
- Science for Life Laboratory and Uppsala University, Uppsala, Sweden
| | | | | | | | | | | | - Robert G Cooper
- Aintree University Hospital, MRC-Arthritis Research UK Centre for integrated Research into Musculoskeletal Ageing, and University of Liverpool, Liverpool, UK
| | - Leonid Padyukov
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anna Tjärnlund
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Maryam Dastmalchi
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | - Øyvind Molberg
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK, and Salford Royal NHS Foundation Trust, Salford, UK
| | | | | | - Kerstin Lindblad-Toh
- Science for Life Laboratory and Uppsala University, Uppsala, Sweden, and Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Ingrid E Lundberg
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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5
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Farghly MFA, Mahrose KM, Cooper RG, Metwally KA, Abougabal MS, El-Ratel IT. Use of available crop by-products as alternative bedding materials to wheat straw for rearing broilers. Animal 2021; 15:100260. [PMID: 34116465 DOI: 10.1016/j.animal.2021.100260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
The provision of suitable bedding for rearing broilers is an ongoing challenge for poultry producers. The aim of the present study was to evaluate the effect of using different types of crop residues as alternative bedding materials to wheat straw on growth performance, carcass traits, health, and welfare of broilers; moreover, the effects on the bedding and air quality were analyzed. We randomly assigned 180 1-day-old chickens (Cobb 500) across six bedding groups (three replicates of 10 birds each). Chickens in all groups were reared under similar housing conditions. Chickens of one group were reared on a wheat straw bedding (control), whereas those of the remaining five groups were reared on clover straw, cornstalk chips (CS), sugarcane top chips, chopped palm spines (CPS), and corn ear husks. Cornstalk chip and chopped palm spines were associated with the lowest (P < 0.05) ammonia concentrations compared with the remaining beddings. The mean values of bedding moisture percentage (P < 0.05), caking score, and ammonia concentrations (P < 0.05) were decreased with 6-week-old broilers reared on cornstalk chips. At 6 weeks, wheat straw, clover straw, sugarcane top chips and corn ear husks resulted in higher (P < 0.0001) BW and average daily gain compared with CS and CPS. Broilers reared on clover straw bedding showed the best FCR during 4-6 weeks of age (P < 0.01), and those kept on clover straw and sugarcane top chips exhibited the best (P < 0.01) feed conversion ratio (1.61 and 1.64, respectively) during 0-6 weeks of age. The carcass dressing yield, airborne dust concentration, bedding pH, and bacterial counts did not differ among the different bedding materials. The proportions of the drumsticks, gizzards, and abdominal fat of 6-week-old broilers were affected by bedding type (P < 0.05); but the differences among the bedding treatments were small. The mean incidence of footpad dermatitis and breast blisters was significantly less using clover straw. Broilers reared on chopped palm spine had the highest (P < 0.05) heterophil/lymphocyte ratio when compared with their counterparts. Conclusively, using clover straw or cornstalks as an alternative bedding material may be a beneficial strategy and should be highly recommended for rearing broilers.
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Affiliation(s)
- M F A Farghly
- Poultry Production Department, Agriculture College, Assiut University, Assiut 71516, Egypt
| | - Kh M Mahrose
- Animal and Poultry Production Department, Faculty of Technology and Development, Zagazig University, Zagazig 44511, Egypt.
| | - R G Cooper
- Visiting Professor of Physiology, Institute of Genetics and Animal Breeding, The Polish Academy of Sciences, Poland
| | - Kh A Metwally
- Soil and Water Sciences Department, Faculty of Technology and Development, Zagazig University, Zagazig 44511, Egypt
| | - M Sh Abougabal
- Animal Production Department, Agriculture College, Al-Azhar University, Cairo, Egypt
| | - I T El-Ratel
- Poultry Production Department, Agriculture College, Damietta University, Damietta 34517, Egypt
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Abstract
The Pandemic taught us that accelerated new-product development is more important than ever, and provided examples of firms developing breakthrough products in record time. Five approaches to accelerated development are outlined here: The first two deal with adequately resourcing new-product projects, namely the use of focused teams; and effective portfolio management to prioritize projects and reallocate resources. Newer digital tools are outlined that speed new-products developments. Finally, two development methods are described that move development projects faster: Lean development and Agile development. Accelerated development also has hidden costs: undertaking less innovative projects and cutting too many corners. Although important, the topic is under-researched, and the limited research has yielded inconclusive results about acceleration's expected benefits.
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Affiliation(s)
- Robert G. Cooper
- De Groote School of BusinessMcMaster UniversityHamiltonONCanada
- Institute for the Study of Business MarketsSmeal College of Business AdministrationPennsylvania State UniversityState CollegePAUSA
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7
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Thoma A, Lyon M, Al-Shanti N, Nye GA, Cooper RG, Lightfoot AP. Eukarion-134 Attenuates Endoplasmic Reticulum Stress-Induced Mitochondrial Dysfunction in Human Skeletal Muscle Cells. Antioxidants (Basel) 2020; 9:antiox9080710. [PMID: 32764412 PMCID: PMC7466046 DOI: 10.3390/antiox9080710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/25/2022] Open
Abstract
Maladaptive endoplasmic reticulum (ER) stress is associated with modified reactive oxygen species (ROS) generation and mitochondrial abnormalities; and is postulated as a potential mechanism involved in muscle weakness in myositis, an acquired autoimmune neuromuscular disease. This study investigates the impact of ROS generation in an in vitro model of ER stress in skeletal muscle, using the ER stress inducer tunicamycin (24 h) in the presence or absence of a superoxide dismutase/catalase mimetic Eukarion (EUK)-134. Tunicamycin induced maladaptive ER stress, which was mitigated by EUK-134 at the transcriptional level. ER stress promoted mitochondrial dysfunction, described by substantial loss of mitochondrial membrane potential, as well as a reduction in respiratory control ratio, reserve capacity, phosphorylating respiration, and coupling efficiency, which was ameliorated by EUK-134. Tunicamycin induced ROS-mediated biogenesis and fusion of mitochondria, which, however, had high propensity of fragmentation, accompanied by upregulated mRNA levels of fission-related markers. Increased cellular ROS generation was observed under ER stress that was prevented by EUK-134, even though no changes in mitochondrial superoxide were noticeable. These findings suggest that targeting ROS generation using EUK-134 can amend aspects of ER stress-induced changes in mitochondrial dynamics and function, and therefore, in instances of chronic ER stress, such as in myositis, quenching ROS generation may be a promising therapy for muscle weakness and dysfunction.
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Affiliation(s)
- Anastasia Thoma
- Musculoskeletal Science & Sports Medicine Research Centre, Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (A.T.); (N.A.-S.)
| | - Max Lyon
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L7 8TX, UK; (M.L.); (R.G.C.)
| | - Nasser Al-Shanti
- Musculoskeletal Science & Sports Medicine Research Centre, Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (A.T.); (N.A.-S.)
| | - Gareth A. Nye
- Chester Medical School, University of Chester, Chester CH1 4BJ, UK;
| | - Robert G. Cooper
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L7 8TX, UK; (M.L.); (R.G.C.)
| | - Adam P. Lightfoot
- Musculoskeletal Science & Sports Medicine Research Centre, Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK; (A.T.); (N.A.-S.)
- Correspondence:
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8
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Oldroyd A, Sergeant JC, New P, McHugh NJ, Betteridge Z, Lamb JA, Ollier WE, Cooper RG, Chinoy H. The temporal relationship between cancer and adult onset anti-transcriptional intermediary factor 1 antibody-positive dermatomyositis. Rheumatology (Oxford) 2020; 58:650-655. [PMID: 30535395 PMCID: PMC6434375 DOI: 10.1093/rheumatology/key357] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 09/16/2018] [Indexed: 01/30/2023] Open
Abstract
Objectives To characterize the 10 year relationship between anti-transcriptional intermediary factor 1 antibody (anti-TIF1-Ab) positivity and cancer onset in a large UK-based adult DM cohort. Methods Data from anti-TIF1-Ab-positive/-negative adults with verified diagnoses of DM from the UK Myositis Network register were analysed. Each patient was followed up until they developed cancer. Kaplan–Meier methods and Cox proportional hazard modelling were employed to estimate the cumulative cancer incidence. Results Data from 263 DM cases were analysed, with a total of 3252 person-years and a median 11 years of follow-up; 55 (21%) DM cases were anti-TIF1-Ab positive. After 10 years of follow-up, a higher proportion of anti-TIF1-Ab-positive cases developed cancer compared with anti-TIF1-Ab-negative cases: 38% vs 15% [hazard ratio 3.4 (95% CI 2.2, 5.4)]. All the detected malignancy cases in the anti-TIF1-Ab-positive cohort occurred between 3 years prior to and 2.5 years after DM onset. No cancer cases were detected within the following 7.5 years in this group, whereas cancers were detected during this period in the anti-TIF1-Ab-negative cases. Ovarian cancer was more common in the anti-TIF1-Ab-positive vs -negative cohort: 19% vs 2%, respectively (P < 0.05). No anti-TIF1-Ab-positive case <39 years of age developed cancer, compared with 21 (53%) of those ≥39 years of age. Conclusion Anti-TIF1-Ab-positive-associated malignancy occurs exclusively within the 3 year period on either side of DM onset, the risk being highest in those ≥39 years of age. Cancer types differ according to anti-TIF1-Ab status, and this may warrant specific cancer screening approaches.
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Affiliation(s)
- Alexander Oldroyd
- Centre for Musculoskeletal Research, University of Manchester, Manchester.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Jamie C Sergeant
- Centre for Biostatistics, University of Manchester, Manchester.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester
| | - Paul New
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath.,Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath Foundation Trust, Bath
| | - Zoe Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath
| | - Janine A Lamb
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester
| | - William E Ollier
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester
| | - Robert G Cooper
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool.,Department of Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Hector Chinoy
- Centre for Musculoskeletal Research, University of Manchester, Manchester.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
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9
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Parker MJS, Oldroyd A, Roberts ME, Lilleker JB, Betteridge ZE, McHugh NJ, Herrick AL, Cooper RG, Chinoy H. The performance of the European League Against Rheumatism/American College of Rheumatology idiopathic inflammatory myopathies classification criteria in an expert-defined 10 year incident cohort. Rheumatology (Oxford) 2020; 58:468-475. [PMID: 30496561 PMCID: PMC6381759 DOI: 10.1093/rheumatology/key343] [Citation(s) in RCA: 22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/17/2018] [Indexed: 01/31/2023] Open
Abstract
Objectives To assess the performance of the EULAR/ACR idiopathic inflammatory myopathies (IIMs) classification criteria in a cohort of incident IIM cases and examine how criteria-assigned IIM subtype correlates with expert opinion. Methods Adults with newly diagnosed IIM attending Salford Royal NHS Foundation Trust were identified over a 10 year period. A retrospective review of all putative cases was performed and those fulfilling a consensus expert opinion diagnosis of IIM were included. Clinical, serological and histological data were collected and each case was assigned a single IIM subtype. The EULAR/ACR classification criteria were then applied and sensitivity, specificity and positive and negative predictive values were calculated, presented with 95% CIs. Results A total of 1637 cases were screened, with 255 consensus expert opinion IIM cases ultimately identified. Applying the EULAR/ACR classification criteria, the sensitivity to diagnose an IIM was 99.6% (95% CI 97.2, 100) and 80.9% (95% CI 76.0, 85.8) for the criteria cut-points of probable and definite diagnoses, respectively. In 94/255 cases the IIM subtype differed between consensus expert opinion and classification criteria, most strikingly in the group subtyped as PM by the EULAR/ACR criteria, where there was discrepancy in the majority (i.e. in 87/161). Conclusion The EULAR/ACR criteria performed with high sensitivity in identifying IIM in this external cohort of incident IIM. However, substantial disagreements arose between consensus expert opinion and the criteria regarding IIM subtype assignments, resulting in a large proportion of criteria-assigned cases of PM having heterogeneous features. These results may have important implications for future use of these criteria in subsequent research.
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Affiliation(s)
- Matthew J S Parker
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.,Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Rheumatology Department, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alexander Oldroyd
- Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Mark E Roberts
- Manchester Academic Health Science Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - James B Lilleker
- Manchester Academic Health Science Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Zoe E Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Disease, Bath, UK
| | - Ariane L Herrick
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.,Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Robert G Cooper
- MRC-ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UK.,Centre for Integrated Genomic Medical Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Hector Chinoy
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.,Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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10
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Oldroyd A, Sergeant JC, New RP, McHugh NJ, Betteridge Z, Lamb JA, Ollier WE, Cooper RG, Chinoy H. Comment on: The temporal relationship between cancer and adult onset anti-transcriptional intermediary factor 1 antibody-positive dermatomyositis: Reply. Rheumatology (Oxford) 2019; 58:2073-2074. [PMID: 31377773 PMCID: PMC6812696 DOI: 10.1093/rheumatology/kez329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alexander Oldroyd
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jamie C Sergeant
- Centre for Biostatistics, Manchester, UK.,Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - R Paul New
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Foundation Trust, Bath, UK
| | - Zoe Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Janine A Lamb
- Division of Population Health, Health Services Research and Primary Care, Manchester, UK
| | - William E Ollier
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - Robert G Cooper
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UK.,Department of Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Hector Chinoy
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
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11
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Edwards K, Cooper RG, Vedsmand T, Nardelli G. Evaluating the Agile-Stage-Gate Hybrid Model: Experiences From Three SME Manufacturing Firms. Int J Innovation Technol Management 2019. [DOI: 10.1142/s0219877019500482] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Agile-Stage-Gate is a hybrid product development model that integrates elements of both Agile and Stage-Gate to help companies realize the strengths of both. Recent studies show positive results in manufacturing companies, although SMEs are notably absent despite being the majority. This paper reports results of a test of the model in three deliberately chosen manufacturing SMEs. Results were improved: time to market, overall new product process, higher success rate. Agile required adaptations, and novel solutions were found by the test firms. The positive results suggest that Agile-Stage-Gate must be considered as a recommended product development approach in SME manufacturers.
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Affiliation(s)
- Kasper Edwards
- DTU Management, Technical University of Denmark, Denmark
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12
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Abstract
Streamlines, vortex lines and magnetic flux tubes in turbulent fluids and plasmas display a great amount of coiling, twisting and linking, raising the question as to whether their topological complexity (continually created and destroyed by reconnections) can be quantified. In superfluid helium, the discrete (quantized) nature of vorticity can be exploited to associate to each vortex loop a knot invariant called the Alexander polynomial whose degree characterizes the topology of that vortex loop. By numerically simulating the dynamics of a tangle of quantum vortex lines, we find that this quantum turbulence always contains vortex knots of very large degree which keep forming, vanishing and reforming, creating a distribution of topologies which we quantify in terms of a knot spectrum and its scaling law. We also find results analogous to those in the wider literature, demonstrating that the knotting probability of the vortex tangle grows with the vortex length, as for macromolecules, and saturates above a characteristic length, as found for tumbled strings.
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Affiliation(s)
- R G Cooper
- School of Mathematics, Statistics and Physics Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - M Mesgarnezhad
- School of Mathematics, Statistics and Physics Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A W Baggaley
- School of Mathematics, Statistics and Physics Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.,JQC (Joint Quantum Centre), Durham-Newcastle, UK
| | - C F Barenghi
- School of Mathematics, Statistics and Physics Newcastle University, Newcastle upon Tyne, NE1 7RU, UK. .,JQC (Joint Quantum Centre), Durham-Newcastle, UK.
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13
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Scott SN, Shepherd SO, Hopkins N, Dawson EA, Strauss JA, Wright DJ, Cooper RG, Kumar P, Wagenmakers AJM, Cocks M. Home‐hit improves muscle capillarisation and eNOS/NAD(P)Hoxidase protein ratio in obese individuals with elevated cardiovascular disease risk. J Physiol 2019; 597:4203-4225. [DOI: 10.1113/jp278062] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/05/2019] [Indexed: 12/17/2022] Open
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14
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Rothwell S, Chinoy H, Lamb JA, Miller FW, Rider LG, Wedderburn LR, McHugh NJ, Mammen AL, Betteridge ZE, Tansley SL, Bowes J, Vencovský J, Deakin CT, Dankó K, Vidya L, Selva-O'Callaghan A, Pachman LM, Reed AM, Molberg Ø, Benveniste O, Mathiesen PR, Radstake TRDJ, Doria A, de Bleecker J, Lee AT, Hanna MG, Machado PM, Ollier WE, Gregersen PK, Padyukov L, O'Hanlon TP, Cooper RG, Lundberg IE. Focused HLA analysis in Caucasians with myositis identifies significant associations with autoantibody subgroups. Ann Rheum Dis 2019; 78:996-1002. [PMID: 31138531 PMCID: PMC6585280 DOI: 10.1136/annrheumdis-2019-215046] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 01/09/2019] [Revised: 03/14/2019] [Accepted: 03/30/2019] [Indexed: 12/23/2022]
Abstract
Objectives Idiopathic inflammatory myopathies (IIM) are a spectrum of rare autoimmune diseases characterised clinically by muscle weakness and heterogeneous systemic organ involvement. The strongest genetic risk is within the major histocompatibility complex (MHC). Since autoantibody presence defines specific clinical subgroups of IIM, we aimed to correlate serotype and genotype, to identify novel risk variants in the MHC region that co-occur with IIM autoantibodies. Methods We collected available autoantibody data in our cohort of 2582 Caucasian patients with IIM. High resolution human leucocyte antigen (HLA) alleles and corresponding amino acid sequences were imputed using SNP2HLA from existing genotyping data and tested for association with 12 autoantibody subgroups. Results We report associations with eight autoantibodies reaching our study-wide significance level of p<2.9×10–5. Associations with the 8.1 ancestral haplotype were found with anti-Jo-1 (HLA-B*08:01, p=2.28×10–53 and HLA-DRB1*03:01, p=3.25×10–9), anti-PM/Scl (HLA-DQB1*02:01, p=1.47×10–26) and anti-cN1A autoantibodies (HLA-DRB1*03:01, p=1.40×10–11). Associations independent of this haplotype were found with anti-Mi-2 (HLA-DRB1*07:01, p=4.92×10–13) and anti-HMGCR autoantibodies (HLA-DRB1*11, p=5.09×10–6). Amino acid positions may be more strongly associated than classical HLA associations; for example with anti-Jo-1 autoantibodies and position 74 of HLA-DRB1 (p=3.47×10–64) and position 9 of HLA-B (p=7.03×10–11). We report novel genetic associations with HLA-DQB1 anti-TIF1 autoantibodies and identify haplotypes that may differ between adult-onset and juvenile-onset patients with these autoantibodies. Conclusions These findings provide new insights regarding the functional consequences of genetic polymorphisms within the MHC. As autoantibodies in IIM correlate with specific clinical features of disease, understanding genetic risk underlying development of autoantibody profiles has implications for future research.
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Affiliation(s)
- Simon Rothwell
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Janine A Lamb
- Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Frederick W Miller
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Lucy R Wedderburn
- NIHR Great Ormond Street Biomedical Research Centre, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Neil J McHugh
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.,Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sarah L Tansley
- Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - John Bowes
- Arthritis Research UK Centre for Genetics and Genomics, The University of Manchester, Manchester, UK
| | - Jiří Vencovský
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Claire T Deakin
- NIHR Great Ormond Street Biomedical Research Centre, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Katalin Dankó
- Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Limaye Vidya
- Rheumatology Unit, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Albert Selva-O'Callaghan
- Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Lauren M Pachman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann M Reed
- Pediatrics, Duke University, Durham, North Carolina, USA
| | - Øyvind Molberg
- Department of Rheumatology, University of Oslo, Oslo, Norway
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, France, France
| | - Pernille R Mathiesen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Timothy R D J Radstake
- Department of Rheumatology and Clinical Immunology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Andrea Doria
- Division of Rheumatology, University of Padova, Padova, Italy
| | | | - Annette T Lee
- Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - Pedro M Machado
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - William E Ollier
- Centre for Epidemiology, The University of Manchester, Manchester, UK.,School of Healthcare Sciences, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Peter K Gregersen
- Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Terrance P O'Hanlon
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Robert G Cooper
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, Merseyside, UK
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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15
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Betteridge Z, Tansley S, Shaddick G, Chinoy H, Cooper RG, New RP, Lilleker JB, Vencovsky J, Chazarain L, Danko K, Nagy-Vincze M, Bodoki L, Dastmalchi M, Ekholm L, Lundberg IE, McHugh N. Frequency, mutual exclusivity and clinical associations of myositis autoantibodies in a combined European cohort of idiopathic inflammatory myopathy patients. J Autoimmun 2019; 101:48-55. [PMID: 30992170 PMCID: PMC6580360 DOI: 10.1016/j.jaut.2019.04.001] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
Abstract
Objectives To determine prevalence and co-existence of myositis specific autoantibodies (MSAs) and myositis associated autoantibodies (MAAs) and associated clinical characteristics in a large cohort of idiopathic inflammatory myopathy (IIM) patients. Methods Adult patients with confirmed IIM recruited to the EuroMyositis registry (n = 1637) from four centres were investigated for the presence of MSAs/MAAs by radiolabelled-immunoprecipitation, with confirmation of anti-MDA5 and anti-NXP2 by ELISA. Clinical associations for each autoantibody were calculated for 1483 patients with a single or no known autoantibody by global linear regression modelling. Results MSAs/MAAs were found in 61.5% of patients, with 84.7% of autoantibody positive patients having a sole specificity, and only three cases (0.2%) having more than one MSA. The most frequently detected autoantibody was anti-Jo-1 (18.7%), with a further 21 specificities each found in 0.2–7.9% of patients. Autoantibodies to Mi-2, SAE, TIF1, NXP2, MDA5, PMScl and the non-Jo-1 tRNA-synthetases were strongly associated (p < 0.001) with cutaneous involvement. Anti-TIF1 and anti-Mi-2 positive patients had an increased risk of malignancy (OR 4.67 and 2.50 respectively), and anti-SRP patients had a greater likelihood of cardiac involvement (OR 4.15). Interstitial lung disease was strongly associated with the anti-tRNA synthetases, anti-MDA5, and anti-U1RNP/Sm. Overlap disease was strongly associated with anti-PMScl, anti-Ku, anti-U1RNP/Sm and anti-Ro60. Absence of MSA/MAA was negatively associated with extra-muscular manifestations. Conclusions Myositis autoantibodies are present in the majority of patients with IIM and identify distinct clinical subsets. Furthermore, MSAs are nearly always mutually exclusive endorsing their credentials as valuable disease biomarkers. Myositis specific autoantibodies very rarely coexist in the one individual allowing endotypes to be more precisely defined. The association of anti-TIF1 and cancer-associated myositis is confirmed with a cut-off age of over 58 years. In a large combined European myositis cohort associations of anti-SRP with carditis and anti-Mi-2 with cancer have emerged. Myositis associated autoantibodies are strongly associated with having myositis in association with another connective tissue disease.
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Affiliation(s)
- Z Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - S Tansley
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - G Shaddick
- Department of Mathematics, University of Exeter, Exeter, UK
| | - H Chinoy
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute of Health Research Manchester Biomedical Research Centre, Manchester University Foundation Trust.UK; Salford Royal NHS Foundation Trust, Manchester, UK
| | - R G Cooper
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R P New
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - J B Lilleker
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Salford Royal NHS Foundation Trust, Manchester, UK
| | - J Vencovsky
- Institute of Rheumatology and Department of Rheumatology, 1stMedical Faculty, Charles University, Prague, Czech Republic
| | - L Chazarain
- Institute of Rheumatology and Department of Rheumatology, 1stMedical Faculty, Charles University, Prague, Czech Republic
| | - K Danko
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - M Nagy-Vincze
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - L Bodoki
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - M Dastmalchi
- Division of Rheumatology, Department of Medicine, Solna Karolinska Institutet, And Karolinska University Hospital, Stockholm, Sweden
| | - L Ekholm
- Division of Rheumatology, Department of Medicine, Solna Karolinska Institutet, And Karolinska University Hospital, Stockholm, Sweden
| | - I E Lundberg
- Division of Rheumatology, Department of Medicine, Solna Karolinska Institutet, And Karolinska University Hospital, Stockholm, Sweden
| | - N McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
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16
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Parker MJS, Oldroyd A, Roberts ME, Ollier WE, New RP, Cooper RG, Chinoy H. Increasing incidence of adult idiopathic inflammatory myopathies in the City of Salford, UK: a 10-year epidemiological study. Rheumatol Adv Pract 2018; 2:rky035. [PMID: 31431976 PMCID: PMC6649983 DOI: 10.1093/rap/rky035] [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: 02/13/2018] [Revised: 08/02/2018] [Indexed: 01/30/2023] Open
Abstract
Objectives The aim was to identify and characterize all incident adult cases of idiopathic inflammatory myopathies (IIM) between 1 January 2007 and 31 December 2016 in the City of Salford, UK. Methods Adults first diagnosed with IIM within the study period were identified by: a Salford Royal NHS Foundation Trust (SRFT) inpatient episode IIM-specific ICD-10 coding search; all new patient appointments to SRFT neuromuscular outpatient clinics; and all Salford residents enrolled within the UKMYONET study. All patients with definite IIM by the 2017 EULAR/ACR classification criteria were included, as were probable cases if consensus expert opinion agreed. Cases were excluded if <18 years of age at disease onset, if they did not meet probable criteria or when probable but expert opinion concluded a non-IIM diagnosis. Results The multimodal case ascertainment identified 1156 cases which, after review and application of exclusion criteria, resulted in 32 incident cases during the study period. Twenty-three of 32 were female, with a mean age of 58.1 years. The mean incidence of adult IIM was 17.6/1 000 000 person years, and higher for females than for males (25.2 vs 10.0/1 000 000 person years, respectively). A significant incidence increase over time was apparent (13.6 vs 21.4/1 000 000 person years; P = 0.032). Using EULAR/ACR classification criteria, the largest IIM subtype (21/32) was PM, followed by DM (8/32), IBM (2/32) and amyopathic DM (1/32). Expert opinion subtype differed from EULAR/ACR classification criteria in 19/32 cases. Conclusion The incidence of adult IIM in Salford is 17.6/1 000 000 person years, higher in females, and is increasing over time. Disagreement exists between EULAR/ACR-derived and expert opinion-derived IIM subtype assignments.
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Affiliation(s)
- Matthew J S Parker
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester
| | - Alexander Oldroyd
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester.,Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Mark E Roberts
- Department of Neurology, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford
| | - William E Ollier
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester
| | - Robert P New
- MRC-ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool
| | - Robert G Cooper
- MRC-ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool.,Centre for Integrated Genomic Medical Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester
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17
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Betteridge ZE, Priest L, Cooper RG, McHugh NJ, Blackhall F, Lamb JA. Investigation of myositis and scleroderma specific autoantibodies in patients with lung cancer. Arthritis Res Ther 2018; 20:176. [PMID: 30092841 PMCID: PMC6085683 DOI: 10.1186/s13075-018-1678-9] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The close temporal association between onset of some connective tissue diseases and cancer suggests a paraneoplastic association. Adult patients with scleroderma with anti-RNA polymerase III autoantibodies and adult patients with dermatomyositis with anti-transcriptional intermediary factor 1 (anti-TIF1) or anti-nuclear matrix protein 2 (anti-NXP2) autoantibodies have a significantly increased risk of developing cancer. Autoantibodies may serve as biomarkers for early detection of cancer and also could be relevant for prediction of responses to immune therapies. We aimed to test whether myositis and scleroderma specific or associated autoantibodies are detectable in individuals with lung cancer. METHODS Serum from 60 Caucasian patients with lung cancer (30 with small cell lung cancer, 30 with non-small cell lung cancer) was screened for myositis and scleroderma specific and associated autoantibodies by radiolabelled immunoprecipitation. RESULTS Anti-TIF1, anti-NXP2 or anti-RNA polymerase III autoantibodies were not detected in any of the 60 patients with lung cancer. Anti-glycyl-transfer RNA (tRNA) synthetase (anti-EJ) autoantibodies were detected in one patient with non-small cell lung cancer. No other known myositis or scleroderma autoantibodies were identified. CONCLUSIONS Myositis and scleroderma specific autoantibodies, including anti-TIF1, anti-NXP2 and anti-RNA polymerase III, are rare in patients with lung cancer without an autoimmune disease. We report here the first case of anti-EJ autoantibodies being detected in a patient with lung cancer without clinical or radiographic evidence of the anti-synthetase syndrome.
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Affiliation(s)
- Zoe E Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Lynsey Priest
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | - Robert G Cooper
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Foundation Trust, Bath, UK
| | - Fiona Blackhall
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK.,CRUK Lung Cancer Centre of Excellence, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
| | - Janine A Lamb
- Centre for Epidemiology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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18
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Lightfoot AP, Cooper RG. Editorial: Endurance Exercise: An Important Therapeutic Adjuvant in the Overall Treatment of Myositis? Arthritis Rheumatol 2018; 68:1578-81. [PMID: 26866277 DOI: 10.1002/art.39615] [Citation(s) in RCA: 2] [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] [Received: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Adam P Lightfoot
- MRC Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UK
| | - Robert G Cooper
- MRC Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UK
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19
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Lilleker JB, Diederichsen ACP, Jacobsen S, Guy M, Roberts ME, Sergeant JC, Cooper RG, Diederichsen LP, Chinoy H. Using serum troponins to screen for cardiac involvement and assess disease activity in the idiopathic inflammatory myopathies. Rheumatology (Oxford) 2018; 57:1041-1046. [PMID: 29538753 PMCID: PMC5965080 DOI: 10.1093/rheumatology/key031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/25/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives Limitations in the methods available for identifying cardiac involvement and accurately quantifying disease activity in the idiopathic inflammatory myopathies (IIMs) may contribute to poor outcomes. We investigated the utility of different serum muscle damage markers [total creatine kinase (CK), cardiac troponin T (cTnT) and cardiac troponin I (cTnI)] to address these issues. Methods We assessed disease activity and cardiac involvement using the International Myositis Assessment and Clinical Studies Group core set measures in 123 participants with confirmed adult-onset IIM from the UK and Denmark. Total CK, cTnT and cTnI were measured. Associations were assessed using logistic regression and Spearman's ranked correlation. Results Cardiac involvement (n = 18) was associated with higher cTnI levels, independent of overall disease activity [adjusted odds ratio 1.03 (95% CI 1.01, 1.05); P = 0.002]. An abnormal cTnI had the highest specificity and positive predictive value for cardiac involvement (95% and 62%, respectively). In those with a normal CK but elevated cTnT or cTnI, an association with increased disease activity scores was observed. Serum cTnT correlated with the physician (ρ = 0.39) and patient-assessed (ρ = 0.28) global visual analogue scales and HAQ (ρ = 0.41) more strongly than CK or cTnI levels. cTnT was the only marker to correlate with manual muscle testing scores (ρ = -0.24). Conclusion Serum cTnI testing may have a role in screening for cardiac involvement in IIMs. Abnormal levels of serum cTnT and cTnI are associated with increased disease activity, including in those with a normal CK.
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Affiliation(s)
- James B Lilleker
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
- Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | | | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark Guy
- Department of Biochemistry, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Mark E Roberts
- Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Jamie C Sergeant
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Robert G Cooper
- MRC-ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UK
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | | | - Hector Chinoy
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Cooper CR, Domínguez E, Cooper RG, Higgins A, Lipka A. Capital, Alienation, and Challenge: How U.S. Mexican Immigrant Students Build Pathways to College and Career Identities. New Dir Child Adolesc Dev 2018; 2018:75-87. [PMID: 29633538 DOI: 10.1002/cad.20239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article considers how the global "academic pipeline problem" constrains immigrant, low-income, and ethnic minority students' pathways to higher education, and how some students build pathways to college and career identities. After aligning theories of social capital, alienation/belonging, and challenge and their integration in Bridging Multiple Worlds Theory, we summarize six longitudinal studies based on this theory from a 23-year university-community partnership serving low-income, primarily U.S. Mexican immigrant youth. Spanning from childhood to early adulthood, the studies revealed two overarching findings: First, students built pathways to college and career identities while experiencing capital, alienation/belonging, and challenges across their evolving cultural worlds. Second, by "giving back" to families, peers, schools, and communities, students became cultural brokers and later, institutional agents, transforming institutional cultures. Findings highlight the value of integrating interdisciplinary theories, research evidence, and educational systems serving diverse communities to open individual pathways and academic pipelines in multicultural societies.
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Cooper RG. What Develops in Cultural Transitions in Identities, Future Orientation, and School and Career Pathways? New Dir Child Adolesc Dev 2018; 2018:101-107. [DOI: 10.1002/cad.20236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Parker MJS, Oldroyd A, Roberts ME, Lilleker JB, Ollier WE, New RP, Cooper RG, Chinoy H. O23 The incidence of adult idiopathic inflammatory myopathies at a UK specialist neuromuscular centre: a ten-year epidemiology study. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matthew J S Parker
- Rheumatology Department, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UNITED KINGDOM
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UNITED KINGDOM
| | - Alexander Oldroyd
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UNITED KINGDOM
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UNITED KINGDOM
| | - Mark E Roberts
- Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UNITED KINGDOM
| | - James B Lilleker
- Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UNITED KINGDOM
| | - William E Ollier
- Rheumatology Department, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UNITED KINGDOM
| | - Robert P New
- MRC-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UNITED KINGDOM
| | - Robert G Cooper
- MRC-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, UNITED KINGDOM
- Centre for Integrated Genomic Medical Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UNITED KINGDOM
| | - Hector Chinoy
- Rheumatology Department, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UNITED KINGDOM
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UNITED KINGDOM
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Cooper RG, Walsh J, Gottlieb AB, Hoepken B, Nurminen T, Mease PJ. 162 Efficacyand safety of certolizumab pegol over four years in psoriatic arthritis patientswith and without concomitant use of DMARDs. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert G Cooper
- Department of Musculoskeletal Biology II, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM
| | - Jessica Walsh
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Alice B Gottlieb
- Department of Dermatology, New York Medical College, Metropolitan Hospital, New York, NY, USA
| | | | | | - Philip J Mease
- Department of Dermatology, Swedish Medical Center and University of Washington, Seattle, WA, USA
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Cotton CV, Betteridge ZE, Spencer LG, New RP, Lamb J, McHugh NJ, Cooper RG. O24 Low level detection of CTD-associated autoantibodies in patients with idiopathic pulmonary fibrosis confirms this as a robust phenotype when diagnosed on clinical grounds alone. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Caroline V Cotton
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM
| | - Zoe E Betteridge
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
| | - Lisa G Spencer
- Aintree Chest Centre, University Hospital Aintree, Liverpool, UNITED KINGDOM
| | - Robert P New
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM
| | - Janine Lamb
- Centre for Epidemiology, University of Manchester, Manchester, UNITED KINGDOM
| | - Neil J McHugh
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
| | - Robert G Cooper
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM
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25
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Kochi Y, Kamatani Y, Kondo Y, Suzuki A, Kawakami E, Hiwa R, Momozawa Y, Fujimoto M, Jinnin M, Tanaka Y, Kanda T, Cooper RG, Chinoy H, Rothwell S, Lamb JA, Vencovský J, Mann H, Ohmura K, Myouzen K, Ishigaki K, Nakashima R, Hosono Y, Tsuboi H, Kawasumi H, Iwasaki Y, Kajiyama H, Horita T, Ogawa-Momohara M, Takamura A, Tsunoda S, Shimizu J, Fujio K, Amano H, Mimori A, Kawakami A, Umehara H, Takeuchi T, Sano H, Muro Y, Atsumi T, Mimura T, Kawaguchi Y, Mimori T, Takahashi A, Kubo M, Kohsaka H, Sumida T, Yamamoto K. Splicing variant of WDFY4 augments MDA5 signalling and the risk of clinically amyopathic dermatomyositis. Ann Rheum Dis 2018; 77:602-611. [PMID: 29331962 DOI: 10.1136/annrheumdis-2017-212149] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 12/30/2017] [Accepted: 01/02/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of rare autoimmune diseases in which both genetic and environmental factors play important roles. To identify genetic factors of IIM including polymyositis, dermatomyositis (DM) and clinically amyopathic DM (CADM), we performed the first genome-wide association study for IIM in an Asian population. METHODS We genotyped and tested 496 819 single nucleotide polymorphism for association using 576 patients with IIM and 6270 control subjects. We also examined the causal mechanism of disease-associated variants by in silico analyses using publicly available data sets as well as by in in vitro analyses using reporter assays and apoptosis assays. RESULTS We identified a variant in WDFY4 that was significantly associated with CADM (rs7919656; OR=3.87; P=1.5×10-8). This variant had a cis-splicing quantitative trait locus (QTL) effect for a truncated WDFY4isoform (tr-WDFY4), with higher expression in the risk allele. Transexpression QTL analysis of this variant showed a positive correlation with the expression of NF-κB associated genes. Furthermore, we demonstrated that both WDFY4 and tr-WDFY4 interacted with pattern recognition receptors such as TLR3, TLR4, TLR9 and MDA5 and augmented the NF-κB activation by these receptors. WDFY4 isoforms also enhanced MDA5-induced apoptosis to a greater extent in the tr-WDFY4-transfected cells. CONCLUSIONS As CADM is characterised by the appearance of anti-MDA5 autoantibodies and severe lung inflammation, the WDFY4 variant may play a critical role in the pathogenesis of CADM.
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Affiliation(s)
- Yuta Kochi
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akari Suzuki
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Eiryo Kawakami
- Laboratory for Disease Systems Modeling, RIKEN Center for Integrated Medical Sciences, Yokohama, Japan
| | - Ryosuke Hiwa
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.,Department of Dermatology, University of Tsukuba, Ibaraki, Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Robert G Cooper
- MRC-ARUK Institute for Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.,Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Centre for Integrated Genomic Medical Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Hector Chinoy
- Rheumatology Department, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.,The National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Simon Rothwell
- The National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Janine A Lamb
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Centre for Integrated Genomic Medical Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Jiří Vencovský
- Institute of Rheumatology, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Charles University, Prague, Czech Republic
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keiko Myouzen
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Kazuyoshi Ishigaki
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuji Hosono
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hidenaga Kawasumi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yukiko Iwasaki
- Department of Allergy and Rheumatology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hiroshi Kajiyama
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Tetsuya Horita
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mariko Ogawa-Momohara
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akito Takamura
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichiro Tsunoda
- Division of Rheumatology Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hirofumi Amano
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akio Mimori
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hisanori Umehara
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Sano
- Division of Rheumatology Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihide Mimura
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Atsushi Takahashi
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazuhiko Yamamoto
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.,Department of Allergy and Rheumatology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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Lilleker JB, Vencovsky J, Wang G, Wedderburn LR, Diederichsen LP, Schmidt J, Oakley P, Benveniste O, Danieli MG, Danko K, Thuy NTP, Vazquez-Del Mercado M, Andersson H, De Paepe B, deBleecker JL, Maurer B, McCann LJ, Pipitone N, McHugh N, Betteridge ZE, New P, Cooper RG, Ollier WE, Lamb JA, Krogh NS, Lundberg IE, Chinoy H. The EuroMyositis registry: an international collaborative tool to facilitate myositis research. Ann Rheum Dis 2018; 77:30-39. [PMID: 28855174 PMCID: PMC5754739 DOI: 10.1136/annrheumdis-2017-211868] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 11/05/2022]
Abstract
AIMS The EuroMyositis Registry facilitates collaboration across the idiopathic inflammatory myopathy (IIM) research community. This inaugural report examines pooled Registry data. METHODS Cross-sectional analysis of IIM cases from 11 countries was performed. Associations between clinical subtypes, extramuscular involvement, environmental exposures and medications were investigated. RESULTS Of 3067 IIM cases, 69% were female. The most common IIM subtype was dermatomyositis (DM) (31%). Smoking was more frequent in connective tissue disease overlap cases (45%, OR 1.44, 95% CI 1.09 to 1.90, p=0.012). Smoking was associated with interstitial lung disease (ILD) (OR 1.32, 95% CI 1.06 to 1.65, p=0.013), dysphagia (OR 1.43, 95% CI 1.16 to 1.77, p=0.001), malignancy ever (OR 1.78, 95% CI 1.36 to 2.33, p<0.001) and cardiac involvement (OR 2.40, 95% CI 1.60 to 3.60, p<0.001).Dysphagia occurred in 39% and cardiac involvement in 9%; either occurrence was associated with higher Health Assessment Questionnaire (HAQ) scores (adjusted OR 1.79, 95% CI 1.43 to 2.23, p<0.001). HAQ scores were also higher in inclusion body myositis cases (adjusted OR 3.85, 95% CI 2.52 to 5.90, p<0.001). Malignancy (ever) occurred in 13%, most commonly in DM (20%, OR 2.06, 95% CI 1.65 to 2.57, p<0.001).ILD occurred in 30%, most frequently in antisynthetase syndrome (71%, OR 10.7, 95% CI 8.6 to 13.4, p<0.001). Rash characteristics differed between adult-onset and juvenile-onset DM cases ('V' sign: 56% DM vs 16% juvenile-DM, OR 0.16, 95% CI 0.07 to 0.36, p<0.001). Glucocorticoids were used in 98% of cases, methotrexate in 71% and azathioprine in 51%. CONCLUSION This large multicentre cohort demonstrates the importance of extramuscular involvement in patients with IIM, its association with smoking and its influence on disease severity. Our findings emphasise that IIM is a multisystem inflammatory disease and will help inform prognosis and clinical management of patients.
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Affiliation(s)
- James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Lucy R Wedderburn
- University College London GOS Institute of Child Health and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Olivier Benveniste
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, UPMC, Paris, France
| | - Maria Giovanna Danieli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche & Ospedali Riuniti, Ancona, Italy
| | - Katalin Danko
- Division of Immunology, University of Debrecen, Debrecen, Hungary
| | - Nguyen Thi Phuong Thuy
- Department of Rheumatology, Bach Mai Hospital, Bach Mai Hospital, Hanoi Medical University, Hanoi, Viet Nam
| | | | - Helena Andersson
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Boel De Paepe
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Jan L deBleecker
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Liza J McCann
- Department of Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Nicolo Pipitone
- Department of Rheumatology, Arcispedale S. Maria Nuova-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, Bath and North East Somer, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Zoe E Betteridge
- Royal National Hospital for Rheumatic Diseases, Bath, Bath and North East Somer, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Paul New
- MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Robert G Cooper
- MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - William E Ollier
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Janine A Lamb
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Ingrid E Lundberg
- Unit of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hector Chinoy
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- The National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Lilleker JB, Vencovsky J, Wang G, Wedderburn LR, Diederichsen LP, Schmidt J, Jordan P, Benveniste O, Danieli MG, Dankó K, Phuong Thuy NT, Vázquez-Del Mercado M, Andersson H, Paepe BD, De Bleecker JL, Maurer B, McCann LJ, Pipitone N, McHugh N, Betteridge Z, New P, Cooper RG, Ollier WE, Lamb JA, Krogh NS, Lundberg IE, Chinoy H. Response to: 'Antisynthetase syndrome or what else? Different perspectives indicate the need for new classification criteria' by Cavagna et al. Ann Rheum Dis 2017; 77:e51. [PMID: 29259048 DOI: 10.1136/annrheumdis-2017-212382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 11/04/2022]
Affiliation(s)
- James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Stott Lane, UK
| | | | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Lucy R Wedderburn
- University College London GOS Institute of Child Health and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Olivier Benveniste
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, UPMC, Paris, France
| | - Maria Giovanna Danieli
- Dipartimento di Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche and Ospedali Riuniti, Ancona, Italy
| | - Katalin Dankó
- Division of Immunology, University of Debrecen, Debrecen, Hungary
| | | | - Monica Vázquez-Del Mercado
- División de Medicina Interna, Servicio de Reumatología, PNPC 004086, CONACyT, Hospital Civil Dr Juan I Menchaca, Guadalajara, Jalisco, Salvador Quevedo y Zubieta S/N, Guadalajara, Mexico
| | - Helena Andersson
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Boel De Paepe
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Liza J McCann
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Nicolo Pipitone
- Department of Rheumatology, Arcispedale S Maria Nuova-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK.,Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Zoe Betteridge
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK.,Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Paul New
- MRC-ARUK Institute for Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Robert G Cooper
- MRC-ARUK Institute for Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.,Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - William E Ollier
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Janine A Lamb
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Ingrid E Lundberg
- Unit of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hector Chinoy
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.,The National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Lilleker JB, Guy M, Roberts ME, Sergeant JC, Cooper RG, Chinoy H. PO203 Assessing disease activity and cardiac involvement in myositis. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Lilleker JB, Gordon P, Lamb JA, Lempp H, Cooper RG, Roberts ME, Jordan P, Chinoy H. Patient-centred standards of care for adults with myositis. BMC Rheumatol 2017; 1:4. [PMID: 30886948 PMCID: PMC6383593 DOI: 10.1186/s41927-017-0002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/19/2017] [Indexed: 11/26/2022] Open
Abstract
Background The idiopathic inflammatory myopathies (IIM, myositis) are a heterogeneous group of chronic autoimmune disorders causing considerable physical and mental health impact. There is a lack of formalised guidance defining best practice for the management of myositis, contributing to inconsistent care provision and some patients feeling isolated and unsupported. To address these issues, we evaluated the clinical services available to adults with myositis in the UK. We then created patient-centred standards of care using a structured process involving patients, their relatives and caregivers, physicians and allied healthcare professionals. Methods After an initial focus group, the clinical services available to patients with myositis were evaluated using a patient-completed questionnaire. Draft standards of care were created, each addressing deficits in care provision identified by patients. In response to feedback, including a two-stage modified Delphi exercise, these draft standards were iteratively improved until consensus was reached. Accompanying plain language versions of the standards of care and an audit tool were also created. Results We identified issues regarding diagnostic pathways, access to specialist services, advice and support regarding employment, medication-related adverse events and the treatment of extra-muscular manifestations. Fifteen standards of care were drafted. After modification, agreement was reached on eleven final standards of care. Conclusion These patient-centred standards of care for adults with myositis provide a benchmark for the evaluation of local practice. Their implementation will promote consistent good practice across care providers and empower patients when seeking access to local services. Electronic supplementary material The online version of this article (10.1186/s41927-017-0002-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James B Lilleker
- 1Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Stott Lane, Salford, UK.,2NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Patrick Gordon
- 3King's College Hospital NHS Foundation Trust, London, UK
| | - Janine A Lamb
- 4Centre for Integrated Genomic Medical Research, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Heidi Lempp
- 5Academic Rheumatology, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Robert G Cooper
- 4Centre for Integrated Genomic Medical Research, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK.,6MRC-ARUK Institute for Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Mark E Roberts
- 1Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Stott Lane, Salford, UK
| | | | - Hector Chinoy
- 2NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, The University of Manchester, Manchester, UK.,8Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Stott Lane, Salford, UK
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30
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Bottai M, Tjärnlund A, Santoni G, Werth VP, Pilkington C, de Visser M, Alfredsson L, Amato AA, Barohn RJ, Liang MH, Singh JA, Aggarwal R, Arnardottir S, Chinoy H, Cooper RG, Danko K, Dimachkie MM, Feldman BM, García-De La Torre I, Gordon P, Hayashi T, Katz JD, Kohsaka H, Lachenbruch PA, Lang BA, Li Y, Oddis CV, Olesinka M, Reed AM, Rutkowska-Sak L, Sanner H, Selva-O’Callaghan A, Wook Song Y, Vencovsky J, Ytterberg SR, Miller FW, Rider LG, Lundberg IE. EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups: a methodology report. RMD Open 2017; 3:e000507. [PMID: 29177080 PMCID: PMC5687535 DOI: 10.1136/rmdopen-2017-000507] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/25/2017] [Accepted: 10/21/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the methodology used to develop new classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIMs) and their major subgroups. METHODS An international, multidisciplinary group of myositis experts produced a set of 93 potentially relevant variables to be tested for inclusion in the criteria. Rheumatology, dermatology, neurology and paediatric clinics worldwide collected data on 976 IIM cases (74% adults, 26% children) and 624 non-IIM comparator cases with mimicking conditions (82% adults, 18% children). The participating clinicians classified each case as IIM or non-IIM. Generally, the classification of any given patient was based on few variables, leaving remaining variables unmeasured. We investigated the strength of the association between all variables and between these and the disease status as determined by the physician. We considered three approaches: (1) a probability-score approach, (2) a sum-of-items approach criteria and (3) a classification-tree approach. RESULTS The approaches yielded several candidate models that were scrutinised with respect to statistical performance and clinical relevance. The probability-score approach showed superior statistical performance and clinical practicability and was therefore preferred over the others. We developed a classification tree for subclassification of patients with IIM. A calculator for electronic devices, such as computers and smartphones, facilitates the use of the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria. CONCLUSIONS The new EULAR/ACR classification criteria provide a patient's probability of having IIM for use in clinical and research settings. The probability is based on a score obtained by summing the weights associated with a set of criteria items.
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Affiliation(s)
- Matteo Bottai
- Unit of Biostatistics, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Tjärnlund
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Giola Santoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Victoria P Werth
- Department of Dermatology, Philadelphia VAMC and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clarissa Pilkington
- Department of Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Marianne de Visser
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anthony A Amato
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Matthew H Liang
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, and Section of Rheumatology, Boston VA Healthcare System, Boston, Massachusetts, USA
| | - Jasvinder A Singh
- University of Alabama at Birmingham (UAB) and Birmingham VA Medical, Birmingham, Alabama, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Hector Chinoy
- National Institute of Health Research, Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Robert G Cooper
- MRC/ARUK Institute of Ageing and Chronic Disease, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - Katalin Danko
- Division of Immunology, 3rd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brian M Feldman
- Department of Pediatrics, Division of Rheumatology, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Ignacio García-De La Torre
- Department of Immunology and Rheumatology, Hospital General de Occidente, Secretaría de Salud, and University of Guadalajara, Guadalajara, Mexico
| | - Patrick Gordon
- Department of Rheumatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Taichi Hayashi
- Clinical Immunology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - James D Katz
- US Department of Health and Human Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Peter A Lachenbruch
- Department of Public Health, Oregon State University, Corvallis, Oregon, USA
| | - Bianca A Lang
- Department of Pediatrics, Division of Rheumatology, IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Yuhui Li
- Department of Rheumatology and Immunology, People’s Hospital of Beijing University, Beijing, China
| | - Chester V Oddis
- Division of Rheumatology and Clinical Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marzena Olesinka
- Connective Tissue Diseases Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Lidia Rutkowska-Sak
- Paediatric Clinic of Rheumatology, Institute of Rheumatology, Warsaw, Poland
| | - Helga Sanner
- Section of Rheumatology, Oslo University Hospital–Rikshospitalet, Oslo, Norway
| | | | - Yeong Wook Song
- Department of Internal Medicine, Medical Research Center, Clinical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, US Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, US Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
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31
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Rider LG, Ruperto N, Pistorio A, Erman B, Bayat N, Lachenbruch PA, Rockette H, Feldman BM, Huber AM, Hansen P, Oddis CV, Lundberg IE, Amato AA, Chinoy H, Cooper RG, Chung L, Danko K, Fiorentino D, García-De la Torre I, Reed AM, Wook Song Y, Cimaz R, Cuttica RJ, Pilkington CA, Martini A, van der Net J, Maillard S, Miller FW, Vencovsky J, Aggarwal R. 2016 ACR-EULAR adult dermatomyositis and polymyositis and juvenile dermatomyositis response criteria-methodological aspects. Rheumatology (Oxford) 2017; 56:1884-1893. [PMID: 28977549 DOI: 10.1093/rheumatology/kex226] [Citation(s) in RCA: 31] [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] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
Objective The objective was to describe the methodology used to develop new response criteria for adult DM/PM and JDM. Methods Patient profiles from prospective natural history data and clinical trials were rated by myositis specialists to develop consensus gold-standard ratings of minimal, moderate and major improvement. Experts completed a survey regarding clinically meaningful improvement in the core set measures (CSM) and a conjoint-analysis survey (using 1000Minds software) to derive relative weights of CSM and candidate definitions. Six types of candidate definitions for response criteria were derived using survey results, logistic regression, conjoint analysis, application of conjoint-analysis weights to CSM and published definitions. Sensitivity, specificity and area under the curve were defined for candidate criteria using consensus patient profile data, and selected definitions were validated using clinical trial data. Results Myositis specialists defined the degree of clinically meaningful improvement in CSM for minimal, moderate and major improvement. The conjoint-analysis survey established the relative weights of CSM, with muscle strength and Physician Global Activity as most important. Many candidate definitions showed excellent sensitivity, specificity and area under the curve in the consensus profiles. Trial validation showed that a number of candidate criteria differentiated between treatment groups. Top candidate criteria definitions were presented at the consensus conference. Conclusion Consensus methodology, with definitions tested on patient profiles and validated using clinical trials, led to 18 definitions for adult PM/DM and 14 for JDM as excellent candidates for consideration in the final consensus on new response criteria for myositis.
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Affiliation(s)
- Lisa G Rider
- Environmental Autoimmunity Group, NIEHS, National Institutes of Health, Bethesda, MD, USA
| | | | - Angela Pistorio
- Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy
| | - Brian Erman
- Social and Scientific Systems, Inc., Durham, NC
| | - Nastaran Bayat
- Environmental Autoimmunity Group, NIEHS, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Lachenbruch
- Environmental Autoimmunity Group, NIEHS, National Institutes of Health, Bethesda, MD, USA
| | - Howard Rockette
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian M Feldman
- Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario
| | - Adam M Huber
- Rheumatology Department, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Chester V Oddis
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ingrid E Lundberg
- Rheumatology Unit, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Anthony A Amato
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Hector Chinoy
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust.,Manchester Academic Health Science Centre, The University of Manchester, Manchester
| | - Robert G Cooper
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Lorinda Chung
- Division of Rheumatology, Stanford University, Redwood City, CA, USA
| | - Katalin Danko
- 3rd Department of Internal Medicine, Division of Immunology, University of Debrecen, Debrecen, Hungary
| | - David Fiorentino
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | | | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Yeong Wook Song
- Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Center, Seoul National University, Seoul, Korea
| | - Rolando Cimaz
- Pediatric Rheumatology, Azienda Ospedaliero Universitaria Meyer, University of Florence, Florence, Italy
| | - Rubén J Cuttica
- Department of Pediatric Rheumatology, Hospital de Niños Pedro de Elizalde, University of Buenos Aires, Buenos Aires, Argentina
| | - Clarissa A Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Alberto Martini
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO.,Università degli Studi di Genova, Dipartimento di Pediatria, Genoa, Italy
| | - Janjaap van der Net
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Susan Maillard
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Frederick W Miller
- Environmental Autoimmunity Group, NIEHS, National Institutes of Health, Bethesda, MD, USA
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Rohit Aggarwal
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
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Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, Visser MD, Alfredsson L, Amato AA, Barohn RJ, Liang MH, Singh JA, Aggarwal R, Arnardottir S, Chinoy H, Cooper RG, Dankó K, Dimachkie MM, Feldman BM, Torre IGDL, Gordon P, Hayashi T, Katz JD, Kohsaka H, Lachenbruch PA, Lang BA, Li Y, Oddis CV, Olesinska M, Reed AM, Rutkowska-Sak L, Sanner H, Selva-O'Callaghan A, Song YW, Vencovsky J, Ytterberg SR, Miller FW, Rider LG. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis 2017; 76:1955-1964. [PMID: 29079590 DOI: 10.1136/annrheumdis-2017-211468] [Citation(s) in RCA: 621] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/23/2017] [Accepted: 07/26/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop and validate new classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIM) and their major subgroups. METHODS Candidate variables were assembled from published criteria and expert opinion using consensus methodology. Data were collected from 47 rheumatology, dermatology, neurology and paediatric clinics worldwide. Several statistical methods were used to derive the classification criteria. RESULTS Based on data from 976 IIM patients (74% adults; 26% children) and 624 non-IIM patients with mimicking conditions (82% adults; 18% children), new criteria were derived. Each item is assigned a weighted score. The total score corresponds to a probability of having IIM. Subclassification is performed using a classification tree. A probability cut-off of 55%, corresponding to a score of 5.5 (6.7 with muscle biopsy) 'probable IIM', had best sensitivity/specificity (87%/82% without biopsies, 93%/88% with biopsies) and is recommended as a minimum to classify a patient as having IIM. A probability of ≥90%, corresponding to a score of ≥7.5 (≥8.7 with muscle biopsy), corresponds to 'definite IIM'. A probability of <50%, corresponding to a score of <5.3 (<6.5 with muscle biopsy), rules out IIM, leaving a probability of ≥50 to <55% as 'possible IIM'. CONCLUSIONS The European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for IIM have been endorsed by international rheumatology, dermatology, neurology and paediatric groups. They employ easily accessible and operationally defined elements, and have been partially validated. They allow classification of 'definite', 'probable' and 'possible' IIM, in addition to the major subgroups of IIM, including juvenile IIM. They generally perform better than existing criteria.
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Affiliation(s)
- Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anna Tjärnlund
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Victoria P Werth
- Department of Dermatology, Philadelphia VAMC and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clarissa Pilkington
- Department of Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Marianne de Visser
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lars Alfredsson
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anthony A Amato
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Matthew H Liang
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Section of Rheumatology, Boston VA Healthcare, Boston, Massachusetts, USA
| | - Jasvinder A Singh
- Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,University of Alabama and Birmingham VA Medical Center, Birmingham, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Hector Chinoy
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Robert G Cooper
- MRC/ARUK Institute of Ageing and Chronic Disease, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - Katalin Dankó
- Division of Immunology, 3rd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brian M Feldman
- Division of Rheumatology, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Ignacio Garcia-De La Torre
- Department of Immunology and Rheumatology, Hospital General de Occidente, Secretaría de Salud, and University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Taichi Hayashi
- Clinical Immunology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - James D Katz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Peter A Lachenbruch
- Department of Public Health, Oregon State University, Corvallis, Oregon, USA
| | - Bianca A Lang
- Division of Rheumatology, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Yuhui Li
- Department of Rheumatology and Immunology, People's Hospital of Beijing University, Beijing, China
| | - Chester V Oddis
- Division of Rheumatology and Clinical Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marzena Olesinska
- Connective Tissue Diseases Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Lidia Rutkowska-Sak
- Paediatric Clinic of Rheumatology, Institute of Rheumatology, Warsaw, Poland
| | - Helga Sanner
- Section of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | | | - Yeong-Wook Song
- Department of Internal Medicine, Medical Research Center, Clinical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiri Vencovsky
- Department of Rheumatology, Institute of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, New York, USA
| | - Frederick W Miller
- US Department of Health and Human Services, Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa G Rider
- US Department of Health and Human Services, Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
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Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, de Visser M, Alfredsson L, Amato AA, Barohn RJ, Liang MH, Singh JA, Aggarwal R, Arnardottir S, Chinoy H, Cooper RG, Dankó K, Dimachkie MM, Feldman BM, Garcia-De La Torre I, Gordon P, Hayashi T, Katz JD, Kohsaka H, Lachenbruch PA, Lang BA, Li Y, Oddis CV, Olesinska M, Reed AM, Rutkowska-Sak L, Sanner H, Selva-O'Callaghan A, Song YW, Vencovsky J, Ytterberg SR, Miller FW, Rider LG. 2017 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Adult and Juvenile Idiopathic Inflammatory Myopathies and Their Major Subgroups. Arthritis Rheumatol 2017; 69:2271-2282. [PMID: 29106061 DOI: 10.1002/art.40320] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/26/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To develop and validate new classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIM) and their major subgroups. METHODS Candidate variables were assembled from published criteria and expert opinion using consensus methodology. Data were collected from 47 rheumatology, dermatology, neurology, and pediatric clinics worldwide. Several statistical methods were utilized to derive the classification criteria. RESULTS Based on data from 976 IIM patients (74% adults; 26% children) and 624 non-IIM patients with mimicking conditions (82% adults; 18% children), new criteria were derived. Each item is assigned a weighted score. The total score corresponds to a probability of having IIM. Subclassification is performed using a classification tree. A probability cutoff of 55%, corresponding to a score of 5.5 (6.7 with muscle biopsy) "probable IIM," had best sensitivity/specificity (87%/82% without biopsies, 93%/88% with biopsies) and is recommended as a minimum to classify a patient as having IIM. A probability of ≥90%, corresponding to a score of ≥7.5 (≥8.7 with muscle biopsy), corresponds to "definite IIM." A probability of <50%, corresponding to a score of <5.3 (<6.5 with muscle biopsy), rules out IIM, leaving a probability of ≥50-<55% as "possible IIM." CONCLUSION The European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for IIM have been endorsed by international rheumatology, dermatology, neurology, and pediatric groups. They employ easily accessible and operationally defined elements, and have been partially validated. They allow classification of "definite," "probable," and "possible" IIM, in addition to the major subgroups of IIM, including juvenile IIM. They generally perform better than existing criteria.
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Affiliation(s)
- Ingrid E Lundberg
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Anna Tjärnlund
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | - Victoria P Werth
- Philadelphia VA Medical Center and Hospital of the University of Pennsylvania, Philadelphia
| | | | | | | | - Anthony A Amato
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Matthew H Liang
- Brigham and Women's Hospital and Boston VA Healthcare, Boston, Massachusetts
| | - Jasvinder A Singh
- Mayo Clinic College of Medicine, Rochester, Minnesota, and University of Alabama and Birmingham VA Medical Center, Birmingham, Alabama
| | - Rohit Aggarwal
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Hector Chinoy
- Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | | | | | | | - Brian M Feldman
- University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Patrick Gordon
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - James D Katz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Bianca A Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yuhui Li
- People's Hospital of Beijing University, Beijing, China
| | - Chester V Oddis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Marzena Olesinska
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | | | - Helga Sanner
- Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | | | - Yeong-Wook Song
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | - Frederick W Miller
- National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
| | - Lisa G Rider
- National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
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Cotton CV, Spencer LG, New RP, Cooper RG. The utility of comprehensive autoantibody testing to differentiate connective tissue disease associated and idiopathic interstitial lung disease subgroup cases. Rheumatology (Oxford) 2017; 56:1264-1271. [PMID: 28339528 DOI: 10.1093/rheumatology/kew320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Indexed: 02/02/2023] Open
Abstract
Interstitial lung disease (ILD) comprises many heterogeneous disease groups, the largest being CTD-associated and those labelled as idiopathic out of necessity. The mechanisms causing ILD are poorly understood, but most CTD- and idiopathic-ILD cases can respond to immunosuppression, clearly suggesting a pathological role for inflammation. By contrast, corticosteroid immunosuppression causes harm without benefit in the feared idiopathic pulmonary fibrosis, suggesting that inflammation plays little pathological role, and where ILD progresses rapidly to lethal outcome even with anti-fibrotic drug use. Given the treatment response differences apparent between ILD subgroups, and the dangers and costs of corticosteroid and anti-fibrotic drug use, respectively, it has become vital in every ILD patient to make an accurate subgroup diagnosis, to optimize treatment selections. This review discusses why differentiating CTD- and idiopathic-ILD subgroup cases remains so problematic, and why existing comprehensive CTD-specific serology would, if generally available, represent an ideal biomarker tool to enhance ILD subgroup diagnostic accuracy.
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Affiliation(s)
- Caroline V Cotton
- Department of Musculoskeletal Biology II, MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool.,University Department of Rheumatology
| | - Lisa G Spencer
- Department of Respiratory Medicine, Aintree Chest Centre, Aintree University Hospital, Liverpool, UK
| | - Robert P New
- Department of Musculoskeletal Biology II, MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool
| | - Robert G Cooper
- Department of Musculoskeletal Biology II, MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool.,University Department of Rheumatology
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Aggarwal R, Rider LG, Ruperto N, Bayat N, Erman B, Feldman BM, Oddis CV, Amato AA, Chinoy H, Cooper RG, Dastmalchi M, Fiorentino D, Isenberg D, Katz JD, Mammen A, de Visser M, Ytterberg SR, Lundberg IE, Chung L, Danko K, García-De la Torre I, Song YW, Villa L, Rinaldi M, Rockette H, Lachenbruch PA, Miller FW, Vencovsky J. 2016 American College of Rheumatology/European League Against Rheumatism criteria for minimal, moderate, and major clinical response in adult dermatomyositis and polymyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Ann Rheum Dis 2017; 76:792-801. [PMID: 28385805 DOI: 10.1136/annrheumdis-2017-211400] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [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: 03/01/2017] [Indexed: 11/03/2022]
Abstract
To develop response criteria for adult dermatomyositis (DM) and polymyositis (PM). Expert surveys, logistic regression, and conjoint analysis were used to develop 287 definitions using core set measures. Myositis experts rated greater improvement among multiple pairwise scenarios in conjoint analysis surveys, where different levels of improvement in 2 core set measures were presented. The PAPRIKA (Potentially All Pairwise Rankings of All Possible Alternatives) method determined the relative weights of core set measures and conjoint analysis definitions. The performance characteristics of the definitions were evaluated on patient profiles using expert consensus (gold standard) and were validated using data from a clinical trial. The nominal group technique was used to reach consensus. Consensus was reached for a conjoint analysis-based continuous model using absolute per cent change in core set measures (physician, patient, and extramuscular global activity, muscle strength, Health Assessment Questionnaire, and muscle enzyme levels). A total improvement score (range 0-100), determined by summing scores for each core set measure, was based on improvement in and relative weight of each core set measure. Thresholds for minimal, moderate, and major improvement were ≥20, ≥40, and ≥60 points in the total improvement score. The same criteria were chosen for juvenile DM, with different improvement thresholds. Sensitivity and specificity in DM/PM patient cohorts were 85% and 92%, 90% and 96%, and 92% and 98% for minimal, moderate, and major improvement, respectively. Definitions were validated in the clinical trial analysis for differentiating the physician rating of improvement (p<0.001). The response criteria for adult DM/PM consisted of the conjoint analysis model based on absolute per cent change in 6 core set measures, with thresholds for minimal, moderate, and major improvement.
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Affiliation(s)
| | | | - Nicolino Ruperto
- Istituto Giannina Gaslini, Pediatria II - Rheumatologia, PRINTO, Genoa, Italy
| | | | - Brian Erman
- Social and Scientific Systems, Inc., Durham, North Carolina, USA
| | | | | | - Anthony A Amato
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hector Chinoy
- Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | | | - Maryam Dastmalchi
- Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Andrew Mammen
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Ingrid E Lundberg
- Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | | | | | - Ignacio García-De la Torre
- Hospital General de Occidente de la Secretaría de Salud and University of Guadalajara, Guadalajara, México
| | - Yeong Wook Song
- Graduate School of Convergence Science and Technology and Seoul National University Hospital, Seoul, Korea
| | - Luca Villa
- Istituto Giannina Gaslini, Pediatria II - Rheumatologia, PRINTO, Genoa, Italy
| | - Mariangela Rinaldi
- Istituto Giannina Gaslini, Pediatria II - Rheumatologia, PRINTO, Genoa, Italy
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Lilleker JB, Rietveld A, Pye SR, Mariampillai K, Benveniste O, Peeters MTJ, Miller JAL, Hanna MG, Machado PM, Parton MJ, Gheorghe KR, Badrising UA, Lundberg IE, Sacconi S, Herbert MK, McHugh NJ, Lecky BRF, Brierley C, Hilton-Jones D, Lamb JA, Roberts ME, Cooper RG, Saris CGJ, Pruijn GJM, Chinoy H, van Engelen BGM. Cytosolic 5'-nucleotidase 1A autoantibody profile and clinical characteristics in inclusion body myositis. Ann Rheum Dis 2017; 76:862-868. [PMID: 28122761 PMCID: PMC5530338 DOI: 10.1136/annrheumdis-2016-210282] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 07/29/2016] [Revised: 10/07/2016] [Accepted: 11/05/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Autoantibodies directed against cytosolic 5'-nucleotidase 1A have been identified in many patients with inclusion body myositis. This retrospective study investigated the association between anticytosolic 5'-nucleotidase 1A antibody status and clinical, serological and histopathological features to explore the utility of this antibody to identify inclusion body myositis subgroups and to predict prognosis. MATERIALS AND METHODS Data from various European inclusion body myositis registries were pooled. Anticytosolic 5'-nucleotidase 1A status was determined by an established ELISA technique. Cases were stratified according to antibody status and comparisons made. Survival and mobility aid requirement analyses were performed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS Data from 311 patients were available for analysis; 102 (33%) had anticytosolic 5'-nucleotidase 1A antibodies. Antibody-positive patients had a higher adjusted mortality risk (HR 1.89, 95% CI 1.11 to 3.21, p=0.019), lower frequency of proximal upper limb weakness at disease onset (8% vs 23%, adjusted OR 0.29, 95% CI 0.12 to 0.68, p=0.005) and an increased prevalence of excess of cytochrome oxidase deficient fibres on muscle biopsy analysis (87% vs 72%, adjusted OR 2.80, 95% CI 1.17 to 6.66, p=0.020), compared with antibody-negative patients. INTERPRETATION Differences were observed in clinical and histopathological features between anticytosolic 5'-nucleotidase 1A antibody positive and negative patients with inclusion body myositis, and antibody-positive patients had a higher adjusted mortality risk. Stratification of inclusion body myositis by anticytosolic 5'-nucleotidase 1A antibody status may be useful, potentially highlighting a distinct inclusion body myositis subtype with a more severe phenotype.
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Affiliation(s)
- J B Lilleker
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - A Rietveld
- Department of Neurology, Center for Neuroscience Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S R Pye
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - K Mariampillai
- Department of Internal Medicine and Clinical Immunology, La Pitié-Salpêtrière Hospital, AP-HP, INSERM U974, UPMC, Paris, France
| | - O Benveniste
- Department of Internal Medicine and Clinical Immunology, La Pitié-Salpêtrière Hospital, AP-HP, INSERM U974, UPMC, Paris, France
| | - M T J Peeters
- Department of Neurology, Center for Neuroscience Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J A L Miller
- Department of Neurology, Royal Victoria Hospitals, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - M G Hanna
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - P M Machado
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
- Centre for Rheumatology Research, University College London, London, UK
| | - M J Parton
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - K R Gheorghe
- Unit of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - U A Badrising
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - I E Lundberg
- Unit of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - S Sacconi
- Peripheral Nervous System, Muscle and ALS Department, Université Côté Azure (UCA), Nice University Hospital, Nice, France
| | - M K Herbert
- Department of Biomolecular Chemistry, Radboud Institute for Molecular Life Sciences and Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - N J McHugh
- Royal National Hospital for Rheumatic Diseases and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - B R F Lecky
- The Walton Centre NHS Foundation Trust, Fazakerley, Liverpool, UK
| | - C Brierley
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Hilton-Jones
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - J A Lamb
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - M E Roberts
- Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - R G Cooper
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
- MRC-ARUK Institute for Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
- Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - C G J Saris
- Department of Neurology, Center for Neuroscience Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G J M Pruijn
- Department of Biomolecular Chemistry, Radboud Institute for Molecular Life Sciences and Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - H Chinoy
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - B G M van Engelen
- Department of Neurology, Center for Neuroscience Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Aggarwal R, Rider LG, Ruperto N, Bayat N, Erman B, Feldman BM, Oddis CV, Amato AA, Chinoy H, Cooper RG, Dastmalchi M, Fiorentino D, Isenberg D, Katz JD, Mammen A, de Visser M, Ytterberg SR, Lundberg IE, Chung L, Danko K, García-De la Torre I, Song YW, Villa L, Rinaldi M, Rockette H, Lachenbruch PA, Miller FW, Vencovsky J. 2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Adult Dermatomyositis and Polymyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol 2017; 69:898-910. [PMID: 28382787 DOI: 10.1002/art.40064] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 01/31/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To develop response criteria for adult dermatomyositis (DM) and polymyositis (PM). METHODS Expert surveys, logistic regression, and conjoint analysis were used to develop 287 definitions using core set measures. Myositis experts rated greater improvement among multiple pairwise scenarios in conjoint analysis surveys, where different levels of improvement in 2 core set measures were presented. The PAPRIKA (Potentially All Pairwise Rankings of All Possible Alternatives) method determined the relative weights of core set measures and conjoint analysis definitions. The performance characteristics of the definitions were evaluated on patient profiles using expert consensus (gold standard) and were validated using data from a clinical trial. The nominal group technique was used to reach consensus. RESULTS Consensus was reached for a conjoint analysis-based continuous model using absolute percent change in core set measures (physician, patient, and extramuscular global activity, muscle strength, Health Assessment Questionnaire, and muscle enzyme levels). A total improvement score (range 0-100), determined by summing scores for each core set measure, was based on improvement in and relative weight of each core set measure. Thresholds for minimal, moderate, and major improvement were ≥20, ≥40, and ≥60 points in the total improvement score. The same criteria were chosen for juvenile DM, with different improvement thresholds. Sensitivity and specificity in DM/PM patient cohorts were 85% and 92%, 90% and 96%, and 92% and 98% for minimal, moderate, and major improvement, respectively. Definitions were validated in the clinical trial analysis for differentiating the physician rating of improvement (P < 0.001). CONCLUSION The response criteria for adult DM/PM consisted of the conjoint analysis model based on absolute percent change in 6 core set measures, with thresholds for minimal, moderate, and major improvement.
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Affiliation(s)
| | | | - Nicolino Ruperto
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO, Genoa, Italy
| | | | - Brian Erman
- Social and Scientific Systems, Inc., Durham, North Carolina
| | | | | | - Anthony A Amato
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hector Chinoy
- Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | | | - Maryam Dastmalchi
- Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Andrew Mammen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Ingrid E Lundberg
- Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | | | | | - Ignacio García-De la Torre
- Hospital General de Occidente de la Secretaría de Salud and University of Guadalajara, Guadalajara, México
| | - Yeong Wook Song
- Graduate School of Convergence Science and Technology and Seoul National University Hospital, Seoul, Korea
| | - Luca Villa
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO, Genoa, Italy
| | - Mariangela Rinaldi
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO, Genoa, Italy
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Rothwell S, Cooper RG, Lundberg IE, Gregersen PK, Hanna MG, Machado PM, Herbert MK, Pruijn GJM, Lilleker JB, Roberts M, Bowes J, Seldin MF, Vencovsky J, Danko K, Limaye V, Selva-O'Callaghan A, Platt H, Molberg Ø, Benveniste O, Radstake TRDJ, Doria A, De Bleecker J, De Paepe B, Gieger C, Meitinger T, Winkelmann J, Amos CI, Ollier WE, Padyukov L, Lee AT, Lamb JA, Chinoy H. Immune-Array Analysis in Sporadic Inclusion Body Myositis Reveals HLA-DRB1 Amino Acid Heterogeneity Across the Myositis Spectrum. Arthritis Rheumatol 2017; 69:1090-1099. [PMID: 28086002 PMCID: PMC5516174 DOI: 10.1002/art.40045] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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] [Received: 09/12/2016] [Accepted: 01/10/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Inclusion body myositis (IBM) is characterized by a combination of inflammatory and degenerative changes affecting muscle. While the primary cause of IBM is unknown, genetic factors may influence disease susceptibility. To determine genetic factors contributing to the etiology of IBM, we conducted the largest genetic association study of the disease to date, investigating immune-related genes using the Immunochip. METHODS A total of 252 Caucasian patients with IBM were recruited from 11 countries through the Myositis Genetics Consortium and compared with 1,008 ethnically matched controls. Classic HLA alleles and amino acids were imputed using SNP2HLA. RESULTS The HLA region was confirmed as the most strongly associated region in IBM (P = 3.58 × 10-33 ). HLA imputation identified 3 independent associations (with HLA-DRB1*03:01, DRB1*01:01, and DRB1*13:01), although the strongest association was with amino acid positions 26 and 11 of the HLA-DRB1 molecule. No association with anti-cytosolic 5'-nucleotidase 1A-positive status was found independent of HLA-DRB1*03:01. There was no association of HLA genotypes with age at onset of IBM. Three non-HLA regions reached suggestive significance, including the chromosome 3 p21.31 region, an established risk locus for autoimmune disease, where a frameshift mutation in CCR5 is thought to be the causal variant. CONCLUSION This is the largest, most comprehensive genetic association study to date in IBM. The data confirm that HLA is the most strongly associated region and identifies novel amino acid associations that may explain the risk in this locus. These amino acid associations differentiate IBM from polymyositis and dermatomyositis and may determine properties of the peptide-binding groove, allowing it to preferentially bind autoantigenic peptides. A novel suggestive association within the chromosome 3 p21.31 region suggests a role for CCR5.
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Affiliation(s)
| | | | - Ingrid E Lundberg
- Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Megan K Herbert
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - James B Lilleker
- University of Manchester, Manchester, UK, and Salford Royal NHS Foundation Trust, Salford, UK
| | | | - John Bowes
- University of Manchester, Manchester, UK
| | | | | | | | - Vidya Limaye
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | | | | | | | | | | | | | | | - Thomas Meitinger
- Technische Universität München, Munich, Germany, and Helmholtz Zentrum München, Neuherberg, Germany
| | - Juliane Winkelmann
- Technische Universität München, Munich, Germany, and Helmholtz Zentrum München, Neuherberg, Germany
| | | | | | | | - Annette T Lee
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Hector Chinoy
- Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
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Lilleker JB, Guy M, Roberts ME, Lamb J, Cooper RG, Chinoy H. 276. SERUM MUSCLE DAMAGE MARKERS IN THE IDIOPATHIC INFLAMMATORY MYOPATHIES: QUANTIFYING DISEASE ACTIVITY AND IDENTIFYING CARDIAC INVOLVEMENT. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.278] [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: 11/13/2022] Open
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Cotton CV, Spencer LG, New RP, Cooper RG. MUSCLE DISORDERS275. COMPREHENSIVE CONNECTIVE TISSUE DISEASE SEROLOGY COULD PREVENT UNNECESSARY LUNG BIOPSIES IN AMYOPATHIC INTERSTITIAL LUNG DISEASE PATIENTS WITH ANTI-SYNTHETASES OTHER THAN ANTI-JO-1: AN ILLUSTRATIVE CASE SERIES. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.277] [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: 11/14/2022] Open
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Bradley WJ, Hannon MP, Benford V, Morehen JC, Twist C, Shepherd S, Cocks M, Impey SG, Cooper RG, Morton JP, Close GL. Metabolic demands and replenishment of muscle glycogen after a rugby league match simulation protocol. J Sci Med Sport 2017; 20:878-883. [PMID: 28238618 DOI: 10.1016/j.jsams.2017.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/24/2017] [Accepted: 02/06/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The metabolic requirements of a rugby league match simulation protocol and the timing of carbohydrate provision on glycogen re-synthesis in damaged muscle were examined. DESIGN Fifteen (mean±SD: age 20.9±2.9 year, body-mass 87.3±14.1kg, height 177.4±6.0cm) rugby league (RL) players consumed a 6gkgday-1 CHO diet for 7-days, completed a time to exhaustion test (TTE) and a glycogen depletion protocol on day-3, a RL simulated-match protocol (RLMSP) on day-5 and a TTE on day-7. Players were prescribed an immediate or delayed (2-h-post) re-feed post-simulation. METHODS Muscle biopsies and blood samples were obtained post-depletion, before and after simulated match-play, and 48-h after match-play with PlayerLoad and heart-rate collected throughout the simulation. Data were analysed using effects sizes±90% CI and magnitude-based inferences. RESULTS PlayerLoad (8.0±0.7 AUmin-1) and %HRpeak (83±4.9%) during the simulation were similar to values reported for RL match-play. Muscle glycogen very likely increased from immediately after to 48-h post-simulation (272±97 cf. 416±162mmolkg-1d.w.; ES±90%CI) after immediate re-feed, but changes were unclear (283±68 cf. 361±144mmolkg-1d.w.; ES±90%CI) after delayed re-feed. CK almost certainly increased by 77.9±25.4% (0.75±0.19) post-simulation for all players. CONCLUSIONS The RLMSP presents a replication of the internal loads associated with professional RL match-play, although difficulties in replicating the collision reduced the metabolic demands and glycogen utilisation. Further, it is possible to replete muscle glycogen in damaged muscle employing an immediate re-feed strategy.
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Affiliation(s)
- Warren J Bradley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Marcus P Hannon
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Victoria Benford
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - James C Morehen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Craig Twist
- Department of Sport and Exercise Sciences, University of Chester, UK
| | - Sam Shepherd
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Matthew Cocks
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Samuel G Impey
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Robert G Cooper
- MRC Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, UK
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK.
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Affiliation(s)
- Robert G. Cooper
- McMaster University's Faculty of Business, Hamilton, Ontario, Canada
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Parkes JE, Rothwell S, Day PJ, McHugh NJ, Betteridge ZE, Cooper RG, Ollier WE, Chinoy H, Lamb JA. Systematic protein-protein interaction and pathway analyses in the idiopathic inflammatory myopathies. Arthritis Res Ther 2016; 18:156. [PMID: 27388770 PMCID: PMC4936183 DOI: 10.1186/s13075-016-1061-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/23/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The idiopathic inflammatory myopathies (IIM) are autoimmune diseases characterised by acquired proximal muscle weakness, inflammatory cell infiltrates in muscle and myositis-specific/associated autoantibodies. It is unclear which pathways are involved in IIM, and the functional relationship between autoantibody targets has not been systematically explored. Protein-protein interaction and pathway analyses were conducted to identify pathways relevant to disease, using autoantibody targets and gene products of IIM-associated single nucleotide polymorphism (SNP) loci. METHODS Protein-protein interactions were analysed using Disease Association Protein-Protein Link Evaluator (DAPPLE). Gene ontology and pathway analyses were conducted using Database for Annotation Visualisation and Integrated Discovery (DAVID) and Gene Relationships Across Implicated Loci (GRAIL). Analyses were undertaken including the targets of published autoantibodies, significant and suggestive SNPs from an IIM association study and autoantibody targets plus SNPs combined. RESULTS The protein-protein interaction networks formed by autoantibody targets and associated SNPs showed significant direct and/or indirect connectivity (p < 0.05). Autoantibody targets plus associated SNPs combined resulted in more significant indirect and common interactor connectivity, suggesting autoantibody targets and proteins encoded by IIM-associated loci may be involved in common pathways. Tumour necrosis factor receptor-associated factor 6 (TRAF6) was identified as a hub protein, and UBE3B, HSPA1A, HSPA1B and PSMD3 also were identified as genes with significant connectivity. Pathway analysis identified that autoantibody targets and associated SNP regions are significantly interconnected (p < 0.01), and confirmed autoantibody target involvement in translational and post-translational processes. 'Ubiquitin' was the only keyword strongly linking significant genes across regions in all three GRAIL analyses of autoantibody targets and IIM-associated SNPs. CONCLUSIONS Autoantibody targets and IIM-associated loci show significant connectivity and inter-relatedness, and identify several key genes and pathways in IIM pathogenesis, possibly mediated via the ubiquitination pathway.
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Affiliation(s)
- Joanna E Parkes
- Centre for Epidemiology, University of Manchester, 2.722 Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Simon Rothwell
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Philip J Day
- Centre for Epidemiology, University of Manchester, 2.722 Stopford Building, Oxford Road, Manchester, M13 9PT, UK.,Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
| | - Neil J McHugh
- Bath Institute of Rheumatic Diseases, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Zoë E Betteridge
- Bath Institute of Rheumatic Diseases, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Robert G Cooper
- MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - William E Ollier
- Centre for Epidemiology, University of Manchester, 2.722 Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Hector Chinoy
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Janine A Lamb
- Centre for Epidemiology, University of Manchester, 2.722 Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
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Abstract
Interest in the possibility of using electrically stimulated muscular contractions in rehabilitation medicine is increasing. Progress is impeded by the phenomenon of fatigue which impairs effectiveness and consistency of contractions. Various methods for minimizing fatigue have been proposed and are presently discussed. These include fibre type conversion as a result of chronic low frequency conditioning stimulation, sequential stimulation, optimization of stimulation parameters and the use of hybrid orthoses.
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Affiliation(s)
| | - Maria J Stokes
- Department of Medicine, University of Liverpool, Liverpool
| | - Henry Gibson
- Department of Medicine, University of Liverpool, Liverpool
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Bradley WJ, Morehen JC, Haigh J, Clarke J, Donovan TF, Twist C, Cotton C, Shepherd S, Cocks M, Sharma A, Impey SG, Cooper RG, Maclaren DPM, Morton JP, Close GL. Muscle glycogen utilisation during Rugby match play: Effects of pre-game carbohydrate. J Sci Med Sport 2016; 19:1033-1038. [PMID: 27134132 DOI: 10.1016/j.jsams.2016.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 10/26/2015] [Revised: 03/07/2016] [Accepted: 03/18/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Although the physical demands of Rugby League (RL) match-play are well-known, the fuel sources supporting energy-production are poorly understood. We therefore assessed muscle glycogen utilisation and plasma metabolite responses to RL match-play after a relatively high (HCHO) or relatively low CHO (LCHO) diet. DESIGN Sixteen (mean±SD age; 18±1 years, body-mass; 88±12kg, height 180±8cm) professional players completed a RL match after 36-h consuming a non-isocaloric high carbohydrate (n=8; 6gkgday-1) or low carbohydrate (n=8; 3gkgday-1) diet. METHODS Muscle biopsies and blood samples were obtained pre- and post-match, alongside external and internal loads quantified using Global Positioning System technology and heart rate, respectively. Data were analysed using effects sizes ±90% CI and magnitude-based inferences. RESULTS Differences in pre-match muscle glycogen between high and low carbohydrate conditions (449±51 and 444±81mmolkg-1d.w.) were unclear. High (243±43mmolkg-1d.w.) and low carbohydrate groups (298±130mmolkg-1d.w.) were most and very likely reduced post-match, respectively. For both groups, differences in pre-match NEFA and glycerol were unclear, with a most likely increase in NEFA and glycerol post-match. NEFA was likely lower in the high compared with low carbohydrate group post-match (0.95±0.39mmoll-1 and 1.45±0.51mmoll-1, respectively), whereas differences between the 2 groups for glycerol were unclear (98.1±33.6mmoll-1 and 123.1±39.6mmoll-1) in the high and low carbohydrate groups, respectively. CONCLUSIONS Professional RL players can utilise ∼40% of their muscle glycogen during a competitive match regardless of their carbohydrate consumption in the preceding 36-h.
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Affiliation(s)
- Warren J Bradley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - James C Morehen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Julian Haigh
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | | | | | - Craig Twist
- Department of Sport and Exercise Sciences, University of Chester, UK
| | | | - Sam Shepherd
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Matthew Cocks
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Asheesh Sharma
- Department of Renal Medicine, Royal Liverpool Hospital, UK
| | - Samuel G Impey
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Robert G Cooper
- MRC Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, UK
| | - Don P M Maclaren
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK.
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48
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Owens DJ, Sharples AP, Polydorou I, Alwan N, Donovan T, Tang J, Fraser WD, Cooper RG, Morton JP, Stewart C, Close GL. A systems-based investigation into vitamin D and skeletal muscle repair, regeneration, and hypertrophy. Am J Physiol Endocrinol Metab 2015; 309:E1019-31. [PMID: 26506852 DOI: 10.1152/ajpendo.00375.2015] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/19/2015] [Indexed: 01/08/2023]
Abstract
Skeletal muscle is a direct target for vitamin D. Observational studies suggest that low 25[OH]D correlates with functional recovery of skeletal muscle following eccentric contractions in humans and crush injury in rats. However, a definitive association is yet to be established. To address this gap in knowledge in relation to damage repair, a randomised, placebo-controlled trial was performed in 20 males with insufficient concentrations of serum 25(OH)D (45 ± 25 nmol/l). Prior to and following 6 wk of supplemental vitamin D3 (4,000 IU/day) or placebo (50 mg of cellulose), participants performed 20 × 10 damaging eccentric contractions of the knee extensors, with peak torque measured over the following 7 days of recovery. Parallel experimentation using isolated human skeletal muscle-derived myoblast cells from biopsies of 14 males with low serum 25(OH)D (37 ± 11 nmol/l) were subjected to mechanical wound injury, which enabled corresponding in vitro studies of muscle repair, regeneration, and hypertrophy in the presence and absence of 10 or 100 nmol 1α,25(OH)2D3. Supplemental vitamin D3 increased serum 25(OH)D and improved recovery of peak torque at 48 h and 7 days postexercise. In vitro, 10 nmol 1α,25(OH)2D3 improved muscle cell migration dynamics and resulted in improved myotube fusion/differentiation at the biochemical, morphological, and molecular level together with increased myotube hypertrophy at 7 and 10 days postdamage. Together, these preliminary data are the first to characterize a role for vitamin D in human skeletal muscle regeneration and suggest that maintaining serum 25(OH)D may be beneficial for enhancing reparative processes and potentially for facilitating subsequent hypertrophy.
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Affiliation(s)
- Daniel J Owens
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Adam P Sharples
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Ioanna Polydorou
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Nura Alwan
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Timothy Donovan
- Department of Sport and Exercise Sciences, Glyndwr University, Plas Coch Campus, Wrexham, United Kingdom
| | - Jonathan Tang
- Faculty of Medicine and Health Science, Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - William D Fraser
- Faculty of Medicine and Health Science, Norwich Medical School, University of East Anglia, Norwich, United Kingdom; and
| | - Robert G Cooper
- Medical Research Council-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, United Kingdom
| | - James P Morton
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Claire Stewart
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Graeme L Close
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom;
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49
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Miller FW, Chen W, O’Hanlon TP, Cooper RG, Vencovsky J, Rider LG, Danko K, Wedderburn LR, Lundberg IE, Pachman LM, Reed AM, Ytterberg SR, Padyukov L, Selva-O’Callaghan A, Radstake TR, Isenberg DA, Chinoy H, Ollier WE, Scheet P, Peng B, Lee A, Byun J, Lamb JA, Gregersen PK, Amos CI. Genome-wide association study identifies HLA 8.1 ancestral haplotype alleles as major genetic risk factors for myositis phenotypes. Genes Immun 2015; 16:470-80. [PMID: 26291516 PMCID: PMC4840953 DOI: 10.1038/gene.2015.28] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [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: 02/28/2015] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 02/06/2023]
Abstract
Autoimmune muscle diseases (myositis) comprise a group of complex phenotypes influenced by genetic and environmental factors. To identify genetic risk factors in patients of European ancestry, we conducted a genome-wide association study (GWAS) of the major myositis phenotypes in a total of 1710 cases, which included 705 adult dermatomyositis, 473 juvenile dermatomyositis, 532 polymyositis and 202 adult dermatomyositis, juvenile dermatomyositis or polymyositis patients with anti-histidyl-tRNA synthetase (anti-Jo-1) autoantibodies, and compared them with 4724 controls. Single-nucleotide polymorphisms showing strong associations (P<5×10(-8)) in GWAS were identified in the major histocompatibility complex (MHC) region for all myositis phenotypes together, as well as for the four clinical and autoantibody phenotypes studied separately. Imputation and regression analyses found that alleles comprising the human leukocyte antigen (HLA) 8.1 ancestral haplotype (AH8.1) defined essentially all the genetic risk in the phenotypes studied. Although the HLA DRB1*03:01 allele showed slightly stronger associations with adult and juvenile dermatomyositis, and HLA B*08:01 with polymyositis and anti-Jo-1 autoantibody-positive myositis, multiple alleles of AH8.1 were required for the full risk effects. Our findings establish that alleles of the AH8.1 comprise the primary genetic risk factors associated with the major myositis phenotypes in geographically diverse Caucasian populations.
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Affiliation(s)
- Frederick W. Miller
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Wei Chen
- M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Terrance P. O’Hanlon
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Robert G. Cooper
- MRC/ARUK Institute for Ageing and Chronic Disease, University of Liverpool, United Kingdom, L69 3GA
| | - Jiri Vencovsky
- Institute of Rheumatology, Charles University, Prague, Czech Republic; Na Slupi, 12850 Prague
| | - Lisa G. Rider
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Katalin Danko
- 3 Department of Internal Medicine, Division of Immunology University of Debrecen, Debrecen, Hungary H-4032
| | - Lucy R. Wedderburn
- Institute of Child Health, University College London, London, United Kingdom, WC1N 1EH
| | - Ingrid E. Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden SE-171 77
| | - Lauren M. Pachman
- Department of Pediatric Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611
| | | | | | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden SE-171 77
| | | | - Timothy R. Radstake
- Department of Rheumatology and Clinical Immunology, Laboratory for Translational Immunology, Utrecht University Medical Center; and Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands 6500.HB
| | - David A. Isenberg
- Division of Medicine, University College London, London, United Kingdom WC1E63T
| | - Hector Chinoy
- The National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom M139PT
| | - William E.R. Ollier
- Centre for Integrated Genomic Medical Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom M13 9PT
| | - Paul Scheet
- M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Bo Peng
- M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Annette Lee
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York 11030
| | - Jinyoung Byun
- Department of Community and Family Medicine, Dartmouth College, Hanover, New Hampshire 03755
| | - Janine A. Lamb
- Centre for Integrated Genomic Medical Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom M13 9PT
| | - Peter K. Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York 11030
| | - Christopher I. Amos
- Department of Community and Family Medicine, Dartmouth College, Hanover, New Hampshire 03755
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50
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Rothwell S, Cooper RG, Lundberg IE, Miller FW, Gregersen PK, Bowes J, Vencovsky J, Danko K, Limaye V, Selva-O'Callaghan A, Hanna MG, Machado PM, Pachman LM, Reed AM, Rider LG, Cobb J, Platt H, Molberg Ø, Benveniste O, Mathiesen P, Radstake T, Doria A, De Bleecker J, De Paepe B, Maurer B, Ollier WE, Padyukov L, O'Hanlon TP, Lee A, Amos CI, Gieger C, Meitinger T, Winkelmann J, Wedderburn LR, Chinoy H, Lamb JA. Dense genotyping of immune-related loci in idiopathic inflammatory myopathies confirms HLA alleles as the strongest genetic risk factor and suggests different genetic background for major clinical subgroups. Ann Rheum Dis 2015; 75:1558-66. [PMID: 26362759 DOI: 10.1136/annrheumdis-2015-208119] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/28/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of rare autoimmune diseases characterised by muscle weakness and extramuscular manifestations such as skin rashes and interstitial lung disease. We genotyped 2566 IIM cases of Caucasian descent using the Immunochip; a custom array covering 186 established autoimmune susceptibility loci. The cohort was predominantly comprised of patients with dermatomyositis (DM, n=879), juvenile DM (JDM, n=481), polymyositis (PM, n=931) and inclusion body myositis (n=252) collected from 14 countries through the Myositis Genetics Consortium. RESULTS The human leucocyte antigen (HLA) and PTPN22 regions reached genome-wide significance (p<5×10(-8)). Nine regions were associated at a significance level of p<2.25×10(-5), including UBE2L3, CD28 and TRAF6, with evidence of independent effects within STAT4. Analysis of clinical subgroups revealed distinct differences between PM, and DM and JDM. PTPN22 was associated at genome-wide significance with PM, but not DM and JDM, suggesting this effect is driven by PM. Additional suggestive associations including IL18R1 and RGS1 in PM and GSDMB in DM were identified. HLA imputation confirmed that alleles HLA-DRB1*03:01 and HLA-B*08:01 of the 8.1 ancestral haplotype (8.1AH) are most strongly associated with IIM, and provides evidence that amino acids within the HLA, such as HLA-DQB1 position 57 in DM, may explain part of the risk in this locus. Associations with alleles outside the 8.1AH reveal differences between PM, DM and JDM. CONCLUSIONS This work represents the largest IIM genetic study to date, reveals new insights into the genetic architecture of these rare diseases and suggests different predominating pathophysiology in different clinical subgroups.
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Affiliation(s)
- Simon Rothwell
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Robert G Cooper
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter K Gregersen
- The Robert S Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - John Bowes
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katalin Danko
- Division of Clinical Immunology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Vidya Limaye
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | | | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Lauren M Pachman
- Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Joanna Cobb
- Arthritis Research UK, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Hazel Platt
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | | | | | - Timothy Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea Doria
- Department of Medicine, University of Padova, Padova, Italy
| | - Jan De Bleecker
- Department of Neurology, Neuromuscular Reference Centre, Ghent University Hospital, Ghent, Belgium
| | - Boel De Paepe
- Department of Neurology, Neuromuscular Reference Centre, Ghent University Hospital, Ghent, Belgium
| | - Britta Maurer
- Department of Rheumatology and Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - William E Ollier
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Terrance P O'Hanlon
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Annette Lee
- The Robert S Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Christopher I Amos
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Christian Gieger
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Neuherberg, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Technische Universität München, Munich, Germany Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Juliane Winkelmann
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, and Institute of Child Health, University College London, London, UK
| | - Hector Chinoy
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Janine A Lamb
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
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