Antigen-specific humoral responses against Helicobacter pylori in patients with systemic sclerosis

Investigating the link between Helicobacter pylori infection and psoriatic disease: an immunological study

Helicobacter pylori (Hp) has been postulated as an infectious trigger of psoriatic disease, namely psoriasis (Ps) and psoriatic arthritis (PsA), but meticulous antibody (ab) reactivity against all dominant and subdominant Hp antigens in demographically matched PsA and Ps patients and healthy controls has not been performed so far. IgG anti-Hp ab testing was performed by combining immunoblotting and line assays in 263 serum samples from 89 patients with PsA, 114 patients with Ps, and 60 demographically matched healthy controls (HCs). Anti-Hp positivity did not differ between PsA, Ps, and HCs (P > 0.05 for all comparisons). In PsA, anti-p75, anti-p67-FSH, anti-p66-UreB, anti-p54-flagellin, anti-p41, and anti-p30-OMP abs were more frequent in patients compared to HCs (P < 0.001, P = 0.028, P = 0.010, P = 0.003, P = 0.012, P = 0.020 respectively). In Ps, anti-p66-UreB and anti-p54-flagellin abs were more frequent than HC (P = 0.015 and P = 0.011, respectively), while anti-p50 abs were less frequent than HCs (P = 0.008). Anti-p75, anti-p67-FSH, anti-p50, anti-p41, anti-p30-OMP, anti-p29 = UreA and anti-p26 ab levels were higher in PsA compared to Ps (P = 0.012, P = 0.036, P < 0.001, P = 0.021, P = 0.002, P = 0.006 and P = 0.021 respectively). DAS28 scores were positively correlated with anti-p19 ab levels (r = 0.349, P = 0.050) in PsA patients by linear regression analysis. No other significant clinical association with anti-Hp responses was noted in patients with PsA and Ps. Our results demonstrate that several antigen-specific anti-Hp abs are more frequent in patients with psoriatic disease; however, negative correlations also exist, raising doubts about whether Hp is immunologically linked to psoriatic disease.

The potential pathogenic role of gut microbiota in rheumatic diseases: a human-centred narrative review

A growing amount of evidence suggests that gut microbiota plays an important role in human health, including a possible role in the pathogenesis of rheumatic and musculoskeletal diseases (RMD). We analysed the current evidence about the role of microbiota in rheumatoid arthritis (RA), spondyloarthritis (SpA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). In RA, we found a general consensus regarding a reduction of diversity and a specific bacterial signature, with consistent changes according to the different ethnic and geographical areas. The major pathogenetic role in RA is recognised for P. copri, L. salivarius and Collinsella, even if findings become more heterogeneous when considering established disease. In SpA, we found a relative gut abundance of Akkermansia, Coprococcus, Ruminoccocus and a relative reduction in Bacterioides and Firmicutes spp. Human and preclinical data suggest loss of mucosal barrier, increased permeability and Th1- and Th17-mediated inflammation. Additionally, HLA-B27 seems to play a role in shaping the intestinal microbiota and the consequent inflammation. In SLE, the typical gut microbiota signature was characterised by a reduction in the Firmicutes/Bacteroidetes ratio and by enrichment of Rhodococcus, Eggerthella, Klebsiella, Prevotella, Eubacterium and Flavonifractor, even if their real pathogenic impact remains unclear. In SSc, gastrointestinal dysbiosis is well documented with an increase of pro-inflammatory species (Fusobacterium, Prevotella, Ruminococcus, Akkermansia, γ-Proteobacteria, Erwinia, Trabsulsiella, Bifidobacterium, Lactobacillus, Firmicutes and Actinobacteria) and a reduction of species as Faecalibacterium, Clostridium, Bacteroidetes and Rikenella. In conclusion, seems possible to recognise a distinct gut microbiota profile for each RMD, even if significant differences in bacterial species do exist between different studies and there is a high risk of bias due to the cross-sectional nature of such studies. Therefore longitudinal studies are needed, especially on patients with preclinical and early disease, to investigate the real role of gut microbiota in the pathogenesis of RMD.

Helicobacter pylori in gastrointestinal manifestation of systemic sclerosis

Aim

To study the prevalence of Helicobacter pylori in systemic sclerosis patients and its gastrointestinal manifestations in comparison with Helicobacter pylori-negative systemic sclerosis patients. Systemic sclerosis gastrointestinal outcome post Helicobacter pylori eradication was evaluated.

Method

In total, 70 systemic sclerosis patients and 70 age-, gender- and race-matched healthy controls had their urea breath test done. Gastrointestinal manifestations in systemic sclerosis were assessed using University of California at Los Angeles 2.0 and Leeds Dyspepsia Questionnaire questionnaires. Systemic sclerosis patients with confirmed Helicobacter pylori infection were given standard Helicobacter pylori eradication therapy. Urea breath test was repeated 6 weeks posteradication therapy with their gastrointestinal symptoms reassessed.

Results

The prevalence of Helicobacter pylori was low in both systemic sclerosis patients (10%) and healthy controls (2.9%). There was no significant difference in gastrointestinal symptoms between Helicobacter pylori-positive and Helicobacter pylori-negative systemic sclerosis patients. However, the Helicobacter pylori-positive patients reported higher median severity scores for the gastrointestinal symptoms of reflux (0.5 vs 0.35), abdominal distension (1.5 vs 0.75) and social functioning impairment score (0.5 vs 0.16) using the University of California at Los Angeles 2.0 score. The Helicobacter pylori-positive patients also indicated increased upper abdominal pain (3.0 vs 0.0), regurgitation (2.0 vs 0.0) and burping (3.0 vs 0.0), observed from the Leeds Dyspepsia Questionnaire scores. Gastrointestinal outcomes post-Helicobacter pylori eradication showed either an improvement or complete resolution of symptoms.

Conclusion

Gastrointestinal symptoms in systemic sclerosis patients are unlikely to be caused by Helicobacter pylori in the recent years in our cohort of patients. No significant difference in gastrointestinal symptoms was seen between Helicobacter pylori-positive and Helicobacter pylori-negative systemic sclerosis patients. Helicobacter pylori can be readily tested by urea breath test to look for present infection.

Recombinant L. lactis vaccine LL-plSAM-WAE targeting four virulence factors provides mucosal immunity against H. pylori infection

BACKGROUND

Helicobacter pylori (H. pylori) causes chronic gastric disease. An efficient oral vaccine would be mucosa-targeted and offer defense against colonization of invasive infection in the digestive system. Proteolytic enzymes and acidic environment in the gastrointestinal tract (GT) can, however, reduce the effectiveness of oral vaccinations. For the creation of an edible vaccine, L. lactis has been proposed as a means of delivering vaccine antigens.

RESULTS

We developed a plSAM (pNZ8148-SAM) that expresses a multiepitope vaccine antigen SAM-WAE containing Urease, HpaA, HSP60, and NAP extracellularly (named LL-plSAM-WAE) to increase the efficacy of oral vaccinations. We then investigated the immunogenicity of LL-plSAM-WAE in Balb/c mice. Mice that received LL-plSAM-WAE or SAM-WAE with adjuvant showed increased levels of antibodies against H. pylori, including IgG and sIgA, and resulted in significant reductions in H. pylori colonization. Furthermore, we show that SAM-WAE and LL-plSAM-WAE improved the capacity to target the vaccine to M cells.

CONCLUSIONS

These findings suggest that recombinant L. lactis could be a promising oral mucosa vaccination for preventing H. pylori infection.

Insights into origins and specificities of autoantibodies in systemic sclerosis

PURPOSE OF REVIEW

Autoantibodies are hallmark findings in systemic sclerosis (SSc), often present prior to disease onset. Clinical diagnosis and prognosis of SSc have long relied on the antitopoisomerase - anticentromere - anti-RNA polymerase antibody trichotomy. However, many more autoantibodies found in SSc are being actively investigated for insights into triggering events, mechanisms of tolerance break, and connections to tissue damage. This review examines recent studies on SSc autoantibodies and the early events that lead to their development.

RECENT FINDINGS

Recent work has elucidated potential connections between human cytomegalovirus infection, silicone breast implants, and malignancy to SSc autoantibody development. At the level of the dendritic cell:T cell interaction, where tolerance is broken, new studies identified shared motifs in the peptide-binding domains of SSc-associated human leukocyte antigen alleles. Immunological analysis of SSc patient B cells has uncovered several anomalies in the regulatory capacities of SSc naïve and memory B cell populations. Expanding efforts to uncover new SSc autoantibodies revealed anti-CXCL4, anticollagen V, and other autoantibodies as potential players in disease pathogenesis.

SUMMARY

Further research into the role of autoantibodies in SSc development may uncover new mechanism-guided therapeutic targets. In addition, a better understanding of autoantibody associations with SSc disease outcomes will improve clinical care.

Digestive Dysbiosis in Systemic Scleroderma: a Review

Systemic sclerosis (SSc) is a rare autoimmune disease characterized by widespread microvasculopathy, inflammation, and fibrosis of the skin and internal organs. The involvement of the gastrointestinal tract is associated with a wide variety of symptoms and affects circa 90% of patients during the course of the disease. The gastrointestinal microbiota contains trillions of microbial cells and has been found to contribute to both local and systemic homeostasis. In both health and disease, a dynamic interrelationship between gut microbiome activity and the host immune system has been identified. Gastrointestinal dysbiosis has been described as having an important role in obesity, diabetes mellitus, liver disease, cardiovascular and neuropsychiatric disorders, neoplasia, as well as autoimmunity. Recent scientific data indicates a notable role of dysbiosis in the pathogenesis of SSc-related digestive involvement together with various other clinical manifestations. The present review aims to summarize the recent findings regarding digestive dysbiosis as well as the relationship between gastrointestinal microbiota and certain features of SSc.