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Monach PA. The Future of Vasculitis: A Manifesto. Rheum Dis Clin North Am 2023; 49:713-729. [PMID: 37331742 DOI: 10.1016/j.rdc.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Predictions for a general path forward in vasculitis care and research are provided based on advances made in the past 20 years. Prospects for advances in translational research with potential to improve care are highlighted, including identification of hemato-inflammatory diseases, autoantigens, disease mechanisms in animal models, and biomarkers. A list of active randomized trials is provided, and areas of potential paradigm shifts in care are highlighted. The importance of patient involvement and international collaboration is noted, and a plea is made for innovative trial designs that would improve access of patients to trials and to clinical experts at referral centers.
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Affiliation(s)
- Paul A Monach
- Rheumatology Section, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 01230, USA.
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Oral Microbiota Profile in Patients with Anti-Neutrophil Cytoplasmic Antibody–Associated Vasculitis. Microorganisms 2022; 10:microorganisms10081572. [PMID: 36013990 PMCID: PMC9412476 DOI: 10.3390/microorganisms10081572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
Abstract
Microbiota has been associated with autoimmune diseases, with nasal Staphylococcus aureus being implicated in the pathogenesis of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Little is known about the role of oral microbiota in AAV. In this study, levels of IgG antibodies to 53 oral bacterial species/subspecies were screened using immunoblotting in plasma/serum in pre-symptomatic AAV-individuals (n = 85), matched controls, and established AAV-patients (n = 78). Saliva microbiota from acute-AAV and controls was sequenced from 16s rDNA amplicons. Information on dental status was extracted from a national register. IgG levels against oral bacteria were lower in established AAV versus pre-AAV and controls. Specifically, pre-AAV samples had, compared to controls, a higher abundance of periodontitis-associated species paralleling more signs of periodontitis in established AAV-patients than controls. Saliva microbiota in acute-AAV showed higher within-sample diversity but fewer detectable amplicon-sequence variants and taxa in their core microbiota than controls. Acute-AAV was not associated with increased abundance of periodontal bacteria but species in, e.g., Arthrospira, Staphylococcus, Lactobacillus, and Scardovia. In conclusion, the IgG profiles against oral bacteria differed between pre-AAV, established AAV, and controls, and microbiota profiles between acute AAV and controls. The IgG shift from a pre-symptomatic stage to established disease cooccurred with treatment of immunosuppression and/or antibiotics.
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Niccolai E, Bettiol A, Baldi S, Silvestri E, Di Gloria L, Bello F, Nannini G, Ricci F, Nicastro M, Ramazzotti M, Vaglio A, Bartolucci G, Emmi G, Amedei A, Prisco D. Gut Microbiota and Associated Mucosal Immune Response in Eosinophilic Granulomatosis with Polyangiitis (EGPA). Biomedicines 2022; 10:biomedicines10061227. [PMID: 35740247 PMCID: PMC9219964 DOI: 10.3390/biomedicines10061227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. A genome-wide association study showed a correlation between ANCA-negative EGPA and variants of genes encoding proteins with intestinal barrier functions, suggesting that modifications of the mucosal layer and consequent gut dysbiosis might be involved in EGPA pathogenesis. Here, we characterized the gut microbiota (GM) composition and the intestinal immune response in a cohort of EGPA patients. Faeces from 29 patients and 9 unrelated healthy cohabitants were collected, and GM and derived metabolites’ composition were compared. Seven intestinal biopsies from EGPA patients with gastrointestinal manifestations were analysed to assess the T-cell distribution and its correlation with GM and EGPA clinical and laboratory features. No significant differences in GM composition, nor in the total amount of faecal metabolites, emerged between patients and controls. Nevertheless, differences in bacterial taxa abundances and compositional GM-derived metabolites profile were observed. Notably, an enrichment of potential pathobionts (Enterobacteriacee and Streptococcaceae) was found in EGPA, particularly in patients with active disease, while lower levels were found in patients on immunosuppression, compared with non-immunosuppressed ones. Significantly lower amounts of hexanoic acid were found in patients, compared to controls. The analysis of the immune response in the gut mucosa revealed a high frequency of IFN-γ/IL-17-producing T lymphocytes, and a positive correlation between EGPA disease activity and intestinal T-cell levels. Our data suggest that an enrichment in potential intestinal pathobionts might drive an imbalanced inflammatory response in EGPA.
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Affiliation(s)
- Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
| | - Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Leandro Di Gloria
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio” University of Florence, 50134 Florence, Italy; (L.D.G.); (M.R.); (A.V.)
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
| | - Federica Ricci
- Core Research Laboratory, Institute for Cancer Research and Prevention (ISPRO), 50139 Florence, Italy;
| | - Maria Nicastro
- Department of Medicine and Surgery, University of Parma and Unit of Occupational Medicine and Industrial Toxicology, University Hospital of Parma, 43121 Parma, Italy;
| | - Matteo Ramazzotti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio” University of Florence, 50134 Florence, Italy; (L.D.G.); (M.R.); (A.V.)
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio” University of Florence, 50134 Florence, Italy; (L.D.G.); (M.R.); (A.V.)
- Nephrology Unit, Meyer Children’s Hospital, 50139 Florence, Italy
| | - Gianluca Bartolucci
- Department of Neurosciences, Psychology, Drug Research and Child Health Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, 50139 Florence, Italy;
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
- Correspondence: (G.E.); (A.A.); Tel.: +39-05-5275-8020 (G.E.); +39-05-5275-8330 (A.A.)
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
- Correspondence: (G.E.); (A.A.); Tel.: +39-05-5275-8020 (G.E.); +39-05-5275-8330 (A.A.)
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
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Lo Gullo A, Giuffrida C, Morace C, Squadrito G, Magnano San Lio P, Ricciardi L, Salvarani C, Mandraffino G. Arterial Stiffness and Adult Onset Vasculitis: A Systematic Review. Front Med (Lausanne) 2022; 9:824630. [PMID: 35646970 PMCID: PMC9133451 DOI: 10.3389/fmed.2022.824630] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/01/2022] [Indexed: 12/31/2022] Open
Abstract
Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD), including vasculitis. Standardized mortality ratios in these patients are higher as compared to the general population, and the excess of premature mortality is due to early atherosclerotic events. Thus, IRD patients need appropriate CV risk assessment and management according to this CV disease (CVD) burden. Adequate control of CV risk is still lacking in usual care, but early diagnosis of silent and subclinical CVD is crucial to improve the long-term prognosis of these patients. Increased arterial stiffness may provide a pathophysiological link between inflammation and increased cardiovascular risk. Several noninvasive methods are now available to estimate artery stiffness in the clinical setting, including pulse wave velocity assessment. The independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in general as well as in selected populations, and reference values adjusted for age and blood pressure have been suggested. Thus, arterial stiffness is an interesting biomarker for cardiovascular risk stratification. This systematic review summarizes the additional value that PWV measurement can provide in the setting of vasculitis, with a focus in the different clinical stages and CV risk prevention. This systematic review is registered with registration number: Prospero CRD42021259603.
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Affiliation(s)
- Alberto Lo Gullo
- Rheumatology Unit, Department of Medicine, ARNAS Garibaldi, Catania, Italy
- *Correspondence: Alberto Lo Gullo
| | - Clemente Giuffrida
- Emergency Unit, Department of Emergency Urgency Unit, IRCCS Neurolesi Bonino Pulejo - Piemonte, Messina, Italy
| | - Carmela Morace
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Squadrito
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paola Magnano San Lio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy AUSL-IRCCS, Reggio Emilia, Italy
| | - Giuseppe Mandraffino
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Clifford AH, Cohen Tervaert JW. Cardiovascular events and the role of accelerated atherosclerosis in systemic vasculitis. Atherosclerosis 2021; 325:8-15. [PMID: 33873090 DOI: 10.1016/j.atherosclerosis.2021.03.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
The spectrum of inflammatory blood vessel diseases includes both atherosclerosis and the primary systemic vasculitides. Although the inciting triggers differ, significant overlap exists in the mechanisms that contribute to sustained inflammation and vascular damage in both entities. With improvement in therapeutics to control acute vasculitis leading to longer survival, cardiovascular morbidity and mortality has emerged as the leading cause of death for vasculitis patients. Cardiovascular events likely occur as a consequence of vasculitis, vascular damage from prior inflammation causing a sustained procoagulant state, and accelerated atherosclerosis. In this review, we discuss the latest evidence regarding risk of cardiovascular events in patients with major forms of primary systemic vasculitis, and review the mechanisms by which accelerated atherosclerosis may occur.
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Affiliation(s)
- Alison H Clifford
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada.
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