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Diederichsen LP, Iversen LV, Nielsen CT, Jacobsen S, Hermansen ML, Witting N, Cortes R, Korsholm SS, Krogager ME, Friis T. Myositis-related autoantibody profile and clinical characteristics stratified by anti-cytosolic 5'-nucleotidase 1A status in connective tissue diseases. Muscle Nerve 2023. [PMID: 37177880 DOI: 10.1002/mus.27841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION/AIMS Cytosolic 5'-nucleotidase 1A (cN-1A) autoantibodies have been recognized as myositis-related autoantibodies. However, their correlations with clinical characteristics and other myositis-specific and myositis-associated autoantibodies (MSAs/MAAs) are still unclear. We aimed to establish the prevalence and clinical and laboratory associations of cN-1A autoantibodies in a cohort of patients with connective tissue diseases. METHODS A total of 567 participants (182 idiopathic inflammatory myopathies [IIM], 164 systemic lupus erythematosus [SLE], 121 systemic sclerosis [SSc], and 100 blood donors [BD]) were tested for the presence of cN-1A autoantibodies and other myositis-specific and myositis-associated autoantibodies (MSAs/MAAs). Clinical and laboratory characteristics were compared between anti-cN-1A positive and negative patients with sporadic inclusion body myositis (sIBM) and between anti-cN-1A positive and negative patients with non-IBM IIM. RESULTS In the sIBM cohort, 30 patients (46.9%) were anti-cN-1A positive vs. 18 (15.2%) in the non-IBM IIM cohort, 17 (10%) were anti-cN-1A positive in the SLE cohort and none in the SSc or the BD cohorts. Anti-cN-1A positivity had an overall sensitivity of 46.9% and a specificity of 93.2% for sIBM. Dysphagia was more frequent in the anti-cN-1A positive vs. negative sIBM patients (p = .04). In the non-IBM IIM group, being anti-cN-1A antibody positive was associated with the diagnosis polymyositis (p = .04) and overlap-myositis (p = .04) and less disease damage evaluated by physician global damage score (p < .001). DISCUSSION cN-1A autoantibodies were predominantly found in IIM patients and was associated with dysphagia in sIBM patients. Notably, anti-cN-1A appears to identify a distinct phenotype of anti-cN-1A positive non-IBM IIM patients with a milder disease course.
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Affiliation(s)
- Louise Pyndt Diederichsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Line Vinderslev Iversen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - Christoffer Tandrup Nielsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Jacobsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie-Louise Hermansen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nanna Witting
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Cortes
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Sine Søndergaard Korsholm
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Tina Friis
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
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Circulating Biomarkers in Neuromuscular Disorders: What Is Known, What Is New. Biomolecules 2021; 11:biom11081246. [PMID: 34439911 PMCID: PMC8393752 DOI: 10.3390/biom11081246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
The urgent need for new therapies for some devastating neuromuscular diseases (NMDs), such as Duchenne muscular dystrophy or amyotrophic lateral sclerosis, has led to an intense search for new potential biomarkers. Biomarkers can be classified based on their clinical value into different categories: diagnostic biomarkers confirm the presence of a specific disease, prognostic biomarkers provide information about disease course, and therapeutic biomarkers are designed to predict or measure treatment response. Circulating biomarkers, as opposed to instrumental/invasive ones (e.g., muscle MRI or nerve ultrasound, muscle or nerve biopsy), are generally easier to access and less “time-consuming”. In addition to well-known creatine kinase, other promising molecules seem to be candidate biomarkers to improve the diagnosis, prognosis and prediction of therapeutic response, such as antibodies, neurofilaments, and microRNAs. However, there are some criticalities that can complicate their application: variability during the day, stability, and reliable performance metrics (e.g., accuracy, precision and reproducibility) across laboratories. In the present review, we discuss the application of biochemical biomarkers (both validated and emerging) in the most common NMDs with a focus on their diagnostic, prognostic/predictive and therapeutic application, and finally, we address the critical issues in the introduction of new biomarkers.
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Lucchini M, Maggi L, Pegoraro E, Filosto M, Rodolico C, Antonini G, Garibaldi M, Valentino ML, Siciliano G, Tasca G, De Arcangelis V, De Fino C, Mirabella M. Anti-cN1A Antibodies Are Associated with More Severe Dysphagia in Sporadic Inclusion Body Myositis. Cells 2021; 10:cells10051146. [PMID: 34068623 PMCID: PMC8151681 DOI: 10.3390/cells10051146] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 01/15/2023] Open
Abstract
In recent years, an autoantibody directed against the 5'-citosolic nucleotidase1A (cN1A) was identified in the sera of sporadic inclusion body myositis (s-IBM) patients with widely variable sensitivity (33%-76%) and specificity (87%-100%). We assessed the sensitivity/specificity of anti-cN1A antibodies in an Italian cohort of s-IBM patients, searching for a potential correlation with clinical data. We collected clinical data and sera from 62 consecutive s-IBM patients and 62 other inflammatory myopathies patients. Testing for anti-cN1A antibodies was performed using a commercial ELISA. Anti-cN1A antibodies were detected in 23 s-IBM patients, resulting in a sensitivity of 37.1% with a specificity of 96.8%. Positive and negative predictive values were 92.0% and 60.6%, respectively. We did not find significant difference regarding demographic variables, nor quadriceps or finger flexor weakness. Nevertheless, we found that anti-cN1A-positive patients presented significantly lower scores in IBMFRS item 1 (swallowing, p = 0.045) and more frequently reported more severe swallowing problems, expressed as an IBMFRS item 1 score ≤ 2 (p < 0.001). We confirmed the low sensitivity and high specificity of anti-cN1A Ab in s-IBM patients with a high positive predictive value. The presence of anti-CN1A antibodies identified patients with a greater risk of more severe dysphagia.
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Affiliation(s)
- Matteo Lucchini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (G.T.); (V.D.A.); (C.D.F.); (M.M.)
- Department of Neurosciences, Section of Neurology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Correspondence:
| | - Lorenzo Maggi
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy;
| | - Elena Pegoraro
- Department of Neurosciences, University of Padova, 35122 Padova, Italy;
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25121 Brescia, Italy;
| | - Carmelo Rodolico
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Giovanni Antonini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (G.A.); (M.G.)
| | - Matteo Garibaldi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), School of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (G.A.); (M.G.)
| | - Maria Lucia Valentino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Giorgio Tasca
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (G.T.); (V.D.A.); (C.D.F.); (M.M.)
- Department of Neurosciences, Section of Neurology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Valeria De Arcangelis
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (G.T.); (V.D.A.); (C.D.F.); (M.M.)
| | - Chiara De Fino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (G.T.); (V.D.A.); (C.D.F.); (M.M.)
| | - Massimiliano Mirabella
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (G.T.); (V.D.A.); (C.D.F.); (M.M.)
- Department of Neurosciences, Section of Neurology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Aguilar-Vazquez A, Chavarria-Avila E, Pizano-Martinez O, Ramos-Hernandez A, Andrade-Ortega L, Rubio-Arellano ED, Vazquez-Del Mercado M. Geographical Latitude Remains as an Important Factor for the Prevalence of Some Myositis Autoantibodies: A Systematic Review. Front Immunol 2021; 12:672008. [PMID: 33968081 PMCID: PMC8100663 DOI: 10.3389/fimmu.2021.672008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
The idiopathic inflammatory myopathies (IIM) are characterized by muscular weakness, cutaneous manifestations, muscle damage revealed by increase of muscular enzymes, muscle biopsy, electromyography and changes on magnetic resonance imaging. However, the hallmark of these IIM, is the development of myositis specific antibodies (MSA) or myositis associated antibodies (MAA). The theories about their presence in the serum of IIM is not known. Some studies have suggested that some of these MSA, such as anti-Mi-2 increases according to the intensity of UV radiation. There is scarce information about the environmental factors that might contribute in order to be considered as triggering factors as UV radiation might be. In this review, we analyzed the reported prevalence of MSAs and MAAs regarding to their geographical location and the possible relation with UV radiation. We collected the prevalence data of fifteen MSA and thirteen MAA from 22 countries around the world and we were able to observe a difference in prevalence between countries and continents. We found differences in anti-PL7, anti-Ro52, anti-La and anti-Ku prevalence according to UV radiation level. Otherwise, we observed that anti-Mi-2 prevalence increases near to the Equator meanwhile anti-MJ/NXP2 and anti-ARS prevalence had an opposite behavior increasing their prevalence in the geographical locations farther to the Equator. Our results highlighted the importance to include the UV radiation and other environmental factors in IIM studies, in order to clarify its association with MSA and MAA prevalence as well as its possible role in the immunopathogenesis of these diseases.
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Affiliation(s)
- Andrea Aguilar-Vazquez
- Centro Universitario de Ciencias de la Salud, Doctorado en Ciencias Biomédicas, Universidad de Guadalajara, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Reumatología y del Sistema Músculo-Esquelético (IIRSME), Universidad de Guadalajara, Guadalajara, Mexico
| | - Efrain Chavarria-Avila
- Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Reumatología y del Sistema Músculo-Esquelético (IIRSME), Universidad de Guadalajara, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Universidad de Guadalajara, Guadalajara, Mexico.,Hospital Civil Dr. Juan I. Menchaca, División de Medicina Interna, Servicio de Reumatología 004086, PNPC CONACyT, Guadalajara, Mexico
| | - Oscar Pizano-Martinez
- Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Reumatología y del Sistema Músculo-Esquelético (IIRSME), Universidad de Guadalajara, Guadalajara, Mexico.,Hospital Civil Dr. Juan I. Menchaca, División de Medicina Interna, Servicio de Reumatología 004086, PNPC CONACyT, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, UDG-CA 703 Inmunología y Reumatología, Universidad de Guadalajara, Guadalajara, Mexico
| | - Alejandra Ramos-Hernandez
- Hospital Civil Dr. Juan I. Menchaca, División de Medicina Interna, Servicio de Reumatología 004086, PNPC CONACyT, Guadalajara, Mexico
| | - Lilia Andrade-Ortega
- Departamento de Reumatología Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Ciudad de México, Mexico
| | - Edy-David Rubio-Arellano
- Centro Universitario de Ciencias de la Salud, Departamento de Fisiología, Universidad de Guadalajara, Guadalajara, Mexico
| | - Monica Vazquez-Del Mercado
- Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Reumatología y del Sistema Músculo-Esquelético (IIRSME), Universidad de Guadalajara, Guadalajara, Mexico.,Hospital Civil Dr. Juan I. Menchaca, División de Medicina Interna, Servicio de Reumatología 004086, PNPC CONACyT, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, UDG-CA 703 Inmunología y Reumatología, Universidad de Guadalajara, Guadalajara, Mexico.,Centro Universitario de Ciencias de la Salud, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara, Mexico
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5
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Paul P, Liewluck T, Ernste FC, Mandrekar J, Milone M. Anti-cN1A antibodies do not correlate with specific clinical, electromyographic, or pathological findings in sporadic inclusion body myositis. Muscle Nerve 2021; 63:490-496. [PMID: 33373040 DOI: 10.1002/mus.27157] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anti-cytosolic 5'-nucleotidase 1A (cN1A) antibodies are commonly detected in patients with sporadic inclusion body myositis (sIBM). However, their pathogenic role has not been established. Moreover, efforts toward identifying sIBM distinct clinicopathologic characteristics associated with these antibodies have yielded conflicting results. METHODS We first searched for patients, seen in our clinics, tested for anti-cN1A antibodies between December 2015 and December 2019. We identified 92 patients who were diagnosed with sIBM, according to the 2011 ENMC or Griggs et al criteria. Thereafter, we reviewed and compared the clinical and investigational findings of these patients in relation to their antibody status. RESULTS Anti-cN1A antibodies were present in 47/92 (51%) patients with sIBM. Comparison of seropositive and seronegative cohorts yielded no significant difference in clinical features, including facial weakness, oropharyngeal and respiratory involvement, or disease severity. The antibody titer did not correlate with the clinical phenotype, CK value, or presence of myotonic discharges on EMG. Anti-cN1A antibody positive patients appeared to have more frequent auto-aggressive inflammation on muscle biopsy but not as an isolated myopathological feature. CONCLUSIONS Our study showed that anti-cN1A antibody positive and negative sIBM patients have similar clinical features and disease severity. Anti-cN1A antibodies in our sIBM cohort did not correlate with any studied clinical or laboratory parameter and, therefore, were of limited value in the patient's assessment.
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Affiliation(s)
- Pritikanta Paul
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Teerin Liewluck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jay Mandrekar
- Biomedical Statistics and Bioinformatics, Mayo Clinic, Rochester, Minnesota, USA
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Limaye VS, Cash K, Smith C, Koszyca B, Patel S, Greenberg SA, Hissaria P. Inclusion-body myositis and primary Sjögren syndrome: mechanisms for shared etiologies. Muscle Nerve 2020; 61:570-574. [PMID: 32035011 DOI: 10.1002/mus.26830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 12/19/2022]
Abstract
Herein we report a case of sporadic inclusion-body myositis (sIBM) occurring at an unusually young age in a patient with primary Sjögren syndrome, and use the case to explore possible shared mechanisms for disease susceptibility. Possible factors may include the association of both conditions with the 8.1 ancestral haplotype; the presence of anti-cN1A antibodies, which, although considered specific for sIBM, are also seen in pSS; and the shared association with T-cell large granular lymphocyte leukemia (T-LGLL). Further evaluation of this patient did in fact reveal underlying T-LGLL and mechanisms by which T cells in sIBM may escape immune regulation and contribute to disease phenotype are explored. Despite myofiber infiltration with CD8-positive T cells in sIBM, and, although sIBM is traditionally considered treatment-refractory, we report a significant response to the anti-CD20 monoclonal antibody, rituximab, and discuss possible mechanisms by which this response may be mediated.
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Affiliation(s)
- Vidya S Limaye
- Rheumatology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kathy Cash
- Anatomical Pathology, SA Pathology, Adelaide, South Australia, Australia
| | - Caroline Smith
- Anatomical Pathology, SA Pathology, Adelaide, South Australia, Australia
| | - Barbara Koszyca
- Anatomical Pathology, SA Pathology, Adelaide, South Australia, Australia
| | - Sandy Patel
- Radiology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Steven A Greenberg
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Pravin Hissaria
- Immunology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Glaubitz S, Zeng R, Schmidt J. New insights into the treatment of myositis. Ther Adv Musculoskelet Dis 2020; 12:1759720X19886494. [PMID: 31949477 PMCID: PMC6950531 DOI: 10.1177/1759720x19886494] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022] Open
Abstract
The myositis syndromes include polymyositis, dermatomyositis (DM), necrotizing myopathy, inclusion body myositis (IBM), antisynthetase syndrome and overlap syndromes with myositis. These syndromes mostly occur in middle-aged patients, while juvenile DM occurs in children and adolescents. Patients mostly show a subacute weakness and myalgia in the upper and lower limbs, the diagnosis is based upon these clinical findings in combination with muscle biopsy results and specific serum autoantibodies. In recent years, research achieved a better understanding about the molecular mechanism underlying the myositis syndromes, as well as disease progress and extramuscular organ manifestations, such as interstitial lung disease and association with neoplasias. Treatment mainly consists of glucocorticosteroids and immunosuppressants. IBM is usually refractory to treatments. This review provides an overview of the current standards of treatment and new treatment options like monoclonal antibodies and new molecular therapies and their first results from clinical trials.
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Affiliation(s)
- Stefanie Glaubitz
- Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Göttingen, Germany
| | - Rachel Zeng
- Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Robert-Koch-Sr. 40, 37075 Göttingen, Germany
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8
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Felice KJ, Whitaker CH, Wu Q, Larose DT, Shen G, Metzger AL, Barton RW. Sensitivity and clinical utility of the anti-cytosolic 5'-nucleotidase 1A (cN1A) antibody test in sporadic inclusion body myositis: Report of 40 patients from a single neuromuscular center. Neuromuscul Disord 2018; 28:660-664. [PMID: 30001928 DOI: 10.1016/j.nmd.2018.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/16/2018] [Accepted: 06/10/2018] [Indexed: 01/09/2023]
Abstract
Sporadic inclusion body myositis (IBM) is the most common acquired myopathy affecting patients over age 50. The discovery of an autoantibody directed against a 43-44 kD protein (anti-cytosolic-5'-nucleotidase 1A or anti-cN1A) has provided support for the hypothesis of an immune-mediated pathogenesis. Previous studies have reported variable test sensitivity and specificity, and inconsistent results on the predictive value. In our cohort of 40 patients with clinico-pathologically or clinically defined IBM, we found the sensitivity of the anti-cN1A antibody test to be 50%. Comparing characteristics for test positive and test negative groups, we found that patients in our cohort testing positive for the anti-cN1A antibody were significantly more likely to be older than age 60 years at symptom onset. We found no positive association between anti-cN1A reactivity and other clinical, laboratory, and muscle histopathologic findings. Based on all clinical studies published to date including the present, the anti-cN1A antibody test shows high diagnostic specificity, moderate sensitivity, and a low predictive value in regards to age of onset, disease severity and other associated clinicopathological findings.
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Affiliation(s)
- Kevin J Felice
- Muscular Dystrophy Association Care Center, Department of Neuromuscular Medicine, Hospital for Special Care, New Britain, CT, USA.
| | - Charles H Whitaker
- Muscular Dystrophy Association Care Center, Department of Neuromuscular Medicine, Hospital for Special Care, New Britain, CT, USA
| | - Qian Wu
- Department of Pathology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Daniel T Larose
- Department of Mathematical Sciences, Central Connecticut State University, New Britain, CT, USA
| | - Guo Shen
- RDL Reference Laboratory, Inc., 10755 Venice Blvd., Los Angeles, CA, USA
| | - Allan L Metzger
- RDL Reference Laboratory, Inc., 10755 Venice Blvd., Los Angeles, CA, USA
| | - Randall W Barton
- Department of Research, Hospital for Special Care, New Britain, CT, USA
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9
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Rietveld A, van den Hoogen LL, Bizzaro N, Blokland SLM, Dähnrich C, Gottenberg JE, Houen G, Johannsen N, Mandl T, Meyer A, Nielsen CT, Olsson P, van Roon J, Schlumberger W, van Engelen BGM, Saris CGJ, Pruijn GJM. Autoantibodies to Cytosolic 5'-Nucleotidase 1A in Primary Sjögren's Syndrome and Systemic Lupus Erythematosus. Front Immunol 2018; 9:1200. [PMID: 29922285 PMCID: PMC5996144 DOI: 10.3389/fimmu.2018.01200] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/14/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction Autoantibodies to cytosolic 5′-nucleotidase 1A (cN-1A; NT5C1A) have a high specificity when differentiating sporadic inclusion body myositis from polymyositis and dermatomyositis. In primary Sjögren’s syndrome (pSS) and systemic lupus erythematosus (SLE) anti-cN-1A autoantibodies can be detected as well. However, various frequencies of anti-cN-1A reactivity have been reported in SLE and pSS, which may at least in part be explained by the different assays used. Here, we determined the occurrence of anti-cN-1A reactivity in a large number of patients with pSS and SLE using one standardized ELISA. Methods Sera from pSS (n = 193) and SLE patients (n = 252) were collected in five European centers. Anti-cN-1A, anti-Ro52, anti-nucleosome, and anti-dsDNA reactivities were tested by ELISA (Euroimmun AG) in a single laboratory. Correlations of anti-cN-1A reactivity with demographic data and clinical data (duration of disease at the moment of serum sampling, autoimmune comorbidity and presence of muscular symptoms) were analyzed using SPSS software. Results Anti-cN-1A autoantibodies were found on average in 12% of pSS patients, with varying frequencies among the different cohorts (range: 7–19%). In SLE patients, the anti-cN-1A positivity on average was 10% (range: 6–21%). No relationship was found between anti-cN-1A reactivity and the presence or absence of anti-Ro52, anti-nucleosome, and anti-dsDNA reactivity in both pSS and SLE. No relationship between anti-cN-1A reactivity and duration of disease at the moment of serum sampling and the duration of serum storage was observed. The frequency of muscular symptoms or viral infections did not differ between anti-cN-1A-positive and -negative patients. In both disease groups anti-cN-1A-positive patients suffered more often from other autoimmune diseases than the anti-cN-1A-negative patients (15 versus 5% (p = 0.05) in pSS and 50 versus 30% (p = 0.02) in SLE). Conclusion Our results confirm the relatively frequent occurrence of anti-cN-1A in pSS and SLE patients and the variation in anti-cN-1A reactivity between independent groups of these patients. The explanation for this variation remains elusive. The correlation between anti-cN-1A reactivity and polyautoimmunity should be evaluated in future studies. We conclude that anti-cN-1A should be classified as a myositis-associated-, not as a myositis-specific-autoantibody based on its frequent presence in SLE and pSS.
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Affiliation(s)
- Anke Rietveld
- Department of Neurology, Center for Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luuk L van den Hoogen
- Laboratory of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio, Azienda Sanitaria Universitaria Integrata di Udine, Tolmezzo, Italy
| | - Sofie L M Blokland
- Laboratory of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Cornelia Dähnrich
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Jacques-Eric Gottenberg
- Service de physiologie et d'explorations fonctionnelles, Service de rhumatologie, Centre de référence des maladies auto-immunes rares and Fédération de médecine translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Gunnar Houen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Nora Johannsen
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Thomas Mandl
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden and Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Alain Meyer
- Service de physiologie et d'explorations fonctionnelles, Service de rhumatologie, Centre de référence des maladies auto-immunes rares and Fédération de médecine translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Christoffer T Nielsen
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Disease, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Olsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden and Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Joel van Roon
- Laboratory of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Baziel G M van Engelen
- Department of Neurology, Center for Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Christiaan G J Saris
- Department of Neurology, Center for Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ger J M Pruijn
- Department of Biomolecular Chemistry, Radboud Institute for Molecular Life Sciences and Institute for Molecules and Materials, Radboud University, Nijmegen, Netherlands
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10
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Abstract
Purpose of review To review the advances in our understanding of the genetics of inclusion body myositis (IBM) in the past year. Recent findings One large genetic association study focusing on immune-related genes in IBM has refined the association within the human leukocyte antigen (HLA) region to HLA-DRB1 alleles, and identified certain amino acid positions in HLA-DRB1 that may explain this risk. A suggestive association with CCR5 may indicate genetic overlap with other autoimmune diseases. Sequencing studies of candidate genes involved in related neuromuscular or neurodegenerative diseases have identified rare variants in VCP and SQSTM1. Proteomic studies of rimmed vacuoles in IBM and subsequent genetic analyses of candidate genes identified rare missense variants in FYCO1. Complex, large-scale mitochondrial deletions in cytochrome c oxidase-deficient muscle fibres expand our understanding of mitochondrial abnormalities in IBM. Summary The pathogenesis of IBM is likely multifactorial, including inflammatory and degenerative changes, and mitochondrial abnormalities. There has been considerable progress in our understanding of the genetic architecture of IBM, using complementary genetic approaches to investigate these different pathways.
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11
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Abstract
PURPOSE OF REVIEW Our goal is to review the recent literature pertaining to the genetics of sporadic inclusion body myositis (IBM). RECENT FINDINGS In a study of 252 IBM patients, the class II MHC allele HLA-DRB1*03:01 showed the most significant association with IBM, and that risk could be largely attributed to amino acids within the peptide-binding pocket. Candidate gene sequencing identified rare missense variants in proteins regulating protein homeostasis including VCP and SQSTM1. An unbiased approach employing exome sequencing of genes encoding rimmed vacuole proteins identified FYCO1 variants in IBM. Ongoing GWAS approaches may shed new light on genetic risk factors for IBM. Many variants have been reported at an increased frequency in IBM in small studies; however, only HLA association has shown genome-wide significance. Future studies are needed to validate variants in larger cohorts and to understand the molecular roles these risk factors play in IBM.
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Affiliation(s)
- Kyla A Britson
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Graduate program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie Y Yang
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Graduate program in Human Genetics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas E Lloyd
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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12
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Yeker RM, Pinal-Fernandez I, Kishi T, Pak K, Targoff IN, Miller FW, Rider LG, Mammen AL. Anti-NT5C1A autoantibodies are associated with more severe disease in patients with juvenile myositis. Ann Rheum Dis 2018; 77:714-719. [PMID: 29363513 DOI: 10.1136/annrheumdis-2017-212436] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/05/2017] [Accepted: 01/03/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Autoantibodies recognising cytosolic 5'-nucleotidase 1A (NT5C1A) are found in adult patients with myositis and other autoimmune diseases. They are especially prevalent in adults with inclusion body myositis (IBM), in which they are associated with more severe weakness and higher mortality. This study was undertaken to define the prevalence and clinical features associated with anti-NT5C1A autoantibodies in juvenile myositis. METHODS We screened sera from 380 patients with juvenile myositis, 30 patients with juvenile idiopathic arthritis (JIA) and 92 healthy control children for anti-NT5C1A autoantibodies. Clinical characteristics were compared between patients with myositis with and without anti-NT5C1A autoantibodies. RESULTS Anti-NT5C1A autoantibodies were present in 102 of 380 (27%) patients with juvenile myositis and in 11 of 92 (12%) healthy control children (P=0.002) and 27% of children with JIA (P=0.05 vs controls). Sera of 83 of 307 (27%) patients with juvenile dermatomyositis and 16 of 46 (35%) patients with juvenile overlap myositis were anti-NT5C1A autoantibody-positive (P<0.01 vs healthy controls for each), but sera of only 3 of 27 (11%) patients with juvenile polymyositis were anti-NT5C1A-positive. Patients with juvenile myositis with and without anti-NT5C1A autoantibodies had similar clinical phenotypes. However, patients with anti-NT5C1A autoantibody-positive myositis had greater pulmonary symptoms at diagnosis (P=0.005), more frequent hospitalisations (P=0.01) and required a larger number of medications (P<0.001). CONCLUSION Anti-NT5C1A autoantibodies are present in more than one-quarter of children with juvenile myositis and JIA compared with only 12% of healthy children, suggesting they are myositis-associated in children. As in adults with IBM, patients with juvenile myositis with anti-NT5C1A autoantibodies have more severe disease.
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Affiliation(s)
- Richard M Yeker
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Iago Pinal-Fernandez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Takayuki Kishi
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Katherine Pak
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Ira N Targoff
- US Department of Veterans Affairs Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Keller CW, Schmidt J, Lünemann JD. Immune and myodegenerative pathomechanisms in inclusion body myositis. Ann Clin Transl Neurol 2017; 4:422-445. [PMID: 28589170 PMCID: PMC5454400 DOI: 10.1002/acn3.419] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 12/17/2022] Open
Abstract
Inclusion Body Myositis (IBM) is a relatively common acquired inflammatory myopathy in patients above 50 years of age. Pathological hallmarks of IBM are intramyofiber protein inclusions and endomysial inflammation, indicating that both myodegenerative and inflammatory mechanisms contribute to its pathogenesis. Impaired protein degradation by the autophagic machinery, which regulates innate and adaptive immune responses, in skeletal muscle fibers has recently been identified as a potential key pathomechanism in IBM. Immunotherapies, which are successfully used for treating other inflammatory myopathies lack efficacy in IBM and so far no effective treatment is available. Thus, a better understanding of the mechanistic pathways underlying progressive muscle weakness and atrophy in IBM is crucial in identifying novel promising targets for therapeutic intervention. Here, we discuss recent insights into the pathomechanistic network of mutually dependent inflammatory and degenerative events during IBM.
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Affiliation(s)
- Christian W. Keller
- Institute of Experimental ImmunologyLaboratory of NeuroinflammationUniversity of ZürichZürichSwitzerland
| | - Jens Schmidt
- Department of NeurologyUniversity Medical Center GöttingenGöttingenGermany
| | - Jan D. Lünemann
- Institute of Experimental ImmunologyLaboratory of NeuroinflammationUniversity of ZürichZürichSwitzerland
- Department of NeurologyUniversity Hospital ZürichZürichSwitzerland
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14
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Lilleker JB, Rietveld A, Pye SR, Mariampillai K, Benveniste O, Peeters MTJ, Miller JAL, Hanna MG, Machado PM, Parton MJ, Gheorghe KR, Badrising UA, Lundberg IE, Sacconi S, Herbert MK, McHugh NJ, Lecky BRF, Brierley C, Hilton-Jones D, Lamb JA, Roberts ME, Cooper RG, Saris CGJ, Pruijn GJM, Chinoy H, van Engelen BGM. Cytosolic 5'-nucleotidase 1A autoantibody profile and clinical characteristics in inclusion body myositis. Ann Rheum Dis 2017; 76:862-868. [PMID: 28122761 PMCID: PMC5530338 DOI: 10.1136/annrheumdis-2016-210282] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/07/2016] [Accepted: 11/05/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Autoantibodies directed against cytosolic 5'-nucleotidase 1A have been identified in many patients with inclusion body myositis. This retrospective study investigated the association between anticytosolic 5'-nucleotidase 1A antibody status and clinical, serological and histopathological features to explore the utility of this antibody to identify inclusion body myositis subgroups and to predict prognosis. MATERIALS AND METHODS Data from various European inclusion body myositis registries were pooled. Anticytosolic 5'-nucleotidase 1A status was determined by an established ELISA technique. Cases were stratified according to antibody status and comparisons made. Survival and mobility aid requirement analyses were performed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS Data from 311 patients were available for analysis; 102 (33%) had anticytosolic 5'-nucleotidase 1A antibodies. Antibody-positive patients had a higher adjusted mortality risk (HR 1.89, 95% CI 1.11 to 3.21, p=0.019), lower frequency of proximal upper limb weakness at disease onset (8% vs 23%, adjusted OR 0.29, 95% CI 0.12 to 0.68, p=0.005) and an increased prevalence of excess of cytochrome oxidase deficient fibres on muscle biopsy analysis (87% vs 72%, adjusted OR 2.80, 95% CI 1.17 to 6.66, p=0.020), compared with antibody-negative patients. INTERPRETATION Differences were observed in clinical and histopathological features between anticytosolic 5'-nucleotidase 1A antibody positive and negative patients with inclusion body myositis, and antibody-positive patients had a higher adjusted mortality risk. Stratification of inclusion body myositis by anticytosolic 5'-nucleotidase 1A antibody status may be useful, potentially highlighting a distinct inclusion body myositis subtype with a more severe phenotype.
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Affiliation(s)
- J B Lilleker
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - A Rietveld
- Department of Neurology, Center for Neuroscience Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S R Pye
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - K Mariampillai
- Department of Internal Medicine and Clinical Immunology, La Pitié-Salpêtrière Hospital, AP-HP, INSERM U974, UPMC, Paris, France
| | - O Benveniste
- Department of Internal Medicine and Clinical Immunology, La Pitié-Salpêtrière Hospital, AP-HP, INSERM U974, UPMC, Paris, France
| | - M T J Peeters
- Department of Neurology, Center for Neuroscience Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J A L Miller
- Department of Neurology, Royal Victoria Hospitals, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - M G Hanna
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - P M Machado
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
- Centre for Rheumatology Research, University College London, London, UK
| | - M J Parton
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - K R Gheorghe
- Unit of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - U A Badrising
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - I E Lundberg
- Unit of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - S Sacconi
- Peripheral Nervous System, Muscle and ALS Department, Université Côté Azure (UCA), Nice University Hospital, Nice, France
| | - M K Herbert
- Department of Biomolecular Chemistry, Radboud Institute for Molecular Life Sciences and Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - N J McHugh
- Royal National Hospital for Rheumatic Diseases and Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - B R F Lecky
- The Walton Centre NHS Foundation Trust, Fazakerley, Liverpool, UK
| | - C Brierley
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Hilton-Jones
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - J A Lamb
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - M E Roberts
- Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - R G Cooper
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
- MRC-ARUK Institute for Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
- Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - C G J Saris
- Department of Neurology, Center for Neuroscience Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G J M Pruijn
- Department of Biomolecular Chemistry, Radboud Institute for Molecular Life Sciences and Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - H Chinoy
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - B G M van Engelen
- Department of Neurology, Center for Neuroscience Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Rothwell S, Cooper RG, Lundberg IE, Gregersen PK, Hanna MG, Machado PM, Herbert MK, Pruijn GJM, Lilleker JB, Roberts M, Bowes J, Seldin MF, Vencovsky J, Danko K, Limaye V, Selva-O'Callaghan A, Platt H, Molberg Ø, Benveniste O, Radstake TRDJ, Doria A, De Bleecker J, De Paepe B, Gieger C, Meitinger T, Winkelmann J, Amos CI, Ollier WE, Padyukov L, Lee AT, Lamb JA, Chinoy H. Immune-Array Analysis in Sporadic Inclusion Body Myositis Reveals HLA-DRB1 Amino Acid Heterogeneity Across the Myositis Spectrum. Arthritis Rheumatol 2017; 69:1090-1099. [PMID: 28086002 PMCID: PMC5516174 DOI: 10.1002/art.40045] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/10/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Inclusion body myositis (IBM) is characterized by a combination of inflammatory and degenerative changes affecting muscle. While the primary cause of IBM is unknown, genetic factors may influence disease susceptibility. To determine genetic factors contributing to the etiology of IBM, we conducted the largest genetic association study of the disease to date, investigating immune-related genes using the Immunochip. METHODS A total of 252 Caucasian patients with IBM were recruited from 11 countries through the Myositis Genetics Consortium and compared with 1,008 ethnically matched controls. Classic HLA alleles and amino acids were imputed using SNP2HLA. RESULTS The HLA region was confirmed as the most strongly associated region in IBM (P = 3.58 × 10-33 ). HLA imputation identified 3 independent associations (with HLA-DRB1*03:01, DRB1*01:01, and DRB1*13:01), although the strongest association was with amino acid positions 26 and 11 of the HLA-DRB1 molecule. No association with anti-cytosolic 5'-nucleotidase 1A-positive status was found independent of HLA-DRB1*03:01. There was no association of HLA genotypes with age at onset of IBM. Three non-HLA regions reached suggestive significance, including the chromosome 3 p21.31 region, an established risk locus for autoimmune disease, where a frameshift mutation in CCR5 is thought to be the causal variant. CONCLUSION This is the largest, most comprehensive genetic association study to date in IBM. The data confirm that HLA is the most strongly associated region and identifies novel amino acid associations that may explain the risk in this locus. These amino acid associations differentiate IBM from polymyositis and dermatomyositis and may determine properties of the peptide-binding groove, allowing it to preferentially bind autoantigenic peptides. A novel suggestive association within the chromosome 3 p21.31 region suggests a role for CCR5.
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Affiliation(s)
| | | | - Ingrid E Lundberg
- Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Megan K Herbert
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - James B Lilleker
- University of Manchester, Manchester, UK, and Salford Royal NHS Foundation Trust, Salford, UK
| | | | - John Bowes
- University of Manchester, Manchester, UK
| | | | | | | | - Vidya Limaye
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | | | | | | | | | | | | | | | - Thomas Meitinger
- Technische Universität München, Munich, Germany, and Helmholtz Zentrum München, Neuherberg, Germany
| | - Juliane Winkelmann
- Technische Universität München, Munich, Germany, and Helmholtz Zentrum München, Neuherberg, Germany
| | | | | | | | - Annette T Lee
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Hector Chinoy
- Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
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16
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Affiliation(s)
- Steven A. Greenberg
- Department of Neurology, Brigham and Women's Hospital; Children's Hospital Informatics Program, and Harvard Medical School; Boston MA
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17
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Maundrell A, Lester S, Rischmueller M, Hill C, Cleland LG, Blumbergs P, Wiese M, Limaye V. The PTPN22 gene is associated with idiopathic inflammatory myopathy. Muscle Nerve 2016; 55:270-273. [PMID: 27312665 DOI: 10.1002/mus.25222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The aim of this study was to determine whether a single-nucleotide polymorphism (SNP; 1858CT, R620W) in the protein tyrosine phosphatase N22 (PTPN22) gene confers susceptibility to idiopathic inflammatory myopathy (IIM) in South Australian patients with IIM. METHODS Genotyping was performed on stored DNA from 199 patients with histologically confirmed polymyositis (PM), dermatomyositis (DM), and inclusion body myositis (IBM), and then compared with 455 matched controls. Associations with the 8.1 ancestral haplotype (AH), and myositis-specific (MSA) and myositis-associated (MAA) autoantibodies were investigated. RESULTS The PTPN22 R620W minor allele frequency was increased in IIM patients (50 of 398, 12.6%) compared with controls (75 of 910, 8.2%) (odds ratio 1.6, 95% confidence interval 1.1-2.3, P = 0.016). In IIM patients, there was no association between the R620W minor allele and detection of any MSA/MAA (P = 0.70), nor any evidence of epistasis with the 8.1 AH (P = 0.69). CONCLUSIONS The PTPN22 R620W minor allele is associated with susceptibility to IIM in SA patients, independent of the 8.1 AH. Muscle Nerve, 2016 Muscle Nerve 55: 270-273, 2017.
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Affiliation(s)
- Adam Maundrell
- Rheumatology Department, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Sue Lester
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Maureen Rischmueller
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Catherine Hill
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Leslie G Cleland
- Rheumatology Department, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Peter Blumbergs
- Tissue Pathology, South Australia Pathology, Adelaide, South Australia, Australia
| | - Michael Wiese
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Vidya Limaye
- Rheumatology Department, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia
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18
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Tieu J, Lundberg IE, Limaye V. Idiopathic inflammatory myositis. Best Pract Res Clin Rheumatol 2016; 30:149-68. [DOI: 10.1016/j.berh.2016.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
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