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Li SC, Rabinovich CE, Becker ML, Torok KS, Ferguson PJ, Dedeoglu F, Hong S, Sivaraman V, Laxer RM, Stewart K, Ibarra MF, Mason T, Higgins G, Pope E, Li X, Lozy T, Fuhlbrigge RC. Capturing the Range of Disease Involvement in Localized Scleroderma: The Localized Scleroderma Total Severity Scale. Arthritis Care Res (Hoboken) 2024; 76:616-626. [PMID: 38148547 DOI: 10.1002/acr.25281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Juvenile localized scleroderma (jLS) is a chronic autoimmune disease commonly associated with poor outcomes, including contractures, hemiatrophy, uveitis, and seizures. Despite improvements in treatment, >25% of patients with jLS have functional impairment. To improve patient evaluation, our workgroup developed the Localized scleroderma Total Severity Scale (LoTSS), an overall disease severity measure. METHODS LoTSS was developed as a weighted measure by a consensus process involving literature review, surveys, case vignettes, and multicriteria decision analysis. Feasibility was assessed in larger Childhood Arthritis and Rheumatology Research Alliance groups. Construct validity with physician assessment and inter-rater reliability was assessed using case vignettes. Additional evaluation was performed in a prospective patient cohort initiating treatment. RESULTS LoTSS severity items were organized into modules that reflect jLS disease patterns, with modules for skin, extracutaneous, and craniofacial manifestations. Construct validity of LoTSS was supported by a strong positive correlation with the Physician Global Assessment (PGA) of severity and damage and weak positive correlation with PGA-Activity, as expected. LoTSS was responsive, with a small effect size identified. Moderate-to-excellent inter-rater reliability was demonstrated. LoTSS was able to discriminate between patient subsets, with higher scores identified in those with greater disease burden and functional limitation. CONCLUSION We developed a new LS measure for assessing cutaneous and extracutaneous severity and have shown it to be reliable, valid, and responsive. LoTSS is the first measure that assesses and scores all the major extracutaneous manifestations in LS. Our findings suggest LoTSS could aid assessment and management of patients and facilitate outcome evaluation in treatment studies.
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Affiliation(s)
- Suzanne C Li
- Joseph M. Sanzari Children's Hospital, Hackensack, and Hackensack Meridian School of Medicine, Nutley, New Jersey
| | | | - Mara L Becker
- Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Sandy Hong
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Vidya Sivaraman
- The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Ronald M Laxer
- Temerty Faculty of Medicine, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katie Stewart
- Texas Children's Hospital and Baylor College of Medicine, Austin, Texas
| | | | | | - Gloria Higgins
- The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Elena Pope
- Temerty Faculty of Medicine, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Xiaohu Li
- Stevens Institute of Technology, Hoboken, New Jersey
| | - Tara Lozy
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey
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Chang MH, Fuhlbrigge RC, Nigrovic PA. Joint-specific memory, resident memory T cells and the rolling window of opportunity in arthritis. Nat Rev Rheumatol 2024; 20:258-271. [PMID: 38600215 DOI: 10.1038/s41584-024-01107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/12/2024]
Abstract
In rheumatoid arthritis, juvenile idiopathic arthritis and other forms of inflammatory arthritis, the immune system targets certain joints but not others. The pattern of joints affected varies by disease and by individual, with flares most commonly involving joints that were previously inflamed. This phenomenon, termed joint-specific memory, is difficult to explain by systemic immunity alone. Mechanisms of joint-specific memory include the involvement of synovial resident memory T cells that remain in the joint during remission and initiate localized disease recurrence. In addition, arthritis-induced durable changes in synovial fibroblasts and macrophages can amplify inflammation in a site-specific manner. Together with ongoing systemic processes that promote extension of arthritis to new joints, these local factors set the stage for a stepwise progression in disease severity, a paradigm for arthritis chronicity that we term the joint accumulation model. Although durable drug-free remission through early treatment remains elusive for most forms of arthritis, the joint accumulation paradigm defines new therapeutic targets, emphasizes the importance of sustained treatment to prevent disease extension to new joints, and identifies a rolling window of opportunity for altering the natural history of arthritis that extends well beyond the initiation phase of disease.
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Affiliation(s)
- Margaret H Chang
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Robert C Fuhlbrigge
- Department of Paediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Peter A Nigrovic
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
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Bloom JL, Pickett K, Silveira L, Fuhlbrigge RC, Cuthbertson D, Akuthota P, Corbridge TC, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Rhee RL, Seo P, Silver J, Specks U, Warrington KJ, Wechsler ME, Merkel PA. The Association Between Age at Diagnosis and Disease Characteristics and Damage in Patients With ANCA-Associated Vasculitis. Arthritis Rheumatol 2023; 75:2216-2227. [PMID: 37433067 PMCID: PMC10782596 DOI: 10.1002/art.42651] [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: 04/01/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This study examined the relationship between age at diagnosis and disease characteristics and damage in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS Analysis of a prospective longitudinal cohort of patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic GPA (EGPA) in the Vasculitis Clinical Research Consortium (2013-2021). Disease cohorts were divided by age at diagnosis (years): children (<18), young adults (18-40), middle-aged adults (41-65), and older adults (>65). Data included demographics, ANCA type, clinical characteristics, Vasculitis Damage Index (VDI) scores, ANCA Vasculitis Index of Damage (AVID) scores, and novel disease-specific and non-disease-specific damage scores built from VDI and AVID items. RESULTS Analysis included data from 1020 patients with GPA/MPA and 357 with EGPA. Female predominance in GPA/MPA decreased with age at diagnosis. AAV in childhood was more often GPA and proteinase 3-ANCA positive. Children with GPA/MPA experienced more subglottic stenosis and alveolar hemorrhage; children and young adults with EGPA experienced more alveolar hemorrhage, need for intubation, and gastrointestinal involvement. Older adults (GPA/MPA) had more neurologic manifestations. After adjusting for disease duration, medications, tobacco, and ANCA, all damage scores increased with age at diagnosis for GPA/MPA (P < 0.001) except the disease-specific damage score, which did not differ (P = 0.44). For EGPA, VDI scores increased with age at diagnosis (P < 0.009), whereas all other scores were not significantly different. CONCLUSION Age at diagnosis is associated with clinical characteristics in AAV. Although VDI and AVID scores increase with age at diagnosis, this is driven by non-disease-specific damage items.
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Affiliation(s)
| | | | | | | | | | | | | | - Nader A. Khalidi
- St. Joseph’s Healthcare Hamilton, McMaster University, Ontario, Canada
| | | | | | | | | | | | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, MD, USA
| | - Jared Silver
- US Medical Affairs - Respiratory GSK, Durham, NC, USA
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Kammeyer R, Ogbu EA, Cooper JC, Stolz E, Piquet AL, Fuhlbrigge RC, Bennett JL, Hutaff-Lee C. Cognitive dysfunction in pediatric systemic lupus erythematosus: current knowledge and future directions. Child Neuropsychol 2023:1-29. [PMID: 37902575 PMCID: PMC11058121 DOI: 10.1080/09297049.2023.2273573] [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: 07/05/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
Cognitive dysfunction (CD) is a neurologic complication of pediatric systemic lupus erythematosus (SLE) that remains poorly understood and understudied, despite the potential negative effects of CD on long-term socioeconomic status and quality of life. Data regarding the prevalence and risk factors for CD in pediatric SLE as well as the optimal screening, treatment, and long-term outcomes for CD are lacking. In this review, we present current knowledge on CD in pediatric SLE with a focus on the application to clinical practice. We discuss the challenges in diagnosis, clinical screening methods, potential impacts, and interventions for this complication. Finally, we discuss the remaining gaps in our knowledge of CD in pediatric SLE, and avenues for future research efforts.
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Affiliation(s)
- Ryan Kammeyer
- Departments of Pediatrics and Neurology, Sections of Child Neurology and Neuroimmunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ekemini A. Ogbu
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer C. Cooper
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erin Stolz
- Department of Child and Adolescent Psychiatry, Section of Pediatric Medical Psychology, John Hopkins Medicine, Baltimore, MA, USA
| | - Amanda L. Piquet
- Department of Neurology, Section of Neuroimmunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert C. Fuhlbrigge
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jeffrey L. Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christa Hutaff-Lee
- Department of Pediatrics, Section of Neurology-Neuropsychology, University of Colorado School of Medicine, Aurora, CO, USA
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Bloom JL, Furniss A, Suresh K, Fuhlbrigge RC, Lamb MM, Rosenberg S, Edwards A, O’Leary ST. The Impact of Altitude at Birth on Perinatal Respiratory Support for Neonates with Trisomy 21. Am J Perinatol 2023; 40:1515-1520. [PMID: 34674211 PMCID: PMC10766162 DOI: 10.1055/s-0041-1736594] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Both high altitude and trisomy 21 (T21) status can negatively impact respiratory outcomes. The objective of this study was to examine the association between altitude and perinatal respiratory support in neonates with T21 compared with those without T21. STUDY DESIGN This retrospective cohort study used the United States all-county natality files that included live, singleton, in-hospital births from 2015 to 2019. Descriptive statistics for neonates with and without the primary outcome of sustained assisted ventilation (>6 hours) were compared using t-tests and Chi-squared analyses. Multivariable logistic regression was used to determine the association between respiratory support and the presence of T21, and included an interaction term to determine whether the association between respiratory support and the presence of T21 was modified by elevation at delivery. RESULTS A total of 17,939,006 neonates, 4,059 (0.02%) with T21 and 17,934,947 (99.98%) without, were included in the study. The odds of requiring sustained respiratory support following delivery were 5.95 (95% confidence interval [CI]: 5.31, 6.66), 4.06 (95% CI: 2.39, 6.89), 2.36 (95% CI: 1.64, 3.40), and 5.04 (95% CI: 1.54, 16.54) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevations, respectively. The odds of requiring immediate ventilation support following delivery were 5.01 (95% CI: 4.59, 5.46), 5.90 (95% CI: 4.16, 8.36), 2.86 (95% CI: 2.15, 3.80), and 12.08 (95% CI: 6.78, 21.51) times as high for neonates with T21 than without T21 when born at low, medium, high, and very high elevation, respectively. CONCLUSION Neonates with T21 have increased odds of requiring respiratory support following delivery when compared with neonates without T21 at all categories of altitude. However, the odds ratios did not increase monotonically with altitude which indicates additional research is critical in understanding the effects of altitude on neonates with T21. KEY POINTS · Neonates with T21 have an increased need for perinatal respiratory support at all altitudes.. · The odds of needing perinatal respiratory support did not increase monotonically with elevation.. · Additional research is critical to understanding the effects of altitude on neonates with T21..
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Affiliation(s)
- Jessica L. Bloom
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna Furniss
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Krithika Suresh
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Robert C. Fuhlbrigge
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Molly M. Lamb
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Sophie Rosenberg
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Anastasia Edwards
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Sean T. O’Leary
- Department of Pediatrics, Section of Infectious Disease, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Chriswell ME, Fuhlbrigge RC, Lovell MA, Monson M, Bloom JL. Why so low? An unusual case of myositis in a child. Pediatr Rheumatol Online J 2023; 21:36. [PMID: 37072782 PMCID: PMC10111759 DOI: 10.1186/s12969-023-00816-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Sarcoidosis is characterized by non-caseating epithelioid granulomas in various tissues throughout the body, most commonly the lung. Non-caseating granulomas may be seen in skeletal muscle, though typically asymptomatic and under-recognized. While rare in children, there is a need to better characterize the disease and its management. Here we present a 12-year-old female with bilateral calf pain who was ultimately found to have sarcoid myositis. CASE PRESENTATION A 12-year-old female presented to rheumatology with significantly elevated inflammatory markers and isolated lower leg pain. MRI of the distal lower extremities demonstrated extensive bilateral myositis with active inflammation, atrophy, and to a lesser extent fasciitis. This distribution of myositis in a child garnered a broad differential requiring a systematic evaluation. Ultimately, muscle biopsy revealed non-caseating granulomatous myositis with perivascular inflammation, extensive muscle fibrosis, and fatty replacement of the muscle with a CD4+ T cell predominant, lymphohistiocytic infiltrate consistent with sarcoidosis. Review of histopathology from age 6 of an extraconal mass resected from her right superior rectus muscle further confirmed the diagnosis. She had no other clinical symptoms or findings of sarcoidosis. The patient improved significantly with methotrexate and prednisone, though flared again after self-discontinuation of medications and was subsequently lost to follow-up. CONCLUSION This is the second reported case of granulomatous myositis associated with sarcoidosis in a pediatric patient, and the first to present with a chief complaint of leg pain. Increased knowledge of pediatric sarcoid myositis within the medical community will enhance recognition of the disease, improve the evaluation of lower leg myositis, and advance outcomes for this vulnerable population.
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Affiliation(s)
- Meagan E Chriswell
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert C Fuhlbrigge
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark A Lovell
- Department of Pathology and Laboratory Services, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew Monson
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jessica L Bloom
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Chang MH, Levescot A, Nelson-Maney N, Blaustein RB, Winden KD, Morris A, Wactor A, Balu S, Grieshaber-Bouyer R, Wei K, Henderson LA, Iwakura Y, Clark RA, Rao DA, Fuhlbrigge RC, Nigrovic PA. Arthritis flares mediated by tissue-resident memory T cells in the joint. Cell Rep 2021; 37:109902. [PMID: 34706228 DOI: 10.1016/j.celrep.2021.109902] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 12/12/2020] [Revised: 08/20/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Rheumatoid arthritis is a systemic autoimmune disease, but disease flares typically affect only a subset of joints, distributed in a distinctive pattern for each patient. Pursuing this intriguing pattern, we show that arthritis recurrence is mediated by long-lived synovial resident memory T cells (TRM). In three murine models, CD8+ cells bearing TRM markers remain in previously inflamed joints during remission. These cells are bona fide TRM, exhibiting a failure to migrate between joints, preferential uptake of fatty acids, and long-term residency. Disease flares result from TRM activation by antigen, leading to CCL5-mediated recruitment of circulating effector cells. Correspondingly, TRM depletion ameliorates recurrence in a site-specific manner. Human rheumatoid arthritis joint tissues contain a comparable CD8+-predominant TRM population, which is most evident in late-stage leukocyte-poor synovium, exhibiting limited T cell receptor diversity and a pro-inflammatory transcriptomic signature. Together, these findings establish synovial TRM as a targetable mediator of disease chronicity in autoimmune arthritis.
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Affiliation(s)
- Margaret H Chang
- Division of Immunology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Anaïs Levescot
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Nathan Nelson-Maney
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Rachel B Blaustein
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Kellen D Winden
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Allyn Morris
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Alexandra Wactor
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Spoorthi Balu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Ricardo Grieshaber-Bouyer
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Kevin Wei
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Lauren A Henderson
- Division of Immunology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Yoichiro Iwakura
- Center for Experimental Animal Models, Research Institute for Biomedical Sciences, Tokyo University of Science, Chiba 278-0022, Japan
| | - Rachael A Clark
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Robert C Fuhlbrigge
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Peter A Nigrovic
- Division of Immunology, Boston Children's Hospital, Boston, MA 02115, USA; Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Abstract
The Childhood Arthritis & Rheumatology Research Alliance (CARRA) launched in 2000 as a small network of pediatric rheumatologists and investigators dedicated to promoting collaborative research to improve the care and outcomes of childhood-onset rheumatic diseases. Over the past 2 decades, CARRA has grown to become a major driver of advances in evidence-based medicine and career development in pediatric rheumatology. Its research approach has transformed pediatric rheumatology. CARRA is a vibrant organization that will continue to facilitate impactful research in the care of children, adolescents, and young adults with rheumatic disease in the years to come.
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Affiliation(s)
- Robert C Fuhlbrigge
- Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave., Rheumatology B-311, Aurora, CO 80045, USA.
| | - Laura E Schanberg
- Duke University Medical Center, Pediatric Rheumatology, Box 3212 Med Ctr, Durham, NC 27710, USA
| | - Yukiko Kimura
- Division of Pediatric Rheumatology, Joseph M. Sanzari Children's Hospital PC 344, Hackensack University Medical Center, 30 Prospect Ave., Hackensack, NJ 07601, USA
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Bloom JL, Frank B, Weinman JP, Galambos C, O'Leary ST, Liptzin DR, Fuhlbrigge RC. Diffuse alveolar hemorrhage in children with trisomy 21. Pediatr Rheumatol Online J 2021; 19:114. [PMID: 34273981 PMCID: PMC8285855 DOI: 10.1186/s12969-021-00592-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory conditions are the leading cause of hospitalization and death in children with Trisomy 21 (T21). Diffuse alveolar hemorrhage (DAH) occurs at higher frequency in children with T21; yet, it is not widely studied nor is there a standardized approach to diagnosis or management. The objective of this study was to identify children with T21 and DAH in order to understand contributing factors and identify opportunities to improve outcomes. We identified 5 children with T21 at a single institution with histology-proven DAH over 10 years and discuss their presentation, evaluation, management, and outcomes. We also reviewed the cases in the literature. CASE PRESENTATION Patient 1 died at age seven due to secondary hemophagocytic lymphohistiocytosis. DAH was seen on autopsy. Patient 2 was a three-year-old with systemic-onset juvenile idiopathic arthritis diagnosed with DAH after presenting for hypoxia. Patient 3 was diagnosed with DAH at age nine after presenting with recurrent suspected pneumonia and aspiration. Patient 4 was diagnosed with DAH at age eight after presenting with pallor and fatigue. She had additional ICU admissions for DAH with infections. Patient 5 developed hemoptysis at age three and had recurrent DAH for 10 years. Four patients responded positively to immune-modulation such as intravenous immunoglobulin, glucocorticoids, and rituximab. Of the 19 patients identified in the literature, only one was from the United States. The majority had anemia, respiratory distress, autoantibodies, and recurrences. Very few patients had hemoptysis. Idiopathic pulmonary hemosiderosis was the most common diagnosis. Almost all received glucocorticoids with or without additional immunosuppression. The majority of our patients and those in the literature had positive auto-antibodies such as anti-neutrophil cytoplasmic antibodies and anti-nuclear antigen antibodies. Diagnostic clues included respiratory distress, hypoxia, anemia, recurrent pneumonia, and/or ground glass opacities on imaging. We identified four contributors to DAH: structural lung abnormalities, pulmonary arterial hypertension, infection/aspiration, and autoimmune disease/immune dysregulation. CONCLUSION These cases demonstrate the need for an increased index of suspicion for DAH in children with T21, particularly given the low frequency of hemoptysis at presentation, enrich the understanding of risk factors, and highlight the favorable response to immunosuppressive therapies in this vulnerable population.
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Affiliation(s)
- Jessica L Bloom
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Benjamin Frank
- Department of Pediatrics, Section of Pediatric Cardiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Jason P Weinman
- Department of Radiology, |University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Csaba Galambos
- Department of Pathology and Laboratory Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sean T O'Leary
- Department of Pediatrics, Section of Infectious Disease, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah R Liptzin
- Department of Pediatrics, Section of Pediatric Pulmonology and Sleep Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Robert C Fuhlbrigge
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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10
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Rao S, Kwan BM, Curtis DJ, Swanson A, Bakel LA, Bajaj L, Boguniewicz J, Lockwood JM, Ogawa K, Pemberton K, Fuhlbrigge RC, Brumbaugh D, Givens P, Nozik ES, Sills MR. Implementation of a Rapid Evidence Assessment Infrastructure during the Coronavirus Disease 2019 (COVID-19) Pandemic to Develop Policies, Clinical Pathways, Stimulate Academic Research, and Create Educational Opportunities. J Pediatr 2021; 230:4-8.e2. [PMID: 33091418 PMCID: PMC7572277 DOI: 10.1016/j.jpeds.2020.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Suchitra Rao
- Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics (Epidemiology), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Bethany M Kwan
- Department of Family Medicine, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO
| | - Donna J Curtis
- Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Angela Swanson
- Clinical Effectiveness, Children's Hospital Colorado, Aurora, CO
| | - Leigh Anne Bakel
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Lalit Bajaj
- Clinical Effectiveness, Children's Hospital Colorado, Aurora, CO; Department of Pediatrics (Emergency Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Juri Boguniewicz
- Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Justin M Lockwood
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Kaleigh Ogawa
- Clinical Effectiveness, Children's Hospital Colorado, Aurora, CO
| | | | - Robert C Fuhlbrigge
- Department of Pediatrics (Rheumatology), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - David Brumbaugh
- Department of Pediatrics (Gastroenterology), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Patricia Givens
- Department of Nursing, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Eva S Nozik
- Department of Pediatrics (Critical Care), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Marion R Sills
- Department of Pediatrics (Emergency Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
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11
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Dulek DE, Fuhlbrigge RC, Tribble AC, Connelly JA, Loi MM, El Chebib H, Chandrakasan S, Otto WR, Diorio C, Keim G, Walkovich K, Jaggi P, Girotto JE, Yarbrough A, Behrens EM, Cron RQ, Bassiri H. Multidisciplinary Guidance Regarding the Use of Immunomodulatory Therapies for Acute Coronavirus Disease 2019 in Pediatric Patients. J Pediatric Infect Dis Soc 2020; 9:716-737. [PMID: 32808988 PMCID: PMC7454742 DOI: 10.1093/jpids/piaa098] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immune-mediated lung injury and systemic hyperinflammation are characteristic of severe and critical coronavirus disease 2019 (COVID-19) in adults. Although the majority of severe acute respiratory syndrome coronavirus 2 infections in pediatric populations result in minimal or mild COVID-19 in the acute phase of infection, a small subset of children develop severe and even critical disease in this phase with concomitant inflammation that may benefit from immunomodulation. Therefore, guidance is needed regarding immunomodulatory therapies in the setting of acute pediatric COVID-19. This document does not provide guidance regarding the recently emergent multisystem inflammatory syndrome in children (MIS-C). METHODS A multidisciplinary panel of pediatric subspecialty physicians and pharmacists with expertise in infectious diseases, rheumatology, hematology/oncology, and critical care medicine was convened. Guidance statements were developed based on best available evidence and expert opinion. RESULTS The panel devised a framework for considering the use of immunomodulatory therapy based on an assessment of clinical disease severity and degree of multiorgan involvement combined with evidence of hyperinflammation. Additionally, the known rationale for consideration of each immunomodulatory approach and the associated risks and benefits was summarized. CONCLUSIONS Immunomodulatory therapy is not recommended for the majority of pediatric patients, who typically develop mild or moderate COVID-19. For children with severe or critical illness, the use of immunomodulatory agents may be beneficial. The risks and benefits of such therapies are variable and should be evaluated on a case-by-case basis with input from appropriate specialty services. When available, the panel strongly favors immunomodulatory agent use within the context of clinical trials. The framework presented herein offers an approach to decision-making regarding immunomodulatory therapy for severe or critical pediatric COVID-19 and is informed by currently available data, while awaiting results of placebo-controlled randomized clinical trials.
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Affiliation(s)
- Daniel E Dulek
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert C Fuhlbrigge
- Section of Rheumatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alison C Tribble
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - James A Connelly
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michele M Loi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Hassan El Chebib
- Division of Infectious Diseases and Immunology, Department of Pediatrics, Connecticut Children's, Hartford, Connecticut, USA
| | - Shanmuganathan Chandrakasan
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William R Otto
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Caroline Diorio
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Garrett Keim
- Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kelly Walkovich
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Preeti Jaggi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer E Girotto
- Division of Infectious Diseases and Immunology, Department of Pediatrics, Connecticut Children's, Hartford, Connecticut, USA.,University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
| | - April Yarbrough
- Department of Pharmacy, Children's of Alabama, Birmingham, Alabama, USA
| | - Edward M Behrens
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Randy Q Cron
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Hamid Bassiri
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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12
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Weiss PF, Fuhlbrigge RC, von Scheven E, Lovell DJ, Colbert RA, Brunner HI. Children with enthesitis-related arthritis could benefit from treatments targeted for adults with spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 74:1058-1064. [PMID: 33278336 DOI: 10.1002/acr.24529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 12/22/2022]
Abstract
This review will summarize clinical, genetic and pathophysiologic characteristics that are shared between children with enthesitis related arthritis (ERA) with axial involvement and adults with non-radiographic, and in some cases radiographic, axial spondyloarthritis (SpA); and between children with ERA and primarily peripheral disease manifestations and adults with peripheral SpA. Due to the differences in classification criteria for children with ERA and adults with axial and peripheral SpA, the FDA granted automatic full waivers of studies in children for new medications for "axial spondyloarthropathies including ankylosing spondylitis" up until July 2020. Thus, although current juvenile idiopathic arthritis (JIA) treatment guidelines recommend the use of biologic disease modifying anti-rheumatic drugs (DMARDs) as part of the early treatment for patients with ERA, none of the FDA-approved therapies for peripheral SpA or non-radiographic axial SpA (certolizumab pegol, ixekizumab, and secukinumab) have been studied or are labelled for use in children with ERA. Considering the similarities between adult spondyloarthritis and ERA in terms of etiology, genetics, pathogenesis and clinical manifestations summarized in this review, medications approved for axial SpA or peripheral SpA should also be studied in children with active ERA involving axial or peripheral joints, respectively, with the intent to achieve labeling for use in children. Considering the current lack of effective FDA-approved therapies for ERA, the FDA should also consider requiring pediatric studies for medications that have already been approved for the treatment of adults with SpA.
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Affiliation(s)
- Pamela F Weiss
- Children's Hospital of Philadelphia, Perlman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Robert C Fuhlbrigge
- Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, USA, Cincinnati
| | - Emily von Scheven
- University of California, San Francisco. California, USA, Cincinnati
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Robert A Colbert
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, USA
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13
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Brunner HI, Schanberg LE, Kimura Y, Dennos A, Co DO, Colbert RA, Fuhlbrigge RC, Goldmuntz E, Kingsbury DJ, Patty-Resk C, Mintz S, Onel K, Rider LG, Schneider R, Watts A, von Scheven E, Lovell DJ, Beukelman T. New Medications Are Needed for Children With Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2020; 72:1945-1951. [PMID: 32524767 DOI: 10.1002/art.41390] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To document the need for additional Food and Drug Administration (FDA)-approved medications for the treatment of juvenile idiopathic arthritis (JIA). METHODS The electronic medical records of JIA patients treated at Cincinnati Children's Hospital Medical Center (CCHMC) and data from JIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry were included in this study. Unmet medication need was defined in 2 ways: (a) the presence of chronically uncontrolled JIA, defined as a physician global assessment of JIA activity ≥3 (on a 0-10 scale, where 0 = inactive) OR ≥3 joints with active arthritis OR a patient global assessment of well-being ≥3 (on a 0-10 scale, where 0 = very well), despite sequential use of ≥2 biologic disease-modifying antirheumatic drugs (bDMARDs); and (b) the use of ≥1 bDMARD not approved for any JIA category. RESULTS At CCHMC, 829 of 1,599 JIA patients (52%) were treated with ≥1 bDMARD, and 304 (19%) had been exposed to ≥1 unapproved bDMARD. In the CARRA Registry, 4,766 of 7,379 children (65%) had received ≥1 bDMARD, and 1,122 (15%) had been prescribed ≥1 unapproved bDMARD. Of those children treated with ≥2 bDMARDs for whom complete data were available, 52% (255 of 487) at CCHMC and 45% (527 of 1,159) in the CARRA Registry had chronically uncontrolled JIA despite the use of ≥2 bDMARDs. CONCLUSION Despite the availability of bDMARDs currently approved for JIA, there is persistent need for additional therapies to control JIA signs and symptoms. Since FDA approval is critical to ensure access to bDMARDs, the study and licensing of new medications is critical to address the unmet medication need and to further improve JIA outcomes.
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Affiliation(s)
| | | | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Anne Dennos
- Duke Center for AIDS Research, Durham, North Carolina
| | - Dominic O Co
- University of Wisconsin School of Medicine and Public Health, Milwaukee
| | | | | | - Ellen Goldmuntz
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | | | | | - Sandra Mintz
- Children's Hospital of Los Angeles, Los Angeles, California
| | - Karen Onel
- Hospital for Special Surgery, New York, New York
| | - Lisa G Rider
- National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
| | | | - Allen Watts
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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Henderson LA, Hoyt KJ, Lee PY, Rao DA, Jonsson AH, Nguyen JP, Rutherford K, Julé AM, Charbonnier LM, Case S, Chang MH, Cohen EM, Dedeoglu F, Fuhlbrigge RC, Halyabar O, Hazen MM, Janssen E, Kim S, Lo J, Lo MS, Meidan E, Son MBF, Sundel RP, Stoll ML, Nusbaum C, Lederer JA, Chatila TA, Nigrovic PA. Th17 reprogramming of T cells in systemic juvenile idiopathic arthritis. JCI Insight 2020; 5:132508. [PMID: 32213704 DOI: 10.1172/jci.insight.132508] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/26/2020] [Indexed: 12/21/2022] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) begins with fever, rash, and high-grade systemic inflammation but commonly progresses to a persistent afebrile arthritis. The basis for this transition is unknown. To evaluate a role for lymphocyte polarization, we characterized T cells from patients with acute and chronic sJIA using flow cytometry, mass cytometry, and RNA sequencing. Acute and chronic sJIA each featured an expanded population of activated Tregs uncommon in healthy controls or in children with nonsystemic JIA. In acute sJIA, Tregs expressed IL-17A and a gene expression signature reflecting Th17 polarization. In chronic sJIA, the Th17 transcriptional signature was identified in T effector cells (Teffs), although expression of IL-17A at the protein level remained rare. Th17 polarization was abrogated in patients responding to IL-1 blockade. These findings identify evolving Th17 polarization in sJIA that begins in Tregs and progresses to Teffs, likely reflecting the impact of the cytokine milieu and consistent with a biphasic model of disease pathogenesis. The results support T cells as a potential treatment target in sJIA.
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Affiliation(s)
- Lauren A Henderson
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kacie J Hoyt
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pui Y Lee
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, and
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, and
| | - A Helena Jonsson
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, and
| | - Jennifer P Nguyen
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kayleigh Rutherford
- Harvard Bioinformatics Core, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Amélie M Julé
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Louis-Marie Charbonnier
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Siobhan Case
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret H Chang
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, and
| | - Ezra M Cohen
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fatma Dedeoglu
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert C Fuhlbrigge
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Rheumatology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Olha Halyabar
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa M Hazen
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Erin Janssen
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Kim
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Lo
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mindy S Lo
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Esra Meidan
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary Beth F Son
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert P Sundel
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew L Stoll
- Division of Pediatric Rheumatology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chad Nusbaum
- Broad Technology Labs, Broad Institute, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - James A Lederer
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Talal A Chatila
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter A Nigrovic
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, and
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15
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Tian T, Lofftus S, Pan Y, Stingley CA, King SL, Zhao J, Pan TY, Lock R, Marglous JW, Liu K, Widlund HR, Fuhlbrigge RC, Cichowski K, Kupper TS. IL1α Antagonizes IL1β and Promotes Adaptive Immune Rejection of Malignant Tumors. Cancer Immunol Res 2020; 8:660-671. [PMID: 32161110 DOI: 10.1158/2326-6066.cir-19-0552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/02/2019] [Accepted: 03/04/2020] [Indexed: 01/25/2023]
Abstract
We assessed the contribution of IL1 signaling molecules to malignant tumor growth using IL1β-/-, IL1α-/-, and IL1R1-/- mice. Tumors grew progressively in IL1R-/- and IL1α-/- mice but were often absent in IL1β-/- mice. This was observed whether tumors were implanted intradermally or injected intravenously and was true across multiple distinct tumor lineages. Antibodies to IL1β prevented tumor growth in wild-type (WT) mice but not in IL1R1-/- or IL1α-/- mice. Antibodies to IL1α promoted tumor growth in IL1β-/- mice and reversed the tumor-suppressive effect of anti-IL1β in WT mice. Depletion of CD8+ T cells and blockade of lymphocyte mobilization abrogated the IL1β-/- tumor suppressive effect, as did crossing IL1β-/- mice to SCID or Rag1-/- mice. Finally, blockade of IL1β synergized with blockade of PD-1 to inhibit tumor growth in WT mice. These results suggest that IL1β promotes tumor growth, whereas IL1α inhibits tumor growth by enhancing T-cell-mediated antitumor immunity.
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Affiliation(s)
- Tian Tian
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Serena Lofftus
- Tufts University School of Medicine, Boston, Massachusetts
| | - Youdong Pan
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Claire A Stingley
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sandra L King
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jingxia Zhao
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy Y Pan
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rebecca Lock
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Kevin Liu
- Vanderbilt University, Nashville, Tennessee
| | - Hans R Widlund
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert C Fuhlbrigge
- Children's Hospital Colorado, University of Colorado - Denver, Aurora, Colorado
| | - Karen Cichowski
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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16
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Li SC, Torok KS, Rabinovich CE, Dedeoglu F, Becker ML, Ferguson PJ, Hong SD, Ibarra MF, Stewart K, Pope E, Higgins GC, Laxer RM, Mason T, Fuhlbrigge RC, Andrews T. Initial Results from a Pilot Comparative Effectiveness Study of 3 Methotrexate-based Consensus Treatment Plans for Juvenile Localized Scleroderma. J Rheumatol 2019; 47:1242-1252. [DOI: 10.3899/jrheum.190311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/27/2022]
Abstract
Objective.To perform a comparative effectiveness feasibility study in juvenile localized scleroderma (LS), using standardized treatment regimens (consensus treatment plans; CTP).Methods.A prospective, multicenter 1-year pilot observational cohort study was performed by Childhood Arthritis and Rheumatology Research Alliance (CARRA) LS workgroup members. Patients with active, moderate to severe juvenile LS were treated with one of 3 CTP: methotrexate alone, or in combination with intravenous (30 mg/kg/dose for 3 mos) or oral corticosteroids (2 mg/kg/day tapered by 48 weeks).Results.Fifty patients, with demographics typical for juvenile LS, were enrolled, and 44 (88%) completed the study. Most had extracutaneous involvement. Patients improved in all 3 CTP, with > 75% having a major or moderate level of improvement compared to baseline. Damage accrued in some patients. Major deviations from prescribed regimen resulted from medication intolerance (n = 6; 14%) or treatment failure (n = 11; 25%); failures occurred in all 3 CTP. Significant responses to treatment were demonstrated by LS skin scoring measures and overall physician assessments, with differences in response level identified in some patient subsets. Response differences were associated with baseline disease activity level, LS subtype, skin disease extent, and extracutaneous involvement.Conclusion.This study demonstrates the feasibility of conducting juvenile LS comparative effectiveness studies. The CTP were found to be safe, effective, and tolerable. Our assessments performed well. Because damage is common and may progress despite effective control of activity, we recommend initial treatment efficacy be evaluated primarily by activity measures. Potential confounders for response were identified that warrant further study.
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17
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Weishaupt C, Steinert M, Brunner G, Schulze HJ, Fuhlbrigge RC, Goerge T, Loser K. Activation of human vascular endothelium in melanoma metastases induces ICAM-1 and E-selectin expression and results in increased infiltration with effector lymphocytes. Exp Dermatol 2019; 28:1258-1269. [PMID: 31444891 DOI: 10.1111/exd.14023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/18/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
Lymphocytic infiltration into melanoma tissue is an important prerequisite for effective antitumoral immunity. However, analysis of human metastatic melanoma has shown that leucocyte adhesion receptor expression on melanoma blood vessels is very low or absent, thereby impairing the entry of cytotoxic lymphocytes into tumor tissue. We hypothesized that adhesion molecules can be induced on melanoma vasculature allowing better infiltration of cytotoxic lymphocytes. Quantitative real-time PCR and immunofluorescence staining indicated that the adhesion molecules ICAM-1 (CD54) and E-selectin (CD62E) can be significantly induced by intralesional application of TNF alpha in tissue from human melanoma metastases either in vitro or in vivo when grafted onto immunodeficient NSG (NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ) mice that preserved human vessels. Furthermore, activated human autologous CD3+ lymphocytes were injected intravenously into mice bearing melanoma xenografts treated with TNF-α or PBS in addition to the leucocyte chemoattractant TARC (CCL17). Significantly increased numbers of CD8+ cells were detected in TNF-α-treated melanoma metastases compared with PBS-treated controls. In addition, tumor cell apoptosis was enhanced and melanoma cell proliferation reduced as shown by TUNEL assay and KI-67 staining. We conclude that adhesion molecules can be induced on human melanoma vasculature resulting in significantly improved homing of activated autologous cytotoxic T cells to melanoma tissue and inhibition of melanoma cell proliferation. These observations should be considered when designing protocols for immunotherapy of malignant melanoma.
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Affiliation(s)
- Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Meike Steinert
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Georg Brunner
- Department of Cancer Research, Fachklinik Hornheide, Münster, Germany
| | | | - Robert C Fuhlbrigge
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Goerge
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Karin Loser
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany.,CRC1009, CRC-TR128 and Interdisciplinary Center of Clinical Research (IZKF), University of Münster, Münster, Germany
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18
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Li SC, Fuhlbrigge RC, Laxer RM, Pope E, Ibarra MF, Stewart K, Mason T, Becker ML, Hong S, Dedeoglu F, Torok KS, Rabinovich CE, Ferguson PJ, Punaro M, Feldman BM, Andrews T, Higgins GC. Developing comparative effectiveness studies for a rare, understudied pediatric disease: lessons learned from the CARRA juvenile localized scleroderma consensus treatment plan pilot study. Pediatr Rheumatol Online J 2019; 17:43. [PMID: 31307476 PMCID: PMC6632199 DOI: 10.1186/s12969-019-0350-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/08/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We designed and initiated a pilot comparative effectiveness study for juvenile localized scleroderma (jLS), for which there is limited evidence on best therapy. We evaluated the process we used, in relation to the specific protocol and to the general task of identifying strategies for implementing studies in rare pediatric diseases. METHODS This was a prospective, multi-center, observational cohort study of 50 jLS patients initiating treatment, designed and conducted by the jLS group of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) from 2012 to 2015. A series of virtual and physical meetings were held to design the study, standardize clinical assessments, generate and refine disease activity and damage measures, and monitor the study. Patients were initiated on one of three standardized methotrexate-based treatment regimens (consensus treatment plans, CTPs) and monitored for 1 year. An optional bio-banking sub-study was included. RESULTS The target enrollment of 50 patients was achieved over 26 months at 10 sites, with patients enrolled into all CTPs. Enrolled patients were typical for jLS. Study eligibility criteria were found to perform well, capturing patients thought appropriate for treatment studies. Minor modifications to the eligibility criteria, primarily to facilitate recruitment for future studies, were discussed with consensus agreement reached on them by the jLS group. There were marked differences in site preferences for specific CTPs, with half the sites treating all their patients with the same CTP. Most patients (88%) completed the study, and 68% participated in the bio-banking substudy. CONCLUSIONS We demonstrate the feasibility of our approach for conducting comparative effectiveness research in a rare pediatric disease. Multi-center collaboration by dedicated investigators who met regularly was a key factor in the success of this project. Other factors that facilitate these studies include having a sufficient number of investigators to enroll in each regimen, and streamlining study approval and management.
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Affiliation(s)
- Suzanne C. Li
- Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, Imus PC337, 30 Prospect Ave, Hackensack, NJ 07061 USA
- Hackensack Meridian School of Medicine at Seton Hall University, Clifton, NJ USA
| | | | - Ronald M. Laxer
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Elena Pope
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | | | - Katie Stewart
- Texas Scottish Rite Hospital and UT Southwestern, Dallas, TX USA
| | | | | | - Sandy Hong
- University of Iowa Stead Family Children’s Hospital, Iowa City, IA USA
| | | | | | | | | | - Marilynn Punaro
- Texas Scottish Rite Hospital and UT Southwestern, Dallas, TX USA
| | - Brian M. Feldman
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Tracy Andrews
- Rutgers School of Public Health, Rutgers University, Newark, NJ USA
| | - Gloria C. Higgins
- The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
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19
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Wu EY, Li SC, Torok KS, Virkud YV, Fuhlbrigge RC, Rabinovich CE. Baseline Description of the Juvenile Localized Scleroderma Subgroup From the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry. ACR Open Rheumatol 2019; 1:119-124. [PMID: 31777788 PMCID: PMC6858014 DOI: 10.1002/acr2.1019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Localized scleroderma (LS) is a chronic inflammatory and fibrosing skin disorder. We present baseline data on the juvenile LS (jLS) cohort from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry, a multicenter observational registry of pediatric rheumatologic disorders. Methods This is a cross-sectional analysis of children with jLS enrolled in the CARRA Legacy Registry between May 2010 and April 2014. Descriptive statistics were used for demographic, clinical, and laboratory features. Data analysis included two-sample t test, χ2 test, Fisher's exact test, linear/logistic regression, and analysis of variance. Results Of 381 children with jLS, 76% were female and 80% Caucasian. Mean onset age was 8.2 years, with 17% having a 2-year or greater delay to first pediatric rheumatology (PRH) visit. Linear scleroderma was the most common subtype (54%). Antinuclear antibody (ANA) positivity was associated with joint contracture (P = 0.04), muscle atrophy (P = 0.014), and extremity shortening (P = 0.007). Elevated aldolase was associated with joint contracture (P = 0.008) and elevated creatine kinase (CK) with muscle atrophy (P = 0.028) and extremity shortening (P = 0.016). Children with functional limitation (27%) had earlier first PRH visit compared with those without (P = 0.01). Poorer function correlated with muscle atrophy, joint contracture, and extremity shortening (P < 0.001). Methotrexate (97%) and corticosteroids (68%) were the most common medications used. Conclusion Children with jLS without joint limitation are referred later, highlighting the insidious onset and need for educating referring providers. Poorer function correlated with muscle atrophy, joint contracture, and limb shortening. ANA positivity and elevated CK or aldolase were associated with muscle atrophy, joint contracture, and/or limb shortening, suggesting predictors of muscle involvement.
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Affiliation(s)
| | - Suzanne C Li
- Hackensack University Medical Center Hackensack New Jersey
| | - Kathryn S Torok
- Children's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania
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Ringold S, Nigrovic PA, Feldman BM, Tomlinson GA, von Scheven E, Wallace CA, Huber AM, Schanberg LE, Li SC, Weiss PF, Fuhlbrigge RC, Morgan EM, Kimura Y. The Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans. Arthritis Rheumatol 2018; 70:669-678. [DOI: 10.1002/art.40395] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/29/2017] [Indexed: 01/17/2023]
Affiliation(s)
| | - Peter A. Nigrovic
- Brigham and Women's Hospital and Boston Children's Hospital; Boston Massachusetts
| | | | | | | | - Carol A. Wallace
- University of Washington School of Medicine and Seattle Children's Hospital; Seattle Washington
| | - Adam M. Huber
- IWK Health Centre; Dalhousie University; Halifax Nova Scotia Canada
| | | | - Suzanne C. Li
- Hackensack University Medical Center; Hackensack New Jersey
| | - Pamela F. Weiss
- Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | | | - Esi M. Morgan
- Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Yukiko Kimura
- Hackensack University Medical Center; Hackensack New Jersey
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21
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Park CO, Fu X, Jiang X, Pan Y, Teague JE, Collins N, Tian T, O'Malley JT, Emerson RO, Kim JH, Jung Y, Watanabe R, Fuhlbrigge RC, Carbone FR, Gebhardt T, Clark RA, Lin CP, Kupper TS. Staged development of long-lived T-cell receptor αβ T H17 resident memory T-cell population to Candida albicans after skin infection. J Allergy Clin Immunol 2017; 142:647-662. [PMID: 29128674 DOI: 10.1016/j.jaci.2017.09.042] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/26/2017] [Accepted: 09/20/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Candida albicans is a dimorphic fungus to which human subjects are exposed early in life, and by adulthood, it is part of the mycobiome of skin and other tissues. Neonatal skin lacks resident memory T (TRM) cells, but in adults the C albicans skin test is a surrogate for immunocompetence. Young adult mice raised under specific pathogen-free conditions are naive to C albicans and have been shown recently to have an immune system resembling that of neonatal human subjects. OBJECTIVE We studied the evolution of the adaptive cutaneous immune response to Candida species. METHODS We examined both human skin T cells and the de novo and memory immune responses in a mouse model of C albicans skin infection. RESULTS In mice the initial IL-17-producing cells after C albicans infection were dermal γδ T cells, but by day 7, αβ TH17 effector T cells were predominant. By day 30, the majority of C albicans-reactive IL-17-producing T cells were CD4 TRM cells. Intravital microscopy showed that CD4 effector T cells were recruited to the site of primary infection and were highly motile 10 days after infection. Between 30 and 90 days after infection, these CD4 T cells became increasingly sessile, acquired expression of CD69 and CD103, and localized to the papillary dermis. These established TRM cells produced IL-17 on challenge, whereas motile migratory memory T cells did not. TRM cells rapidly clear an infectious challenge with C albicans more effectively than recirculating T cells, although both populations participate. We found that in normal human skin IL-17-producing CD4+ TRM cells that responded to C albicans in an MHC class II-restricted fashion could be identified readily. CONCLUSIONS These studies demonstrate that C albicans infection of skin preferentially generates CD4+ IL-17-producing TRM cells, which mediate durable protective immunity.
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Affiliation(s)
- Chang Ook Park
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Xiujun Fu
- Center for Systems Biology and Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Xiaodong Jiang
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Youdong Pan
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Jessica E Teague
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Nicholas Collins
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Australia
| | - Tian Tian
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - John T O'Malley
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | - Ji Hye Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yookyung Jung
- Center for Systems Biology and Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Rei Watanabe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Robert C Fuhlbrigge
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Francis R Carbone
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Australia
| | - Thomas Gebhardt
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Australia
| | - Rachael A Clark
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Charles P Lin
- Center for Systems Biology and Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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22
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Henderson LA, Volpi S, Frugoni F, Janssen E, Kim S, Sundel RP, Dedeoglu F, Lo MS, Hazen MM, Beth Son M, Mathieu R, Zurakowski D, Yu N, Lebedeva T, Fuhlbrigge RC, Walter JE, Nee Lee Y, Nigrovic PA, Notarangelo LD. Next-Generation Sequencing Reveals Restriction and Clonotypic Expansion of Treg Cells in Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2017; 68:1758-68. [PMID: 26815131 DOI: 10.1002/art.39606] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/19/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Treg cell-mediated suppression of Teff cells is impaired in juvenile idiopathic arthritis (JIA); however, the basis for this dysfunction is incompletely understood. Animal models of autoimmunity and immunodeficiency demonstrate that a diverse Treg cell repertoire is essential to maintain Treg cell function. The present study was undertaken to investigate the Treg and Teff cell repertoires in JIA. METHODS Treg cells (CD4+CD25+CD127(low) ) and Teff cells (CD4+CD25-) were isolated from peripheral blood and synovial fluid obtained from JIA patients, healthy controls, and children with Lyme arthritis. Treg cell function was measured in suppressive assays. The T cell receptor β chain (TRB) was amplified by multiplex polymerase chain reaction and next-generation sequencing was performed, with amplicons sequenced using an Illumina HiSeq platform. Data were analyzed using ImmunoSEQ, International ImMunoGeneTics system, and the Immunoglobulin Analysis Tools. RESULTS Compared to findings in controls, the JIA peripheral blood Treg cell repertoire was restricted, and clonotypic expansions were found in both blood and synovial fluid Treg cells. Skewed usage and pairing of TRB variable and joining genes, including overuse of gene segments that have been associated with other autoimmune conditions, was observed. JIA patients shared a substantial portion of synovial fluid Treg cell clonotypes that were private to JIA and not identified in Lyme arthritis. CONCLUSION We identified restriction and clonotypic expansions in the JIA Treg cell repertoire with sharing of Treg cell clonotypes across patients. These findings suggest that abnormalities in the Treg cell repertoire, possibly engendered by shared antigenic triggers, may contribute to disease pathogenesis in JIA.
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Affiliation(s)
| | | | | | - Erin Janssen
- Boston Children's Hospital, Boston, Massachusetts
| | - Susan Kim
- Boston Children's Hospital, Boston, Massachusetts
| | | | | | - Mindy S Lo
- Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Neng Yu
- American Red Cross Blood Services-East Division, New England HLA Services, Dedham, Massachusetts
| | - Tatiana Lebedeva
- American Red Cross Blood Services-East Division, New England HLA Services, Dedham, Massachusetts
| | - Robert C Fuhlbrigge
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | - Jolan E Walter
- Boston Children's Hospital and Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Yu Nee Lee
- Boston Children's Hospital, Boston, Massachusetts
| | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | - Luigi D Notarangelo
- Boston Children's Hospital, Harvard Medical School, and Harvard Stem Cell Institute, Boston, Massachusetts
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23
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Tian T, Jin MQ, Dubin K, King SL, Hoetzenecker W, Murphy GF, Chen CA, Kupper TS, Fuhlbrigge RC. IL-1R Type 1-Deficient Mice Demonstrate an Impaired Host Immune Response against Cutaneous Vaccinia Virus Infection. J Immunol 2017; 198:4341-4351. [PMID: 28468973 DOI: 10.4049/jimmunol.1500106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/05/2017] [Indexed: 01/08/2023]
Abstract
The IL-1 superfamily of cytokines and receptors has been studied extensively. However, the specific roles of IL-1 elements in host immunity to cutaneous viral infection remain elusive. In this study, we applied vaccinia virus (VACV) by scarification to IL-1R1 knockout mice (IL-1R1-/-) and found that these mice developed markedly larger lesions with higher viral genome copies in skin than did wild-type mice. The phenotype of infected IL-1R1-/- mice was similar to eczema vaccinatum, a severe side effect of VACV vaccination that may develop in humans with atopic dermatitis. Interestingly, the impaired cutaneous response of IL-1R1-/- mice did not reflect a systemic immune deficiency, because immunized IL-1R1-/- mice survived subsequent lethal VACV intranasal challenge, or defects of T cell activation or T cell homing to the site of inoculation. Histologic evaluation revealed that VACV infection and replication after scarification were limited to the epidermal layer of wild-type mice, whereas lack of IL-1R1 permitted extension of VACV infection into dermal layers of the skin. We explored the etiology of this discrepancy and determined that IL-1R1-/- mice contained significantly more macrophages and monocyte-derived dendritic cells in the dermis after VACV scarification. These cells were vulnerable to VACV infection and may augment the transmission of virus to adjacent skin, thus leading to larger skin lesions and satellite lesions in IL-1R1-/- mice. These results suggest new therapeutic strategies for treatment of eczema vaccinatum and inform assessment of risks in patients receiving IL-1 blocking Abs for treatment of chronic inflammatory disorders.
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Affiliation(s)
- Tian Tian
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115;
| | | | - Krista Dubin
- Weill Cornell Medical College, New York, NY 10065
| | - Sandra L King
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
| | - Wolfram Hoetzenecker
- Department of Dermatology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - George F Murphy
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
| | | | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
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24
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Batu ED, Kara Eroğlu F, Tsoukas P, Hausmann JS, Bilginer Y, Kenna MA, Licameli GR, Fuhlbrigge RC, Özen S, Dedeoğlu F. Periodic Fever, Aphthosis, Pharyngitis, and Adenitis Syndrome: Analysis of Patients From Two Geographic Areas. Arthritis Care Res (Hoboken) 2016; 68:1859-1865. [DOI: 10.1002/acr.22901] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/25/2016] [Accepted: 03/29/2016] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | - Jonathan S. Hausmann
- Boston Children's Hospital and Beth Israel Deaconess Medical Center; Boston Massachusetts
| | | | | | | | - Robert C. Fuhlbrigge
- Boston Children's Hospital and Brigham and Women's Hospital; Boston Massachusetts
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25
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Bohr AH, Fuhlbrigge RC, Pedersen FK, de Ferranti SD, Müller K. Premature subclinical atherosclerosis in children and young adults with juvenile idiopathic arthritis. A review considering preventive measures. Pediatr Rheumatol Online J 2016; 14:3. [PMID: 26738563 PMCID: PMC4704268 DOI: 10.1186/s12969-015-0061-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/18/2015] [Indexed: 12/18/2022] Open
Abstract
Many studies show that Juvenile Idiopathic Arthritis (JIA) is associated with early subclinical signs of atherosclerosis. Chronic inflammation per se may be an important driver but other known risk factors, such as dyslipidemia, hypertension, insulin insensitivity, a physically inactive lifestyle, obesity, and tobacco smoking may also contribute substantially. We performed a systematic review of studies through the last 20 years on early signs of subclinical atherosclerosis in children and adolescents with JIA with the purpose of investigating whether possible risk factors, other than inflammation, were considered.We found 13 descriptive cross sectional studies with healthy controls, one intervention study and two studies on adults diagnosed with JIA. Only one study addressed obesity, and physical activity (PA) has only been assessed in one study on adults with JIA and only by self-reporting. This is important as studies on PA in children with JIA have shown that most patients are less physically active than their healthy peers, and as physical inactivity in several large studies of normal schoolchildren is found to be associated with increased clustering of risk factors for cardiovascular disease. It is thus possible that an inactive lifestyle in patients with JIA is an important contributor to development of the subclinical signs of atherosclerosis seen in children with JIA, and that promotion of an active lifestyle in childhood and adolescence may diminish the risk for premature atherosclerotic events in adulthood.
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Affiliation(s)
- Anna-Helene Bohr
- Department of Paediatrics and Adolescent Medicine, JMC Research Unit, Rigshospitalet Afs. 7821, Tagensvej 22, DK 2200, Copenhagen N, Denmark.
| | | | - Freddy Karup Pedersen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | | | - Klaus Müller
- Department of Paediatrics and Adolescent Medicine, and Institute for Inflammation Research, Rigshospitalet, Copenhagen, Denmark
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26
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Freeman S, Bhatt A, Pedamallu C, King S, Duke F, Jung J, Lawton M, Anderson E, Fuhlbrigge RC, Kenna M, Licameli G, Meyerson M, Dedeoglu F. A121: In Search of Infectious Triggers of Periodic Fever, Aphthous Stomatitis, Pharyngitis and Adenitis Syndrome. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Ami Bhatt
- Broad Institute, Cambridge, MA; Cambridge MA
| | | | | | | | - Joonil Jung
- Broad Institute, Cambridge, MA; Cambridge MA
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27
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Henderson LA, King SL, Ameri S, Martin SD, Simmons BP, Nigrovic PA, Fuhlbrigge RC. A161: Novel 3-Dimensional Explant Method Facilitates the Study of Lymphocyte Populations in the Synovium and Reveals a Large Population of Resident Memory T cells in Rheumatoid Arthritis. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Henderson LA, Volpi S, Frugoni F, Kim S, Janssen E, Sundel RP, Dedeoglu F, Lo MS, Hazen MM, Mathieu R, Fuhlbrigge RC, Lee YN, Nigrovic PA, Notarangelo LD. A119: Deep Sequencing Analysis of the T Regulatory and T Effector Repertoire in Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38540] [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: 11/08/2022]
Affiliation(s)
| | | | | | - Susan Kim
- Boston Children's Hospital; Boston MA
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29
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Vander Lugt B, Tubo NJ, Nizza ST, Boes M, Malissen B, Fuhlbrigge RC, Kupper TS, Campbell JJ. CCR7 plays no appreciable role in trafficking of central memory CD4 T cells to lymph nodes. J Immunol 2013; 191:3119-27. [PMID: 23935190 DOI: 10.4049/jimmunol.1200938] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CCR7⁻/⁻ mice exhibit profound anomalies in lymph node and spleen architecture, which complicates the study of CCR7-mediated T cell trafficking in vivo. To circumvent this problem, we established in vivo models in which wild-type and CCR7⁻/⁻ populations coexist within mice possessing normal lymphoid organs and must compete for developmental niches within the tissues of these mice. Under the conditions we have created in vivo, we find the entry of memory CD4 T cells into lymph nodes from the blood to be independent of CCR7. Thus, the central memory CD4 T cells that traffic though lymph nodes, which are often defined by their expression of CCR7, do not appear to gain any competitive homing advantage by expressing this receptor. Furthermore, in contrast to cutaneous dendritic cell populations, we found that CCR7 deficiency had no appreciable effect on the exit of CD4 T cells from inflamed skin. Finally, we found that wild-type and CCR7⁻/⁻ precursors were equally represented within the major thymic subpopulations, despite previous findings that CCR7 plays a role in seeding the thymus from bone marrow-derived T cell precursors.
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Affiliation(s)
- Bryan Vander Lugt
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA 02115, USA
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30
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Ercan A, Barnes MG, Hazen M, Tory H, Henderson L, Dedeoglu F, Fuhlbrigge RC, Grom A, Holm IA, Kellogg M, Kim S, Adamczyk B, Rudd PM, Son MB, Sundel RP, Foell D, Glass DN, Thompson SD, Nigrovic PA. Multiple juvenile idiopathic arthritis subtypes demonstrate proinflammatory IgG glycosylation. ACTA ACUST UNITED AC 2012; 64:3025-33. [PMID: 22549726 DOI: 10.1002/art.34507] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Rheumatoid arthritis is associated with an excess of agalactosylated (G0) IgG that is considered relatively proinflammatory. Assessment of this association in juvenile idiopathic arthritis (JIA) is complicated by age-dependent IgG glycan variation. The aim of this study was to conduct the first large-scale survey of IgG glycans in healthy children and patients with JIA, with a focus on early childhood, the time of peak JIA incidence. METHODS IgG glycans from healthy children and disease-modifying antirheumatic drug-naive patients with JIA were characterized using high-performance liquid chromatography. Agalactosylated glycans were quantitated with reference to monogalactosylated (G1) species. Associations were sought between the G0:G1 ratio and disease characteristics. RESULTS Among healthy children ages 9 months to 16 years (n = 165), the G0:G1 ratio was highly age dependent, with the ratio peaking to 1.19 in children younger than age 3 years and declining to a nadir of 0.83 after age 10 years (Spearman's ρ = 0.60, P < 0.0001). In patients with JIA (n = 141), the G0:G1 ratio was elevated compared with that in control subjects (1.32 versus 1.02; P < 0.0001). The G0:G1 ratio corrected for age was abnormally high in all JIA subtypes (enthesitis-related arthritis was not assessed), most strikingly in systemic JIA. Glycosylation aberrancy was comparable in patients with and those without antinuclear antibodies and in both early- and late-onset disease and exhibited at most a weak correlation with markers of inflammation. CONCLUSION IgG glycosylation is skewed toward proinflammatory G0 variants in healthy children, in particular during the first few years of life. This deviation is exaggerated in patients with JIA. The role for IgG glycan variation in immune function in children, including the predilection of JIA for early childhood, remains to be defined.
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Affiliation(s)
- Altan Ercan
- Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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31
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Li SC, Torok KS, Pope E, Dedeoglu F, Hong S, Jacobe HT, Rabinovich CE, Laxer RM, Higgins GC, Ferguson PJ, Lasky A, Baszis K, Becker M, Campillo S, Cartwright V, Cidon M, Inman CJ, Jerath R, O'Neil KM, Vora S, Zeft A, Wallace CA, Ilowite NT, Fuhlbrigge RC. Development of consensus treatment plans for juvenile localized scleroderma: a roadmap toward comparative effectiveness studies in juvenile localized scleroderma. Arthritis Care Res (Hoboken) 2012; 64:1175-85. [PMID: 22505322 DOI: 10.1002/acr.21687] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Juvenile localized scleroderma (LS) is a chronic inflammatory skin disorder associated with substantial morbidity and disability. Although a wide range of therapeutic strategies has been reported in the literature, a lack of agreement on treatment specifics and accepted methods for clinical assessment has made it difficult to compare approaches and identify optimal therapy. Our objective was to develop standardized treatment plans, clinical assessments, and response criteria for active, moderate to high severity juvenile LS. METHODS A core group of pediatric rheumatologists, dermatologists, and a lay advisor was engaged by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) to develop standardized treatment plans and assessment parameters for juvenile LS using consensus methods/nominal group techniques. Recommendations were validated in 2 face-to-face conferences with a larger group of practitioners with expertise in juvenile LS and with the full membership of CARRA, which encompasses the majority of pediatric rheumatologists in the US and Canada. RESULTS Consensus was achieved on standardized treatment plans that reflect the prevailing treatment practices of CARRA members. Standardized clinical assessment methods and provisional treatment response criteria were also developed. Greater than 90% of pediatric rheumatologists responding to a survey (66% of CARRA membership) affirmed the final recommendations and agreed to utilize these consensus plans to treat patients with juvenile LS. CONCLUSION Using consensus methodology, we have developed standardized treatment plans and assessment methods for juvenile LS. The high level of support among pediatric rheumatologists will support future comparative effectiveness studies and enable the development of evidence-based guidelines for the treatment of juvenile LS.
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Affiliation(s)
- Suzanne C Li
- Hackensack University Medical Center, New Jersey, USA
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32
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Chang DK, Sui J, Geng S, Muvaffak A, Bai M, Fuhlbrigge RC, Lo A, Yammanuru A, Hubbard L, Sheehan J, Campbell JJ, Zhu Q, Kupper TS, Marasco WA. Humanization of an anti-CCR4 antibody that kills cutaneous T-cell lymphoma cells and abrogates suppression by T-regulatory cells. Mol Cancer Ther 2012; 11:2451-61. [PMID: 22869555 DOI: 10.1158/1535-7163.mct-12-0278] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cutaneous T-cell lymphoma (CTCL) is a heterogeneous group of neoplastic disorders characterized by clonally derived and skin-homing malignant T cells that express high level of chemokine receptor CCR4, which is associated with their skin-homing capacity. CCR4 is also highly expressed on T-regulatory cells (Tregs) that can migrate to several different types of chemotactic ligand CCL17- and CCL22-secreting tumors to facilitate tumor cell evasion from immune surveillance. Thus, its high-level expression on CTCL cells and Tregs makes CCR4 a potential ideal target for antibody-based immunotherapy for CTCL and other types of solid tumors. Here, we conducted humanization and affinity optimization of a murine anti-CCR4 monoclonal antibody (mAb), mAb1567, that recognizes both the N-terminal and extracellular domains of CCR4 with high affinity and inhibits chemotaxis of CCR4(+) CTCL cells. In a mouse CTCL tumor model, mAb1567 exhibited a potent antitumor effect and in vitro mechanistic studies showed that both complement-dependent cytotoxicity (CDC) and neutrophil-mediated antibody-dependent cellular cytotoxicity (ADCC) likely mediated this effect. mAb1567 also exerts human NK cell-mediated ADCC activity in vitro. Moreover, mAb1567 also effectively inhibits chemotaxis of CD4(+)CD25(high) Tregs via CCL22 and abrogates Treg suppression activity in vitro. An affinity-optimized variant of humanized mAb1567, mAb2-3, was selected for further preclinical development based on its higher binding affinity and more potent ADCC and CDC activities. Taken together, this high-affinity humanized mAb2-3 with potent antitumor effect and a broad range of mechanisms of action may provide a novel immunotherapy for CTCL and other solid tumors.
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Affiliation(s)
- De-Kuan Chang
- Dana-Farber Cancer Institute-Harvard Medical School, 450 Brookline Ave., Boston, MA 02215, USA.
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Purwar R, Schlapbach C, Xiao S, Kang HS, Elyaman W, Jiang X, Jetten AM, Khoury SJ, Fuhlbrigge RC, Kuchroo VK, Clark RA, Kupper TS. Robust tumor immunity to melanoma mediated by interleukin-9-producing T cells. Nat Med 2012; 18:1248-53. [PMID: 22772464 PMCID: PMC3518666 DOI: 10.1038/nm.2856] [Citation(s) in RCA: 311] [Impact Index Per Article: 25.9] [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: 02/17/2012] [Accepted: 06/08/2012] [Indexed: 12/12/2022]
Abstract
Interleukin-9 is a T cell cytokine that acts through a γC-family receptor on target cells. We determined that T cells from mice deficient in the TH17 pathway genes ROR-γ and IL-23R produced abundant IL-9, and observed significant growth inhibition of B16F10 melanoma tumor in these mice. IL-9 blocking antibodies reversed this tumor growth inhibition, and enhanced tumor growth in normal mice. IL9R−/− mice showed accelerated tumor growth, while administration of rIL-9 to tumor bearing mice inhibited tumor growth. Adoptive transfer of tumor antigen-specific TH9 cells blocked tumor growth; this was reversed by anti-IL-9. Exogenous rIL-9 inhibited tumor growth in Rag1−/− mice, but not in mast cell deficient mice, suggesting a T cell independent process. Finally, we found TH9 cells in normal human skin and blood, and low IL-9 production from melanoma tumor infiltrating lymphocytes. These results suggest a role for IL-9 in tumor immunity, and suggest therapeutic strategies.
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Affiliation(s)
- Rahul Purwar
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Li SC, Fuhlbrigge RC, Dedeoglu F, Ferguson PJ, Higgins GC, Hong SD, Jacobe H, Lasky A, Laxer RM, Morris MC, Pope E, Rabinovich CE, Torok KS. Developing juvenile localized scleroderma (jLS) consensus treatment regimens for comparative effectiveness studies. Pediatr Rheumatol Online J 2012. [PMCID: PMC3403067 DOI: 10.1186/1546-0096-10-s1-a68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wu E, Rabinovich EC, Torok KS, Li SC, Fuhlbrigge RC, Investigators CARRA. Description of the localized scleroderma subgroup of CARRAnet. Pediatr Rheumatol Online J 2012. [PMCID: PMC3402948 DOI: 10.1186/1546-0096-10-s1-a71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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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36
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Tian T, Dubin K, Jin Q, Qureshi A, King SL, Liu L, Jiang X, Murphy GF, Kupper TS, Fuhlbrigge RC. Disruption of TNF-α/TNFR1 function in resident skin cells impairs host immune response against cutaneous vaccinia virus infection. J Invest Dermatol 2012; 132:1425-34. [PMID: 22318381 PMCID: PMC3326195 DOI: 10.1038/jid.2011.489] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
One strategy adopted by vaccinia virus (VV) to evade the host immune system is to encode homologs of TNF receptors (TNFRs) that block TNF-α function. The response to VV skin infection under conditions of TNF-α deficiency, however, has not been reported. We found that TNFR1-/- mice developed larger primary lesions, numerous satellite lesions, and higher skin virus levels after VV scarification. Following their recovery, VV-scarified TNFR1-/- mice were fully protected against challenge with a lethal intranasal dose of VV, suggesting these mice had developed an effective memory immune response. A functional systemic immune response was further demonstrated by enhanced production of VV-specific IFN-γ and VV-specific CD8(+) T cells in spleens and draining lymph nodes. Interestingly, bone marrow (BM)-reconstitution studies using wild-type (WT) BM in TNFR1-/- host mice, but not TNFR1-/- BM in WT host mice, reproduced the original results seen in TNFR1-/- mice, indicating that TNFR1 deficiency in resident skin cells, rather than hematopoietic cells, accounts for the impaired cutaneous immune response. Our data suggest that lack of TNFR1 leads to a skin-specific immune deficiency, and that resident skin cells have a crucial role in mediating an optimal immune defense to VV cutaneous infection via TNF-α/TNFR1 signaling.
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Affiliation(s)
- Tian Tian
- Department of Dermatology, Harvard Skin Disease Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
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Vander Lugt B, Beck ZT, Fuhlbrigge RC, Hacohen N, Campbell JJ, Boes M. TGF-β suppresses β-catenin-dependent tolerogenic activation program in dendritic cells. PLoS One 2011; 6:e20099. [PMID: 21625453 PMCID: PMC3098869 DOI: 10.1371/journal.pone.0020099] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 04/13/2011] [Indexed: 12/31/2022] Open
Abstract
The mechanisms that underlie the critical dendritic cell (DC) function in
maintainance of peripheral immune tolerance are incompletely understood,
although the β-catenin signaling pathway is critical for this role. The
molecular details by which β-catenin signaling is regulated in DCs are
unknown. Mechanical disruption of murine bone marrow-derived DC (BMDC) clusters
activates DCs while maintaining their tolerogenic potential and this activation
is associated with β-catenin signaling, providing a useful model with which
to explore tolerance-associated β-catenin signaling in DCs. In this report,
we demonstrate novel molecular features of the signaling events that control DC
activation in response to mechanical stimulation. Non-canonical β-catenin
signaling is an essential component of this tolerogenic activation and is
modulated by adhesion molecules, including integrins. This unique
β-catenin-dependent signaling pathway is constitutively active at low
levels, suggesting that mechanical stimulation is not necessarily required for
induction of this unique activation program. We additionally find that the
immunomodulatory cytokine TGF-β antagonizes β-catenin in DCs, thereby
selectively suppressing signaling associated with tolerogenic DC activation
while having no impact on LPS-induced, β-catenin-independent immunogenic
activation. These findings provide new molecular insight into the regulation of
a critical signaling pathway for DC function in peripheral immune tolerance.
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Affiliation(s)
- Bryan Vander Lugt
- Department of Dermatology, Brigham and Women's Hospital, Boston,
Massachusetts, United States of America
| | - Zachary T. Beck
- Department of Dermatology, Brigham and Women's Hospital, Boston,
Massachusetts, United States of America
| | - Robert C. Fuhlbrigge
- Department of Dermatology, Brigham and Women's Hospital, Boston,
Massachusetts, United States of America
| | - Nir Hacohen
- Center for Immunology and Inflammatory Diseases, Division of
Rheumatology, Allergy, and Immunology, Massachusetts General Hospital,
Charlestown, Massachusetts, United States of America
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United
States of America
| | - James J. Campbell
- Department of Dermatology, Brigham and Women's Hospital, Boston,
Massachusetts, United States of America
- * E-mail: jcampbell@ rics.bwh.harvard.edu (JJC); (MB)
| | - Marianne Boes
- Department of Dermatology, Brigham and Women's Hospital, Boston,
Massachusetts, United States of America
- Division of Pediatric Immunology, University Medical Center Utrecht,
Wilhelmina Children's Hospital, Utrecht, The Netherlands
- * E-mail: jcampbell@ rics.bwh.harvard.edu (JJC); (MB)
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Abstract
As the body's largest organ and first line of defense against the environment, the skin plays a vital role in host immune defense. In addition to its function as a physical barrier, the skin contains an active immune surveillance network and can mount highly specific responses to eliminate invading organisms. In this review, we discuss the functions of adhesion molecules in regulating the recruitment of distinct cell populations to skin in both healthy and disease states, and the interaction between innate and adaptive immune mechanisms active in the skin. We also review how these systems underlie the pathogenesis of skin manifestations of pediatric rheumatologic diseases.
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Affiliation(s)
- Robert C Fuhlbrigge
- Program in Rheumatology, Division of Immunology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Yamanaka KI, Fuhlbrigge RC, Mizutani H, Kupper TS. Restoration of peripheral blood T cell repertoire complexity during remission in advanced cutaneous T cell lymphoma. Arch Dermatol Res 2010; 302:453-9. [PMID: 20111968 DOI: 10.1007/s00403-009-1023-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 10/29/2009] [Accepted: 11/02/2009] [Indexed: 12/11/2022]
Abstract
In advanced stages, cutaneous T cell lymphomas (CTCL) are associated with increased mortality from infections and also increased susceptibility to skin malignancies. In this study, we analyzed the complexity of the peripheral blood T cell repertoire with a sensitive b-variable (BV) complementarity-determining region 3 (CDR3) spectratyping analysis and flow cytometry in three-stage IV CTCL/Sezary syndrome patients who achieved complete clinical remission after therapy. The T cell repertoire of peripheral blood T cells before treatment was profoundly abnormal across multiple BV subfamilies. Following treatment, CDR3 spectratype patterns showed dramatic restoration of normal diversity and complexity. However, absolute CD4 counts across multiple BV families remained low for many months, even after identifiable circulating malignant T cell populations were eliminated. These data suggest that the diversity of the T cell repertoire can be recovered after successful treatment of even advanced CTCL.
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MESH Headings
- Aged
- Aged, 80 and over
- Blood Circulation/immunology
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- CD4-Positive T-Lymphocytes/pathology
- Cell Separation
- Diphtheria Toxin/therapeutic use
- Female
- Flow Cytometry
- Humans
- Interferon-alpha/therapeutic use
- Interleukin-2/therapeutic use
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Cutaneous/physiopathology
- Male
- Middle Aged
- Neoplasm Staging
- Receptors, Antigen, T-Cell/genetics
- Recombinant Fusion Proteins/therapeutic use
- Remission Induction
- Skin/blood supply
- Skin/immunology
- Skin/pathology
- T-Lymphocyte Subsets/drug effects
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
- T-Lymphocyte Subsets/pathology
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Affiliation(s)
- Kei-ichi Yamanaka
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
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Kim S, El-Hallak M, Dedeoglu F, Zurakowski D, Fuhlbrigge RC, Sundel RP. Complete and sustained remission of juvenile dermatomyositis resulting from aggressive treatment. ACTA ACUST UNITED AC 2009; 60:1825-1830. [PMID: 19479872 DOI: 10.1002/art.24571] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the time needed to achieve sustained, medication-free remission in a cohort of patients with juvenile dermatomyositis (DM) receiving a stepwise, aggressive treatment protocol. METHODS Between 1994 and 2004, a cohort of 49 children with juvenile DM who were followed up at a single tertiary care children's hospital using disease activity measures according to a specific protocol received standardized therapy with steroids and methotrexate. If a patient's strength or muscle enzyme levels did not normalize with this initial therapy, additional medications were added in rapid succession to the treatment regimen. The primary outcome measure was time to complete remission. Additional outcome measures were onset of calcinosis, effect of treatment on height, and complications resulting from medications. RESULTS Forty-nine patients were followed up for a mean+/-SD of 48+/-30 months. All but 1 patient received 2 or more medications simultaneously. Transient localized calcifications occurred in 4 patients (8%), and 2 additional patients (4%) had persistent calcinosis. Despite the aggressive therapy, complications associated with treatment were mild and were primarily attributable to steroids. No persistent effect on longitudinal growth was observed. A complete, medication-free remission was achieved in 28 patients; the median time to achievement of complete remission was 38 months (95% confidence interval 32-44 months). None of these patients experienced a disease flare that required resumption of medications during the subsequent period of observation (mean+/-SD 36+/-19.7 months). CONCLUSION Our findings suggest that aggressive treatment of juvenile DM aimed at achieving rapid, complete control of muscle weakness and inflammation improves outcomes and reduces disease-related complications. In more than one-half of the children whose disease was treated in this manner (28 of 49), a prolonged, medication-free remission was attained within a median of 38 months from the time of diagnosis.
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Affiliation(s)
- Susan Kim
- Children's Hospital Boston, Boston, Massachusetts
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Affiliation(s)
- Rachael A Clark
- Department of Dermatology, Brigham and Women's Hospital and the Harvard Skin Disease Research Center, Boston, Massachusetts, USA.
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42
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Bianchi T, Pincus LB, Wurbel MA, Rich BE, Kupper TS, Fuhlbrigge RC, Boes M. Maintenance of peripheral tolerance through controlled tissue homing of antigen-specific T cells in K14-mOVA mice. J Immunol 2009; 182:4665-74. [PMID: 19342642 DOI: 10.4049/jimmunol.0803628] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Immunological tolerance is crucial to avoid autoimmune and inflammatory diseases; however, the mechanisms involved are incompletely understood. To study peripheral tolerance to skin-associated Ags, we generated new transgenic mice expressing a membrane-bound form of OVA in skin under the human keratin 14 (K14) promoter (K14-mOVA mice). In contrast to other transgenic mice expressing similar self-Ags in skin, adoptive transfer of Ag-specific T cells does not induce inflammatory skin disease in our K14-mOVA mice. OVA-specific T cells transferred into K14-mOVA mice are activated in lymphoid tissues, undergo clonal expansion, and eventually acquire effector function. Importantly, these Ag-specific T cells selectively up-regulate expression of E-selectin ligand in cutaneous lymph nodes but not in mesenteric lymph nodes and spleen, demonstrating that expression of endogenous self-Ags in skin dictates imprinting of skin tissue homing in vivo. However, an additional inflammatory signal, here induced by tape stripping, is required in K14-mOVA mice to induce T cell migration to skin and development of inflammatory skin disease. Depletion of regulatory CD4(+)CD25(+) T cells did not provoke homing of transferred T cells to skin under steady-state conditions, indicating that these cells are not the key regulators for inhibiting T cell homing in K14-mOVA mice. Both skin-derived and lymph node-resident CD8alpha(+) dendritic cells are responsible for Ag presentation in vivo and induce tolerance to skin Ags, as we show by selective depletion of langerin(+) and CD11c(+) dendritic cells. Taken together, controlled skin homing of T cells is critical for the maintenance of peripheral immune tolerance to epidermal self-Ags.
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Affiliation(s)
- Teresa Bianchi
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Ota S, Cron RQ, Schanberg LE, O'Neil K, Mellins ED, Fuhlbrigge RC, Feldman BM. Research priorities in pediatric rheumatology: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus. Pediatr Rheumatol Online J 2008; 6:5. [PMID: 18380905 PMCID: PMC2330140 DOI: 10.1186/1546-0096-6-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 04/01/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND North American pediatric rheumatologists have created an investigator-initiated research network (the Childhood Arthritis and Rheumatology Research Alliance - CARRA) to facilitate multi-centre studies. One of the first projects undertaken by this network was to define, by consensus, research priorities for the group, and if possible a first group-sponsored clinical trial in which all members could participate. METHODS We determined consensus using the Delphi approach. This approach has been used extensively in health research to reach consensus in large groups. It uses several successive iterations of surveys eliciting ideas and opinions from specialists in the field. Three surveys were designed based on this method and were distributed to members of CARRA to elicit and rank-order research priorities. RESULTS A response rate of 87.6% was achieved in the final survey. The most highly ranked research suggestion was to study infliximab treatment of uveitis unresponsive to methotrexate. Other highly ranked suggestions were to study i) the treatment of systemic arthritis with anakinra and ii) the treatment of pediatric systemic lupus erythematosus with mycophenolate mofetil. CONCLUSION The Delphi approach was an effective and practical method to define research priorities in this group. Ongoing discussion and cooperation among pediatric rheumatologists in CARRA and others world-wide will help in developing further research priorities and to facilitate the execution of clinical trials in the future.
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Affiliation(s)
- Sylvia Ota
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
| | - Randy Q Cron
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Laura E Schanberg
- Department of Pediatrics, Duke University Medical Center, North Carolina, USA
| | - Kathleen O'Neil
- Division of Pediatric Rheumatology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | | | | | - Brian M Feldman
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada,Department of Pediatrics, University of Toronto, Toronto, Canada,Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada,Department of Public Health Sciences, University of Toronto, Toronto, Canada,Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
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44
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Yamanaka KI, Dimitroff CJ, Fuhlbrigge RC, Kakeda M, Kurokawa I, Mizutani H, Kupper TS. Vitamins A and D are potent inhibitors of cutaneous lymphocyte-associated antigen expression. J Allergy Clin Immunol 2007; 121:148-157.e3. [PMID: 17910894 PMCID: PMC2566300 DOI: 10.1016/j.jaci.2007.08.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [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: 02/13/2007] [Revised: 08/01/2007] [Accepted: 08/02/2007] [Indexed: 01/28/2023]
Abstract
BACKGROUND Cutaneous lymphocyte-associated antigen (CLA) is a surface glycoprotein expressed by skin-homing T cells. This carbohydrate moiety expressed on mucin-like surface glycoproteins, including P-selectin glycoprotein ligand 1 and CD43, confers binding activity to dermal endothelial E-selectin and is critical for T-cell recruitment to the skin. Vitamin A (retinoic acid [RA]) and the active form of vitamin D3 (1,25 dihydroxyvitamin D3 [1,25D(3)]) have been used to treat certain T cell-mediated inflammatory skin diseases, as well as cutaneous T-cell lymphomas; however, their effect on CLA expression has not been studied. OBJECTIVE We analyzed the effects of RA and 1,25D(3) on expression of CLA and other lymphocyte-homing receptors on human T cells. METHODS We cultured human T cells with 1,25D(3) and RA and analyzed the expression of CLA and other homing receptors. We also pretreated mice with either vitamin and then induced an antigen-dependent contact hypersensitivity response. RESULTS Both RA and 1,25D(3) downregulated expression of the CLA and, in parallel, functional E-selectin ligand. Whereas RA increased expression of the gut-homing receptor alpha4beta7 and reduced L-selectin expression, 1,25D(3) had no effect on other homing receptors. In an in vivo assay treatment with RA or 1,25D(3) downregulated the skin infiltration of effector CD4+ T cells. CONCLUSION These findings suggest that 1,25D(3) can selectively downregulate CLA expression without influencing lymphocyte migration patterns to other tissues.
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Affiliation(s)
- Kei-ichi Yamanaka
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women’s Hospital, Boston, Mass
- Department of Dermatology, Mie University, Graduate School of Medicine, Mie, Japan
| | - Charles J. Dimitroff
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women’s Hospital, Boston, Mass
| | - Robert C. Fuhlbrigge
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women’s Hospital, Boston, Mass
| | - Masato Kakeda
- Department of Dermatology, Mie University, Graduate School of Medicine, Mie, Japan
| | - Ichiro Kurokawa
- Department of Dermatology, Mie University, Graduate School of Medicine, Mie, Japan
| | - Hitoshi Mizutani
- Department of Dermatology, Mie University, Graduate School of Medicine, Mie, Japan
| | - Thomas S. Kupper
- Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women’s Hospital, Boston, Mass
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45
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Abstract
Skin serves a vital role, providing protection from the broad array of pathogens present in our environment. In addition to the passive barrier functions of the skin, mammals have evolved a robust and versatile surveillance and rapid response system for recognition and elimination of invading organisms. This immune surveillance network directs the movement of immune cells, regulating homeostatic populations of immune cells in the skin, as well as recruitment to sites of inflammation. In this review, we discuss current understanding of the regulation and function of adhesion molecules in cutaneous immune surveillance and their relevance to the immunopathology of inflammatory skin disease.
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Affiliation(s)
- Robert C Fuhlbrigge
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Eugene Braunwald Research Center, Boston, MA 02115, USA.
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46
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Clark RA, Fuhlbrigge RC. Meeting report of immunology and skin disease: new perspectives. J Invest Dermatol 2007; 127:1838-41. [PMID: 17632556 DOI: 10.1038/sj.jid.5700886] [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: 11/09/2022]
Affiliation(s)
- Rachael A Clark
- Department of Dermatology, Brigham and Women's Hospital and the Harvard Skin Disease Research Center, Boston, Massachusetts 02115, USA.
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Abstract
PURPOSE Metastatic malignant melanoma is a devastating disease with a poor prognosis. Recent therapeutic trials have focused on immunotherapy to induce development of endogenous antitumor immune responses. To date, such protocols have shown success in activation of tumor-specific CTL but no overall improvement in survival. To kill tumor, antigen-specific CTL must efficiently target and enter tumor tissue. The purpose of this study was to examine the pathway of leukocyte migration to metastatic melanoma. EXPERIMENTAL DESIGN Peripheral blood and metastatic melanoma tissues (n = 65) were evaluated for expression of adhesion molecules using immunohistochemistry of tumor sections and flow cytometry of tumor-associated and peripheral blood CTL and compared with healthy controls. CTL expressing T-cell receptors for the melanoma antigen MART-1 were identified in a subset of samples by reactivity with HLA-A2 tetramers loaded with MART-1 peptide. RESULTS Results show that the majority of metastatic melanoma samples examined do not express the vascular adhesion receptors E-selectin (CD62E), P-selectin (CD62P), and intercellular adhesion molecule-1 (CD54) on vessels within the tumor boundaries. Strong adhesion receptor expression was noted on vessels within adjacent tissue. Tumor-associated T lymphocytes accumulate preferentially in these adjacent areas and are not enriched for skin- or lymph node-homing receptor phenotype. CONCLUSION Expression of leukocyte homing receptors is dysregulated on the vasculature of metastatic melanoma. This results in a block to recruitment of activated tumor-specific CTL to melanoma metastases and is a likely factor limiting the effectiveness of current immunotherapy protocols.
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Affiliation(s)
- Carsten Weishaupt
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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48
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El-Hallak M, Binstadt BA, Leichtner AM, Bennett CM, Neufeld EJ, Fuhlbrigge RC, Zurakowski D, Sundel RP. Clinical effects and safety of rituximab for treatment of refractory pediatric autoimmune diseases. J Pediatr 2007; 150:376-82. [PMID: 17382113 DOI: 10.1016/j.jpeds.2006.10.067] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 08/19/2006] [Accepted: 10/19/2006] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the safety, tolerability, and clinical effects of rituximab, an anti-CD20 monoclonal antibody, in the treatment of severe pediatric autoimmune diseases. STUDY DESIGN We reviewed the records of 10 patients treated with rituximab for severe, refractory autoimmune diseases at a single tertiary care children's hospital. Adverse events as well as treatment effects were recorded. RESULTS All patients received 4 weekly doses of rituximab at 375 mg/m2 per dose. One patient died as the result of complications of her underlying systemic lupus erythematosus 7 weeks after rituximab therapy. Three patients had serious infections, all of which resolved with standard therapy. Rituximab led to transient or sustained improvement in clinical and laboratory parameters in nine subjects. At a median follow-up of 9 months, the median prednisone dose was reduced in the responders by 0.75 mg/kg per day (mean decrease of 63%), and four patients were able to discontinue corticosteroids entirely. With longer follow-up (median, 22 months), we found that 5 of 9 patients remained clinically stable after rituximab therapy, whereas 4 patients had recurrent or new features of their underlying autoimmune disorders requiring additional corticosteroids or other immunosuppressive medications. CONCLUSIONS Rituximab had an acceptable toxicity profile in this group of patients with severe, refractory autoimmune diseases, although there were three serious infections and one patient death. Rituximab appears to be beneficial for patients with refractory autoimmune diseases and may reduce corticosteroid exposure. Although rituximab therapy provided a durable clinical benefit for some patients in this population, other patients had reemergence of their underlying autoimmune disease.
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Affiliation(s)
- Moussa El-Hallak
- Department of Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA
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49
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Thieu KP, King S, Fuhlbrigge RC. Assessing function of skin homing T cell selectin-ligands via selective knockdown with siRNA (B62). The Journal of Immunology 2007. [DOI: 10.4049/jimmunol.178.supp.b62] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
The recruitment of T cells to skin is a key feature of inflammatory diseases such as psoriasis and eczema. Skin homing T cells express cutaneous lymphocyte-associated antigen (CLA), a carbohydrate epitope that binds to E-selectin on postcapillary venules and mediates lymphocyte tethering and rolling in shear flow. E-selectin ligand (ESL) activity and CLA epitope expression have been described on P-selectin glycoprotein ligand-1 (PSGL-1) and leukosialin (CD43). CLA+ PSGL-1 serves as both a P-selectin ligand (PSL) and an ESL, whereas CLA+ CD43 is only an ESL. Although their ESL functions appear redundant, the true relative contribution of PSGL-1 and CD43 to ESL activity in human CLA+ T cells has not yet been evaluated.
Using siRNA, we inhibited expression of PSGL-1, CD43, or both on CLA+ T cells by 70–80%, as measured by flow cytometry. PSGL-1 knockdown resulted in a 70% reduction of PSL but relatively unchanged ESL activity, as assessed by shear flow binding assays. CD43 knockdown did not signficantly impact either PSL or ESL activity. Surprisingly, knockdown of both PSGL-1 and CD43 did not noticeably reduce ESL activity nor CLA expression.
As predicted from animal models, PSGL-1 is the major PSL on human CLA+ T cells but serves a redundant role as an ESL. The high residual amounts of CLA expression and ESL activity remaining after knockdown of both PSGL-1 and CD43 suggest that an uncharacterized ESL distinct from PSGL-1 and CD43 exists and may represent a signficant pool of ESL function on skin homing T cells.
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Affiliation(s)
- Khanh P Thieu
- Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., EBRC 501, Boston, MA, 02115
| | - Sandy King
- Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., EBRC 501, Boston, MA, 02115
| | - Robert C Fuhlbrigge
- Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., EBRC 501, Boston, MA, 02115
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50
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Alcaide P, King SL, Dimitroff CJ, Lim YC, Fuhlbrigge RC, Luscinskas FW. The 130-kDa glycoform of CD43 functions as an E-selectin ligand for activated Th1 cells in vitro and in delayed-type hypersensitivity reactions in vivo. J Invest Dermatol 2007; 127:1964-72. [PMID: 17392823 DOI: 10.1038/sj.jid.5700805] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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] [Indexed: 11/08/2022]
Abstract
Selectins are carbohydrate-binding molecules involved in constitutive lymphocyte homing and chronic and acute inflammation processes. Th1 lymphocytes participate in cell-mediated inflammatory reactions, where the selectins play a role and predominate in delayed-type hypersensitivity (DTH) reactions of the skin. Of the many candidate ligands for selectins, only P-selectin glycoprotein ligand 1 (PSGL-1), which also acts as an E-selectin ligand, has been characterized extensively at molecular, cellular, and functional levels on T cells. Here, we report that the glycosylated form of CD43 expressed in Th1 cells is a functional E-selectin-specific ligand in vitro. Furthermore, we have generated PSGL-1(-/-)/CD43(-/-) double-deficient mice (double knockout (DKO)) to demonstrate the relevance of CD43 as an E-selectin ligand in vitro and in vivo. Under flow conditions, DKO Th1 cells exhibited impaired E-selectin binding as compared with wild-type, PSGL-1(-/-), or CD43(-/-) Th1 cells. DKO mice also showed diminished ear inflammation in response to dinitrofluorobenzene-induced DTH that correlated with a reduced number of T cells in infiltrates in the challenged ear. These results demonstrate that both PSGL-1 and CD43 are major E-selectin ligands and are likely to be important during leukocyte recruitment in the development of inflammatory reactions.
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Affiliation(s)
- Pilar Alcaide
- Department of Pathology, Center for Excellence in Vascular Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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