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Favalli A, Favalli EG, Gobbini A, Zagato E, Bombaci M, Maioli G, Pesce E, Donnici L, Gruarin P, Biggioggero M, Curti S, Manganaro L, Marchisio E, Bevilacqua V, Martinovic M, Fabbris T, Sarnicola ML, Crosti M, Marongiu L, Granucci F, Notarbartolo S, Bandera A, Gori A, De Francesco R, Abrignani S, Caporali R, Grifantini R. Immunosuppressant Treatment in Rheumatic Musculoskeletal Diseases Does Not Inhibit Elicitation of Humoral Response to SARS-CoV-2 Infection and Preserves Effector Immune Cell Populations. Front Immunol 2022; 13:873195. [PMID: 35757699 PMCID: PMC9226581 DOI: 10.3389/fimmu.2022.873195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
COVID-19 has proven to be particularly serious and life-threatening for patients presenting with pre-existing pathologies. Patients affected by rheumatic musculoskeletal disease (RMD) are likely to have impaired immune responses against SARS-CoV-2 infection due to their compromised immune system and the prolonged use of disease-modifying anti-rheumatic drugs (DMARDs), which include conventional synthetic (cs) DMARDs or biologic and targeted synthetic (b/ts) DMARDs. To provide an integrated analysis of the immune response following SARS-CoV-2 infection in RMD patients treated with different classes of DMARDs we carried out an immunological analysis of the antibody responses toward SARS-CoV-2 nucleocapsid and RBD proteins and an extensive immunophenotypic analysis of the major immune cell populations. We showed that RMD individuals under most DMARD treatments mount a sustained antibody response to the virus, with neutralizing activity. In addition, they displayed a sizable percentage of effector T and B lymphocytes. Among b-DMARDs, we found that anti-TNFα treatments are more favorable drugs to elicit humoral and cellular immune responses as compared to CTLA4-Ig and anti-IL6R inhibitors. This study provides a whole picture of the humoral and cellular immune responses in RMD patients by reassuring the use of DMARD treatments during COVID-19. The study points to TNF-α inhibitors as those DMARDs permitting elicitation of functional antibodies to SARS-CoV-2 and adaptive effector populations available to counteract possible re-infections.
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Affiliation(s)
- Andrea Favalli
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Ph.D. Program in Translational and Molecular Medicine, Dottorato in Medicina Molecolare e Traslazionale (DIMET), University of Milan-Bicocca, Monza, Italy
| | - Ennio Giulio Favalli
- Division of Clinical Rheumatology, Aziende Socio Sanitarie Territoriali (ASST) Gaetano Pini-Centro Traumatologico Ortopedico (CTO) Institute, Milan, Italy
| | - Andrea Gobbini
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy
| | - Elena Zagato
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mauro Bombaci
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Gabriella Maioli
- Division of Clinical Rheumatology, Aziende Socio Sanitarie Territoriali (ASST) Gaetano Pini-Centro Traumatologico Ortopedico (CTO) Institute, Milan, Italy
| | - Elisa Pesce
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Lorena Donnici
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Paola Gruarin
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Martina Biggioggero
- Division of Clinical Rheumatology, Aziende Socio Sanitarie Territoriali (ASST) Gaetano Pini-Centro Traumatologico Ortopedico (CTO) Institute, Milan, Italy
| | - Serena Curti
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Lara Manganaro
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | | | - Valeria Bevilacqua
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Martina Martinovic
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Tanya Fabbris
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Maria Lucia Sarnicola
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Mariacristina Crosti
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Laura Marongiu
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy
| | - Francesca Granucci
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy
| | - Samuele Notarbartolo
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
| | - Alessandra Bandera
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Infectious Diseases Unit, Foundation Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale MaggiorePoliclinico, Milan, Italy.,Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Andrea Gori
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Infectious Diseases Unit, Foundation Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale MaggiorePoliclinico, Milan, Italy.,Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Raffaele De Francesco
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Sergio Abrignani
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, Aziende Socio Sanitarie Territoriali (ASST) Gaetano Pini-Centro Traumatologico Ortopedico (CTO) Institute, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Renata Grifantini
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, Milan, Italy
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Ingegnoli F, Schioppo T, Ubiali T, Bollati V, Ostuzzi S, Buoli M, Caporali R. Relevant non-pharmacologic topics for clinical research in rheumatic musculoskeletal diseases: The patient perspective. Int J Rheum Dis 2020; 23:1305-1310. [PMID: 32757261 DOI: 10.1111/1756-185x.13932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The research approach on rheumatic musculoskeletal diseases (RMDs) is challenging and patient involvement is an emerging issue to obtain relevant information to research. Despite growing interest in non-pharmacologic aspects of clinical research in RMDs, the patients' perspectives are currently poorly explored. METHODS A cross-sectional no-profit online survey was devised to identify and rank the priorities for clinical research in RMDs according to patients' perspectives. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, work activity, social participation, physical activity, emotional well-being/stress, alternative medicine, and patient-physician relationship. The survey was disseminated by ALOMAR (Lombard Association for Rheumatic Diseases) between June and October 2019. RESULTS Two hundred RMD patients completed the survey. The topic most rated 188 (94%) was the doctor-patient relationship, considered very or extremely important. Other topics rated as follows: psychological well-being 185 (92.5%), physical activity 155 (77.5%), nutrition, eating habits 150 (75%), alternative therapies 144 (72%), work activity 144 (72%), environmental pollution 134 (67%), social life 121 (60.5%) and cigarette smoke 119 (59.5%). The topics considered relevant were perceived to be able to influence disease symptoms. Environmental pollution and smoking were considered the most important for RMD prevention in 43.3% and 48.7% respectively. CONCLUSIONS This survey highlights the relevance of several unmet needs and indicates that active patient involvement is essential to design successful translational studies and improve clinical outcomes.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Tommaso Schioppo
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Tania Ubiali
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Valentina Bollati
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy.,EPIGET - Epidemiology, Epigenetics and Toxicology Lab, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Silvia Ostuzzi
- ALOMAR Lombard Association for Rheumatic Diseases, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
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Nikiphorou E, Alunno A, Carmona L, Kouloumas M, Bijlsma J, Cutolo M. Patient-physician collaboration in rheumatology: a necessity. RMD Open 2017; 3:e000499. [PMID: 29152329 PMCID: PMC5686831 DOI: 10.1136/rmdopen-2017-000499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 02/04/2023] Open
Abstract
Over the past few decades, there has been significant and impressive progress in the understanding and management of rheumatic diseases. One of the key reasons for succeeding in making this progress has been the increasingly stronger partnership between physicians and patients, setting a milestone in patient care. In this viewpoint, we discuss the recent evolution of the physician-patient relationship over time in Europe, reflecting on the 'journey' from behind the clinic walls through to clinical and research collaborations at national and international level and the birth of healthcare professional and 'rheumatic' patient organisations. The role of expert patients and patient advocates in clinical and scientific committees now represents a core part of the decision-making process. In more recent years and following the recognition that the young patients, physicians and academics have a voice and needs of their own, including the need to be educated and instructed, has encouraged the establishment of youth organisations, enabling change and innovation to take place at a uniquely different level.
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Affiliation(s)
- Elena Nikiphorou
- Academic Rheumatology Department, King's College London, London, UK.,Rheumatology Department, Whittington Hospital NHS Trust, London, UK
| | - Alessia Alunno
- Department of Medicine, Rheumatology Unit, University of Perugia, Italy
| | | | | | - Johannes Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - Maurizio Cutolo
- Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
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