1
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Henderson SR, Horsley H, Frankel P, Khosravi M, Goble T, Carter S, Antonelou M, Evans RDR, Zhang X, Chu TY, Lin HH, Gordon S, Salama AD. Proteinase 3 promotes formation of multinucleated giant cells and granuloma-like structures in patients with granulomatosis with polyangiitis. Ann Rheum Dis 2023; 82:848-856. [PMID: 36801813 PMCID: PMC10314067 DOI: 10.1136/ard-2021-221800] [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: 11/05/2021] [Accepted: 02/08/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVES Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are autoimmune vasculitides associated with antineutrophil cytoplasm antibodies that target proteinase 3 (PR3) or myeloperoxidase (MPO) found within neutrophils and monocytes. Granulomas are exclusively found in GPA and form around multinucleated giant cells (MGCs), at sites of microabscesses, containing apoptotic and necrotic neutrophils. Since patients with GPA have augmented neutrophil PR3 expression, and PR3-expressing apoptotic cells frustrate macrophage phagocytosis and cellular clearance, we investigated the role of PR3 in stimulating giant cell and granuloma formation. METHODS We stimulated purified monocytes and whole peripheral blood mononuclear cells (PBMCs) from patients with GPA, patients with MPA or healthy controls with PR3 or MPO and visualised MGC and granuloma-like structure formation using light, confocal and electron microscopy, as well as measuring the cell cytokine production. We investigated the expression of PR3 binding partners on monocytes and tested the impact of their inhibition. Finally, we injected zebrafish with PR3 and characterised granuloma formation in a novel animal model. RESULTS In vitro, PR3 promoted monocyte-derived MGC formation using cells from patients with GPA but not from patients with MPA, and this was dependent on soluble interleukin 6 (IL-6), as well as monocyte MAC-1 and protease-activated receptor-2, found to be overexpressed in the cells of patients with GPA. PBMCs stimulated by PR3 formed granuloma-like structures with central MGC surrounded by T cells. This effect of PR3 was confirmed in vivo using zebrafish and was inhibited by niclosamide, a IL-6-STAT3 pathway inhibitor. CONCLUSIONS These data provide a mechanistic basis for granuloma formation in GPA and a rationale for novel therapeutic approaches.
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Affiliation(s)
| | - Harry Horsley
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Paul Frankel
- UCL Institute of Cardiovascular Science Faculty of Population Health Sciences, London, UK
| | - Maryam Khosravi
- Department of Cell and Developmental Biology, UCL Division of Biosciences, London, UK
| | - Talya Goble
- Department of Cell and Developmental Biology, UCL Division of Biosciences, London, UK
| | - Stephen Carter
- Department of Cell and Developmental Biology, UCL Division of Biosciences, London, UK
| | | | - Rhys D R Evans
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Xiang Zhang
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Tai-Ying Chu
- Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan
| | - Hsi-Hsien Lin
- Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan
- Department of Anatomic Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Siamon Gordon
- Graduate Institute of Biomedical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Sir William Dunn School of Pathology, Oxford University, Oxford, UK
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2
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Antonelou M, Horsley H, Heptinstall L, Harber M, Salama AD. Binding Truths: Seronegative Anti-Glomerular Basement Membrane Disease Mediated by IgM Anti-Glomerular Basement Membrane Antibodies. Kidney Int Rep 2023; 8:1117-1120. [PMID: 37180519 PMCID: PMC10166737 DOI: 10.1016/j.ekir.2023.02.1091] [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] [Received: 12/21/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Marilina Antonelou
- University College London Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Harry Horsley
- University College London Department of Renal Medicine, Royal Free Hospital, London, UK
| | | | - Mark Harber
- University College London Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Alan D. Salama
- University College London Department of Renal Medicine, Royal Free Hospital, London, UK
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3
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Fehmi J, Davies AJ, Antonelou M, Keddie S, Pikkupeura S, Querol L, Delmont E, Cortese A, Franciotta D, Persson S, Barratt J, Pepper R, Farinha F, Rahman A, Canetti D, Gilbertson JA, Rendell NB, Radunovic A, Minton T, Fuller G, Murphy SM, Carr AS, Reilly MR, Eftimov F, Wieske L, Teunissen CE, Roberts ISD, Ashman N, Salama AD, Rinaldi S. Contactin-1 links autoimmune neuropathy and membranous glomerulonephritis. PLoS One 2023; 18:e0281156. [PMID: 36893151 PMCID: PMC9997925 DOI: 10.1371/journal.pone.0281156] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/11/2023] [Indexed: 03/10/2023] Open
Abstract
Membranous glomerulonephritis (MGN) is a common cause of nephrotic syndrome in adults, mediated by glomerular antibody deposition to an increasing number of newly recognised antigens. Previous case reports have suggested an association between patients with anti-contactin-1 (CNTN1)-mediated neuropathies and MGN. In an observational study we investigated the pathobiology and extent of this potential cause of MGN by examining the association of antibodies against CNTN1 with the clinical features of a cohort of 468 patients with suspected immune-mediated neuropathies, 295 with idiopathic MGN, and 256 controls. Neuronal and glomerular binding of patient IgG, serum CNTN1 antibody and protein levels, as well as immune-complex deposition were determined. We identified 15 patients with immune-mediated neuropathy and concurrent nephrotic syndrome (biopsy proven MGN in 12/12), and 4 patients with isolated MGN from an idiopathic MGN cohort, all seropositive for IgG4 CNTN1 antibodies. CNTN1-containing immune complexes were found in the renal glomeruli of patients with CNTN1 antibodies, but not in control kidneys. CNTN1 peptides were identified in glomeruli by mass spectroscopy. CNTN1 seropositive patients were largely resistant to first-line neuropathy treatments but achieved a good outcome with escalation therapies. Neurological and renal function improved in parallel with suppressed antibody titres. The reason for isolated MGN without clinical neuropathy is unclear. We show that CNTN1, found in peripheral nerves and kidney glomeruli, is a common target for autoantibody-mediated pathology and may account for between 1 and 2% of idiopathic MGN cases. Greater awareness of this cross-system syndrome should facilitate earlier diagnosis and more timely use of effective treatment.
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Affiliation(s)
- Janev Fehmi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alexander J Davies
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Marilina Antonelou
- University College London Department of Renal Medicine, Royal Free Hospital, London, United Kingdom
| | - Stephen Keddie
- Centre for Neuromuscular Disease, National Hospital of Neurology and Neurosurgery and Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Sonja Pikkupeura
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Luis Querol
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emilien Delmont
- Referral Centre for ALS and Neuromuscular Diseases, Hospital La Timone, Marseille, France
| | - Andrea Cortese
- Centre for Neuromuscular Disease, National Hospital of Neurology and Neurosurgery and Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, United Kingdom.,Department of Brain and Behaviour sciences, University of Pavia, Pavia, Italy
| | | | - Staffan Persson
- Faculty of Medicine, Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Ruth Pepper
- University College London Department of Renal Medicine, Royal Free Hospital, London, United Kingdom
| | - Filipa Farinha
- Centre for Rheumatology and Bloomsbury Rheumatology Unit, Division of Medicine, University College London, London, United Kingdom
| | - Anisur Rahman
- Centre for Rheumatology and Bloomsbury Rheumatology Unit, Division of Medicine, University College London, London, United Kingdom
| | - Diana Canetti
- Wolfson Drug Discovery Unit and National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, University College London, London, United Kingdom
| | - Janet A Gilbertson
- Wolfson Drug Discovery Unit and National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, University College London, London, United Kingdom
| | - Nigel B Rendell
- Wolfson Drug Discovery Unit and National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, University College London, London, United Kingdom
| | - Aleksandar Radunovic
- Barts Neuromuscular Diseases Centre, Royal London Hospital, London, United Kingdom
| | - Thomas Minton
- Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom
| | - Geraint Fuller
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, United Kingdom
| | - Sinead M Murphy
- Department of Neurology, Tallaght University Hospital & Academic Unit of Neurology, Trinity College, Dublin, Ireland
| | - Aisling S Carr
- Centre for Neuromuscular Disease, National Hospital of Neurology and Neurosurgery and Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Mary R Reilly
- Centre for Neuromuscular Disease, National Hospital of Neurology and Neurosurgery and Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Ian S D Roberts
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Neil Ashman
- Barts Renal Unit, The Royal London Hospital, London, United Kingdom
| | - Alan D Salama
- University College London Department of Renal Medicine, Royal Free Hospital, London, United Kingdom
| | - Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
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Chu TY, Zheng-Gérard C, Huang KY, Chang YC, Chen YW, I KY, Lo YL, Chiang NY, Chen HY, Stacey M, Gordon S, Tseng WY, Sun CY, Wu YM, Pan YS, Huang CH, Lin CY, Chen TC, El Omari K, Antonelou M, Henderson SR, Salama A, Seiradake E, Lin HH. GPR97 triggers inflammatory processes in human neutrophils via a macromolecular complex upstream of PAR2 activation. Nat Commun 2022; 13:6385. [PMID: 36302784 PMCID: PMC9613636 DOI: 10.1038/s41467-022-34083-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/13/2022] [Indexed: 12/25/2022] Open
Abstract
Neutrophils play essential anti-microbial and inflammatory roles in host defense, however, their activities require tight regulation as dysfunction often leads to detrimental inflammatory and autoimmune diseases. Here we show that the adhesion molecule GPR97 allosterically activates CD177-associated membrane proteinase 3 (mPR3), and in conjugation with several protein interaction partners leads to neutrophil activation in humans. Crystallographic and deletion analysis of the GPR97 extracellular region identified two independent mPR3-binding domains. Mechanistically, the efficient binding and activation of mPR3 by GPR97 requires the macromolecular CD177/GPR97/PAR2/CD16b complex and induces the activation of PAR2, a G protein-coupled receptor known for its function in inflammation. Triggering PAR2 by the upstream complex leads to strong inflammatory activation, prompting anti-microbial activities and endothelial dysfunction. The role of the complex in pathologic inflammation is underscored by the finding that both GPR97 and mPR3 are upregulated on the surface of disease-associated neutrophils. In summary, we identify a PAR2 activation mechanism that directs neutrophil activation, and thus inflammation. The PR3/CD177/GPR97/PAR2/CD16b protein complex, therefore, represents a potential therapeutic target for neutrophil-mediated inflammatory diseases.
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Affiliation(s)
- Tai-Ying Chu
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | - Kuan-Yeh Huang
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chi Chang
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Wen Chen
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Yu I
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ling Lo
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Nien-Yi Chiang
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yi Chen
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Martin Stacey
- Faculty of Biological Sciences, School of Molecular and Cellular Biology, University of Leeds, Leeds, UK
| | - Siamon Gordon
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Sir William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - Wen-Yi Tseng
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Keelung, Keelung, Taiwan
| | - Chiao-Yin Sun
- Department of Nephrology, Chang Gung Memorial Hospital-Keelung, Keelung, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Mu Wu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Yi-Shin Pan
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Chien-Hao Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Tse-Ching Chen
- Department of Anatomic Pathology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Kamel El Omari
- Diamond Light Source Limited, Harwell Science and Innovation Campus, Didcot, UK
| | | | | | - Alan Salama
- Department of Renal Medicine, Royal Free Campus, UCL, London, UK
| | - Elena Seiradake
- Department of Biochemistry, University of Oxford, Oxford, UK.
| | - Hsi-Hsien Lin
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Keelung, Keelung, Taiwan.
- Department of Anatomic Pathology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan.
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5
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Antonelou M, Evans RDR, Henderson SR, Salama AD. Neutrophils are key mediators in crescentic glomerulonephritis and targets for new therapeutic approaches. Nephrol Dial Transplant 2022; 37:230-238. [PMID: 33057680 DOI: 10.1093/ndt/gfaa206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Indexed: 12/26/2022] Open
Abstract
Crescentic glomerulonephritis (CGN) results from a diverse set of diseases associated with immune dysregulation and the breakdown of self-tolerance to a wide range of autoantigens, some known and some that remain unknown. Experimental data demonstrate that neutrophils have an important role in the pathogenesis of CGN. Upon activation, neutrophils generate reactive oxygen species, release serine proteases and form neutrophil extracellular traps (NETs), all of which can induce direct tissue damage. In addition, serine proteases such as myeloperoxidase and proteinase 3, presented on NETs, can be processed and recognized as autoantigens, leading to the generation and maintenance of autoimmune responses in susceptible individuals. The basis of the specificity of autoimmune responses in different patients to NET proteins is unclear, but relates at least in part to differences in human leucocyte antigen expression. Conditions associated with CGN are often characterized by aberrant neutrophil activation and NETosis and, in some, impaired NET degradation. Targeting neutrophil degranulation and NETosis is now possible using a variety of novel compounds and may provide a promising therapeutic alternative to glucocorticoid use, which has been a mainstay of management in CGN for decades and is associated with significant adverse effects. In this review, we discuss the evidence supporting the role of neutrophils in the development of CGN and the pathways identified in neutrophil degranulation and NETosis that may translate to novel therapeutic applications.
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Affiliation(s)
- Marilina Antonelou
- University College London, Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Rhys D R Evans
- University College London, Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Scott R Henderson
- University College London, Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Alan D Salama
- University College London, Department of Renal Medicine, Royal Free Hospital, London, UK
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6
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Antonelou M, Abro A, Heath R, Iacovou A, Ashley C, Caplan J, Morgan MD, Logan S, Harper L, Salama AD. Comparison of outcomes using the rituximab originator MabThera with the biosimilar Truxima in patients with ANCA-associated vasculitis. Scand J Rheumatol 2021; 51:135-141. [PMID: 34474634 DOI: 10.1080/03009742.2021.1926318] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The use of rituximab (MabThera®), an anti-CD20 monoclonal antibody, is the most significant development in the management of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) since the introduction of cytotoxic therapy in 1950. Truxima® is the first anti-CD20 biosimilar approved for the same indications, and has been available in the UK since 2017. Significant cost savings have been reported when switching to biosimilars, which could lead to greater patient access to such treatment. Therefore, it is important to know whether patients' clinical and laboratory parameters respond equally well to biosimilars as to reference medicines, tested in clinical trials. METHOD We retrospectively reviewed the clinical outcomes and laboratory parameters in 257 consecutive patients treated with anti-CD20 depletion therapy using MabThera or Truxima, for induction and maintenance of remission, in two tertiary renal centres between 2010 and 2019. RESULTS We demonstrated no difference between patients treated with MabThera or Truxima in rates of remission, relapse, and hospitalization with infection when used for either induction or maintenance of remission of AAV. In one hospital subgroup analysis, we showed comparable levels of hypogammaglobulinaemia, B-cell depletion, and frequency of infusion reactions, with no significant differences. CONCLUSION The efficacy and safety of the rituximab biosimilar Truxima are not inferior to the originator MabThera in patients with AAV. Truxima represents a cheaper and safe therapeutic alternative that could increase patient access to rituximab.
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Affiliation(s)
- M Antonelou
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - A Abro
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - R Heath
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - A Iacovou
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - C Ashley
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK.,Pharmacy Department, Royal Free Hospital, London, UK
| | - J Caplan
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, UK
| | - M D Morgan
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, UK
| | - S Logan
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, UK
| | - L Harper
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, UK
| | - A D Salama
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
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7
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Rutherford MA, Scott J, Karabayas M, Antonelou M, Gopaluni S, Gray D, Barrett J, Brix SR, Dhaun N, McAdoo SP, Smith RM, Geddes C, Jayne D, Luqmani R, Salama AD, Little MA, Basu N. Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study. Arthritis Rheumatol 2021; 73:1713-1719. [PMID: 33750043 PMCID: PMC8251299 DOI: 10.1002/art.41728] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 10/29/2020] [Accepted: 03/04/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE COVID-19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and may be at risk of severe outcomes following COVID-19. We undertook this study to establish the risk factors for severe COVID-19 outcomes in these patients, including the impact of immunosuppressive therapies. METHODS A multicenter cohort was developed through the participation of centers affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes are described. Logistic regression was used to evaluate associations between potential risk factors and a severe COVID-19 outcome, defined as a requirement for advanced oxygen therapy, a requirement for invasive ventilation, or death. RESULTS The cohort included 65 patients with systemic vasculitis who developed COVID-19 (median age 70 years, 49% women), of whom 25 patients (38%) experienced a severe outcome. Most patients (55 of 65 [85%]) had antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Almost all patients required hospitalization (59 of 65 [91%]), 7 patients (11%) were admitted to intensive care, and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcomes (adjusted odds ratio [OR] 3.7 [95% confidence interval 1.1-14.9]; P = 0.047), as was comorbid respiratory disease (adjusted OR 7.5 [95% confidence interval 1.9-38.2]; P = 0.006). Vasculitis disease activity and nonglucocorticoid immunosuppressive therapy were not associated with severe outcomes. CONCLUSION In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID-19. These data can inform clinical decision-making relating to the risk of severe COVID-19 in this vulnerable patient group.
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Affiliation(s)
| | | | | | | | | | | | | | - Silke R. Brix
- Manchester University NHS Foundation Trust and University of ManchesterManchesterUK
| | | | | | | | | | | | | | - Alan D. Salama
- University College London and Royal Free HospitalLondonUK
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8
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Caplin B, Ashby D, McCafferty K, Hull R, Asgari E, Ford ML, Cole N, Antonelou M, Blakey SA, Srinivasa V, Braide-Azikwe DC, Roper T, Clark G, Cronin H, Hayes NJ, Manson B, Sarnowski A, Corbett R, Bramham K, Lioudaki E, Kumar N, Frankel A, Makanjuola D, Sharpe CC, Banerjee D, Salama AD. Risk of COVID-19 Disease, Dialysis Unit Attributes, and Infection Control Strategy among London In-Center Hemodialysis Patients. Clin J Am Soc Nephrol 2021; 16:1237-1246. [PMID: 34074636 PMCID: PMC8455047 DOI: 10.2215/cjn.03180321] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients receiving in-center hemodialysis treatment face unique challenges during the coronavirus disease 2019 (COVID-19) pandemic, specifically the need to attend for treatment that prevents self-isolation. Dialysis unit attributes and isolation strategies that might reduce dialysis center COVID-19 infection rates have not been previously examined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We explored the role of variables, including community disease burden, dialysis unit attributes (size and layout), and infection control strategies, on rates of COVID-19 among patients receiving in-center hemodialysis in London, United Kingdom, between March 2, 2020 and May 31, 2020. The two outcomes were defined as (1) a positive test for infection or admission with suspected COVID-19 and (2) admission to the hospital with suspected infection. Associations were examined using a discrete time multilevel time-to-event analysis. RESULTS Data on 5755 patients dialyzing in 51 units were analyzed; 990 (17%) tested positive and 465 (8%) were admitted with suspected COVID-19 between March 2 and May 31, 2020. Outcomes were associated with age, diabetes, local community COVID-19 rates, and dialysis unit size. A greater number of available side rooms and the introduction of mask policies for asymptomatic patients were inversely associated with outcomes. No association was seen with sex, ethnicity, or deprivation indices, nor with any of the different isolation strategies. CONCLUSIONS Rates of COVID-19 in the in-center hemodialysis population relate to individual factors, underlying community transmission, unit size, and layout.
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Affiliation(s)
- Ben Caplin
- Department of Renal Medicine, University College London, London, United Kingdom,Renal Services, Royal Free London NHS Foundation Trust, London, United Kingdom,Correspondence: Dr. Ben Caplin, Department of Renal Medicine, University College London, 2nd Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom.
| | - Damien Ashby
- Kidney and Transplant Services, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Richard Hull
- Renal Department, St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Elham Asgari
- Kidney Services, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Martin L. Ford
- Department of Renal Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,Faculty of Life Sciences & Medicine, Kings College London, London, United Kingdom
| | - Nicholas Cole
- South West Thames Renal and Transplantation Unit, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom
| | - Marilina Antonelou
- Department of Renal Medicine, University College London, London, United Kingdom,Renal Services, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sarah A. Blakey
- Kidney and Transplant Services, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Vinay Srinivasa
- Renal Service, Barts Health NHS Trust, London, United Kingdom
| | | | - Tayeba Roper
- Kidney Services, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Grace Clark
- Renal Services, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Helen Cronin
- Department of Renal Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nathan J. Hayes
- Renal Services, North Middlesex University Hospital NHS Trust, London, United Kingdom
| | - Bethia Manson
- Renal Services, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Alexander Sarnowski
- Renal Department, St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Richard Corbett
- Kidney and Transplant Services, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kate Bramham
- Department of Renal Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,Faculty of Life Sciences & Medicine, Kings College London, London, United Kingdom
| | - Eirini Lioudaki
- Department of Renal Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,Faculty of Life Sciences & Medicine, Kings College London, London, United Kingdom
| | - Nicola Kumar
- Kidney Services, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Andrew Frankel
- Kidney and Transplant Services, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - David Makanjuola
- South West Thames Renal and Transplantation Unit, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom
| | - Claire C. Sharpe
- Department of Renal Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,Faculty of Life Sciences & Medicine, Kings College London, London, United Kingdom
| | - Debasish Banerjee
- Renal Department, St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alan D. Salama
- Department of Renal Medicine, University College London, London, United Kingdom,Renal Services, Royal Free London NHS Foundation Trust, London, United Kingdom
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9
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Neradova A, Vajgel G, Hendra H, Antonelou M, Kostakis ID, Wright D, Masson P, Milne SE, Jones G, Salama A, Davenport A, Burns Á. Frailty score before admission as risk factor for mortality of renal patients during the first wave of the COVID pandemic in London. G Ital Nefrol 2021; 38:38-03-2021-02. [PMID: 34169690] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: Frailty is a known predictor of mortality and poor outcomes during hospital admission. In this large renal retrospective cohort study, we investigated whether frailer COVID-19 positive renal patients had worse outcomes. Design: All SARS-Cov-2 positive renal patients aged ≥18 years who presented to the emergency department at the Royal Free Hospital or at the satellite dialysis centres from 10th of March until the 10th of May 2020, with recent data on frailty, were included. The follow up was until 26th of May 2020. Age, gender, ethnicity, body mass index, chronic kidney disease stage, modality of renal replacement therapy, co-morbidities, Rockwood clinical frailty score (CFS), C reactive protein and the neutrophil-to-lymphocyte count were collected at presentation. The primary outcome was the overall mortality rate following COVID-19 diagnosis. Secondary outcomes included the need for hospital admission. Results: A total of 200 renal patients were SARS-Cov-2 positive. In the 174 patients who had a CFS recorded, the age was 65.4 years ± 15.8 (mean ± SD) and 57,5% were male. At the end of follow up, 26% had died. Frail patients (CFS 5-7) were more than three times more likely to die compared to less frail patients (CFS of 1-4) (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.0-10.6). 118 patients (68%) required admission, but there was no difference in hospital admission rates for frail vs non-frail patients (OR 0.6, CI 0.3-1.7). Conclusions: Frailty is a better predictor of mortality than age and co-morbidities in COVID-19 positive renal patients.
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Affiliation(s)
- Aegida Neradova
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK; Dianet Amsterdam, Amsterdam UMC Department of Nephrology, Amsterdam, The Netherlands
| | - Gisele Vajgel
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, UK; Nephrology Department, Hospital das Clinicas - Federal University of Pernambuco (HC-UFPE), Brazil; Laboratório Imunopatologia Keizo Azami - Federal University of Pernambuco (LIKA/UFPE), Brazil
| | - Heidy Hendra
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK; Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, UK
| | - Marilina Antonelou
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK; Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, UK
| | - Ioannis D Kostakis
- Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - David Wright
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Philip Masson
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Sarah E Milne
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Gareth Jones
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Alan Salama
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK; Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, UK
| | - Andrew Davenport
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Áine Burns
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
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10
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Salama A, Fehmi J, Antonelou M, Barratt J, Ashman N, Carr A, Reilly M, Keddie S, Querol L, Pikkuoeura S, Cortese A, Delmont E, Persson S, Radunovic A, Roberts ISD, Davies A, Rinaldi S. FC 030CONTACTIN-1 IS A NOVEL ANTIGEN IN IDIOPATHIC MEMBRANOUS GLOMERULONEPHRITIS AND IN CIDP- ASSOCIATED GLOMERULONEPHRITIS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab120.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Recently a number of antigens have been identified as pathogenic antibody targets in cases of primary membranous glomerulonephritis(MGN), including phospholipase A2 receptor (PLA2R), thrombospondin type 1 domain containing 7A(THSD7A), and NELL-1, while exostosin is found in secondary (lupus associated) MGN. However, other as yet undiscovered antigens are thought to exist. Although rare, there is a recognised association between chronic inflammatory demyelinating polyneuriopathy (CIDP) and nephrotic syndrome.
Method
We investigated the link between CICP and MGN and the associations with Contactin-1(CNTN1), a node of Ranvier neuronal protein, as a potential common autoantigen, by immunohistochemistry, RT-PCR and proteomic analysis of isolated glomeruli. We tested sera from 468 patients with suspected immune-mediated neuropathies, 295 with idiopathic MGN, and 210 disease controls, for CNTN1 antibodies.
Results
We describe a series of 16 patients, all presenting with CIDP, nephrotic syndrome due to MGN, and with circulating and deposited anti-contactin-1 (CNTN1) antibodies (IgG4 predominant in those tested) in the kidney. The onset and resolution of both disorders had a close temporal relationship, and the majority of cases were resistant to first-line therapies typically employed for inflammatory neuropathies, but achieved a good outcome with non-standard treatment. Importantly, four (1.4%) further patients with isolated MGN identified from a serum bank of 295 idiopathic MGN patients with no CIDP were also positive for anti-CNTN1 antibodies. CNTN1 protein was detected by mass spectroscopy within glomeruli from patients with CNTN1 antibodies, but not in healthy kidney or anti-PLA2R associated MGN. CNTN1 mRNA was found in renal cortical tissue.
Conclusion
These data provide evidence that CNTN1 antibodies precipitate both autoimmune neuropathy and MGN. The temporal correlation of these disorders, as well as the presence of CNTN1 protein and antibodies in both peripheral nerve and diseased glomeruli, supports a common antibody-mediated pathological process, and defines a new antigenic target in MGN. CNTN1 antibodies have diagnostic and therapeutic relevance, and may additionally serve as a means of monitoring disease activity in both conditions. Other factors may explain presentation with isolated neurological disease or MGN.
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Affiliation(s)
- Alan Salama
- UCL, Department of Renal Medicine, London, United Kingdom
| | - Janev Fehmi
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | | | | | | | | | - Luis Querol
- University autonoma de Barcelona, Neurology, Spain
| | - Sonja Pikkuoeura
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | | | | | | | - Alexander Davies
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
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11
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Hendra H, Vajgel G, Antonelou M, Neradova A, Manson B, Clark SG, Kostakis ID, Caplin B, Salama AD. Identifying prognostic risk factors for poor outcome following COVID-19 disease among in-centre haemodialysis patients: role of inflammation and frailty. J Nephrol 2021; 34:315-323. [PMID: 33515380 PMCID: PMC7846911 DOI: 10.1007/s40620-020-00960-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/27/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The pandemic of coronavirus disease (COVID-19) has highly affected patients with comorbidities and frailty who cannot self-isolate, such as individuals undergoing haemodialysis. The aim of the study was to identify risk factors for mortality and hospitalisation, which may be useful in future disease spikes. METHODS We collected data retrospectively from the electronic medical records of all patients receiving a diagnosis of COVID-19 between 11th March and 10th May 2020 undergoing maintenance haemodialysis at four satellite dialysis units from the Royal Free London NHS Foundation Trust, London, UK. Mortality was the primary outcome, and the need for hospitalization was the secondary one. RESULTS Out of 746 patients undergoing regular haemodialysis, 148 symptomatic patients tested positive for SARS-CoV-2 by RT-PCR and were included in the analysis. The overall mortality rate was 24.3%. By univariate analysis, older age, ischaemic heart disease, lower systolic blood pressure, lower body mass index (BMI) and higher frailty scores were associated with higher rates of mortality (all p value < 0.05). The laboratory factors associated with mortality were higher values of WBC, neutrophil counts, neutrophil to lymphocyte ratios (NLR), C-reactive protein (CRP), bilirubin, ferritin, troponin, and lower serum albumin level (all p value < 0.05). In the logistic regression, mortality was associated with older age and higher CRP, while high levels of NLR and CRP were associated with the need for hospitalization. DISCUSSION Haemodialysis patients are susceptible to COVID-19 and have a high mortality rate. Our study identifies prognostic risk factors associated with poor outcome including age, frailty and markers of inflammation, which may support more informed clinical decision-making.
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Affiliation(s)
- Heidy Hendra
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK
| | - Gisele Vajgel
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK
- Department of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (HC-UFPE), Recife, Brazil
- Laboratório Imunopatologia Keizo Asami, Federal University of Pernambuco (LIKA/UFPE), Recife, Brazil
| | - Marilina Antonelou
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK
| | - Aegida Neradova
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Dianet Amsterdam, Amsterdam UMC Department of Nephrology, Amsterdam, The Netherlands
| | - Bethia Manson
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Grace Clark
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
| | - Ioannis D Kostakis
- Department of Hepatobiliary Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Ben Caplin
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK
| | - Alan D Salama
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK.
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK.
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12
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Evans RDR, Antonelou M, Sathiananthamoorthy S, Rega M, Henderson S, Ceron-Gutierrez L, Barcenas-Morales G, Müller CA, Doffinger R, Walsh SB, Salama AD. Inherited salt-losing tubulopathies are associated with immunodeficiency due to impaired IL-17 responses. Nat Commun 2020; 11:4368. [PMID: 32868758 PMCID: PMC7459119 DOI: 10.1038/s41467-020-18184-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Increased extracellular sodium activates Th17 cells, which provide protection from bacterial and fungal infections. Whilst high salt diets have been shown to worsen autoimmune disease, the immunological consequences of clinical salt depletion are unknown. Here, we investigate immunity in patients with inherited salt-losing tubulopathies (SLT). Forty-seven genotyped SLT patients (with Bartter, Gitelman or EAST Syndromes) are recruited. Clinical features of dysregulated immunity are recorded with a standardised questionnaire and immunological investigations of IL-17 responsiveness undertaken. The effects of altering extracellular ionic concentrations on immune responses are then assessed. Patients are hypokalaemic and hypomagnesaemic, with reduced interstitial sodium stores determined by 23Na-magnetic resonance imaging. SLT patients report increased mucosal infections and allergic disease compared to age-matched controls. Aligned with their clinical phenotype, SLT patients have an increased ratio of Th2:Th17 cells. SLT Th17 and Tc17 polarisation is reduced in vitro, yet STAT1 and STAT3 phosphorylation and calcium flux following T cell activation are unaffected. In control cells, the addition of extracellular sodium (+40 mM), potassium (+2 mM), or magnesium (+1 mM) reduces Th2:Th17 ratio and augments Th17 polarisation. Our results thus show that the ionic environment typical in SLT impairs IL-17 immunity, but the intracellular pathways that mediate salt-driven Th17 polarisation are intact and in vitro IL-17 responses can be reinvigorated by increasing extracellular sodium concentration. Whether better correction of extracellular ions can rescue the immunophenotype in vivo in SLT patients remains unknown. Salt levels in culture affect the polarisation of Th17 cells, which normally protect the host from fungal and bacterial infections. Here, the authors study patients with salt-losing tubulopathies (SLT) to find that, while Th17 immunity is dampened in SLT patients, their Th17-inducing signaling pathways are intact and can be reinvigorated by exogenous salt.
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Affiliation(s)
- Rhys D R Evans
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK.
| | - Marilina Antonelou
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK
| | | | - Marilena Rega
- Institute of Nuclear Medicine, University College London, University College London Hospital, London, UK
| | - Scott Henderson
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK
| | | | | | - Christoph A Müller
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.,German Consortium for Translational Cancer Research (DKTK), Partner site Freiburg, German Center for Cancer Research (DKFZ), 69120, Heidelberg, Germany
| | - Rainer Doffinger
- Department of Clinical Biochemistry and Immunology, Addenbrookes's Hospital, Cambridge, UK.,National Institute of Health Research (NIHR), Cambridge Biomedical Research Centre, Cambridge, UK
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK.
| | - Alan D Salama
- Department of Renal Medicine, University College London, Royal Free Hospital, London, UK.
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13
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Antonelou M, Michaëlsson E, Evans RDR, Wang CJ, Henderson SR, Walker LSK, Unwin RJ, Salama AD. Therapeutic Myeloperoxidase Inhibition Attenuates Neutrophil Activation, ANCA-Mediated Endothelial Damage, and Crescentic GN. J Am Soc Nephrol 2019; 31:350-364. [PMID: 31879336 DOI: 10.1681/asn.2019060618] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/01/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Myeloperoxidase released after neutrophil and monocyte activation can generate reactive oxygen species, leading to host tissue damage. Extracellular glomerular myeloperoxidase deposition, seen in ANCA-associated vasculitis, may enhance crescentic GN through antigen-specific T and B cell activation. Myeloperoxidase-deficient animals have attenuated GN early on, but augmented T cell responses. We investigated the effect of myeloperoxidase inhibition, using the myeloperoxidase inhibitor AZM198, to understand its potential role in treating crescentic GN. METHODS We evaluated renal biopsy samples from patients with various forms of crescentic GN for myeloperoxidase and neutrophils, measured serum myeloperoxidase concentration in patients with ANCA-associated vasculitis and controls, and assessed neutrophil extracellular trap formation, reactive oxygen species production, and neutrophil degranulation in ANCA-stimulated neutrophils in the absence and presence of AZM198. We also tested the effect of AZM198 on ANCA-stimulated neutrophil-mediated endothelial cell damage in vitro, as well as on crescentic GN severity and antigen-specific T cell reactivity in the murine model of nephrotoxic nephritis. RESULTS All biopsy specimens with crescentic GN had extracellular glomerular myeloperoxidase deposition that correlated significantly with eGFR and crescent formation. In vitro, AZM198 led to a significant reduction in neutrophil extracellular trap formation, reactive oxygen species production, and released human neutrophil peptide levels, and attenuated neutrophil-mediated endothelial cell damage. In vivo, delayed AZM198 treatment significantly reduced proteinuria, glomerular thrombosis, serum creatinine, and glomerular macrophage infiltration, without increasing adaptive T cell responses. CONCLUSIONS Myeloperoxidase inhibition reduced neutrophil degranulation and neutrophil-mediated endothelial cell damage in patients with ANCA-associated vasculitis. In preclinical crescentic GN, delayed myeloperoxidase inhibition suppressed kidney damage without augmenting adaptive immune responses, suggesting it might offer a novel adjunctive therapeutic approach in crescentic GN.
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Affiliation(s)
| | | | | | - Chun Jing Wang
- Institute of Immunity & Transplantation, University College London, London, United Kingdom
| | | | - Lucy S K Walker
- Institute of Immunity & Transplantation, University College London, London, United Kingdom
| | - Robert John Unwin
- Centre for Nephrology and.,Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden; and.,Cambridge, United Kingdom
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14
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Evans RDR, Antonelou M, Henderson S, Walsh SB, Salama AD. Emerging evidence of an effect of salt on innate and adaptive immunity. Nephrol Dial Transplant 2019; 34:2007-2014. [PMID: 30521016 DOI: 10.1093/ndt/gfy362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 02/02/2023] Open
Abstract
Salt intake as part of a western diet currently exceeds recommended limits, and the small amount found in the natural diet enjoyed by our Paleolithic ancestors. Excess salt is associated with the development of hypertension and cardiovascular disease, but other adverse effects of excess salt intake are beginning to be recognized, including the development of autoimmune and inflammatory disease. Over the last decade there has been an increasing body of evidence demonstrating that salt affects multiple components of both the innate and adaptive immune systems. In this review we outline the recent laboratory, animal and human data, highlighting the effect of salt on immunity, with a particular focus on the relevance to inflammatory kidney disease.
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Affiliation(s)
- Rhys D R Evans
- Department of Renal Medicine, University College London (UCL), London, UK
| | - Marilina Antonelou
- Department of Renal Medicine, University College London (UCL), London, UK
| | - Scott Henderson
- Department of Renal Medicine, University College London (UCL), London, UK
| | - Stephen B Walsh
- Department of Renal Medicine, University College London (UCL), London, UK
| | - Alan D Salama
- Department of Renal Medicine, University College London (UCL), London, UK
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15
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Kang A, Antonelou M, Wong NL, Tanna A, Arulkumaran N, Tam FWK, Pusey CD. Dr. Kang, et al, reply. J Rheumatol 2019; 46:1244. [PMID: 31263073 DOI: 10.3899/jrheum.181446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Amy Kang
- Imperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust
| | - Marilina Antonelou
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust
| | - Nikki L Wong
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust
| | - Anisha Tanna
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | | | - Frederick W K Tam
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Charles D Pusey
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.
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16
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Kang A, Antonelou M, Wong NL, Tanna A, Arulkumaran N, Tam FWK, Pusey CD. Dr. Kang, et al reply. J Rheumatol 2019; 46:866-867. [PMID: 31154407 DOI: 10.3899/jrheum.190500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Amy Kang
- Imperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust
| | - Marilina Antonelou
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust
| | - Nikki L Wong
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust
| | - Anisha Tanna
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | | | - Frederick W K Tam
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Charles D Pusey
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.
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17
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Heath R, Iacovou A, Ashley C, Antonelou M, Salama A. FP208CLINICAL EVALUATION OF BIOSIMILAR ANTI-CD20 MONOCLONAL ANTIBODY WITH RITUXIMAB IN THE TREATMENT OF ANCA-ASSOCIATED VASCULITIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Anna Iacovou
- University College London, London, United Kingdom
| | | | | | - Alan Salama
- University College London, London, United Kingdom
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18
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Antonelou M, Michaëlsson E, Wang CJ, Walker L, Unwin R, Salama A. FP192THERAPEUTIC MYELOPEROXIDASE INHIBITION ATTENUATES NEUTROPHIL ACTIVATION, ANCA-MEDIATED ENDOTHELIAL DAMAGE AND CRESCENTIC GLOMERULONEPHRITIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp192] [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)
| | | | | | - Lucy Walker
- University College London, London, United Kingdom
| | - Robert Unwin
- University College London, London, United Kingdom
| | - Alan Salama
- University College London, London, United Kingdom
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19
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Antonelou M, Michaëlsson E, Wang C, Walker L, Unwin R, Salama A. 187. THERAPEUTIC MYELOPEROXIDASE INHIBITION ATTENUATES NEUTROPHIL ACTIVATION, ANCA-MEDIATED ENDOTHELIAL DAMAGE AND CRESCENTIC GLOMERULONEPHRITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez061.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Chunjing Wang
- UCL Institute of Immunity Transplantation London, United Kingdom
| | - Lucy Walker
- UCL Institute of Immunity Transplantation London, United Kingdom
| | | | - Alan Salama
- University College London London, United Kingdom
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20
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Sonnemann J, Antonelou M, Henderson S, Pusey C, Little M, Salama A, Mcadoo S, Prendecki M. 220. DEFINING THE PATHOGENESIS OF ANCA AND ANTI-GBM DOUBLE POSITIVITY. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez061.035] [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)
| | | | | | - Charles Pusey
- Imperial College NHS Trust Hammersmith Hospital Campus London, United Kingdom
| | - Mark Little
- UCL Department of Renal Medicine London, United Kingdom
| | - Alan Salama
- University College London London, United Kingdom
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21
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Iacovou A, Heath R, Ashley C, Antonelou M, Salama A. 282. CLINICAL EVALUATION OF BIOSIMILAR ANTI-CD20 MONOCLONAL ANTIBODY WITH RITUXIMAB IN THE TREATMENT OF ANCA-ASSOCIATED VASCULITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez063.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna Iacovou
- Centre for Nephrology UCL London, United Kingdom
| | | | | | | | - Alan Salama
- University College London London, United Kingdom
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22
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Antonelou M, Perea Ortega L, Harvey J, Salama AD. Anti-myeloperoxidase antibody positivity in patients without primary systemic vasculitis. Clin Exp Rheumatol 2019; 37 Suppl 117:86-89. [PMID: 30767872] [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] [Received: 04/05/2018] [Accepted: 06/18/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aimed to elucidate the frequency and associations of MPO-ANCA positivity in patients without ANCA-associated vasculitis (AAV), in a large urban, multi-ethnic teaching hospital. METHODS Retrospective review of 200 patients identified as MPO-ANCA positive over a five-year period at Royal Free Hospital, London, UK. RESULTS The incidence of anti-MPO positivity in patients without AAV was 39.5%. Gastrointestinal tract disorders, infections and other connective tissue disorders made up the majority of diagnoses, and there was a higher incidence of other concomitant autoantibodies compared to the group with known AAV. Renal disease was common in non-vasculitic patients with anti-MPO antibody positivity (occurring in 48%), the majority of whom went on to renal biopsy to exclude vasculitic involvement. CONCLUSIONS The high incidence of MPO-ANCA positivity in patients with non-vasculitic conditions highlights the need for careful clinical correlation and confirmatory tissue diagnosis.
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Affiliation(s)
| | | | - Jennifer Harvey
- Clinical immunology Laboratory, Royal Free NHS Trust, London, UK
| | - Alan D Salama
- UCL Centre for Nephrology, Royal Free Hospital, London, UK.
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Kang A, Antonelou M, Wong NL, Tanna A, Arulkumaran N, Tam FWK, Pusey CD. High Incidence of Arterial and Venous Thrombosis in Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Rheumatol 2018; 46:285-293. [PMID: 30385704 DOI: 10.3899/jrheum.170896] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the incidence of arterial thrombotic events (ATE) and venous thromboembolism (VTE) in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS This is a retrospective cohort study presenting the incidence of ATE (coronary events or ischemic stroke) and VTE [pulmonary embolism (PE) or deep venous thrombosis (DVT)] in patients diagnosed with AAV between 2005 and 2014. RESULTS There were 204 patients with AAV who were identified. Median followup for surviving patients was 5.8 (range 1-10) years, accounting for 1088 person-years (PY). The incidence of ATE was 2.67/100 PY (1.56 for coronary events and 1.10 for ischemic stroke) and for VTE was 1.47/100 PY (0.83 for DVT only and 0.64 for PE with/without DVT). On multivariate analysis, prior ischemic heart disease (IHD) and advancing age were the only independent predictors of ATE. Among patients without prior IHD or stroke, the incidence of ATE remained elevated at 2.32/100 PY (1.26 for coronary events and 1.06 for ischemic stroke). ATE, but not VTE, was an independent predictor of all-cause mortality. Event rates for both ATE and VTE were highest in the first year after diagnosis of AAV but remained above the population incidence during the 10-year followup period. In comparison to reported rates for the UK population, the event rates in our AAV patients were 15-times higher for coronary events, 11-times higher for incident stroke, and 20-times higher for VTE. CONCLUSION Patients with AAV have a high incidence of arterial and venous thrombosis, particularly in the first year after diagnosis.
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Affiliation(s)
- Amy Kang
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Marilina Antonelou
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Nikki L Wong
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Anisha Tanna
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Nishkantha Arulkumaran
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Frederick W K Tam
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Charles D Pusey
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK. .,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London.
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Antonelou M, Henderson SR, Bhangal G, Heptinstall L, Oliveira B, Hamour S, Harber M, Salama AD. Binding Truths: Atypical Anti-Glomerular Basement Membrane Disease Mediated by IgA Anti-Glomerular Basement Membrane Antibodies Targeting the α1 Chain of Type IV Collagen. Kidney Int Rep 2018; 4:163-167. [PMID: 30596180 PMCID: PMC6308376 DOI: 10.1016/j.ekir.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/06/2023] Open
Affiliation(s)
- Marilina Antonelou
- University College London Centre for Nephrology, Royal Free Hospital, London, UK
| | - Scott R Henderson
- University College London Centre for Nephrology, Royal Free Hospital, London, UK
| | - Gurjeet Bhangal
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College, London, UK
| | - Lauren Heptinstall
- University College London Centre for Nephrology, Royal Free Hospital, London, UK
| | - Ben Oliveira
- University College London Centre for Nephrology, Royal Free Hospital, London, UK
| | - Sally Hamour
- University College London Centre for Nephrology, Royal Free Hospital, London, UK
| | - Mark Harber
- University College London Centre for Nephrology, Royal Free Hospital, London, UK
| | - Alan D Salama
- University College London Centre for Nephrology, Royal Free Hospital, London, UK
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Prendecki M, Martin L, Tanna A, Antonelou M, Pusey CD. Increased Prevalence of Thyroid Disease in Patients with Antineutrophil Cytoplasmic Antibodies–associated Vasculitis. J Rheumatol 2018; 45:686-689. [DOI: 10.3899/jrheum.170661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/22/2022]
Abstract
Objective.Antineutrophil cytoplasmic antibodies (ANCA)–associated vasculitis (AAV) has been linked with thyroid disease as a result of antithyroid medications. We assessed the prevalence of thyroid disease in our patients with AAV.Methods.Clinical records of 279 patients with AAV diagnosed between 1991 and 2014 were analyzed.Results.Thyroid disease was identified in 21.5% of patients, but only 2 had previously received propylthiouracil. There was a greater proportion of female patients, patients with antimyeloperoxidase antibodies, and patients with renal disease in the group with thyroid disease.Conclusion.Our data show a higher prevalence of thyroid disease in patients with AAV than the general population. This was not attributable to antithyroid drugs.
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Antonelou M, El-Kateb S, Davies N, Davenport A. Changes in serum osmotic pressure following haemodialysis treatments lead to changes in bioimpedance spectroscopy estimates of lean and adipose tissue. Eur J Clin Nutr 2017; 71:564-565. [DOI: 10.1038/ejcn.2016.270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/25/2016] [Accepted: 11/27/2016] [Indexed: 12/12/2022]
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Mohan P, Antonelou M, Dadzie O, Dubrey S. Headache in a young woman: leptomeningeal metastasis as the first presentation of underlying breast malignancy. BMJ Case Rep 2015; 2015:bcr-2014-207643. [PMID: 25948846 DOI: 10.1136/bcr-2014-207643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A 37-year-old woman presented with a 2-week history of persistent headache in an occipitotemporal distribution. The patient had experienced prior headaches and migraines, but this presentation was characterised by its intensity and duration. There was associated dizziness and blurring of vision in episodes occurring up to 4-5 times per day. Whole body cross-sectional CT imaging and MRI of neuronal axes were normal. Cerebrospinal fluid cytology demonstrated large abnormal pleomorphic cells expressing the tumour marker CA125. Positron emission tomography-fluorodeoxyglucose revealed bilateral axillary and cervical lymphadenopathy as well as increased uptake in the lateral regions of both breasts. These results correlated with MRI breast and mammography findings. Axillary lymph node biopsy showed poorly differentiated adenocarcinoma making the diagnosis of breast malignancy, the most likely primary site of metastatic leptomeningeal disease. In the 6-week interval between initial presentation and diagnosis, the patient deteriorated significantly with the new onset of facial nerve palsy and partial seizures. The treatment intent was palliative, focusing on symptom control with systemic chemotherapy and whole brain radiotherapy.
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Affiliation(s)
- Poornima Mohan
- Department of Acute Medicine, Hillingdon Hospital, Uxbridge, UK
| | | | - Ophelia Dadzie
- Department of Histopathology, Hillingdon Hospital, Uxbridge, UK
| | - Simon Dubrey
- Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex, UK
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Abstract
A term neonate with a transient form of Behçet's disease (BD) is described. The mother had a 3-year history of BD treated with corticosteroids, which remained in remission during pregnancy. On day 1 of life, the neonate was noted to have papulopustular lesions of the labia and perineum. She remained clinically well and bacterial and viral infection screens were negative. The lesions disappeared within 3 weeks without scarring. No recurrence has been reported.
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Abstract
A 41-year-old female presented with a superficial buttock abscess. In the preceding 6 months she had four other abscesses at different anatomical sites. Screening for diabetes and immunocompromise was negative. Review of microbiology revealed Methicillin resistant Staphylococcus aureus harbouring Panton-Valentine leukocidin (PVL) genes. PVL syndrome is an emerging disorder associated with recurrent necrotic skin lesions in the young, otherwise healthy population.
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Affiliation(s)
- Marilina Antonelou
- Department of General Surgery/Care of the Elderly/Intensive Care and Urology, Barnet and Chase Farm Hospital, London, UK.
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Antonelou M, Papassideri IS, Karababa F, Gyparaki M, Loutradi A, Margaritis LH. A novel case of haemoglobin H disease associated with clinical and morphological characteristics of congenital dyserythropoietic anaemia type I. Eur J Haematol 2002; 68:247-52. [PMID: 12071943 DOI: 10.1034/j.1600-0609.2002.01590.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report, for the first time, an unusual case of congenital anaemia with the clinical diagnosis of haemoglobin H disease complicated by morphological features at the light and electron microscopy level very similar to those of CDA-I. The red cell indices and the globin chain biosynthetic ratio were not characteristic of the defective haemoglobin genotype. The haematological, clinical and morphological data strongly suggest the novel coexistence of the two defects in a patient. The disease is characterised by a unique dyserythropoietic phenotype of diagnostic importance, which possibly brings new data regarding the reciprocal interaction between the two diseases, especially concerning a specific abnormality in globin chain synthesis in CDA-I, as previously suggested.
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Affiliation(s)
- M Antonelou
- Department of Cell Biology and Biophysics, Faculty of Biology, University of Athens, Greece
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Papassideri I, Antonelou M, Karababa F, Loutradi-Anagnostou A, Delaunay J, Margaritis LH. The frequency of allele alpha(LELY), a low expression allele of the gene encoding erythroid spectrin alpha-chain, in the Greek population. Haematologica 1999; 84:754-5. [PMID: 10457417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
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