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Burleigh A, Omoyinmi E, Papadopoulou C, Al-Abadi E, Hong Y, Price-Kuehne F, Moraitis E, Titheradge H, Montesi F, Xu D, Eleftheriou D, Brogan P. Genetic testing of Behçet's disease using next-generation sequencing to identify monogenic mimics and HLA-B*51. Rheumatology (Oxford) 2023:kead628. [PMID: 38006337 DOI: 10.1093/rheumatology/kead628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/27/2023] Open
Abstract
OBJECTIVE Several monogenic autoinflammatory disorders and primary immunodeficiencies can present early in life with features that may be mistaken for Behçet's disease (BD). We aimed to develop a genetic analysis workflow to identify rare monogenic BD-like diseases and establish the contribution of HLA haplotype in a cohort of patients from the UK. METHODS Patients with clinically suspected BD were recruited from four BD specialist care centres in the UK. All participants underwent whole exome sequencing (WES), and genetic analysis thereafter by 1. examining genes known to cause monogenic immunodeficiency, autoinflammation or vasculitis by virtual panel application; 2. scrutiny of variants prioritised by Exomiser using Human Phenotype Ontology (HPO); 3. identification of copy number variants using ExomeDepth; and 4. HLA-typing using OptiType. RESULTS Thirty-one patients were recruited: median age 15 (4-52), and median disease onset age 5 (0-20). Nine/31 (29%) patients had monogenic disease mimicking BD: 5 cases of Haploinsufficiency of A20 with novel TNFAIP3 variants (p.T76I, p.M112Tfs*8, p.S548Dfs*128, p.C657Vfs*14, p.E661Nfs*36); 1 case of ISG15 deficiency with a novel nonsense variant (ISG15:p.Q16X) and 1p36.33 microdeletion; 1 case of Common variable immune deficiency (TNFRSF13B:p.A181E); and 2 cases of TNF receptor associated periodic syndrome (TNFRSF1A:p.R92Q). Of the remaining 22 patients, 8 (36%) were HLA-B*51 positive. CONCLUSION We describe a novel genetic workflow for BD, which can efficiently detect known and potentially novel monogenic forms of BD, whilst additionally providing HLA-typing. Our results highlight the importance of genetic testing before BD diagnosis, since this has impact on choice of therapy, prognosis, and genetic counselling.
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Affiliation(s)
- Alice Burleigh
- Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, London, UK
| | - Ebun Omoyinmi
- Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Charalampia Papadopoulou
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eslam Al-Abadi
- Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Ying Hong
- Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Fiona Price-Kuehne
- Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Elena Moraitis
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Hannah Titheradge
- Clinical Genetics, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
- Clinical Sciences Department, University of Birmingham, Birmingham, UK
| | - Francesca Montesi
- Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Diane Xu
- Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Despina Eleftheriou
- Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, London, UK
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paul Brogan
- Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Foley CM, McKenna D, Gallagher K, McLellan K, Alkhdher H, Lacassagne S, Moraitis E, Papadopoulou C, Pilkington C, Al Obaidi M, Eleftheriou D, Brogan P. Systemic juvenile idiopathic arthritis: The Great Ormond Street Hospital experience (2005-2021). Front Pediatr 2023; 11:1218312. [PMID: 37780048 PMCID: PMC10536248 DOI: 10.3389/fped.2023.1218312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a complex, systemic inflammatory disorder driven by both innate and adaptive immunity. Improved understanding of sJIA pathophysiology has led to recent therapeutic advances including a growing evidence base for the earlier use of IL-1 or IL-6 blockade as first-line treatment. We conducted a retrospective case notes review of patients diagnosed with sJIA over a 16-year period (October 2005-October 2021) at Great Ormond Street Hospital for Children. We describe the clinical presentation, therapeutic interventions, complications, and remission rates at different timepoints over the disease course. We examined our data, which spanned a period of changing therapeutic landscape, to try and identify potential therapeutic signals in patients who received biologic treatment early in the disease course compared to those who did not. A total of 76-children (female n = 40, 53%) were diagnosed with sJIA, median age 4.5 years (range 0.6-14.1); 36% (27/76) presented with suspected or confirmed macrophage activation syndrome. A biologic disease-modifying anti-rheumatic drug (bDMARD) alone was commenced as first-line treatment in 28% (n = 21/76) of the cohort; however, at last review, 84% (n = 64/76) had received treatment with a bDMARD. Clinically inactive disease (CID) was achieved by 88% (n = 67/76) of the cohort at last review; however, only 32% (24/76) achieved treatment-free CID. At 1-year follow-up, CID was achieved in a significantly greater proportion of children who received treatment with a bDMARD within 3 months of diagnosis compared to those who did not (90% vs. 53%, p = 0.002). Based on an ever-increasing evidence base for the earlier use of bDMARD in sJIA and our experience of the largest UK single-centre case series described to date, we now propose a new therapeutic pathway for children diagnosed with sJIA in the UK based on early use of bDMARDs. Reappraisal of the current National Health Service commissioning pathway for sJIA is now urgently required.
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Affiliation(s)
- C. M. Foley
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - D. McKenna
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - K. Gallagher
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - K. McLellan
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - H. Alkhdher
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - S. Lacassagne
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - E. Moraitis
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - C. Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - C. Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - M. Al Obaidi
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - D. Eleftheriou
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - P. Brogan
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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De Benedetti F, Grom AA, Brogan PA, Bracaglia C, Pardeo M, Marucci G, Eleftheriou D, Papadopoulou C, Schulert GS, Quartier P, Antón J, Laveille C, Frederiksen R, Asnaghi V, Ballabio M, Jacqmin P, de Min C. Efficacy and safety of emapalumab in macrophage activation syndrome. Ann Rheum Dis 2023; 82:857-865. [PMID: 37001971 PMCID: PMC10314091 DOI: 10.1136/ard-2022-223739] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/02/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Macrophage activation syndrome (MAS) is a severe, life-threatening complication of systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still's disease (AOSD). The objective of this study was to confirm the adequacy of an emapalumab dosing regimen in relation to interferon-γ (IFNγ) activity by assessing efficacy and safety. The efficacy outcome was MAS remission by week 8, based on clinical and laboratory criteria. METHODS We studied emapalumab, a human anti-IFNγ antibody, administered with background glucocorticoids, in a prospective single-arm trial involving patients who had MAS secondary to sJIA or AOSD and had previously failed high-dose glucocorticoids, with or without anakinra and/or ciclosporin. The study foresaw 4-week treatment that could be shortened or prolonged based on investigator's assessment of response. Patients entered a long-term (12 months) follow-up study. RESULTS Fourteen patients received emapalumab. All patients completed the trial, entered the long-term follow-up and were alive at the end of follow-up. The investigated dosing regimen, based on an initial loading dose followed by maintenance doses, was appropriate, as shown by rapid neutralisation of IFNγ activity, demonstrated by a prompt decrease in serum C-X-C motif chemokine ligand 9 (CXCL9) levels. By week 8, MAS remission was achieved in 13 of the 14 patients at a median time of 25 days. Viral infections and positive viral tests were observed. CONCLUSIONS Neutralisation of IFNγ with emapalumab was efficacious in inducing remission of MAS secondary to sJIA or AOSD in patients who had failed high-dose glucocorticoids. Screening for viral infections should be performed, particularly for cytomegalovirus. TRIAL REGISTRATION NUMBER NCT02069899 and NCT03311854.
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Affiliation(s)
| | - Alexei A Grom
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul A Brogan
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Claudia Bracaglia
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Manuela Pardeo
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Giulia Marucci
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Grant S Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Pierre Quartier
- Pediatric Immuno-Hematology and Rheumatology Unit, RAISE Rare Disease Reference Centre, Hopital Universitaire Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - Jordi Antón
- Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain
- Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
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Papadopoulou C, Chew C, Wilkinson MGL, McCann L, Wedderburn LR. Juvenile idiopathic inflammatory myositis: an update on pathophysiology and clinical care. Nat Rev Rheumatol 2023; 19:343-362. [PMID: 37188756 PMCID: PMC10184643 DOI: 10.1038/s41584-023-00967-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The childhood-onset or juvenile idiopathic inflammatory myopathies (JIIMs) are a heterogenous group of rare and serious autoimmune diseases of children and young people that predominantly affect the muscles and skin but can also involve other organs, including the lungs, gut, joints, heart and central nervous system. Different myositis-specific autoantibodies have been identified that are associated with different muscle biopsy features, as well as with different clinical characteristics, prognoses and treatment responses. Thus, myositis-specific autoantibodies can be used to subset JIIMs into sub-phenotypes; some of these sub-phenotypes parallel disease seen in adults, whereas others are distinct from adult-onset idiopathic inflammatory myopathies. Although treatments and management have much improved over the past decade, evidence is still lacking for many of the current treatments and few validated prognostic biomarkers are available with which to predict response to treatment, comorbidities (such as calcinosis) or outcome. Emerging data on the pathogenesis of the JIIMs are leading to proposals for new trials and tools for monitoring disease.
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Affiliation(s)
- Charalampia Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
| | - Christine Chew
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Meredyth G Ll Wilkinson
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy R Wedderburn
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK.
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK.
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK.
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Wilkinson MGL, Moulding D, McDonnell TCR, Orford M, Wincup C, Ting JYJ, Otto GW, Restuadi R, Kelberman D, Papadopoulou C, Castellano S, Eaton S, Deakin CT, Rosser EC, Wedderburn LR. Role of CD14+ monocyte-derived oxidised mitochondrial DNA in the inflammatory interferon type 1 signature in juvenile dermatomyositis. Ann Rheum Dis 2023; 82:658-669. [PMID: 36564154 PMCID: PMC10176342 DOI: 10.1136/ard-2022-223469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To define the host mechanisms contributing to the pathological interferon (IFN) type 1 signature in Juvenile dermatomyositis (JDM). METHODS RNA-sequencing was performed on CD4+, CD8+, CD14+ and CD19+ cells sorted from pretreatment and on-treatment JDM (pretreatment n=10, on-treatment n=11) and age/sex-matched child healthy-control (CHC n=4) peripheral blood mononuclear cell (PBMC). Mitochondrial morphology and superoxide were assessed by fluorescence microscopy, cellular metabolism by 13C glucose uptake assays, and oxidised mitochondrial DNA (oxmtDNA) content by dot-blot. Healthy-control PBMC and JDM pretreatment PBMC were cultured with IFN-α, oxmtDNA, cGAS-inhibitor, TLR-9 antagonist and/or n-acetyl cysteine (NAC). IFN-stimulated gene (ISGs) expression was measured by qPCR. Total numbers of patient and controls for functional experiments, JDM n=82, total CHC n=35. RESULTS Dysregulated mitochondrial-associated gene expression correlated with increased ISG expression in JDM CD14+ monocytes. Altered mitochondrial-associated gene expression was paralleled by altered mitochondrial biology, including 'megamitochondria', cellular metabolism and a decrease in gene expression of superoxide dismutase (SOD)1. This was associated with enhanced production of oxidised mitochondrial (oxmt)DNA. OxmtDNA induced ISG expression in healthy PBMC, which was blocked by targeting oxidative stress and intracellular nucleic acid sensing pathways. Complementary experiments showed that, under in vitro experimental conditions, targeting these pathways via the antioxidant drug NAC, TLR9 antagonist and to a lesser extent cGAS-inhibitor, suppressed ISG expression in pretreatment JDM PBMC. CONCLUSIONS These results describe a novel pathway where altered mitochondrial biology in JDM CD14+ monocytes lead to oxmtDNA production and stimulates ISG expression. Targeting this pathway has therapeutical potential in JDM and other IFN type 1-driven autoimmune diseases.
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Affiliation(s)
- Meredyth G Ll Wilkinson
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, UCL, London, UK
- NIHR Biomedical Research Centre, Great Ormond Street Hospital, London, UK
| | - Dale Moulding
- NIHR Biomedical Research Centre, Great Ormond Street Hospital, London, UK
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Thomas C R McDonnell
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Michael Orford
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Chris Wincup
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Joanna Y J Ting
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Georg W Otto
- NIHR Biomedical Research Centre, Great Ormond Street Hospital, London, UK
- Experimental and Personalised Medicine, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
- Genetics and Genomic Medicine Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Restuadi Restuadi
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, UCL, London, UK
- NIHR Biomedical Research Centre, Great Ormond Street Hospital, London, UK
| | - Daniel Kelberman
- NIHR Biomedical Research Centre, Great Ormond Street Hospital, London, UK
- Experimental and Personalised Medicine, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
- Genetics and Genomic Medicine Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Charalampia Papadopoulou
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Rheumatology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Sergi Castellano
- NIHR Biomedical Research Centre, Great Ormond Street Hospital, London, UK
- Genetics and Genomic Medicine Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Simon Eaton
- NIHR Biomedical Research Centre, Great Ormond Street Hospital, London, UK
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Claire T Deakin
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, UCL, London, UK
- NIHR Biomedical Research Centre, Great Ormond Street Hospital, London, UK
| | - Elizabeth C Rosser
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, UCL, London, UK
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, UCL, London, UK
- NIHR Biomedical Research Centre, Great Ormond Street Hospital, London, UK
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Nguyen HD, Papadopoulou C, Cancemi D, Wedderburn LR, Tansley SL. OA29 Blotting-based assays under-detected TIF1-gamma and NXP2 autoantibodies compared to immunoprecipitation in Juvenile Dermatomyositis cohorts. Rheumatol Adv Pract 2022. [PMCID: PMC9515780 DOI: 10.1093/rap/rkac066.029] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Background
The rare heterogenous autoimmune disease Juvenile Dermatomyositis (JDM) relies on prognostic tools including myositis specific antibodies (MSA) and myositis associated antibodies (MAA) to guide early treatment and reduce the risks of poor outcome. However, there is an emerging concern regarding the inter-assay validity due to the current lack of a standardised protocol for MSA/MAA screening across healthcare centres. Among available MSA/MAA screening assays, most laboratories prefer using immunoblot over immunoprecipitation, due to its practicality and lower cost. Notably, blotting-based assays were reported to have reduced specificity at detecting certain MSA/MAA subgroups.
Description/Method
A total of 472 JDM patients recruited via UK Juvenile Dermatomyositis Cohort and Biomarker Study (JDCBS) were included in this study. For immunoprecipitation cohort, the sera of 383 JDM-diagnosed patients were determined at the University of Bath using radio-labelled protein immunoprecipitation, and 140kDa bands were confirmed with ELISA for NXP2 or MDA5. For immunoblot cohort (n = 89), MSA/MAA results were obtained from the patients’ records at the centre of care. The immunoprecipitation group and immunoblot group were investigated for the frequency of each autoantibody subgroup within each cohort. The objective was to determine the sensitivity of each assay in detecting myositis relevant antibodies (MSA/MAA) in the context of JDM.
Discussion/Results
Overall, the majority of patients were female, and self-identified as white. Specifically, in immunoprecipitation cohort, 70.9% of the patients were female, while 77.1% of the patients self-identified as white. In the immunoblot cohort, 72.7% of the patient were female, while 65.9% self-identified as white.
Regarding MSA/MAA status in each cohort, 225 out of 383 (58%) immunoprecipitation samples were positive for at least 1 myositis relevant autoantibody (MSA/MAA). In the immunoblot cohort the proportion was 53% (47 out of 89 samples). Despite the similar gender and ethnicity distribution, the frequencies of autoantibody subgroups varied between two cohorts. In descending order, the 3 most common MSAs detected by immunoprecipitation group were anti-TIF1γ (18.1%), anti-NXP2 (15.8%) and anti-MDA5 (5.9%). On the contrary, anti-MDA5 (15.5%) was the most prevalent autoantibody detected by immunoblot, followed by anti-TIF1γ (11.3%) and anti-NXP2 (9.3%), respectively.
The prevalence of more than one myositis relevant autoantibodies detected in a patient was rare in both cohorts. Specifically, when excluding anti-Ro52, a MAA that is not detected with immunoprecipitation, 2.2% of the total patients in immunoblot cohort had more than 1 MSA/MAA. This rate is lower in immunoprecipitation cohort, as only 0.5% of the patients in this cohort were determined to be positive for more than one autoantibody subgroup. When accounting for anti-Ro52 in immunoblot cohort, 7 out of 8 anti-Ro52 positive patients were also positive for anti-MDA5, making up 7.9% of immunoblot cohort.
Key learning points/Conclusion
The variance between autoantibody frequencies detected by each method suggested that immunoprecipitation and immunoblot assays do not perform equally for all MSA and MAA. The lower detection of anti-TIF1γ in immunoblot is consistent with previous reports. Additionally, a potential reduction of sensitivity in anti-NXP2 detection using immunoblot is observed for the first time. Higher rate of anti-MDA5 in immunoblot cohort might reflect the earlier pre-treatment samples compared to the samples tested in immunoprecipitation cohort, as the titre of anti-MDA5 was reported to decrease with treatment. As MSA/MAA status are interpreted by clinicians to classify JDM patients into homogenous subgroups for more focused treatment plans, the reliability of autoantibody screening process is an issue of interest. Further investigations are necessary to characterise the sensitivity and specificity of each method.
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Affiliation(s)
- Huong D Nguyen
- UCL Great Ormond Street Institute of Child Health , London, United Kingdom
| | - Charalampia Papadopoulou
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children , London, United Kingdom
| | - Dario Cancemi
- UCL Great Ormond Street Institute of Child Health , London, United Kingdom
| | - Lucy R Wedderburn
- UCL Great Ormond Street Institute of Child Health , London, United Kingdom
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children , London, United Kingdom
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH , London, United Kingdom
| | - Sarah L Tansley
- Royal United Hospitals Bath NHS Foundation Trust , Bath, United Kingdom
- The University of Bath , Bath, United Kingdom
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McLellan K, Al-Obaidi M, Compeyrot-Lacassagne S, Pilkington C, Moraitis E, Papadopoulou C. OA05 Clinical presentation, risk factors and prognosis of MDA5-positive JDM; clinical diversity and red flags. Rheumatol Adv Pract 2022. [PMCID: PMC9515758 DOI: 10.1093/rap/rkac066.005] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction/Background MDA5-positive juvenile dermatomyositis (JDM) represents a distinct clinical phenotype associated with skin and oral ulceration, milder muscle involvement and a higher incidence of interstitial lung disease (ILD) and severe rapidly progressive ILD (RP-ILD). Description/Method The objectives were to describe the presenting clinical characteristics of patients with MDA5-positive JDM, the incidence of ILD and risk factors associated with development of RP-ILD. Retrospective clinical notes review of patients with MDA5-positive JDM managed at Great Ormond Street Hospital (GOSH) over a 24-year period. Discussion/Results Demographics Twenty-five patients were managed at our centre with MDA5-positive JDM. One additional patient was excluded as no notes available. Sixty-four % females. Sixty % were White British, 20% Black African, 8% Mixed, 8% Asian, 8% European and 4% South Asian. Median age of presentation was 10.0 years (IQR 6.9,12.3). Diagnostic delay was significant, with median 14 weeks (8,26) between initial symptoms and diagnosis. 24% of this cohort were also Ro-52 positive. Presentation: All patients had skin involvement; 52% ulcerating skin disease, 64% heliotrope rash and 100% Gottrons papules on initial presentation. Forty-four % had peri-ungal changes, 35% digital pitting/infarcts and 64% nailfold changes. 40% had peri-orbital oedema. Muscle involvement was present in all, with median CMAS 40/52 (36,44) and MMT8 57/80 (51,62). Eighty-eight % had arthritis; initial active joint count was available for 16 patients with median 5.5 joints (3,16). 40% had gastrointestinal symptoms; fever, weight loss and mouth ulcers were present in 52%, 52% and 60% respectively. Twenty-four % had respiratory symptoms at diagnosis. Interstitial lung disease: 52% were diagnosed with ILD and a further 20% had abnormal pulmonary CT scans not thought to be diagnostic of ILD. 13% (2 patients) had RP-ILD; both of whom died despite immunosuppression and extracorporeal membrane oxygenation. There were no other deaths amongst this cohort. No respiratory involvement was identified in 28%. Of 19 patients who had a CT chest at diagnosis, 84% were abnormal. Only 1 patient developed respiratory involvement during disease course whilst on treatment; the other 93% with ILD had evidence of ILD at diagnosis. Out of 58 putative variables, 4 risk factors were associated with development of RP-ILD which reached statistical significance, a further 3 factors were significantly protective, as is shown in Table 1. 2 patients had pneumocystis pneumonia (PCP), both of whom required intensive care and one associated with death. Key learning points/Conclusion Skin and muscle involvement were identified in all patients, with the majority also presenting with ulcerating skin disease, oral ulceration and arthritis. The majority of this cohort had lung involvement and 2 patients died of RP-ILD. Four risk factors were found to be predictive of RP-ILD and a further 3 protective factors were identified. Rapid deterioration of respiratory symptoms was associated with PCP, while ILD was unlikely to develop whilst on treatment if not present at diagnosis. These findings need to be validated in a larger cohort of patients.
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8
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Merve A, Schneider U, Kara E, Papadopoulou C, Stenzel W. Muscle biopsy in myositis: What the rheumatologist needs to know. Best Pract Res Clin Rheumatol 2022; 36:101763. [PMID: 35773136 DOI: 10.1016/j.berh.2022.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The appropriate analysis of skeletal muscle tissues is a key element in many diagnostic procedures and can deliver valuable information about the organ that is affected. Although arguably the frequency of muscle biopsy may be declining in certain domains where genetic analysis is now the first line of diagnostic evaluation, it still has an important role in assessment of patients with neuromuscular disorders such as congenital myopathies, muscular dystrophies, metabolic and inflammatory diseases. Here, we have comprehensively discussed the aspects of a modern and fruitful approach to muscle biopsy histopathological studies in rheumatological disorders. We have focussed on the neuromuscular involvement in myositis and its differential diagnoses in both adult and paediatric settings. We have also covered the clinical indications for the biopsy, technical aspects and practical points relevant for the rheumatologists. Finally, we have critically discussed the current and future opportunities that a muscle biopsy may offer and its limitations.
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Affiliation(s)
- Ashirwad Merve
- Department of Neuropathology, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Udo Schneider
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology, Charitéplatz 1, 10117 Berlin, Germany
| | - Eleanna Kara
- Department of Neuropathology, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK
| | | | - Werner Stenzel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany.
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9
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Peet CJ, Rowczenio D, Omoyinmi E, Papadopoulou C, Mapalo BRR, Wood MR, Capon F, Lachmann HJ. Pericarditis and Autoinflammation: A Clinical and Genetic Analysis of Patients With Idiopathic Recurrent Pericarditis and Monogenic Autoinflammatory Diseases at a National Referral Center. J Am Heart Assoc 2022; 11:e024931. [PMID: 35658515 PMCID: PMC9238712 DOI: 10.1161/jaha.121.024931] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Idiopathic recurrent pericarditis (IRP) is an orphan disease that carries significant morbidity, partly driven by corticosteroid dependence. Innate immune modulators, colchicine and anti-interleukin-1 agents, pioneered in monogenic autoinflammatory diseases, have demonstrated remarkable efficacy in trials, suggesting that autoinflammation may contribute to IRP. This study characterizes the phenotype of patients with IRP and monogenic autoinflammatory diseases, and establishes whether autoinflammatory disease genes are associated with IRP. Methods and Results We retrospectively analyzed the medical records of patients with IRP (n=136) and monogenic autoinflammatory diseases (n=1910) attending a national center (London, UK) between 2000 and 2021. We examined 4 genes (MEFV, MVK, NLRP3, TNFRSF1A) by next-generation sequencing in 128 patients with IRP and compared the frequency of rare deleterious variants to controls obtained from the Genome Aggregation Database. In this cohort of patients with IRP, corticosteroid dependence was common (39/136, 28.7%) and was associated with chronic pain (adjusted odds ratio 2.8 [95% CI, 1.3-6.5], P=0.012). IRP frequently manifested with systemic inflammation (raised C-reactive protein [121/136, 89.0%] and extrapericardial effusions [68/136, 50.0%]). Pericarditis was observed in all examined monogenic autoinflammatory diseases (0.4%-3.7% of cases). Rare deleterious MEFV variants were more frequent in IRP than in ancestry-matched controls (allele frequency 9/200 versus 2932/129 200, P=0.040). Conclusions Pericarditis is a feature of interleukin-1 driven monogenic autoinflammatory diseases and IRP is associated with variants in MEFV, a gene involved in interleukin-1β processing. We also found that corticosteroid dependence in IRP is associated with chronic noninflammatory pain. Together these data implicate autoinflammation in IRP and support reducing reliance on corticosteroids in its management.
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Affiliation(s)
- Claire J Peet
- National Amyloidosis Centre Royal Free London NHS Foundation Trust & Division of Medicine University, College London London United Kingdom.,Department of Medical and Molecular Genetics King's College London London United Kingdom
| | - Dorota Rowczenio
- National Amyloidosis Centre Royal Free London NHS Foundation Trust & Division of Medicine University, College London London United Kingdom
| | - Ebun Omoyinmi
- National Amyloidosis Centre Royal Free London NHS Foundation Trust & Division of Medicine University, College London London United Kingdom
| | - Charalampia Papadopoulou
- National Amyloidosis Centre Royal Free London NHS Foundation Trust & Division of Medicine University, College London London United Kingdom
| | - Bella Ruth R Mapalo
- National Amyloidosis Centre Royal Free London NHS Foundation Trust & Division of Medicine University, College London London United Kingdom
| | - Michael R Wood
- National Amyloidosis Centre Royal Free London NHS Foundation Trust & Division of Medicine University, College London London United Kingdom
| | - Francesca Capon
- Department of Medical and Molecular Genetics King's College London London United Kingdom
| | - Helen J Lachmann
- National Amyloidosis Centre Royal Free London NHS Foundation Trust & Division of Medicine University, College London London United Kingdom
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10
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De Benedetti F, Grom A, Brogan P, Bracaglia C, Pardeo M, Marucci G, Eleftheriou D, Papadopoulou C, Quartier P, Anton J, Frederiksen R, Asnaghi V, de Min C. OP0193 EFFICACY AND SAFETY OF EMAPALUMAB, AN ANTI-INTERFERON GAMMA MONOCLONAL ANTIBODY, IN PATIENTS WITH MACROPHAGE ACTIVATION SYNDROME (MAS) IN SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS (sJIA) WHO HAD FAILED HIGH-DOSE GLUCOCORTICOIDS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundMAS is a severe, life-threatening complication of rheumatic diseases that occurs most frequently in patients with sJIA. The mainstay of treatment for MAS is high dose glucocorticoids (GCs); however, GCs do not provide adequate control in all patients. Additional treatments are used without a standardized approach; however, morbidity and mortality remain high. Data from animal models of MAS and from observational studies in patients suggest that overproduction of IFNγ is a driver of the hyperinflammation observed in MAS; neutralization of IFNγ has been shown to revert the signs and symptoms of MAS in murine models, and high IFNγ levels are strongly correlated with laboratory parameters of disease severity in patients.ObjectivesTo assess the efficacy and safety of intravenous (IV) infusions of emapalumab, a fully human, anti-IFNγ monoclonal antibody, in patients with MAS in sJIA.MethodsOpen-label, single-arm, phase 2 study (NCT03311854) that included patients with MAS (2016 ACR/EULAR criteria) in sJIA who had failed high-dose IV GCs and other treatments. Emapalumab was initiated at a dose of 6 mg/kg on Day 0 and continued at 3 mg/kg every 3 days until Day 15, and then twice weekly until Day 28 to ensure rapid and complete IFNγ neutralization after initiating treatment. As per protocol, 10 infusions were planned over the 4 weeks; however, treatment could be shortened if MAS remission was achieved earlier, or extended if required to achieve remission. Complete response (CR) was defined as resolution of clinical signs and symptoms of MAS according to the investigator, and normalization of laboratory parameters relevant to MAS. All patients were followed up for 4 weeks after the last infusion of emapalumab and offered to enter a 1-year, follow-up study (NCT02069899).ResultsFourteen patients (10 females) were enrolled (11 in Europe, 3 in the USA). Several patients had previously received cyclosporine A and/or anakinra, in addition to high-dose GCs. Six patients received emapalumab until Day 28. Seven patients discontinued emapalumab early due to MAS remission (as per investigator’s assessment); one patient received treatment up to Day 38. Emapalumab treatment rapidly neutralized IFNγ, as documented by CXCL9 levels. A CR was achieved by 13/14 patients during the study. One patient stopped emapalumab after 3 doses because of achievement of MAS remission as per investigator’s assessment, but lactate dehydrogenase levels remained >1.5× upper limit of normal. At Week 8, 11/14 patients had a CR; 2 achieved a CR during the study, but not at Week 8, because of a single laboratory parameter abnormality in each patient. Overall, all measured laboratory parameters related to MAS activity rapidly improved with emapalumab treatment. GCs were tapered in all patients by Week 8 (≥50% reduction, n=12; GC dose ≤1 mg/kg/day, n=8). Administration of anakinra for the treatment of underlying sJIA was maintained/introduced during the study, as required. No patients discontinued treatment for safety reasons. One treatment-related serious adverse event was reported (cytomegalovirus reactivation that resolved with antiviral treatment). All patients entered the long-term, follow-up study and were alive at last visit.ConclusionEmapalumab administration led to rapid IFNγ neutralization, was efficacious in controlling MAS in all patients, and was well tolerated with a favorable safety profile. These results support the pathogenic role of IFNγ in MAS in sJIA and the therapeutic value of IFNγ neutralization in MAS patients who have failed high-dose GCs.Disclosure of InterestsFabrizio De Benedetti Consultant of: Sobi, AbbVie, Pfizer, Roche, Sanofi, Novartis, Novimmune, Grant/research support from: Sobi, AbbVie, Pfizer, Roche, Sanofi, Novartis, Novimmune, Alexei Grom Consultant of: Novartis, AB2 Bio, Paul Brogan Consultant of: Sobi, Novartis, Roche, UCB, Claudia Bracaglia: None declared, Manuela Pardeo: None declared, Giulia Marucci: None declared, Despina Eleftheriou Speakers bureau: Sobi, Charalampia Papadopoulou Speakers bureau: Sobi, Pierre Quartier Speakers bureau: Sobi, AbbVie, Chugai-Roche, Lilly, Novartis, Pfizer, Consultant of: Sobi, AbbVie, Chugai-Roche, Lilly, Novartis, Pfizer, Jordi Anton Consultant of: Sobi, Novartis, Roche, Pfizer, AbbVie, GSK, Rikke Frederiksen Employee of: Sobi, Veronica Asnaghi Employee of: Sobi, Cristina de Min Consultant of: Sobi
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11
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Oldroyd AGS, Lilleker JB, Amin T, Aragon O, Bechman K, Cuthbert V, Galloway J, Gordon P, Gregory WJ, Gunawardena H, Hanna MG, Isenberg D, Jackman J, Kiely PDW, Livermore P, Machado PM, Maillard S, McHugh N, Murphy R, Pilkington C, Prabu A, Rushe P, Spinty S, Swan J, Tahir H, Tansley SL, Truepenny P, Truepenny Y, Warrier K, Yates M, Papadopoulou C, Martin N, McCann L, Chinoy H. British Society for Rheumatology guideline on management of paediatric, adolescent and adult patients with idiopathic inflammatory myopathy. Rheumatology (Oxford) 2022; 61:1760-1768. [PMID: 35355064 PMCID: PMC9398208 DOI: 10.1093/rheumatology/keac115] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 02/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander G S Oldroyd
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - James B Lilleker
- Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Tania Amin
- Department of Paediatric Rheumatology, Leeds Children's Hospital, Leeds, UK
| | - Octavio Aragon
- Pharmacy Department, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.,School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Katie Bechman
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Verna Cuthbert
- Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - William J Gregory
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK.,Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Harsha Gunawardena
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK.,Department of Clinical and Academic Rheumatology, University of Bristol, Bristol, UK
| | - Michael G Hanna
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - David Isenberg
- Department of Rheumatology, Division of Medicine, University College London, London, UK
| | - John Jackman
- Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK
| | - Patrick D W Kiely
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK.,Institute of Medical and Biomedical Education, St George's, University of London, London, UK
| | - Polly Livermore
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,NIHR Great Ormond Street and University College London Biomedical Research Centre, London, UK
| | - Pedro M Machado
- Department of Neuromuscular Diseases, Centre for Rheumatology, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals (UCLH) NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Sue Maillard
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Ruth Murphy
- Department of Dermatology, Sheffield University Teaching Hospitals, Sheffield, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Athiveeraramapandian Prabu
- Rheumatology Research Group, Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Stefan Spinty
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Joanne Swan
- Juvenile Dermatomyositis Parent Representative
| | - Hasan Tahir
- Department of Rheumatology, Royal Free London NHS Trust, London, UK.,Division of Medicine, University College London, London, UK
| | - Sarah L Tansley
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | - Kishore Warrier
- Department of Paediatric Rheumatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mark Yates
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Charalampia Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Neil Martin
- Department of Paediatric Rheumatology, Royal Hospital for Children, Glasgow, UK.,Scottish Paediatric & Adolescent Rheumatology Network, Glasgow, Scotland
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Hector Chinoy
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
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12
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Hong Y, Casimir M, Houghton BC, Zhang F, Jensen B, Omoyinmi E, Torrance R, Papadopoulou C, Cummins M, Roderick M, Thrasher AJ, Brogan PA, Eleftheriou D. Lentiviral Mediated ADA2 Gene Transfer Corrects the Defects Associated With Deficiency of Adenosine Deaminase Type 2. Front Immunol 2022; 13:852830. [PMID: 35529868 PMCID: PMC9073084 DOI: 10.3389/fimmu.2022.852830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/28/2022] [Indexed: 12/23/2022] Open
Abstract
Deficiency of adenosine deaminase type 2 (DADA2) is an autosomal recessive disease caused by bi-allelic loss-of-function mutations in ADA2. Treatment with anti-TNF is effective for the autoinflammatory and vasculitic components of the disease but does not correct marrow failure or immunodeficiency; and anti-drug antibodies cause loss of efficacy over time. Allogeneic haematopoietic stem cell transplantation may be curative, but graft versus host disease remains a significant concern. Autologous gene therapy would therefore be an attractive longer-term therapeutic option. We investigated whether lentiviral vector (LV)–mediated ADA2 gene correction could rescue the immunophenotype of DADA2 in primary immune cells derived from patients and in cell line models. Lentiviral transduction led to: i) restoration of ADA2 protein expression and enzymatic activity; (ii) amelioration of M1 macrophage cytokine production, IFN-γ and phosphorylated STAT1 expression in patient-derived macrophages; and (iii) amelioration of macrophage-mediated endothelial activation that drives the vasculitis of DADA2. We also successfully transduced human CD34+ haematopoietic stem progenitor cells (HSPC) derived from a DADA2 patient with pure red cell aplasia and observed restoration of ADA2 expression and enzymatic activity in CD34+HSPC, alongside recovery of stem-cell proliferative and colony forming unit capacity. These preclinical data now expand the evidence for the efficacy of gene transfer strategies in DADA2, and strongly support clinical translation of a lentivirus-mediated gene therapy approach to treat DADA2.
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Affiliation(s)
- Ying Hong
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
- *Correspondence: Ying Hong,
| | - Marina Casimir
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Benjamin C. Houghton
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fang Zhang
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Barbara Jensen
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ebun Omoyinmi
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Robert Torrance
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Charalampia Papadopoulou
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Michelle Cummins
- Paediatric Haematology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Marion Roderick
- Paediatric Clinical Immunology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Adrian J. Thrasher
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Paul A. Brogan
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Despina Eleftheriou
- Infection, Immunity, Inflammation Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
- Versus Arthritis Centre for Adolescent Rheumatology, University College London (UCL), London, United Kingdom
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13
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Ll Wilkinson MG, Deakin CT, Papadopoulou C, Eleftheriou D, Wedderburn LR. JAK inhibitors: a potential treatment for JDM in the context of the role of interferon-driven pathology. Pediatr Rheumatol Online J 2021; 19:146. [PMID: 34563217 PMCID: PMC8466894 DOI: 10.1186/s12969-021-00637-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/28/2021] [Indexed: 12/29/2022] Open
Abstract
Juvenile Idiopathic Inflammatory Myopathies (IIM) are a group of rare diseases that are heterogeneous in terms of pathology that can include proximal muscle weakness, associated skin changes and systemic involvement. Despite options for treatment, many patients continue to suffer resistant disease and lasting side-effects. Advances in the understanding of the immunopathology and genetics underlying IIM may specify new therapeutic targets, particularly where conventional treatment has not achieved a clinical response. An upregulated type I interferon signature is strongly associated with disease and could be a prime target for developing more specific therapeutics. There are multiple components of the IFN pathway that could be targeted for blockade therapy.Downstream of the cytokine receptor complexes are the Janus kinase-signal transducers and activators of transcription (JAK-STAT) pathway, which consists of JAK1-3, TYK2, and STAT1-6. Therapeutic inhibitors have been developed to target components of this pathway. Promising results have been observed in case studies reporting the use of the JAK inhibitors, Baricitinib, Tofacitinib and Ruxolitinib in the treatment of refractory Juvenile Dermatomyositis (JDM). There is still the question of safety and efficacy for the use of JAK inhibitors in JDM that need to be addressed by clinical trials. Here we review the future for the use of JAK inhibitors as a treatment for JDM.
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Affiliation(s)
- Meredyth G Ll Wilkinson
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, University College London, London, UK.
- NIHR Biomedical Research Centre at GOSH, London, UK.
| | - Claire T Deakin
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, University College London, London, UK
- NIHR Biomedical Research Centre at GOSH, London, UK
| | - Charalampia Papadopoulou
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Despina Eleftheriou
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, University College London, London, UK
- NIHR Biomedical Research Centre at GOSH, London, UK
- Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
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14
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Peet CJ, Papadopoulou C, Sombrito BRM, Wood MR, Lachmann HJ. COVID-19 and autoinflammatory diseases: prevalence and outcomes of infection and early experience of vaccination in patients on biologics. Rheumatol Adv Pract 2021; 5:rkab043. [PMID: 34466775 PMCID: PMC8397842 DOI: 10.1093/rap/rkab043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/04/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives The systemic autoinflammatory diseases are rare conditions; to date, data on coronavirus disease 2019 (COVID-19) infection and vaccination safety are scarce. Agents targeting innate immune pathways have transformed the management of affected patients, and their outcomes are of wider interest given the role of inflammation in both viral clearance and severe COVID-19 disease. We surveyed patients with systemic autoinflammatory disease on biologic therapy to determine the prevalence and outcomes of COVID-19 infection and to gather early safety data on vaccination. Methods Electronic medical records of 248 patients with systemic autoinflammatory disease on biologic therapy at a national centre were reviewed. Patients were then surveyed in clinic or using a Web-based survey. Results In the cohort of 248 patients, no deaths were recorded. One hundred and seventy-five survey responses were received. Among the respondents, 27 reported suspected COVID-19 infection, of which 14 were confirmed by testing (8.0%). Two patients required hospital admission owing to dehydration. No patient required respiratory support or intensive care. One hundred and thirty-eight doses of COVID-19 vaccine had been administered to 130 patients. Side effects were reported after 71 of 138 (51.4%) administrations and were consistent with a flare of the underlying disease in 26 of 138 (18.8%) instances. No serious adverse events or hospital admissions were reported after vaccination. Conclusion These data, including the largest published series of patients on anti-IL-1/6 biologics to receive any adenoviral vector or messenger RNA vaccine, show no serious early concerns regarding vaccination and will provide an urgently needed resource to inform decision-making of these patients and their clinicians.
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Affiliation(s)
- Claire J Peet
- CAPS and Autoinflammatory Diseases Treatment Service, National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital.,Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Charalampia Papadopoulou
- CAPS and Autoinflammatory Diseases Treatment Service, National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital
| | - Bella Ruth M Sombrito
- CAPS and Autoinflammatory Diseases Treatment Service, National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital
| | - Michael R Wood
- CAPS and Autoinflammatory Diseases Treatment Service, National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital
| | - Helen J Lachmann
- CAPS and Autoinflammatory Diseases Treatment Service, National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital
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Brogan PA, Arch B, Hickey H, Anton J, Iglesias E, Baildam E, Mahmood K, Cleary G, Moraitis E, Papadopoulou C, Beresford MW, Riley P, Demir S, Ozen S, Culeddu G, Hughes DA, Dolezalova P, Hampson LV, Whitehead J, Jayne D, Ruperto N, Tudur-Smith C, Eleftheriou D. Mycophenolate Mofetil Versus Cyclophosphamide for Remission Induction in Childhood Polyarteritis Nodosa: An Open-Label, Randomized, Bayesian Noninferiority Trial. Arthritis Rheumatol 2021; 73:1673-1682. [PMID: 33760371 DOI: 10.1002/art.41730] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Cyclophosphamide (CYC) is used in clinical practice off-label for the induction of remission in childhood polyarteritis nodosa (PAN). Mycophenolate mofetil (MMF) might offer a less toxic alternative. This study was undertaken to explore the relative effectiveness of CYC and MMF treatment in a randomized controlled trial (RCT). METHODS This was an international, open-label, Bayesian RCT to investigate the relative effectiveness of CYC and MMF for remission induction in childhood PAN. Eleven patients with newly diagnosed childhood PAN were randomized (1:1) to receive MMF or intravenous CYC; all patients received the same glucocorticoid regimen. The primary end point was remission within 6 months while compliant with glucocorticoid taper. Bayesian distributions for remission rates were established a priori for MMF and CYC by experienced clinicians and updated to posterior distributions on trial completion. RESULTS Baseline disease activity and features were similar between the 2 treatment groups. The primary end point was met in 4 of 6 patients (67%) in the MMF group and 4 of 5 patients (80%) in the CYC group. Time to remission was shorter in the MMF group compared to the CYC group (median 7.1 weeks versus 17.6 weeks). No relapses occurred in either group within 18 months. Two serious infections were found to be likely linked to MMF treatment. Physical and psychosocial quality-of-life scores were superior in the MMF group compared to the CYC group at 6 months and 18 months. Combining the prior expert opinion with results from the present study provided posterior estimates of remission of 71% for MMF (90% credibility interval [90% CrI] 51, 83) and 75% for CYC (90% CrI 57, 86). CONCLUSION The present results, taken together with prior opinion, indicate that rates of remission induction in childhood PAN are similar with MMF treatment and CYC treatment, and MMF treatment might be associated with better health-related quality of life than CYC treatment.
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Affiliation(s)
- Paul A Brogan
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | | | | | - Eileen Baildam
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Kamran Mahmood
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Gavin Cleary
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Elena Moraitis
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | - Phil Riley
- Royal Manchester Children's Hospital, Manchester, UK
| | | | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | | | | | - Pavla Dolezalova
- General University Hospital in Prague and Charles University, Prague, Czech Republic
| | | | | | | | - Nicola Ruperto
- Instituto Giannina Gaslini, IRCCS, UOSID Centro Trial, Genoa, Italy
| | | | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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16
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Papadopoulou C, Hong Y, Krol P, Al Obaidi M, Pilkington C, Wedderburn LR, Brogan PA, Eleftheriou D. The Vasculopathy of Juvenile Dermatomyositis: Endothelial Injury, Hypercoagulability, and Increased Arterial Stiffness. Arthritis Rheumatol 2021; 73:1253-1266. [PMID: 33393715 DOI: 10.1002/art.41639] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Vasculopathy is considered central to the pathogenesis of juvenile dermatomyositis (DM) and is associated with severe extramuscular manifestations. We undertook this study to investigate the hypothesis that the vasculopathy of juvenile DM can be noninvasively tracked by examining biomarkers of endothelial injury, subclinical inflammation, hypercoagulability, and vascular arterial stiffness. METHODS The study population was a UK cohort of children with juvenile DM. Circulating endothelial cells (CECs) and microparticles (MPs) were identified using immunomagnetic bead extraction and flow cytometry, respectively. Plasma thrombin generation was determined using a fluorogenic assay. Cytokine and chemokine levels were measured by electrochemiluminescence. Arterial stiffness was assessed using pulse wave velocity (PWV). Results were expressed as the median and interquartile range (IQR), and statistical significance was assessed using nonparametric analyses. RESULTS Ninety patients with juvenile DM and 79 healthy control subjects were included. The median age of the patients was 10.21 years (IQR 6.68-13.40), and the median disease duration was 1.63 years (IQR 0.28-4.66). CEC counts were higher in all patients with juvenile DM compared to controls (median 96 cells/ml [IQR (40-192] and 12 cells/ml [IQR 8-24], respectively; P < 0.0001). Circulating MP numbers were also significantly higher in patients with active juvenile DM compared to controls (median 204.7 × 103 /ml [IQR 87.9-412.6] and 44.3 × 103 /ml [IQR 15.0-249.1], respectively; P < 0.0001). MPs were predominantly of platelet and endothelial origin. Enhanced plasma thrombin generation was demonstrated in patients with active juvenile DM compared to those with inactive disease (P = 0.0003) and controls (P < 0.0001). Carotid-radial PWV adjusted for age was increased in patients with juvenile DM compared to controls (P = 0.003). CONCLUSION We observed increased endothelial injury and increased levels of proinflammatory cytokines in patients with active juvenile DM. MP profiles reflected distinct disease activity status in juvenile DM and are markers of vascular pathology, platelet activation, and thrombotic propensity. Ongoing long-term vascular injury may result in increased arterial stiffness in patients with juvenile DM.
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Affiliation(s)
- Charalampia Papadopoulou
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ying Hong
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Petra Krol
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK, and Skåne University Hospital, Lund, Sweden
| | - Muthana Al Obaidi
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Clarissa Pilkington
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Lucy R Wedderburn
- University College London Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, NIHR Great Ormond Street Hospital Biomedical Research Centre, and Centre for Adolescent Rheumatology Versus Arthritis, London, UK
| | - Paul A Brogan
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, and Centre for Adolescent Rheumatology Versus Arthritis, London, UK
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Deakin CT, Papadopoulou C, McCann LJ, Martin N, Al-Obaidi M, Compeyrot-Lacassagne S, Pilkington CA, Tansley SL, McHugh NJ, Wedderburn LR, De Stavola BL. Identification and prediction of novel classes of long-term disease trajectories for patients with juvenile dermatomyositis using growth mixture models. Rheumatology (Oxford) 2021; 60:1891-1901. [PMID: 33146389 PMCID: PMC8023987 DOI: 10.1093/rheumatology/keaa497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/11/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Uncertainty around clinical heterogeneity and outcomes for patients with JDM represents a major burden of disease and a challenge for clinical management. We sought to identify novel classes of patients having similar temporal patterns in disease activity and relate them to baseline clinical features. Methods Data were obtained for n = 519 patients, including baseline demographic and clinical features, baseline and follow-up records of physician’s global assessment of disease (PGA), and skin disease activity (modified DAS). Growth mixture models (GMMs) were fitted to identify classes of patients with similar trajectories of these variables. Baseline predictors of class membership were identified using Lasso regression. Results GMM analysis of PGA identified two classes of patients. Patients in class 1 (89%) tended to improve, while patients in class 2 (11%) had more persistent disease. Lasso regression identified abnormal respiration, lipodystrophy and time since diagnosis as baseline predictors of class 2 membership, with estimated odds ratios, controlling for the other two variables, of 1.91 for presence of abnormal respiration, 1.92 for lipodystrophy and 1.32 for time since diagnosis. GMM analysis of modified DAS identified three classes of patients. Patients in classes 1 (16%) and 2 (12%) had higher levels of modified DAS at diagnosis that improved or remained high, respectively. Patients in class 3 (72%) began with lower DAS levels that improved more quickly. Higher proportions of patients in PGA class 2 were in DAS class 2 (19%, compared with 16 and 10%). Conclusion GMM analysis identified novel JDM phenotypes based on longitudinal PGA and modified DAS.
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Affiliation(s)
- Claire T Deakin
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospitals and Great Ormond Street Hospital, London, UK.,NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Charalampia Papadopoulou
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Rheumatology Unit, Great Ormond Street Hospital, London, UK
| | - Liza J McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Neil Martin
- Rheumatology Department, Royal Hospital for Sick Children, Glasgow
| | | | | | | | - Sarah L Tansley
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospitals and Great Ormond Street Hospital, London, UK.,NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK.,Rheumatology Unit, Great Ormond Street Hospital, London, UK
| | - Bianca L De Stavola
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Doudouliaki T, Papadopoulou C, Deakin CT. Use of Rescue Therapy with IVIG or Cyclophosphamide in Juvenile Myositis. Curr Rheumatol Rep 2021; 23:24. [PMID: 33686540 DOI: 10.1007/s11926-021-00990-3] [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] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review aims to present the literature available to date on the use of intravenous immunoglobulin and cyclophosphamide for juvenile patients with inflammatory myopathies, to evaluate the strength of the evidence so far for both these medications, and to reach conclusions about their efficacy. RECENT FINDINGS Juvenile idiopathic inflammatory myopathies, mainly represented by juvenile dermatomyositis (JDM), are rare diseases but quite debilitating for the patients. JDM is an autoimmune condition with predominantly muscle and skin involvement but also systemic features affecting the cardiovascular, respiratory, and gastrointestinal systems. The mainstay therapy is based on corticosteroids and methotrexate, but often other therapeutic alternatives are sought for patients with severe or refractory disease. The rarity of these conditions makes research for new medications even more challenging. Innovative trial designs or statistical methods can be used to emulate a randomized study and investigate drug effectiveness. Despite the lack of Level I evidence on the use and efficacy of intravenous immunoglobulin and cyclophosphamide, their use is advocated by a substantial number of case reports and case series as well as analyses using marginal structural models.
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Affiliation(s)
- Theonymfi Doudouliaki
- Department of Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Charalampia Papadopoulou
- Department of Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Infection, Immunity and Inflammation Research and Teaching Department, UCL, Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Claire T Deakin
- Infection, Immunity and Inflammation Research and Teaching Department, UCL, Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, UK.
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK.
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19
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Abstract
PURPOSE OF REVIEW Juvenile dermatomyositis (JDM) is a rare autoimmune disease characterised by muscle and skin involvement. Calcinosis is a debilitating complication of JDM which is difficult to treat and may cause long-term morbidity. The purpose of this review is to provide an update for the treatment of JDM-associated calcinosis based on previously published studies. RECENT FINDINGS Evidence-based studies are lacking for the management of calcinosis, and current treatment modalities have been largely based on case reports, case series, cohort studies, limited controlled studies and anecdotal clinical experience. The use of early aggressive therapy for resistant cases is strongly suggested to halt persistent disease activity which may help in reducing steroid use and their associated complications. Recent insights into disease pathogenesis, myositis-specific antibodies and genetic associations have led to identification of novel therapeutic targets such as Janus kinase (JAK) 1/2. Different treatment regimens with variable outcomes are in use for the treatment of refractory calcinosis; nevertheless, the level of evidence is not sufficient to propose specific guidelines. Recently, JAK 1/2 inhibitors have shown to be effective as an emerging therapeutic option highlighting that translational and clinical research is crucial to develop targeted treatment for JDM-associated calcinosis.
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Affiliation(s)
- Ovgu Kul Cinar
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. .,Division of Infection and Immunity, University College London, London, WC1E 6BT, UK.
| | - Charalampia Papadopoulou
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Clarissa A Pilkington
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,NIHR Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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20
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Papadopoulou C, Al Obaidi M, Moraitis E, Compeyrot-Lacassagne S, Eleftheriou D, Brogan P. Management of severe hyperinflammation in the COVID-19 era: the role of the rheumatologist. Rheumatology (Oxford) 2021; 60:911-917. [PMID: 33197261 PMCID: PMC7717388 DOI: 10.1093/rheumatology/keaa652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Indexed: 01/17/2023] Open
Abstract
Objectives The objectives of this study were (i) to describe the clinical presentation, treatment and outcome of paediatric inflammatory multisystem syndrome temporally related to Sars-CoV-2 (PIMS-TS) in children; (ii) to propose a framework to guide multidisciplinary team (MDT) management; and (iii) to highlight the role of the paediatric rheumatologist in this context. Methods This study involved a retrospective case notes review of patients referred to a single specialist paediatric centre with suspected PIMS-TS, with a focus on clinical presentation, laboratory parameters, treatment, and outcome in the context of an MDT framework. Results Nineteen children of median age 9.1 years fulfilled the definition of PIMS-TS and were managed within an MDT framework: 5/19 were female; 14/19 were of Black, Asian or minority ethnicity; 9/19 also fulfilled diagnostic criteria for complete or incomplete Kawasaki disease (KD). Severe systemic inflammation, shock, and abdominal pain were ubiquitous. Treatment was stratified within an MDT framework and included CSs in all; i.v. immunoglobulin in all; anakinra in 4/19; infliximab in 1/19; and antiviral (aciclovir) in 4/19. Conclusions We observed significant diagnostic equipoise using a current definition of PIMS-TS, overlapping with KD. Outside of clinical trials, an MDT approach is vital. The role of the paediatric rheumatologist is to consider differential diagnoses of hyperinflammation in the young, to advise on empiric immunomodulatory therapy, to set realistic therapeutic targets, to gauge therapeutic success, to oversee timely step-down of immunomodulation, and to contribute to the longer-term MDT follow-up of any late inflammatory sequelae.
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Affiliation(s)
- Charalampia Papadopoulou
- Department of Paediatric Rheumatology, London, UK.,Infection, Inflammation and Rheumatology Section, London, UK.,NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Muthana Al Obaidi
- Department of Paediatric Rheumatology, London, UK.,Infection, Inflammation and Rheumatology Section, London, UK.,NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Elena Moraitis
- Department of Paediatric Rheumatology, London, UK.,Infection, Inflammation and Rheumatology Section, London, UK.,NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sandrine Compeyrot-Lacassagne
- Department of Paediatric Rheumatology, London, UK.,NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Despina Eleftheriou
- Department of Paediatric Rheumatology, London, UK.,Infection, Inflammation and Rheumatology Section, London, UK.,NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis, London, UK
| | - Paul Brogan
- Department of Paediatric Rheumatology, London, UK.,Infection, Inflammation and Rheumatology Section, London, UK.,NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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21
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Cooray S, Omyinmi E, Hong Y, Papadopoulou C, Harper L, Al-Abadi E, Goel R, Dubey S, Wood M, Jolles S, Berg S, Ekelund M, Armon K, Eleftheriou D, Brogan PA. Anti-tumour necrosis factor treatment for the prevention of ischaemic events in patients with deficiency of adenosine deaminase 2 (DADA2). Rheumatology (Oxford) 2021; 60:4373-4378. [DOI: 10.1093/rheumatology/keaa837] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/12/2020] [Indexed: 02/07/2023] Open
Abstract
Abstract
Objective
To evaluate the impact of anti-Tumour Necrosis Factor-α (anti-TNF) treatment on the occurrence of vasculitic ischaemic events in patients with deficiency of adenosine deaminase 2 (DADA2).
Methods
A retrospective analysis of DADA2 patients referred from six centres to Great Ormond Street Hospital for Children was conducted. Ischaemic events, vasculitic disease activity, biochemical, immunological, and radiological features were compared, before and after anti-TNF treatment.
Results
A total of 31 patients with genetically confirmed DADA2 were included in the study. The median duration of active disease activity prior to anti-TNF treatment was 73 months (inter-quartile range [IQR] 27.5–133.5 months). Twenty seven/31 patients received anti-TNF treatment for a median of 32 months (IQR 12.0–71.5 months). The median event rate of central nervous system (CNS) and non-CNS ischemic events before anti-TNF treatment was 2.37 per 100 patient-months (IQR 1.25–3.63); compared with 0.00 per 100 patient-months (IQR 0.0–0.0) post-treatment (p< 0.0001). Paediatric vasculitis activity score (PVAS) was also significantly reduced: median score of 20/63 (IQR 13.0–25.8/63) pre-treatment vs. 2/63 (IQR 0.0–3.8/63) following anti-TNF treatment (p< 0.0001), with mild livedoid rash being the main persisting feature. Anti-TNF treatment was not effective for severe immunodeficiency or bone marrow failure, which required haematopoietic stem cell transplantation (HSCT).
Conclusion
Anti-TNF treatment significantly reduced the incidence of ischaemic events and other vasculitic manifestations of DADA2, but was not effective for immunodeficiency or bone marrow failure.
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Affiliation(s)
- Samantha Cooray
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London
| | - Ebun Omyinmi
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London
| | - Ying Hong
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London
| | - Charalampia Papadopoulou
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London
| | - Lorraine Harper
- Institute of Applied Health Research, University of Birmingham
| | - Eslam Al-Abadi
- Rheumatology Department, Birmingham Women's and Children’s NHS Foundation Trust, Birmingham
| | - Ruchika Goel
- Institute of Applied Health Research, University of Birmingham
| | - Shirish Dubey
- Rheumatology Department, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Mark Wood
- Paediatric Rheumatology Department, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Stephen Jolles
- Department of Immunology, University Hospital of Wales, Cardiff, UK
| | - Stefan Berg
- Paediatric Rheumatology, The Queen Silvia Children’s Hospital and University of Gothenburg, Gothenburg
| | | | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Despina Eleftheriou
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London
| | - Paul A Brogan
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London
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Vroulias D, Gkoulemani N, Papadopoulou C, Matralis H. W–modified Ni/Al2O3 catalysts for the dry reforming of methane: Effect of W loading. Catal Today 2020. [DOI: 10.1016/j.cattod.2019.05.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Rowczenio DM, Youngstein T, Trojer H, Omoyinmi E, Baginska A, Brogan P, Papadopoulou C, Rezk T, Hawkins PN, Lachmann HJ. British kindred with dominant FMF associated with high incidence of AA amyloidosis caused by novel MEFV variant, and a review of the literature. Rheumatology (Oxford) 2020; 59:554-558. [PMID: 31384939 DOI: 10.1093/rheumatology/kez334] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/05/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Hereditary systemic autoinflammatory diseases are rare genetic disorders, which if untreated, can be complicated by AA amyloidosis leading to renal failure and premature death. Our objective was to find a genetic cause in a British family with a dominantly inherited autoinflammatory disease complicated by AA amyloidosis. METHODS The index patient and his sister underwent comprehensive clinical and laboratory assessment including the next-generation sequencing panel targeting autoinflammatory genes. Subsequently, other relatives underwent clinical evaluation and genetic testing. Screening of the SAA1 gene was performed in all symptomatic cases. RESULTS The index case and his sister presented with proteinuria due to AA amyloidosis. They have been suffering from episodes of fever accompanied by severe abdominal and chest pain, arthritis and erythema since childhood. Their father died aged 52 years from complications following a cadaveric renal transplantation. The post-mortem examination demonstrated AA amyloidosis. The index case's grandmother, two paternal cousins and two of their children described similar symptoms. All symptomatic individuals had excellent responses to colchicine. Next-generation sequencing analysis identified a single MEFV p.P373L variant in the index case, his sister and subsequently, in symptomatic family members. Sequencing of the SAA1 gene revealed all cases were heterozygous for the SAA1.1 allele. CONCLUSION Typically FMF is an autosomal recessive disorder; nonetheless rare cases of dominantly inherited disease have previously been described. Here we report a novel MEFV variant p.P373L, causing dominant FMF complicated by AA amyloidosis in four generations of a British family.
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Affiliation(s)
| | | | - Hadija Trojer
- National Amyloidosis Centre, University College London, UK
| | - Ebun Omoyinmi
- University College London Great Ormond Street Institute of Child Health (ICH), London, UK
| | - Anna Baginska
- National Amyloidosis Centre, University College London, UK
| | - Paul Brogan
- University College London Great Ormond Street Institute of Child Health (ICH), London, UK
| | | | - Tamer Rezk
- National Amyloidosis Centre, University College London, UK
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De Benedetti F, Brogan P, Bracaglia C, Pardeo M, Marucci G, Sacco E, Eleftheriou D, Papadopoulou C, Grom A, Quartier P, Schneider R, Jacqmin P, Frederiksen R, Ballabio M, De Min C. OP0290 EMAPALUMAB (ANTI-INTERFERON-GAMMA MONOCLONAL ANTIBODY) IN PATIENTS WITH MACROPHAGE ACTIVATION SYNDROME (MAS) COMPLICATING SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS (SJIA). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:MAS is a severe complication of rheumatic diseases and occurs most frequently in patients with sJIA. Data from animal models and from observational studies in patients suggest that interferon gamma (IFNy) is a driver of the hyperinflammation and hypercytokinemia observed in MAS.Objectives:To assess the pharmacokinetics, efficacy, and safety of intravenous (IV) infusions of emapalumab, a fully human anti-IFNγ monoclonal antibody, in patients with MAS in the context of sJIA.Methods:This ongoing, pilot, open-label, single-arm study (NCT03311854) includes patients with MAS (2016 ACR/EULAR criteria) on a background of confirmed, or high presumption of, sJIA, and with inadequate response to high-dose IV glucocorticoids. Emapalumab is initiated at 6 mg/kg (1 dose) and continued at 3 mg/kg twice weekly for a total of 4 weeks, or less upon achievement of complete response (CR). CR is defined as an absence of MAS clinical signs plus white blood cell and platelet counts above the lower limit of normal, LDH, AST and ALT <1.5 x upper limit of normal, fibrinogen >100 mg/dL, and ferritin decreased by ≥80% or to <2,000 ng/mL.Results:We report preliminary data from the first 9 patients (median age [range] 11.6 [2.1-25.3] years) enrolled (7 in Europe and 2 in the USA). All patients had failed high-dose methylprednisolone, of which there were prior treatment failures from cyclosporin A (n=4) and from anakinra (n=4). Treatment with emapalumab resulted in rapid IFNγ neutralization, as demonstrated by the decrease in CXCL9 levels (Figure 1), and subsequent deactivation of T cells, as indicated by the decrease in sIL-2R levels. CR was achieved in all patients after a median of 23 (12-56) days. A progressive improvement in all clinical and laboratory parameters of MAS was observed (Table 1 and Figure 2). Glucocorticoids were tapered in all patients (median % tapering -92%; range -45% to -98% at Week 8). Emapalumab infusions were well tolerated by all patients, with no discontinuation. CMV reactivation was reported in 1 patient as a serious event possibly related to emapalumab and resolved with antiviral treatment.Table 1.Time to response for key clinical and laboratory parameters.ParametersMedian baseline value (range)Median days of treatment (range)D-dimers to <1000 mg/L12,480 (550-89,552)15 (1-49)sIL-2R to <2000 ng/L4596 (1664-20,954)21 (6-37)Ferritin <500 mg/L29,240 (716-192,584)21 (9-42)Physician visual analog scale of MAS activity ≤19.0 (2-10)19 (9-56)All MAS laboratory parameters within range of CRNA21 (15-55)All MAS parameters within range of CRNA23 (12-56)Glucocorticoid tapering at ≤1 mg/kg prednisolone equivalent*NA42 (16-50)*Data incomplete for 1 patientFigure 1.Rapid neutralization of IFNy. Each line represents an individual patient (n=9).Figure 2.Ferritin levels and platelet counts over time.Conclusion:Emapalumab administration led to rapid neutralization of IFNy and was efficacious in controlling MAS with a favorable safety profile. These results support the pathogenic role of IFNγ in MAS/sJIA and the therapeutic value of IFNγ neutralization in MAS patients who have failed standard of care.Disclosure of Interests:Fabrizio De Benedetti Grant/research support from: AbbVie, Pfizer, Novartis, Novimmune, Sobi, Sanofi, Roche, Speakers bureau: AbbVie, Novartis, Roche, Sobi, Paul Brogan Grant/research support from: Sobi, Novartis, Roche, Chemocentryx, Consultant of: Roche, Sobi, Speakers bureau: Sobi, Roche, Novartis, UCB, Claudia Bracaglia: None declared, Manuela Pardeo: None declared, Giulia Marucci: None declared, Emanuela Sacco: None declared, Despina Eleftheriou Speakers bureau: Sobi, Charalampia Papadopoulou: None declared, Alexei Grom Grant/research support from: Novartis, AB2Bio, Consultant of: Novartis, Pierre Quartier Consultant of: AbbVie, Chugai-Roche, Lilly, Novartis, Sanofi, Sobi, Speakers bureau: AbbVie, BMS, Chugai-Roche, Novartis, Pfizer, Sobi, Rayfel Schneider Grant/research support from: Roche, Novartis, Sobi, Pfizer, Consultant of: Sobi, Novartis, Novimmune, Philippe Jacqmin Consultant of: Sobi, Rikke Frederiksen Employee of: Sobi, Maria Ballabio Employee of: Sobi, Cristina De Min Employee of: Sobi
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Papa R, Lane T, Bovis F, Minden K, Touitou I, Cantarini L, Cattalini M, Obici L, Jansson A, Belot A, Woska-Kuśnierz B, Berendes R, Remesal A, Jelusic M, Espada G, Nikishina I, Hoppenreijs E, Maggio MC, Youngstein T, Rezk T, Papadopoulou C, Brogan P, Hawkins PN, Woo P, Ruperto N, Gattorno M, Lachmann HJ. FRI0457 LONG-TERM OUTCOMES AND TREATMENT EFFICACY IN PATIENTS WITH TNF RECEPTOR-ASSOCIATED AUTOINFLAMMATORY SYNDROME (TRAPS) FROM THE EUROFEVER INTERNATIONAL REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Tumour necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) is one of the best-known monogenic auto-inflammatory disorders resulting from an autosomal dominant variation in the TNF super family receptor 1A (TNFRSF1A) gene (1).Objectives:To define best treatment approach in patients with TRAPS and effect on long-term outcomes.Methods:We reviewed all data on patients with TRAPS enrolled in the Eurofever international registry according the INSAID gene variant classification and the new Eurofever/PRINTO classification criteria (EPCC).Results:Data on 226 patients were available. Patients not fulfilling the EPCC carrying likely benign/benign variants (21 patients, 9%) or VOUS/not classified variants (40 patients, 18%) displayed a milder disease than the patients fulfilling the EPCC with VOUS/not classified variants (38 patients, 17%) or pathogenic/likely pathogenic variants (127 patients, 56%). In particular, in patients not fulfilling the EPCC, less frequent abdominal pain and skin rashes, higher efficacy rate of colchicine and no development of AA amyloidosis have been reported. Almost 90% of patients fulfilling the EPCC required maintenance therapy and anti-interleukin (IL)-1 drugs were the most frequently used, with the highest efficacy rate (>85% complete response), while Etanercept was less effectively used and discontinued in 65% of patients.Conclusion:Anti-IL-1 drugs are the best maintenance treatment in TRAPS with potential to reverse the most serious disease complications of AA amyloidosis and infertility. The diagnosis of TRAPS should be considered very carefully in patients carrying VOUS/not classified variants not fulfilling the EPCC.References:[1]Lachmann HJ, Papa R, Gerhold K, Obici L, Touitou I, Cantarini L, et al. The phenotype of TNF receptor-associated autoinflammatory syndrome (TRAPS) at presentation: a series of 158 cases from the Eurofever/EUROTRAPS international registry. Annals of the rheumatic diseases 2014;73:2160-7.Acknowledgments:RP would like to thank the European Federation of Immunology (EFIS) for the short-term bursary and HL for her continuous support and guidance during the fellowship at the National Amyloidosis Centre in London.Disclosure of Interests:Riccardo Papa: None declared, Thirusha Lane: None declared, Francesca Bovis: None declared, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche, Isabelle Touitou: None declared, Luca Cantarini: None declared, Marco Cattalini: None declared, Laura Obici: None declared, Annette Jansson: None declared, Alexander Belot: None declared, Beata Woska-Kuśnierz: None declared, Rainer Berendes: None declared, Agustin Remesal: None declared, Marija Jelusic: None declared, Graciela Espada: None declared, Irina Nikishina: None declared, Esther Hoppenreijs: None declared, Maria Cristina Maggio: None declared, Taryn Youngstein: None declared, Tamer Rezk: None declared, Charalampia Papadopoulou: None declared, Paul Brogan Grant/research support from: Roche, Novartis, SOBI, Chemocentryx, Novimmune, Consultant of: Roche, SOBI, UCB, Novartis, Speakers bureau: Roche, SOBI, UCB, Novartis, Philip N Hawkins: None declared, Patricia Woo: None declared, Nicolino Ruperto Grant/research support from: Bristol-Myers Squibb, Eli Lily, F Hoffmann-La Roche, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sobi (paid to institution), Consultant of: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Speakers bureau: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Marco Gattorno Consultant of: Sobi, Novartis, Speakers bureau: Sobi, Novartis, Helen J. Lachmann: None declared
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Campanilho-Marques R, Deakin CT, Simou S, Papadopoulou C, Wedderburn LR, Pilkington CA. Retrospective analysis of infliximab and adalimumab treatment in a large cohort of juvenile dermatomyositis patients. Arthritis Res Ther 2020; 22:79. [PMID: 32293539 PMCID: PMC7161150 DOI: 10.1186/s13075-020-02164-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 03/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anti-TNF treatment may be useful for the treatment of patients with refractory juvenile dermatomyositis (JDM). The aim of this study was to describe the use of infliximab and adalimumab therapy in juvenile dermatomyositis as an adjunctive treatment. METHODS Sixty children recruited to the UK JDM Cohort and Biomarker Study that had received at least 3 months of anti-TNF treatment (infliximab or adalimumab) were studied. Childhood Myositis Assessment Scale (CMAS), Manual Muscle Testing (MMT8) and physician's global assessment (PGA) were recorded. Skin disease was assessed using the modified skin disease activity score (DAS). Data were analysed using Friedman's test for repeated measures analysis of variance. RESULTS Compared to baseline, there were improvements at 6 and 12 months in skin disease (χ2(2) = 15.52, p = 0.00043), global disease (χ2(2) = 8.14, p = 0.017) and muscle disease (CMAS χ2(2) = 17.02, p = 0.0002 and MMT χ2(2) = 10.56, p = 0.005) in infliximab patients. For patients who switched from infliximab to adalimumab, there was improvement in global disease activity (χ2(2) = 6.73, p = 0.03), and trends towards improvement in CMAS, MMT8 and modified DAS. The median initial prednisolone dose was 6 [0-10] mg, and final was 2.5 [0-7.5] mg (p < 0.0001). Fifty-four per cent of patients had a reduction in the number and/or size of calcinosis lesions. Twenty-five per cent switched their anti-TNF treatment from infliximab to adalimumab. 66.7%of the switches were to improve disease control, 26.7% due to adverse events and 6.6% due to patient preference. A total of 13.9 adverse reactions occurred in 100 patient-years, of which 5.7 were considered serious. CONCLUSION Reductions in muscle and skin disease, including calcinosis, were seen following treatment with infliximab and adalimumab.
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Affiliation(s)
- Raquel Campanilho-Marques
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN-Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa-Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Claire T Deakin
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, UK
| | - Stefania Simou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
| | - Charalampia Papadopoulou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Lucy R Wedderburn
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, UK
| | - Clarissa A Pilkington
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK.
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Papadopoulou C, Hong Y, Omoyinmi E, Brogan PA, Eleftheriou D. Janus kinase 1/2 inhibition with baricitinib in the treatment of juvenile dermatomyositis. Brain 2019; 142:e8. [PMID: 30715143 PMCID: PMC6391598 DOI: 10.1093/brain/awz005] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Charalampia Papadopoulou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ying Hong
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ebun Omoyinmi
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Paul A Brogan
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Despina Eleftheriou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, London, UK
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McCreary D, Omoyinmi E, Hong Y, Mulhern C, Papadopoulou C, Casimir M, Hacohen Y, Nyanhete R, Ahlfors H, Cullup T, Lim M, Gilmour K, Mankad K, Wassmer E, Berg S, Hemingway C, Brogan P, Eleftheriou D. Development and Validation of a Targeted Next-Generation Sequencing Gene Panel for Children With Neuroinflammation. JAMA Netw Open 2019; 2:e1914274. [PMID: 31664448 PMCID: PMC6824223 DOI: 10.1001/jamanetworkopen.2019.14274] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Neuroinflammatory disorders are a range of severe neurological disorders causing brain and spinal inflammation and are now increasingly recognized in the pediatric population. They are often characterized by marked genotypic and phenotypic heterogeneity, complicating diagnostic work in clinical practice and molecular diagnosis. OBJECTIVE To develop and evaluate a next-generation sequencing panel targeting genes causing neuroinflammation or mimicking neuroinflammation. DESIGN, SETTING, AND PARTICIPANTS Cohort study in which a total of 257 genes associated with monogenic neuroinflammation and/or cerebral vasculopathy, including monogenic noninflammatory diseases mimicking these entities, were selected. A customized enrichment capture array, the neuroinflammation gene panel (NIP), was created. Targeted high-coverage sequencing was applied to DNA samples taken from eligible patients referred to Great Ormond Street Hospital in London, United Kingdom, between January 1, 2017, and January 30, 2019, because of onset of disease early in life, family history, and/or complex neuroinflammatory phenotypes. MAIN OUTCOMES AND MEASURES The main outcome was the percentage of individuals with definitive molecular diagnoses, variant classification, and clinical phenotyping of patients with pathogenic variants identified using the NIP panel. The NIP panel was initially validated in 16 patients with known genetic diagnoses. RESULTS The NIP was both sensitive (95%) and specific (100%) for detection of known mutations, including gene deletions, copy number variants, small insertions and deletions, and somatic mosaicism with allele fraction as low as 3%. Prospective testing of 60 patients (30 [50%] male; median [range] age, 9.8 [0.8-20] years) presenting with heterogeneous neuroinflammatory phenotypes revealed at least 1 class 5 (clearly pathogenic) variant in 9 of 60 patients (15%); 18 of 60 patients (30%) had at least 1 class 4 (likely pathogenic) variant. Overall, a definitive molecular diagnosis was established in 12 of 60 patients (20%). CONCLUSIONS AND RELEVANCE The NIP was associated with molecular diagnosis in this cohort and complemented routine laboratory and radiological workup of patients with neuroinflammation. Unexpected genotype-phenotype associations in patients with pathogenic variants deviating from the classic phenotype were identified. Obtaining an accurate molecular diagnosis in a timely fashion informed patient management, including successful targeted treatment in some instances and early institution of hematopoietic stem cell transplantation in others.
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Affiliation(s)
- Dara McCreary
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ebun Omoyinmi
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ying Hong
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ciara Mulhern
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Charalampia Papadopoulou
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Marina Casimir
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Yael Hacohen
- Paediatric Neurology Department, Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Rodney Nyanhete
- North East Thames Regional Genetics Laboratory, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Helena Ahlfors
- North East Thames Regional Genetics Laboratory, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Cullup
- North East Thames Regional Genetics Laboratory, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Ming Lim
- Children’s Neurosciences Unit, Evelina London Children’s Hospital, Women’s and Children’s Department, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Kimberly Gilmour
- Immunology Department, Great Ormond Street Hospital NHS Foundations Trust, London, United Kingdom
| | - Kshitij Mankad
- Paediatric Neuroradiology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Evangeline Wassmer
- Paediatric Neurology Department, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Stefan Berg
- Paediatric Rheumatology Department, University of Gothenburg, Gothenburg, Sweden
| | - Cheryl Hemingway
- Paediatric Neurology Department, Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Paul Brogan
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Despina Eleftheriou
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
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Papadopoulou C, Omoyinmi E, Standing A, Pain CE, Booth C, D’Arco F, Gilmour K, Buckland M, Eleftheriou D, Brogan PA. Monogenic mimics of Behçet’s disease in the young. Rheumatology (Oxford) 2019; 58:1227-1238. [DOI: 10.1093/rheumatology/key445] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/13/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- C Papadopoulou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - E Omoyinmi
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - A Standing
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - C E Pain
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - C Booth
- Infection, Immunity, Inflammation, Molecular and Cellular Immunology Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - F D’Arco
- Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - K Gilmour
- Immunology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - M Buckland
- Immunology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - D Eleftheriou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UCLH and GOSH, London, UK
| | - P A Brogan
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Al Obaidi M, Papadopoulou C, Hussain S, Lei L, Eleftheriou D. R10 Predictors associated with secondary Raynaud’s phenomenon in children. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key273.060] [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)
- Muthana Al Obaidi
- Paediatric Rheumatology, Great Ormond Street Hospital, London, UNITED KINGDOM
| | - Charalampia Papadopoulou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UNITED KINGDOM
| | - Sami Hussain
- University College London Medical School., University Collgee London, London, UNITED KINGDOM
| | - Lind Lei
- University College London Medical School., University Collgee London, London, UNITED KINGDOM
| | - Despina Eleftheriou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UNITED KINGDOM
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Papachristodoulou C, Tsiamou MC, Sakkas H, Papadopoulou C. Determination of minerals in infant milk formulae by energy dispersive X-ray fluorescence spectrometry. J Food Compost Anal 2018. [DOI: 10.1016/j.jfca.2018.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Juvenile dermatomyositis (JDM) is a rare autoimmune disease mainly characterized by muscle and skin involvement. Vasculopathy is considered central to the pathogenesis of the disease. The exact nature of vasculopathy is not yet understood but it is a complex process with both an inflammatory and a non-inflammatory, occlusive component. Impaired function of JDM vasculature includes immune complex deposition, altered expression of cell adhesion molecules predominantly inducing Th17 cell infiltration, and endothelial cell dysfunction. Development of vasculopathy is associated with the severe extra-muscular manifestations of JDM, such as gastrointestinal and cardiac manifestations, interstitial lung disease, ulcerative skin disease or development of calcinosis, and portends a poor prognosis. Correlation of histopathological findings, autoantibodies, and extensive diagnostic workup represent key elements to the early detection of vasculopathic features and early aggressive treatment. Monitoring of vasculopathy remains challenging due to the lack of non-invasive biomarkers. Current treatment approaches provide variable benefit, but better understanding of the essential pathogenic mechanisms should help lead to improved outcomes. Whilst acknowledging that evidence is limited, this review aims to describe the vasculopathy of JDM in the context of pathophysiology, clinical features, and treatment of disease.
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Affiliation(s)
- Charalampia Papadopoulou
- Infection, Inflammation, and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Liza J McCann
- Department of Pediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
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Glackin Y, Chaplin H, Simou S, Almeida B, Papadopoulou C, Barwick L, Ioannou Y, Wedderburn LR, Pilkington C. 28. A pilot project to assess the impact of a Family Day – Helping young people and their families to meet and share their experiences of living with Juvenile Dermatomyositis. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex390.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Papadopoulou C, Hong Y, Krol P, Ioannou Y, Pilkington C, Chaplin H, Simou S, Charakida M, Wedderburn L, Brogan P, Eleftheriou D. 7. The vasculopathy of JDM; evidence of persistent endothelial injury, hypercoagulability, subclinical inflammation and increased arterial stiffness. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex390.007] [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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Fedorov E, Nikishina I, Kaleda M, Arman N, Tarakci E, Barut K, Adrovic A, Sahin S, Kasapcopur O, Arman N, Tarakci E, Kasapcopur O, Toumoulin L, Frossard J, Archimbaut S, Paitier A, Guastalli R, Czitrom SG, Charuvanij S, Chaiyadech C, Miyamae T, Yamanaka H, Picard C, Thouvenin G, Kannengiesser C, Dubus JC, Jeremiah N, Rieux-Laucat F, Crestani B, Secq V, Ménard C, Reynaud-Gaubert M, Thivolet-Bejui F, Reix P, Belot A, Batu ED, Sonmez HE, Erden A, Taskiran EZ, Karadag O, Kalyoncu U, Oncel İ, Kaplan B, Arici ZS, Temucin CM, Topaloglu H, Bilginer Y, Alikasifoglu M, Ozen S, Van Eyck L, De Langhe E, Jéru I, Van Nieuwenhove E, Lagou V, Baker PJ, Garcia-Perez J, Dooley J, De Somer L, Sciot R, Jeandel PY, Ruuth-Praz J, Copin B, Medley-Hashim M, Megarbane A, Savic S, Goris A, Amselem S, Liston A, Masters S, Wouters C, Okamoto N, Sugita Y, Shabana K, Murata T, Tamai H, Ferenczová J, Banóova E, Mrážik P, Vargova V, Bajramovic D, Novacki KS, Potocki K, Frkovic M, Jelusic M, Nikishina I, Kostareva O, Arsenyeva S, Kaleda M, Shapovalenko A, Jans L, Herregods N, Jaremko J, Joos R, Dehoorne J, Herregods N, Jaremko J, Baraliakos X, Dehoorne J, Joos R, Jans L, Ramiro S, Casasola-Vargas JC, van der Heijde D, Landewé R, Burgos-Vargas R, Burgos-Vargas R, Tse SM, Horneff G, Unnebrink K, Anderson JK, Kisaarslan AP, Sözeri B, Gündüz Z, Zararsız G, Poyrazoğlu H, Düşünsel R, Ouchi K, Akioka S, Kubo H, Nakagawa N, Hosoi H, Lamot L, Borovecki F, Kapitanovic S, Gotovac K, Vidovic M, Lamot M, Bosak EP, Harjacek M, Russo RA, Katsicas MM, Vargas RB, Ortiz-Peyegahud AL, Pingping Z, Yikun M, Jun Q, Yutong J, Jieruo G, Kostik MM, Ekaterina S, Avrusin I, Korin Y, Kopchak O, Isupova E, Chikova I, Tatyana P, Dubko M, Masalova V, Snegireva L, Kornishina T, Kalashnikova O, Chasnyk V, Kostik MM, Chikova I, Isupova E, Dubko M, Masalova V, Snegireva L, Kornishina T, Likhacheva T, Kalashnikova O, Chasnyk V, Ruperto N, Brunner HI, Quartier P, Constantin T, Alexeeva E, Schneider R, Kone-Paut I, Schikler K, Marzan K, Wulffraat N, Padeh S, Chasnyk V, Wouters C, Kuemmerle-Deschner JB, Kallinich T, Lauwerys B, Haddad E, Nasonov E, Trachana M, Vougiouka O, Leon K, Speziale A, Lheritier K, Vritzali E, Martini A, Lovell D, Ter Haar N, Scholman R, de Jager W, Tak T, Leliefeld P, Vastert B, de Roock S, Ter Haar N, Scholman R, de Jager W, de Ganck A, Ryter N, Lavric M, Foell D, de Roock S, Vastert B, Modica RF, Lomax KG, Batzel P, Cassanas A, Elder ME, Denisova R, Alexeeva E, Valieva S, Bzarova T, Isayeva K, Sleptsova T, Lomakina O, Chomahidze A, Soloshenko M, Shingarova M, Kachshenko E, De Jager W, Vastert SJ, Mijnheer G, Prakken BJ, Wulffraat NM, Sönmez HE, Karhan AN, Batu ED, Bilginer Y, Arıcı ZS, Gümüş E, Demir H, Yüce A, Özen S, Ahluwalia J, Bharti B, Rajpal S, Uppal V, Walia A, Samlok SS, Kumar N, Valões CC, Molinari BC, Pitta ACG, Gormezano NW, Farhat SC, Kozu K, Sallum AM, Appenzeller S, Sakamoto AP, Terreri MT, Pereira RM, Magalhães CS, Barbosa CM, Gomes FH, Bonfá E, Silva CA, Ozturk K, Ekinci Z, Helal M, Cabrera N, Belot A, Lega JC, Drai J, Ecochard R, Shpitonkova OV, Podchernyaeva NS, Kostina YO, Dashkova NG, Osminina MK, Yucel G, Sahin S, Adrovic A, Barut K, Tarakci E, Arvas A, Moorthy N, Kasapcopur O, Dimou P, Midgley A, Peak M, Satchell SC, Wright RD, Beresford MW, Corkhill R, Smith EM, Beresford MW, Bhattad S, Rawat A, Singh S, Gupta A, Suri D, de Boer M, Kuijpers T, Bhattad S, Rawat A, Gupta A, Suri D, Pandiarajan V, Singh S, Sandal S, Rawat A, Gupta A, Singh S, Giraldo S, Sanguino R, Diaz AS, Uzuner S, Sahin S, Durcan G, Adrovic A, Barut K, Kilicoglu AG, Bilgic A, Bahali K, Kasapcopur O, Sahin S, Adrovic A, Barut K, Durmus S, Uzun H, Kasapcopur O, Sahin S, Adrovic A, Barut K, Canpolat N, Caliskan S, Sever L, Kasapcopur O, Sato T, Kimura F, Suwairi W, Abdwani R, Al Rowais A, Al qanatish J, Al Asiri A, Ozturk K, Ekinci Z, Gaidar E, Kostik M, Dubko M, Masalova V, Serogodskaya E, Snegireva L, Nikitina T, Chasnyk V, Kalashnikova O, Isupova E, Sardar E, Dusser P, Rousseau A, Labetoulle M, Barreau E, Bodaghi B, Kone-Paut I, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Angarita JMM, Bou R, de Vicuña CG, Hernandez MV, Adan A, Llorens V, Alcobendas R, Noval S, Robledillo JCL, Valls I, Pinedo MC, Fonollosa A, de Inocencio J, Tejada P, Bravo B, Torribio M, de Yebenes MJG, Antón J, Argolini LM, Pontikaki I, Borghi MO, Cesana L, Miserocchi E, Castiglioni B, Gattinara M, Meroni P, Quartier P, Despert V, Poignant S, Baptiste A, Elie C, Kone-Paut I, Belot A, Kodjikian L, Monnet D, Weber M, Bodaghi B, Moal L, Rousseau A, Pham L, Barreau E, Titah C, Dureau P, Labetoulle M, Bodaghi B, Czitrom SG, Cecchin V, Zannin ME, Ferrari D, Comacchio F, Pontikaki I, Bracaglia C, Cimaz R, Falcini F, Petaccia A, Viola S, Breda L, La Torre F, Vittadello F, Martini G, Zulian F, Galeotti C, Sarrabay G, Fogel O, Touitou I, Bodaghi B, Miceli-Richard C, Koné-Paut I, Etayari H, Soad H, El Kadry I, Eatamadi H, AlAlgawi K, Al Maini M, Khawaja K, Van den Berghe S, de Schryver I, Raes A, Joos R, Dehoorne J, Teixeira LLC, Duarte A, Sousa S, Vinagre F, Santos MJ, Shevchenko NS, Bogmat LF, Demyanenko MV, Ramchurn NR, Friswell M, James RA, Wedderburn LR, Edelsten C, Pattani R, Pilkington CA, Compeyrot-Lacassagne S, James RA, Compeyrot-Lacassagne S, Edelsten C, Pattani R, Pilkington CA, Wedderburn LR, Villarreal AV, Acevedo N, Faugier E, Maldonado R, Yılmaz D, Uysal HB, Fedorov E, Salugina S, Kamenets E, Zaharova E, Radenska-Lopovok S, Nascimento J, Sofia H, Zilhão C, Almeida R, Guedes M, Ozturk K, Deveci M, Ekinci Z, Rodionovskaya S, Vinnikova V, Salugina S, Fedorov E, Tsymbal I, Olesińska E, Postępski J, Mroczkowska-Juchkiewicz A, Pawłowska-Kamieniak A, Chrapko B, Ključevšek D, Emeršič N, Toplak N, Avčin T, Rokhlina F, Glazyrina G, Kolyadina N, Kim K, Eom S, Kim D, Rhim J, Ricci F, Montesano P, Bonafini B, Medeghini V, Parissenti I, Meini A, Cattalini M, Airò P, Panko N, Shevchenko N, Lebec I, Zajceva Y, Rostlund S, André M, Hara T, Kishi T, Tani Y, Hanaya A, Miyamae T, Nagata S, Yamanaka H, Selmanovic V, Omercahic-Dizdarevic A, Cengic A, Cosickic A, Dizdarević AO, Lepri G, Picco P, Malattia C, Bellucci E, Matucci-Cerinic M, Falcini F, Dubko M, Solovyev A, Fedotova E, Maldonado R, Faugier E, Villarreal AV, Acevedo N, Diaz T, Ramirez Y, Giani T, Marino A, Simonini G, Cimaz R, Hunt D, Al Obaidi M, Veli V, Papadopoulou C, Kammermeier J, Olesińska E, Poluha A, Postępski J, Bharmappanavara GC, Kelly A, Shaw L, Giani T, Ferrara G, Luzzati M, Marino A, Giovannini M, Simonini G, Cimaz R, Jurado L, Giraldo S, Chamorro J, Sarmiento L, Diaz AS, Medeghini V, Ricci F, Montesano P, Bonafini B, Parissenti I, Meini A, Conversano E, Cattalini M, Gicchino MF, Macchini G, Granato C, Tirelli A, Olivieri AN, Perica M, Bukovac LT, Bogmat LF, Shevchenko NS, Demyanenko MV, Sinaei R, Parvaneh VJ, Shiari R, Rahmani K, Mehregan FF, Yeganeh MH, Penadés IC, Montesinos BL, Fernández MIG, Vidal AR, Rao AP, Romana A, Raghuram J, Kumar A, Suri D, Gupta V, Rawat A, Singh S, Comak E, Aksoy GK, Yılmaz A, Atalay A, Koyun M, Artan R, Akman S, Gicchino MF, Macchini G, Granato C, Olivieri AN, Kaleda MI, Nikishina IP, Soloviev SK, Malievsky VA, Nikolaeva EV, Giani T, Marino A, Simonini G, Cimaz R, Gazda A, Kołodziejczyk B, Rutkowska-Sak L, Mauro A, Giani T, Simonini G, Cimaz R, Gicchino MF, Marzuillo P, Guarino S, Olivieri AN, La Manna A. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part three. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461520 DOI: 10.1186/s12969-017-0143-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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Santos MJ, Nemcova D, Battagliotti C, Eleftheriou D, Harel L, Janarthanan M, Kallinich T, Demir F, Lopez JA, Minden K, Nielsen S, Torok K, Uziel Y, Helmus N, Foeldvari I, Baildem E, Blakley M, Boros C, Ozturk K, Fligelstone K, Kienast A, Nemcova D, Pain C, Saracino A, Simoni G, Torok K, Weibel L, Helmus N, Foeldvari I, Gunduz Z, Klotsche J, Kasapçopur O, Adrovic A, Stanevicha V, Terreri MT, Alexeeva E, Katsicas M, Cimaz R, Kostik M, Lehman T, Sozeri B, Sifuentes-Giraldo WA, Smith V, Sztajnbok F, Avcin T, Santos MJ, Nemcova D, Battagliotti C, Eleftheriou D, Harel L, Janarthanan M, Makay B, Kallinich T, Lopez JA, Minden K, Nielsen S, Torok K, Uziel Y, Helmus N, Osminina MK, Geppe NA, Niconorova OV, Ayaz N, Karashtina OV, Abbyasova OV, Shpitonkova OV, Adrovic A, Sahin S, Barut K, Durmus S, Uzun H, Kasapcopur O, Foeldvari I, Yavascan O, Klotsche J, Kasapçopur O, Adrovic A, Stanevicha V, Terreri MT, Alexeeva E, Katsicas M, Cimaz R, Kostik M, Lehman T, Aydog O, Sifuentes-Giraldo WA, Smith V, Sztajnbok F, Avcin T, Santos MJ, Nemcova D, Battagliotti C, Eleftheriou D, Harel L, Janarthanan M, Bilginer Y, Kallinich T, Lopez JA, Minden K, Nielsen S, Torok K, Uziel Y, Helmus N, Mauro A, Fanti E, Voller F, Ekinci Z, Rusconi F, Cimaz R, Garcia-Rodriguez F, Villarreal-Treviño AV, Flores-Pineda AJ, Lara-Herrea PB, Salinas-Encinas DR, Diaz-Prieto T, Maldonado-Velazquez MR, Moreno-Espinosa S, Yıldız D, Faugier-Fuentes E, Gallizzi R, Finetti M, Crapanzano M, Cantarini L, Cattalini M, Filocamo G, Insalaco A, Mauro A, Rigante D, Gök F, Zulian F, Alessio M, Parissenti I, Ruperto N, Gattorno M, Cimaz R, Parihar MS, Singh S, Vignesh P, Gupta A, Erguven M, Rohit M, Gopalan K, Singh S, Vignesh P, Gupta A, Rohit M, Attri SV, Hong Y, Eleftheriou D, Nanthapisal S, Unsal E, Salama A, Jayne D, Little M, Brogan P, Kostina Y, Lyskina G, Shpitonkova O, Torbyak A, Lyskina G, Shirinsky O, Kasapcopur O, Mauro A, Gicchino MF, Smaldone MC, Diplomatico M, Olivieri AN, Spencer CH, Aziz RA, McClead R, Bout-Tabaku S, Patel H, Ozen S, Yu CY, Ozkececi CF, Basbozkurt G, Simsek D, Kurt E, Gok F, Demirkaya E, Cebecauerová D, Dallos T, Kabíčková E, Demirkaya E, Kynčl M, Chroustová D, Hoza J, Němcová D, Tesař V, Doležalová P, Batu ED, Sonmez HE, Hazirolan T, Ozaltin F, Sönmez HE, Bilginer Y, Ozen S, Almeida F, de Paula IHF, Sampaio MM, Arita FN, Alves AG, Santos MC, Okuda EM, Sacchetti SB, Batu ED, Falcini F, Francesca M, Stagi S, Rigante D, Lepri G, Matucci-Cerinic M, Brandi ML, Di Landro G, Torreggiani S, Petaccia A, Sözeri B, Torcoletti M, Corona F, Filocamo G, Kisaoglu H, Misir S, Demir S, Aliyazicioglu Y, Kalyoncu M, de Paula IHF, Ramalho CE, Butbul Y, Almeida FD, Alves AG, Santos MC, Sacchetti SB, Okuda EM, Calzada-Hernández J, Bou R, Iglesias E, Sánchez-Manubens J, Martínez FHP, Bilginer Y, Roca CG, Fernández SB, Angarita JMM, Anton J, Bohm M, Mahmood K, Leone V, Wood M, Yamaguchi KI, Fujikawa S, Özen S, Kim KY, Kim DY, Kim DS, Ioseliani M, Chkhaidze I, Lekishvili M, Tskhakaia N, Tvalabeishvili S, Kajrishvili A, Takakura M, Bracaglia C, Shimizu M, Inoue N, Mizuta M, Yachie A, Alizzi C, Corsello G, Maggio MC, Piram M, Maldini C, Biscardi S, Prencipe G, Desuremain N, Orzechowski C, Georget E, Regnard D, Kone-Paut I, Mahr A, Sparchez M, Damian L, Sparchez Z, Silva NA, Pardeo M, Treviño AVV, Loyola YR, Prieto TD, Fuentes EF, Velazquez MDRM, Perez P, Mosquera AC, Malagon C, Bhattad S, Rawat A, Lapeyre G, Saikia B, Minz R, Shandilya J, Singh S, Parihar MS, Singh S, Vignesh P, Gupta A, Rohit M, Maldonado R, Marasco E, Faugier E, Villarreal A, Acevedo N, Ramírez Y, Diaz T, Kostina Y, Lyskina G, Shpitonkova O, Ozturk K, Ekinci Z, Insalaco A, Özçakar ZB, Fitoz S, Yalcinkaya F, Horne A, Minoia F, Bovis F, Davi S, Pal P, Anton J, Stein K, Ferlin W, Enciso S, Kasapcopur O, Jeng M, Maritsi D, Cron RC, Ravelli A, Thorwarth A, von Stuckrad SL, Rösen-Wolff A, Luksch H, Nelson R, Hundsdoerfer P, Minden K, Krawitz P, Kallinich T, Sozeri B, Ayaz NA, Batu ED, Makay B, Şahin S, Simsek D, de Min C, Kılıc ŞS, Ozturk K, Sonmez E, Kisaarslan AP, Gucenmez OA, Cakan M, Arıcı ZS, Adrovic A, Kelesoglu F, Bilginer Y, De Benedetti F, Demirkaya E, Ekinci ZE, Dusunsel R, Unsal E, Kasapcopur O, Ozen S, Lerkvaleekul B, Vilaiyuk S, Miranda-Garcia M, Pretzer C, Ruperto N, Huppertz HI, Horneff G, Haas JP, Ganser G, Kuemmerle-Deschner J, Wittkowski H, Frosch M, Roth J, Foell D, Holzinger D, Brunner HI, Gohar F, McArdle A, Callan N, Hernandez B, Lavric M, Kessel C, Holzinger D, FitzGerald O, Pennington SR, Foell D, Quartier P, Horneff G, Peitz J, Kekow J, Klein A, Horneff G, Schulz AC, Minden K, Weller-Heinemann F, Hospach A, Haas JP, Constantin T, Put K, Vandenhaute J, Avau A, van Nieuwenhuijze A, Brisse E, Dierckx T, Rutgeerts O, Garcia-Perez JE, Toelen J, Waer M, Alexeeva E, Leclercq G, Goris A, Van Weyenbergh J, Liston A, De Somer L, Matthys P, Wouters CH, Mizuta M, Shimizu M, Inoue N, Kone-Paut I, Nakagishi Y, Yachie A, Shimizu M, Inoue N, Mizuta M, Yachie A, Ombrello MJ, Arthur V, Remmers EF, Hinks A, Marzan K, Kastner DL, Woo P, Thomson W, Stanimirovic B, Djurdjevic-Banjac B, Ljuboja O, Hugle B, Speth F, Haas JP, Maritsi D, Wulffraat N, Onoufriou MA, Vougiouka O, Eleftheriou D, Horneff G, Peitz J, Kekow J, Foell D, Bouayed K, El Hani S, Hafid I, Schneider R, Mikou N, Ioseliani M, Lekishvili M, Shelia N, Tvalabeishvili S, Kajrishvili A, Laan M, Ilisson J, Pruunsild C, Padeh S, Chasnyk V, Wouters C, Kuemmerle-Deschner JB, Kallinich T, Lauwerys B, Haddad E, Nasonov E, Trachana M, Vougiouka O, Leon K, Vritzali E, Lheritier K, Martini A, Lovell D, Schena F, Volpi S, Caorsi R, Penco F, Pastorino C, Kalli F, Omenetti A, Chiesa S, Bertoni A, Picco P, Filaci G, Aksentijevich I, Grossi A, Ceccherini I, Martini A, Traggiai E, Gattorno M, Melki I, Rose Y, Uggenti C, Fremond ML, Van Eyck L, Kitabayashi N, Gattorno M, Volpi S, Sacco O, Meyts I, Morren MA, Wouters C, Legius E, Callebaut I, Bodemer C, Rieux-Laucat F, Rodero M, Crow Y, Frémond ML, Rodero MP, Jeremiah N, Belot A, Jeziorski E, Duffy D, Bessis D, Cros G, Rice GI, Charbit B, Hulin A, Khoudour N, Caballero CM, Bodemer C, Fabre M, Berteloot L, Le Bourgeois M, Reix P, Walzer T, Moshous D, Blanche S, Fischer A, Bader-Meunier B, Rieux-Laucat F, Crow Y, Neven B, Annink K, ter Haar N, Al-Mayouf S, Amaryan G, Anton J, Barron K, Benseler S, Brogan P, Cantarini L, Cattalini M, Cochino A, De Benedetti F, Dedeoglu F, De Jesus A, Dellacasa O, Demirkaya E, Dolezalova P, Durrant K, Fabio G, Gallizzi R, Goldbach-Mansky R, Hachulla E, Hentgen V, Herlin T, Hofer M, Hoffman H, Insalaco A, Jansson A, Kallinich T, Koné-Paut I, Kozlova A, Kuemmerle-Deschner J, Lachmann H, Laxer R, Martini A, Nielsen S, Nikishina I, Ombrello A, Ozen S, Papadopoulou-Alataki E, Quartier P, Ravelli A, Rigante D, Russo R, Simon A, Trachana M, Uziel Y, Gattorno M, Frenkel J, ter Haar N, Jeyaratnam J, Lachmann H, Simon A, Brogan P, Doglio M, Cattalini M, Anton J, Modesto C, Quartier P, Hoppenreijs E, Martino S, Insalaco A, Cantarini L, Lepore L, Alessio M, Penades IC, Boros C, Consolini R, Rigante D, Russo R, Schmid JP, Lane T, Martini A, Ruperto N, Frenkel J, Gattorno M, Passarelli C, Pisaneschi E, Messia V, Pardeo M, Novelli A, Debenedetti F, Insalaco A, Brogan PA, Hofer M, Kuemmerle-Deschner JB, Lauwerys B, Speziale A, Wei X, Laxer R, Insalaco A, Marafon DP, Finetti M, Pardeo M, Martino S, Cattalini M, Alessio M, Orlando F, Taddio A, Pastore S, Cortis E, Miniaci A, Ruperto N, Martini A, De Benedetti F, Gattorno M, Eijkelboom C, ter Haar N, Cantarini L, Finetti M, Brogan P, Dolezalova P, Koné-Paut I, Insalaco A, Jelusic-Drazic M, Bezrodnik L, Pinedo MC, Stanevicha V, van Gijn M, Federici S, Ruperto N, Frenkel J, Gattorno M, Girschick H, Finetti M, Orlando F, Insalaco A, Ganser G, Nielsen S, Herlin T, Koné-Paut I, Martino S, Cattalini M, Anton J, Al-Mayouf SM, Hofer M, Quartier P, Boros C, Kuemmerle-Deschner J, Schalm S, Alessio M, Ruperto N, Martini A, Jansson A, Gattorno M, Finetti M, Marchi M, Marini C, Doglio M, Malattia C, Ravelli A, Martini A, Garaventa A, Gattorno M, Bertoni A, Carta S, Balza E, Castellani P, Pellecchia C, Penco F, Schena F, Borghini S, Trotta ML, Pastorino C, Ceccherini I, Martini A, Gattorno M, Rubartelli A, Chiesa S, Guzman J, Henrey A, Loughin T, Berard R, Shiff N, Jurencak R, Benseler S, Tucker L, Papadopoulou C, Hong Y, Krol P, Ioannou Y, Pilkington C, Chaplin H, Simou S, Charakida M, Wedderburn L, Brogan P, Eleftheriou D, Spiegel LR, Kohut SA, Stinson J, Forgeron P, Kaufman M, Luca N, Amaria K, Bell M, Swart J, Boris F, Castagnola E, Groll A, Giancane G, Horneff G, Huppertz HI, Lovell D, Wolfs T, Hofer M, Alekseeva E, Panaviene V, Nielsen S, Anton J, Uettwiller F, Stanevicha V, Trachana M, De Benedetti F, Ailioaie LM, Tsitami E, Kamphuis S, Herlin T, Dolezalova P, Susic G, Sztajnbok F, Flato B, Pistorio A, Martini A, Wulffraat N, Ruperto N, Shoop SJW, Verstappen SMM, McDonagh JE, Thomson W, Hyrich KL, Tarkiainen M, Tynjala P, Lahdenne P, Martikainen J, Wilkinson M, Piper C, Otto G, Deakin CT, Dowle S, Simou S, Kelberman D, Ioannou Y, Mauri C, Jury E, Isenberg D, Wedderburn LR, Nistala K, Foeldvari I, Ruperto N, Lovell DJ, Horneff G, Huppertz HI, Quartier P, Simonini G, Bereswill M, Kalabic J, Martini A, Brunner HI, Oen K, Guzman J, Feldman BM, Dufault B, Lee J, Shiff N, Duffy KW, Tucker L, Duffy C, Ruperto N, Lovell DJ, Tzaribachev N, Vega-Cornejo G, Louw I, Berman A, Calvo I, Cuttica R, Horneff G, Avila-Zapata F, Anton J, Cimaz R, Solau-Gervais E, Joos R, Espada G, Li X, Nys M, Wong R, Banerjee S, Martini A, Brunner HI, Nicolai R, Marafon DP, Verardo M, D’Amico A, Bracci-Laudiero L, De Benedetti F, Moneta GM, Belot A, Rice G, Mathieu AL, Omarjee SO, Bader-Meunier B, Walzer T, Briggs TA, O’Sullivan J, Williams S, Cimaz R, Smith E, Beresford MW, Crow YJ, Rooney M, Bishop N, davidson J, pilkington C, Beresford M, Clinch J, Satyapal R, Foster H, Medwin JG, McDonagh J, Wyatt S, Modignani VL, Baldo F, Lanni S, Consolaro A, Ravelli A, Filocamo G, Omenetti A, Frenkel J, Lachmann HJ, Ozen S, Ruperto N, Gattorno M, Insalaco A, Moneta G, Pardeo M, Passarelli C, Celani C, Messia V, De Benedetti F, Cherqaoui B, Rossi-Semerano L, Dusser P, Hentgen V, Koné-Paut I, Grimwood C, Dusser P, Rossi L, Paut IK, Hentgen V, Lasigliè D, Ferrera D, Amico G, Di Duca M, Caorsi R, Lepore L, Insalaco A, Cattalini M, Obici L, Consolini R, Ravazzolo R, Martini A, Ceccherini I, Nishikomori R, Arostegui J, Gattorno M, Borghini S, Penco F, Petretto A, Lavarello C, Inglese E, Omenetti A, Finetti M, Pastorino C, Bertoni A, Gattorno M, Vanoni F, Federici S, Ozen S, Frenkel J, Lachmann H, Martini A, Ruperto N, Gattorno M, Hofer M, Kuemmerle-Deschner JB, Hoffman HM, Hawkins PN, van der Poll T, Walker UA, Speziale A, Joubert Y, Tilson HH, Kuemmerle-Deschner J, Ozen S, Tyrrell PN, Koné-Paut I, Goldbach-Mansky R, Lachmann H, Blank N, Hoffman HM, Weissbarth-Riedel E, Huegle B, Kallinich T, Gattorno M, Gul A, ter Haar NM, Oswald M, Dedeoglu F, Benseler SM, Hanaya A, Miyamae T, Kawamoto M, Tani Y, Hara T, Kawaguchi Y, Nagata S, Yamanaka H, Ćosićkić A, Skokić F, Čolić B, Suljendić S, Kozlova A, Mersiyanova I, Panina M, Hachtryan L, Burlakov V, Raikina E, Maschan A, Shcherbina A, Acar B, Albayrak M, Sozeri B, Sahin S, Barut K, Adrovic A, Inan N, Sevgi S, Kasapcopur O, Andreasen CM, Jurik AG, Glerup MB, Høst C, Mahler BT, Hauge EM, Herlin T, Lazea C, Damian L, Lazar C, Manasia R, Stephenson CM, Prajapati V, Miettunen PM, Yılmaz D, Tokgöz Y, Bulut Y, Çakmak H, Sönmez F, Comak E, Aksoy GK, Koyun M, Akman S, Arıkan Y, Terzioğlu E, Özdeş ON, Keser İ, Koçak H, Bingöl A, Yılmaz A, Artan R, De Benedetti F, Anton J, Gattorno M, Lachmann H, Kone-Paut I, Ozen S, Frenkel J, Simon A, Zeft A, Ben-Chetrit E, Hoffman HM, Joubert Y, Lheritier K, Speziale A, Guido J, Xu X, Mehregan FF, Ziaee V, Moradinejad MH, Ferrara G, Pastore S, Insalaco A, Pardeo M, Tommasini A, La Torre F, Alizzi C, Cimaz R, Finetti M, Gattorno M, D’Adamo P, Taddio A, Lachmann H, Simon A, Anton J, Gattorno M, Kone-Paut I, Ozen S, Frenkel J, Ben-Chetrit E, Hoffman H, Zeft A, Joubert Y, Lheritier K, Speziale A, Junge G, Gregson J, De Benedetti F, Sargsyan H, Sargsyan H, Zengin H, Fidanci BE, Kaymakamgil C, Konukbay D, Simsek D, Batu ED, Yildiz D, Gok F, Ozen S, Demirkaya E, Stoler I, Freytag J, Orak B, Seib C, Esmann L, Seipelt E, Gohar F, Foell D, Wittkowski H, Kallinich T, Dursun I, Tulpar S, Yel S, Kartal D, Borlu M, Bastug F, Poyrazoglu H, Gunduz Z, Kose K, Yuksel ME, Calıskan A, Cekgeloglu AB, Dusunsel R, Bouchalova K, Franova J, Schuller M, Macku M, Theodoropoulou K, Carlomagno R, von Scheven-Gête A, Poloni C, Hofer M, Damian LO, Cosma D, Radulescu A, Vasilescu D, Rogojan L, Lazar C, Rednic S, Lupse M, De Somer L, Moens P, Wouters C, Zavala RG, Pedraz LM, Cuadros EN, Rego GDC, Cardona ALU, Zavala RG, Pedraz LM, Cuadros EN, Rego GDC, Cardona ALU, Forno ID, Pieropan S, Viapiana O, Gatti D, Dallagiacoma G, Caramaschi P, Biasi D, Windschall D, Trauzeddel R, Lehmann H, Ganser G, Berendes R, Haller M, Krumrey-Langkammerer M, Nimtz-Talaska A, Schoof P, Trauzeddel RF, Nirschl C, Quesada-Masachs E, Blancafort CA, Barril SM, Caballero CM, Aguiar F, Fonseca R, Alves D, Vieira A, Vieira A, Dias JA, Brito I, Susic G, Milic V, Radunovic G, Boricic I, Marteau P, Adamsbaum C, Rossi-Semerano L, De Bandt M, Lemelle I, Deslandre C, Tran TA, Lohse A, Solau-Gervais E, Pillet P, Bader-Meunier B, Wipff J, Gaujoux-Viala C, Breton S, Devauchelle-Pensec V, Gran S, Fehler O, Zenker S, Schäfers M, Roth J, Vogl T, Czitrom SG, Foell D, Holzinger D, Lanni S, Van Dijkhuizen EHP, Manzoni SM, Marafon DP, Magnaguagno F, de Horatio LT, Ter Haar NM, Littooij AS, Vastert SJ, De Benedetti F, Ravelli A, Martini A, Malattia C, Teixeira VA, Campanilho-Marques R, Mourão AF, Ramos FO, Costa M, Madan WA, Killeen OG, Vidal AR, Delgado DS, Fernandez MIG, Montesinos BL, Penades IC, Kozhevnikov A, Pozdeeva N, Konev M, Melchenko E, Kenis V, Novik G, Sozeri B, Kısaarslan AP, Gunduz Z, Poyrazoglu H, Dusunsel R, Lerkvaleekul B, Jaovisidha S, Sungkarat W, Chitrapazt N, Fuangfa P, Ruangchaijatuporn T, Vilaiyuk S, Pradsgaard DØ, Hørlyck A, Spannow AH, Heuck CW, Herlin T, Diaz T, Garcia F, De La Cruz L, Rubio N, Świdrowska-Jaros J, Smolewska E, Lamot M, Lamot L, Vidovic M, Bosak EP, Rados I, Harjacek M, Tzaribachev N, Louka P, Hagoug R, Trentin C, Kubassova O, Hinton M, Boesen M, Oshlianska OA, Chaikovsky IA, Mjasnikov G, Kazmirchyk A, Garagiola U, Borzani I, Cressoni P, Corona F, Dzsida E, Farronato G, Garagiola U, Cressoni P, Corona F, Petaccia A, Dzsida E, Farronato G, Gagro A, Pasini AM, Roic G, Vrdoljak O, Lujic L, Zutelija-Fattorini M, Esser MM, Abraham DR, Kinnear C, Durrheim G, Urban M, Hoal E, Crow Y, Oshlianska OA. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part one. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461530 DOI: 10.1186/s12969-017-0141-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Papadopoulou C, Solbach MC, Lorenz B, Luciani F. [Treatment Options for Basal Cell Carcinomas of the Medial Canthus]. Klin Monbl Augenheilkd 2016; 233:38-43. [PMID: 26797885 DOI: 10.1055/s-0041-110134] [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: 10/22/2022]
Abstract
Basal cell carcinoma is the most common skin cancer of the eyelid. It most frequently occurs on the lower eyelid and the medial canthus. Although metastases appear only very rarely, basal cell carcinoma is locally destructive if left untreated. Nowadays several surgical and nonsurgical treatments can be used to remove or destroy basal cell carcinomas. The selection of optimal treatment depends on the initial individual situation as well as the age and the general condition of the patient. The "gold standard" method for the treatment of basal cell carcinomas is surgical removal with subsequent histological examination. Because of the complex anatomical characteristics of the medial canthus and the lateral nasal root region, basal cell carcinomas of this area present great challenges for any treatment method. These characteristics also explain the higher rates of incomplete removal and greater risk of recurrence, with in depth extension of the tumor. Additionally, surgical removal of the tumor from the medial canthus area often results in extended tissue defects. The plastic covering of these defects can be achieved by various reconstruction procedures.
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Affiliation(s)
- C Papadopoulou
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - M C Solbach
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - B Lorenz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - F Luciani
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
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Lanni S, Bovis F, Papadopoulou C, Kostik M, Gonzalez-Fernandez MI, Bohm M, Nieto-Gonzalez JC, Bertamino M, Martini A, Ravelli A. PReS-FINAL-2167: What is the potential of intra-articular corticosteroid injections to induce sustained remission in children with juvenile idiopathic arthritis? Pediatr Rheumatol Online J 2013. [PMCID: PMC4044052 DOI: 10.1186/1546-0096-11-s2-p179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Papadopoulou C, Kostik M, Gonzalez-Fernandez MI, Bohm M, Nieto-Gonzalez JC, Pistorio A, Lanni S, Consolaro A, Martini A, Ravelli A. Delineating the role of multiple intraarticular corticosteroid injections in the management of juvenile idiopathic arthritis in the biologic era. Arthritis Care Res (Hoboken) 2013; 65:1112-20. [PMID: 23335483 DOI: 10.1002/acr.21947] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/21/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the outcome and predicting factors of multiple intraarticular corticosteroid (IAC) injections in children with juvenile idiopathic arthritis (JIA). METHODS The clinical charts of patients who received their first IAC injection in ≥3 joints between January 2002 and December 2011 were reviewed. The corticosteroid used was triamcinolone hexacetonide for large joints and methylprednisolone acetate for small or difficult to access joints. In each patient, the followup period after IAC injection was censored in case of synovitis flare or at the last visit with continued remission. Predictors included sex, age at disease onset, JIA category, antinuclear antibody (ANA) status, age and disease duration, disease course, general anesthesia, number and type of injected joints, acute-phase reactants, and concomitant systemic medications. RESULTS A total of 220 patients who had 1,096 joints injected were included. Following IAC therapy, 66.4% of patients had synovitis flare after a median of 0.5 years, whereas 33.6% of patients had sustained remission after a median of 0.9 years. The cumulative probability of survival without synovitis flare was 50.0%, 31.5%, and 19.5% at 1, 2, and 3 years, respectively. On Cox regression analysis, positive C-reactive protein value, negative ANA, lack of concomitant methotrexate administration, and a polyarticular (versus an oligoarticular) disease course were the strongest predictors for synovitis flare. CONCLUSION Multiple IAC injection therapy induced sustained remission of joint synovitis in a substantial proportion of patients. A controlled trial comparing multiple IAC injection therapy and methotrexate versus methotrexate and a tumor necrosis factor antagonist is worthy of consideration.
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Papadopoulou C, Kostik M, Böhm M, Nieto-Gonzalez JC, Gonzalez-Fernandez MI, Gallo MC, Calandra S, Consolaro A, Martini A, Ravelli A. SAT0451 Methotrexate Therapy may Prevent the Onset of Uveitis in Juvenile Idiopathic Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2175] [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: 11/03/2022]
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Vlachos C, Gaitanis G, Alexopoulos EC, Papadopoulou C, Bassukas ID. Phospholipase activity after β-endorphin exposure discriminates Malassezia strains isolated from healthy and seborrhoeic dermatitis skin. J Eur Acad Dermatol Venereol 2012; 27:1575-8. [PMID: 22757641 DOI: 10.1111/j.1468-3083.2012.04638.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Phospholipase activity and its induction by β-endorphin have been associated with pathogenic Malassezia pachydermatis animal isolates. OBJECTIVE To evaluate Malassezia phosholipase activity in human isolates from seborrhoeic dermatitis (SD) and healthy controls before and after β-endorphin exposure. METHODS Eighty-four volunteers with or without SD (N = 41) were sampled. Isolated Malassezia strains were incubated in Dixon's medium with and without 100 nmol/L β-endorphin. Subsequently, phospholipase activity was assessed in egg-yolk agar and the results were compared employing Wilcoxon sign test for paired data, chi-squared test and multinomial logistic regression analysis. RESULTS A total of 64 Malassezia strains were isolated. SD strains tended to have decreased phospholipase activity before (P = 0.057) and increased after exposure to β-endorphin (P = 0.061) compared to isolates from healthy skin. Phospholipase activity after β-endorphin exposure related to basal enzyme activity as a measure of per strain phospholipase inducibility by β-endorphin did not depend on Malassezia species (P = 0.652). However, this latter biochemical trait discriminates strains isolated from SD lesional and healthy skin (P = 0.036). CONCLUSION β-endorphin exposure modifies the in vitro phosholipase activity in Malassezia species isolated from SD lesional skin. This is in accordance with emerging evidence that enhanced local lipase activity is involved in the pathogenesis of SD.
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Affiliation(s)
- Ch Vlachos
- Departments ofSkin and Venereal DiseasesMicrobiology, University of Ioannina Medical School, Ioannina, Greece
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Klimentopoulou A, Antonopoulos CN, Papadopoulou C, Kanavidis P, Tourvas AD, Polychronopoulou S, Baka M, Athanasiadou-Piperopoulou F, Kalmanti M, Sidi V, Moschovi M, Petridou ET. Maternal smoking during pregnancy and risk for childhood leukemia: a nationwide case-control study in Greece and meta-analysis. Pediatr Blood Cancer 2012; 58:344-51. [PMID: 21990018 DOI: 10.1002/pbc.23347] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 08/22/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Maternal smoking during pregnancy has been often implicated in the development of childhood leukemia with ambiguous results. Hence, we conducted a meta-analysis aiming to summarize current evidence and quantify any tentative impact. PROCEDURE We retrieved one cohort (553 leukemias compared to 1,440,542 children), 20 case-control studies and also analyzed the updated Greek case-control dataset with unpublished data, yielding in total 11,092 cases and 25,221 controls. RESULTS Odds ratios reported in the studies included ranged from 0.70 to 2.20 for acute lymphocytic (ALL) and from 0.60 to 2.17 for acute myelocytic leukemia (AML). The combined effect regarding the association of maternal smoking (any vs. no) and leukemia risk was 1.03 for ALL (95% CI = 0.95-1.12, random effects model) and 0.99 for AML (95% CI = 0.90-1.09, fixed effects model). The results remained unchanged when sensitivity analyses were undertaken of studies reporting same maternal smoking periods, those focusing only on childhood leukemia deaths or investigations which did not clearly define AML subtype. CONCLUSIONS The findings of the meta-analysis challenge the limits of traditional epidemiology to provide sound inferences when point estimates of constituent studies range around the null. In particular, this study provides no support to a hypothesis linking maternal smoking during pregnancy with subsequent development of main childhood leukemia subtypes. Further investigations employing molecular and genetic epidemiology, however, might be needed in the hope to reveal even minimal risks pertaining individuals with specific susceptibility to tobacco compounds who sustain high environmental exposures prenatally or postnatally.
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Affiliation(s)
- Alexandra Klimentopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, 75 M. Asias Str., Goudi, Athens, Greece
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Papadopoulou C, Kotronoulas G, Simpson M, Maguire R. 4237 POSTER Supportive Care Needs of Patients With Lung Cancer – a Systematic Review of the Literature. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Papadopoulou C, Johnston B, Themessl-Huber M. 4211 POSTER The Experience of Leukaemia: a Thematic Synthesis of the Literature. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71377-6] [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: 10/17/2022]
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Kotronoulas G, Papadopoulou C, Simpson M, Maguire R. 4232 POSTER Patient Reported Outcome Measures (PROM) for the Delivery of Supportive Care to People With Lung Cancer – Identification and Selection of Existent Tools. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71398-3] [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: 10/17/2022]
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Papadopoulou C, Antonopoulos CN, Sergentanis TN, Panagopoulou P, Belechri M, Petridou ET. Is birth weight associated with childhood lymphoma? A meta-analysis. Int J Cancer 2011; 130:179-89. [PMID: 21351088 DOI: 10.1002/ijc.26001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 02/01/2011] [Indexed: 11/06/2022]
Abstract
Several risk factors have been identified for childhood lymphomas. The purpose of this meta-analysis was to synthesize current evidence regarding the association between birth weight with primarily the risk for non-Hodgkin lymphoma (NHL), given its similarity to acute lymphoblastic leukemia, Hodgkin lymphoma (HL) and any category of lymphoma. Two cohort (278,751 children) and seven case-control studies (2,660 cases and 69,274 controls) were included. Effects estimates regarding NHL, HL and any lymphoma were appropriately pooled using fixed or random effects model in two separate analyses: specifically, high was compared to normal or any birth weight. Similarly, low was compared to normal or any birth weight. No statistically significant association was found between high birth weight, as compared to normal birth weight, and risk for NHL plus Burkitt lymphoma (OR = 1.17, 95% CI = 0.76-1.80, random effects), HL (OR = 0.94, 95% CI = 0.64-1.38, fixed effects) or any plus Burkitt lymphoma (OR = 1.09, 95% CI = 0.76-1.56, fixed effects). A null association emerged when low was compared with normal birth weight for NHL plus Burkitt lymphoma (OR = 1.07, 95% CI = 0.71-1.62, random effects), HL (OR = 0.94, 95% CI = 0.54-1.65, fixed effects) or any plus Burkitt lymphoma (OR = 1.02, 95% CI = 0.79-1.33, fixed effects). Accordingly, no association was found when high or low birth weight was compared to any birth weight. Although current evidence suggests no association, birth weight might be a too crude indicator to reveal a genuine association of fetal growth with specific lymphoma categories; hence, there is an emerging need for use of more elaborate proxies, at least those accounting for gestational week.
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Affiliation(s)
- C Papadopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Antonopoulos CN, Sergentanis TN, Papadopoulou C, Andrie E, Dessypris N, Panagopoulou P, Polychronopoulou S, Pourtsidis A, Athanasiadou-Piperopoulou F, Kalmanti M, Sidi V, Moschovi M, Petridou ET. Maternal smoking during pregnancy and childhood lymphoma: a meta-analysis. Int J Cancer 2011; 129:2694-703. [PMID: 21225624 DOI: 10.1002/ijc.25929] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 12/23/2010] [Indexed: 12/19/2022]
Abstract
Results from epidemiological studies exploring the association between childhood lymphoma and maternal smoking during pregnancy have been contradictory. This meta-analysis included all published cohort (n = 2) and case-control (n = 10) articles; among the latter, the data of the Greek Nationwide Registry for Childhood Hematological Malignancies study were updated to include all recently available cases (-2008). Odds ratios (ORs), relative risks and hazard ratios were appropriately pooled in three separate analyses concerning non-Hodgkin lymphoma (NHL, n = 1,072 cases), Hodgkin lymphoma (HL, n = 538 cases) and any lymphoma (n = 1,591 cases), according to data availability in the included studies. An additional metaregression analysis was conducted to explore dose-response relationships. A statistically significant association between maternal smoking (any vs. no) during pregnancy and risk for childhood NHL was observed (OR = 1.22, 95% confidence interval, CI: 1.03-1.45, fixed effects model), whereas the risk for childhood HL was not statistically significant (OR = 0.90, 95% CI: 0.66-1.21, fixed effects model). The analysis on any lymphoma did not reach statistical significance (OR = 1.10, 95% CI = 0.96-1.27, fixed effects model), possibly because of the case-mix of NHL to HL. No dose-response association was revealed in the metaregression analysis. In conclusion, this meta-analysis points to a modest increase in the risk for childhood NHL, but not HL, among children born by mothers smoking during pregnancy. Further investigation of dose-response phenomena in the NHL association, however, warrants accumulation of additional data.
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Affiliation(s)
- C N Antonopoulos
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Abstract
Surveillance data for clinical disease in cattle in Great Britain due to Salmonella infections were analysed for the period 2003 to 2008 in order to describe seasonality and to investigate possible associations between Salmonella diagnoses and other variables such as region, climate, age and production type. A clear seasonal pattern was shown for Salmonella infection, coinciding with the second half of the year. The incidence of Salmonella Dublin and Salmonella Typhimurium was highest in the west of the country, which has the greatest cattle density, but this was not a feature of diagnoses with other serovars. Abortion was a more common clinical sign of S Dublin infections, but was relatively unusual in the case of S Typhimurium. The observed clinical picture and age of affected animals were largely determined by the seasonality of dairy cattle calving in Great Britain.
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Affiliation(s)
- J J Carrique-Mas
- ECTAD, FAO Representation in Vietnam, United Nations, 3 Nguyen Gia Thieu, Hanoi, Vietnam
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Papadopoulou C, Carrique-Mas JJ, Davies RH, Sayers AR. Retrospective analysis of Salmonella isolates recovered from animal feed in Great Britain. Vet Rec 2009; 165:681-688. [PMID: 19966331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
To examine feed contamination rates with Salmonella, the diversity of serovars and the antimicrobial resistance of isolates from animal feedingstuffs in Great Britain, and to compare Salmonella strains found in animal feed and in livestock, data collected under voluntary and statutory Salmonella surveillance during the period 1987 to 2006 were analysed retrospectively. The feed contamination rate decreased from 3.8 per cent in 1993 to 1.1 per cent in 2006. A total of 263 Salmonella serovars were recovered: S Mbandaka (11.2 per cent), S Tennessee (10.4 per cent), S Senftenberg (8.4 per cent), S Agona (6.4 per cent), S Montevideo (6.4 per cent) and S Ohio (3.1 per cent) were the most prevalent. S Typhimurium was recovered at a proportion of 1.6 per cent from raw ingredients and 2.4 per cent from finished feed, while S Enteritidis was recovered at a proportion of 0.5 per cent from raw ingredients and 0.6 per cent from finished feed; 14.1 per cent of the isolates were resistant to at least one antimicrobial, and 1.9 per cent were multiresistant. There was no evidence of a statistical association (P<0.05) between the top 10 serovars recovered from feed and from livestock.
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Affiliation(s)
- C Papadopoulou
- Centre for Epidemiology and Risk Analysis, Veterinary Laboratories Agency - Weybridge, New Haw, Addlestone, Surrey KT15 3NB.
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Papadopoulou C, Davies RH, Carrique-Mas JJ, Evans SJ. Salmonellaserovars and their antimicrobial resistance in British turkey flocks in 1995 to 2006. Avian Pathol 2009; 38:349-57. [DOI: 10.1080/03079450903183678] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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