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El Hasbani G, Jawad A, Uthman I. Axial and peripheral spondyloarthritis triggered by sars-cov-2 infection: a report of two cases. Reumatismo 2021; 73:59-63. [PMID: 33874649 DOI: 10.4081/reumatismo.2021.1374] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can show musculoskeletal symptoms such as peripheral arthritis. In rare cases, peripheral arthritis can develop after the resolution of SARS-CoV-2. We present two cases of spondyloarthritis induced by SARS-CoV-2; one case with axial and peripheral spondyloarthritis and the other with peripheral spondyloarthritis. Both cases refer to Lebanese patients who were HLA-B27 positive. These two cases highlight the possible predisposition of HLA-B27 positive patients to the development of spondyloarthritis symptoms triggered by SARS-CoV-2.
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Affiliation(s)
- G El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut.
| | - A Jawad
- Rheumatology department, Royal London Hospital, London.
| | - I Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut.
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Ziade NR, Mallak I, Merheb G, Ghorra P, Baerlecken N, Witte T, Baraliakos X. Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 Prevalence. Front Immunol 2019; 10:574. [PMID: 30972069 PMCID: PMC6445325 DOI: 10.3389/fimmu.2019.00574] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/04/2019] [Indexed: 01/08/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is often diagnosed late due to the non-specific nature of its main symptom [chronic back pain (CBP)] and to the paucity of diagnostic markers, particularly in regions with low HLA-B27 prevalence, such as the Middle-East. We tested the performance of IgG4 and IgA anti-CD74 antibodies as an early diagnostic marker for axSpA, compared with the performance of HLA-B27, in Lebanon. Sera of axSpA patients diagnosed by the rheumatologist and also fulfilling the imaging arm of the ASAS criteria (patients) and of blood donors (BD) (controls) were analyzed for HLA-B27, IgG4 and IgA anti-CD74, blinded to clinical characteristics. Receiver Operating Characteristic curves were constructed to identify an optimal cut-off point for anti-CD74 antibodies. Diagnostic properties were calculated (sensitivity, specificity, positive, and positive predictive values (PPV, NPV), Likelihood ratios) for each marker. Forty-nine axSpA patients and 102 BD were included in the final analysis. IgA anti-CD74 correlated poorly with axSpA (Area Under the Curve (AUC) 0.657), whereas IgG4 anti-CD74 had a good discriminative value (AUC 0.837). Respectively, for HLA-B27, IgG4 anti-CD74, and the combination of both, we found a sensitivity of 33-92-33%, specificity of 96-79-98%, PPV 80-68-89%, NPV 75-95-75%, and LR+ 8.2-4.4-16.5. IgG4 anti-CD 74 were positive in 88% of HLA-B27 negative axSpA patients, and correlated with BASDAI. In this first study in a population with low HLA-B27 prevalence, IgG4 anti-CD74 antibodies combined with HLA-B27 showed higher diagnostic value than HLA-B27 alone for early axSpA. IgG4 anti-CD74 should be considered for further evaluation as an early axSpA diagnostic marker in future dedicated research, particularly in patients with CBP.
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Affiliation(s)
- Nelly R Ziade
- Department of Rheumatology, Saint-Joseph University, Beirut, Lebanon.,Department of Rheumatology, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Iyad Mallak
- Department of Radiology, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Georges Merheb
- Department of Rheumatology, Holy Spirit University, Kaslik, Lebanon.,Department of Rheumatology, ND Secours Hospital, Byblos, Lebanon
| | - Pierre Ghorra
- Blood Transfusion Center, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | | | - Torsten Witte
- Department of Immunology and Rheumatology, Medical University, Hanover, Germany
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-University Bochum, Bochum, Germany
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Ziade N, Abi Karam G, Merheb G, Mallak I, Irani L, Alam E, Messaykeh J, Menassa J, Mroue' K, Uthman I, Masri AF, Ghorra P, Witte T, Baraliakos X. HLA-B27 prevalence in axial spondyloarthritis patients and in blood donors in a Lebanese population: Results from a nationwide study. Int J Rheum Dis 2019; 22:708-714. [PMID: 30729696 DOI: 10.1111/1756-185x.13487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/31/2022]
Abstract
AIM To calculate the prevalence of human leukocyte antigen (HLA)-B27 in axial spondyloarthritis patients (axSpA) compared to blood donors (BD) in Lebanon, to identify the clinical and radiological findings associated with HLA-B27 and to estimate the proportion of patients fulfilling the clinical arm of the Assessment of the Spondyloarthritis International Association (ASAS) criteria. METHOD Consecutive Lebanese adult axSpA patients fulfilling the ASAS classification criteria were included from 12 rheumatology clinics across Lebanon. BD served as controls. A binary logistic regression was used to study the association between HLA-B27 and the disease features. RESULTS A total of 247 individuals were included (141 axSpA patients and 106 BD). The prevalence of HLA-B27 was 3.8% in BD and 41.1% in axSpA. Overall, 39.7% of the axSpA patients fulfilled the clinical arm of the ASAS classification criteria. Sensitivity of HLA-B27 for axSpA was 41.1%, specificity was 96.2%, positive predictive value was 93.6%, and negative predictive value was 55.13%. Positive likelihood ratio (LR) was 10.9 and negative LR was 1.63. We found a positive association of HLA-B27 with family history of SpA and psoriasis. CONCLUSION Our study confirmed a low prevalence of HLA-B27 in axSpA patients and BD in this Lebanese population, However, we found a high specificity and positive LR, as well as the same number of axSpA patients fulfilling the clinical arm of the ASAS criteria as in European studies. HLA-B27 is therefore valuable for identification of axSpA in Lebanese patients despite the overall low prevalence in this population. Our results may guide future evaluations the role of HLA-B27 in planning local referral strategies.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Ghada Abi Karam
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Georges Merheb
- Rheumatology Department, Holy Spirit University, Kaslik, Lebanon.,Rheumatology Department, Notre-Dame des Secours University, Lebanon
| | - Iyad Mallak
- Radiology Department, Hotel-Dieu de France, Beirut, Lebanon
| | - Laure Irani
- Lebanese University Hospital, Beirut, Lebanon.,Rizk University Medical Center, Beirut, Lebanon
| | - Elie Alam
- Levant Hospital, Sin-el-Fil, Lebanon
| | | | - Jeanine Menassa
- Lebanese University Hospital, Beirut, Lebanon.,Geitawi Hospital, Beirut, Lebanon
| | | | - Imad Uthman
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Pierre Ghorra
- Blood Transfusion Center, Hotel-Dieu de France, Beirut, Lebanon
| | | | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-Universität Bochum, Bochum, Germany
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Quraishi MK, Badsha H, Khan B, Shahzeb M, Hegde S, Mofti A, Ooi KK. Interethnic Variations and Clinical Features of Spondyloarthropathies in a Middle Eastern Country. Open Rheumatol J 2018; 12:10-18. [PMID: 29456775 PMCID: PMC5806196 DOI: 10.2174/1874312901812010010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/12/2017] [Accepted: 01/12/2018] [Indexed: 01/15/2023] Open
Abstract
Objectives The study aimed to demonstrate the interethnic differences and clinical features of Spondyloarthropathy(SpA) patients in a diverse Middle Eastern Country. Methods A retrospective review of medical records to collect the required data was conducted for SpA patients at two study institutions in the United Arab Emirates. Results Of 141 SpA patients found, 88 AS(Ankylosing Spondylitis) patients and 53 'other SpA' patients were identified. Males constituted 81% of AS and 55% of 'other SpA' patients. Patients with AS and 'other SpA' had a mean age of symptom onset of 28 and 34 years, respectively.49% and 40% of AS and 'other SpA' patients had a history of Anti-TNF therapy usage. Enthesitis and Uveitis were noted in 16% and 18% of AS patients whilst 53% and 11% in 'other SpA' patients, respectively.Caucasian, Indian Subcontinent and Arabs constituted 93% of our cohort. Mean age of onset of symptoms in the Indian Subcontinent 'other SpA' group was much greater than the other two ethnicities. Duration of symptoms to diagnosis was 3.5 and 4 years in AS and other SpA patients' respectively. HLA-B27 positivity was found in 53%, 80% and 93% of Arab, Indian Subcontinent and Caucasian AS patients, respectively, whilst seen in 50%, 25% and 33% of the same respective ethnicties in 'other SpA' patients. Conclusion This study on 141 patients is the largest to analyse inter-ethnic variations in SpA patients in the region. Our cohort shows a short delay in diagnosis with a relatively higher Anti-TNF usage.
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Affiliation(s)
| | - Humeira Badsha
- Department of Rheumatology. Dr. Humeira Badsha Medical Center, Dubai, UAE
| | - Bhavna Khan
- Department of Rheumatology, Dubai Mall Medical Center, Dubai, UAE
| | - Muhammad Shahzeb
- Department of Medicine, Jinnah Medical College Hospital, Karachi, Pakistan
| | - Srilakshmi Hegde
- Department of Rheumatology, Al Biraa Arthritis & Bone Center, Dubai, UAE
| | - Ayman Mofti
- Department of Rheumatology, Al Biraa Arthritis & Bone Center, Dubai, UAE
| | - Kong Kok Ooi
- Department of Rheumatology, Tan Tock Seng Hospital, Singapore
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Ziade NR. HLA B27 antigen in Middle Eastern and Arab countries: systematic review of the strength of association with axial spondyloarthritis and methodological gaps. BMC Musculoskelet Disord 2017; 18:280. [PMID: 28662723 PMCID: PMC5492927 DOI: 10.1186/s12891-017-1639-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 06/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Axial spondyloarthritis (AxSpA) is a relatively frequent and debilitating disease, with a prevalence ranging from 0.1 to 2% in the Caucasian population. Current Assessment of Spondyloarthritis International Society (ASAS) classification criteria of AxSpA rely either on sacroiliitis on imaging plus one SpA feature or positive HLAB27 antigen plus two SpA features, in a patient with chronic low back pain and age at onset of less than 45 years. Therefore, HLA-B27 is a central feature in SpA classification and plays a pivotal role in referral strategies and early diagnosis. The primary objective of the study is to review the prevalence of HLA-B27 in normal and AxSpA populations in Middle Eastern and Arab Countries and to assess the strength of association between HLA-B27 antigen and AxSpA. The secondary objective is to identify the gaps in the methodology of the studies and suggest a framework for future research. Methods Studies were included in the analysis if they reported prevalence of HLA-B27 in AxSpA and/or general population and if they covered geographical location in the Middle East or Arab countries in the Mediterranean basin. Odds ratios (OR) were calculated for each country, as a measure of the strength of association between HLA-B27 and AxSpA, compared to the normal population, using the two-by-two frequency table. Available data from the literature were analyzed according to the following quality indicators: sample size, method of HLA-B27 testing, presence of control group and external validity. Results Twenty-seven studies were analyzed. HLAB27 prevalence in the normal population ranged from 0.3% (Oman) to 6.8% (Turkey). HLA-B27 prevalence in AxSpA ranged from 26.2% (Lebanon) to 91% (Turkey). HLA-B27 prevalence in all SpA ranged from 13.87% (Lebanon) to 69.43% (Kuwait). Peripheral SpA was less associated with HLA-B27 than AxSpA, indicating the need of differentiating between the two entities when calculating prevalence. When available (8 studies), the OR ranged from 21.63 (Morocco) to 105.6 (Syria). The high heterogeneity between the results can be due to differences in methodology: study sample size, different classification criteria, absence of control groups, HLA-B27 testing method. Conclusions The prevalence of HLA-B27 in the normal population is significantly lower in the Middle Eastern and Arab countries than in Western Countries. However, HLA-B27 testing can be useful for AxSpA positive diagnosis, given the high OR. Heterogeneity between countries may be due to methodological differences.
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Affiliation(s)
- Nelly Raymond Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon. .,Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon. .,Tour des Consultations Externes, Hotel-Dieu de France hospital, 6th floor, Alfred Naccache blvd, Achrafieh, PO BOX 166830, Beirut, Lebanon.
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MUSTAFA KHADERN, HAMMOUDEH MOHAMMED, KHAN MUHAMMADASIM. HLA-B27 Prevalence in Arab Populations and Among Patients with Ankylosing Spondylitis: Table 1. J Rheumatol 2012; 39:1675-7. [DOI: 10.3899/jrheum.120403] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective.To investigate prevalence of HLA-B27 among general Arab populations and among patients with ankylosing spondylitis (AS), and to review published data.Methods.The prevalence of HLA-B27 was studied among 2579 unrelated healthy Jordanians, almost equally divided among Palestinian refugees and natives of Jordan, reflecting the general population of Jordan. The prevalence of HLA-B27 was also studied among 129 patients with AS, 70 from Jordan, and the remaining 59 from Qatar. HLA typing was performed by standard 2-stage micro-lymphocytotoxicity method. We also reviewed published English language studies of HLA-B27 in Arab patients with AS and general populations retrieved through Medline and cross-reference search.Results.We observed that the general prevalence of HLA-B27 among Jordanians is 2.4%; while the reported prevalence ranges between 2% and 5% among major Arab populations. The prevalence of HLA-B27 among patients with AS is 71% in Jordan and 73% in Qatar, while the reported prevalence from pooled published data from various Arab populations is 64%.Conclusion.From these data one can conclude that HLA-B27 is present in about 2% to 5% among major Arab populations and that its prevalence in Arab patients with AS is closer to 70%.
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Breban M, Said-Nahal R, Hugot JP, Miceli-Richard C. Familial and genetic aspects of spondyloarthropathy. Rheum Dis Clin North Am 2003; 29:575-94. [PMID: 12951869 DOI: 10.1016/s0889-857x(03)00029-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Predisposition to SpA is largely determined by genetic factors including HLA-B27 and other as yet unknown genes that might be tracked by a positional cloning approach. Analysis performed on a large cohort of SpA multiplex families revealed that the different articular and extra-articular inflammatory manifestations comprising the SpA spectrum were linked together, implying that they were determined by a shared set of factors, including HLA-B27. The variety of phenotypes appeared to be related to ubiquitous and secondary factors. Hence, SpA appeared to be more homogenous than previously thought and should be regarded as a unique disease. This conclusion also implies that genetic studies should be performed on the whole group. Such an approach allowed identification of HLA-DR4 as a gene contributing to SpA predisposition independently of linkage disequilibrium with HLA-B27. A significant role for CARD15/NOD2 gene in predisposition to SpA was ruled out, in agreement with the hypothesis that the inflammatory bowel disease in SpA is determined by factors different than those responsible for isolated Crohn's disease.
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Affiliation(s)
- Maxime Breban
- Department of Rheumatology, Medical University of Paris-Ile-de-France-Ouest, Hôpital Ambroise Paré, 9 avenue Charles de Graulle, 92100 Boulogne Billancourt, Paris, France.
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Perez-Guijo V, Muñoz E, Escudero A, Veroz R, Sánchez M, Muñoz-Villanueva MC, González R, Peña J, Collantes-Estevez E. Distribution of HLA-DRB1 genes in patients with sporadic ankylosing spondylitis in the south of Spain. Joint Bone Spine 2002; 69:458-62. [PMID: 12477229 DOI: 10.1016/s1297-319x(02)00430-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the relationship between the presence of different HLA-DRB1 genes and predisposition to develop a sporadic form of ankylosing spondylitis (AS) in a demographically well-defined population. METHODS One hundred fifteen selected patients with sporadic (non-familial) forms of AS from six different cities and 748 bone marrow donors as control group. All individuals were typed for HLA-B27 by flow cytometry with monoclonal antibodies and PCR -SSP, as well as for HLA-DRB using the Dynal ELI SSO HLA-DRB Test (Dynal AS, Oslo, Norway). The Inno-Lipa DRB Decoder (Innogenetics NV Zwijndrecht, Belgium), was used for high-resolution HLA-DRB typing. RESULTS The presence of the DRB1*01 antigen in the studied population is significantiy higher in B27 positive healthy individuals (bone marrow donors) than in B27 positive AS patients; also, DRB1*01 is higher in B27 negative AS patients than 827 negative controls. The frequency of DRB1*03 is higher in B27 negative controls than B27 negative AS patients. CONCLUSION The results of this study suggest that DRB1*01 antigens might be involved in the development of sporadic forms of ankylosing spondylitis in HLA-B27 negative individuals in the studied area.
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Affiliation(s)
- V Perez-Guijo
- Rheumatology Service, Reina Sofía University Hospital, Cordoba, Spain
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Tamouza R, Mansour I, Bouguacha N, Klayme S, Djouadi K, Laoussadi S, Azoury M, Dulphy N, Ramasawmy R, Krishnamoorthy R, Toubert A, Naman R, Charron D. A new HLA-B*27 allele (B*2719) identified in a Lebanese patient affected with ankylosing spondylitis. TISSUE ANTIGENS 2001; 58:30-3. [PMID: 11580853 DOI: 10.1034/j.1399-0039.2001.580105.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Eighteen different HLA-B*27 alleles (B*2701-B2718) have so far been recognized by the WHO Nomenclature Committee for Factors of the HLA System. Frequency and disease association of these alleles with spondyloarthropathies differ among ethnic groups. We describe here a novel HLA-B*27 subtype identified in a Lebanese patient suffering from ankylosing spondylitis (AS). This new variant differs from the common HLA-B*2705 DNA sequence at five different nucleotide positions. These nucleotide changes lead to three amino acid differences in the alpha2 domain; Thr to Ile at position 94, Leu to Ile at position 95 and Asn to Arg at position 97. Since this novel allele is encountered in an AS patient, the associated sequence changes are not expected to affect significantly neither the presentation of a putative arthritogenic peptide nor the conformation-dependent recognition by effector cells.
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Affiliation(s)
- R Tamouza
- Laboratoire d'Immunologie et d'Histocompatibilité, Hôpital Saint Louis, avenue Claude Vellefaux, 75010 Paris, France.
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Sobao Y, Tsuchiya N, Takiguchi M, Tokunaga K. Overlapping peptide-binding specificities of HLA-B27 and B39: evidence for a role of peptide supermotif in the pathogenesis of spondylarthropathies. ARTHRITIS AND RHEUMATISM 1999; 42:175-81. [PMID: 9920028 DOI: 10.1002/1529-0131(199901)42:1<175::aid-anr21>3.0.co;2-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Previous studies indicated the increase of HLA-B39 among HLA-B27 negative patients with spondylarthropathies (SpA). This study was performed to examine whether the natural ligands of HLA-B27 are capable of binding to HLA-B39. METHODS Peptides were synthesized according to the sequences of known natural ligands of HLA-B27 or B39 and were tested for their binding to HLA-B*3901 and B*2705 by quantitative peptide binding assay, using a TAP-deficient RMA-S cell line transfected with human beta2-microglobulin and HLA class I heavy chain genes. RESULTS Four of the 10 HLA-B27 binding peptides significantly bound to HLA-B*3901. All 4 peptides had hydrophobic/aromatic amino acids (Leu or Phe) at the C-terminus. In contrast, peptides with basic residues (Lys, Arg) or Tyr at the C-terminus did not bind to B*3901. In parallel experiments, 1 of the 2 natural ligands of HLA-B*3901 was found to bind to B*2705. CONCLUSION A subset of natural HLA-B27 ligands was capable of binding to B*3901. In addition to Arg at position 2 (Arg2), hydrophobic/aromatic C-terminal residues, such as Leu or Phe, seemed to be crucial for the cross-specificity. These results suggested that HLA-B27 and B39 recognize overlapping peptide repertoires, supporting the hypothesis that the peptides presented by both of these class I antigens play a role in the pathogenesis of SpA.
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Abdelnoor A. HLA-B27 and the spondylarthropathies in Lebanon: comment on the article by Awada et al. ARTHRITIS AND RHEUMATISM 1998; 41:949. [PMID: 9588754 DOI: 10.1002/1529-0131(199805)41:5<949::aid-art34>3.0.co;2-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Population and peptide specificity analyses and studies in transgenic rodents support a role of HLA-B27 as an antigen-presenting molecule in spondyloarthropathy. The interplay between HLA-B27 and arthritogenic bacteria on infected cells suggests that HLA-B27 might also influence disease by other mechanisms. Recent genetic advances promise the identification of additional susceptibility genes.
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Affiliation(s)
- J A López de Castro
- Centro de Biología Molecular Severo Ochoa (CSIC-UAM), Universidad Autónoma de Madrid, Facultad de Ciencias, Spain.
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