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Del Vescovo S, Venerito V, Iannone C, Lopalco G. Uncovering the Underworld of Axial Spondyloarthritis. Int J Mol Sci 2023; 24:6463. [PMID: 37047435 PMCID: PMC10095023 DOI: 10.3390/ijms24076463] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
Axial spondyloarthritis (axial-SpA) is a multifactorial disease characterized by inflammation in sacroiliac joints and spine, bone reabsorption, and aberrant bone deposition, which may lead to ankylosis. Disease pathogenesis depends on genetic, immunological, mechanical, and bioenvironmental factors. HLA-B27 represents the most important genetic factor, although the disease may also develop in its absence. This MHC class I molecule has been deeply studied from a molecular point of view. Different theories, including the arthritogenic peptide, the unfolded protein response, and HLA-B27 homodimers formation, have been proposed to explain its role. From an immunological point of view, a complex interplay between the innate and adaptive immune system is involved in disease onset. Unlike other systemic autoimmune diseases, the innate immune system in axial-SpA has a crucial role marked by abnormal activity of innate immune cells, including γδ T cells, type 3 innate lymphoid cells, neutrophils, and mucosal-associated invariant T cells, at tissue-specific sites prone to the disease. On the other hand, a T cell adaptive response would seem involved in axial-SpA pathogenesis as emphasized by several studies focusing on TCR low clonal heterogeneity and clonal expansions as well as an interindividual sharing of CD4/8 T cell receptors. As a result of this immune dysregulation, several proinflammatory molecules are produced following the activation of tangled intracellular pathways involved in pathomechanisms of axial-SpA. This review aims to expand the current understanding of axial-SpA pathogenesis, pointing out novel molecular mechanisms leading to disease development and to further investigate potential therapeutic targets.
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Affiliation(s)
- Sergio Del Vescovo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Polyclinic Hospital, University of Bari, 70124 Bari, Italy
| | - Vincenzo Venerito
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Polyclinic Hospital, University of Bari, 70124 Bari, Italy
| | - Claudia Iannone
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, 20122 Milan, Italy
| | - Giuseppe Lopalco
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Polyclinic Hospital, University of Bari, 70124 Bari, Italy
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2
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Ortolan A, Webers C, Sepriano A, Falzon L, Baraliakos X, Landewé RB, Ramiro S, van der Heijde D, Nikiphorou E. Efficacy and safety of non-pharmacological and non-biological interventions: a systematic literature review informing the 2022 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. Ann Rheum Dis 2023; 82:142-152. [PMID: 36261247 DOI: 10.1136/ard-2022-223297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To update the evidence of non-biological treatments for axial spondyloarthritis (axSpA), as a basis for the 2022 Assessment of SpondyloArthritis international Society-European Alliance of Associations for Rheumatology (ASAS-EULAR) recommendations for the management of axSpA. METHODS A systematic literature review (2016-2021) on efficacy and safety of non-pharmacological and non-biological pharmacological treatments was performed, up to 1 January 2022. The research question was formulated according to the PICO format: Population: adult patients with r-axSpA and nr-axSpA; Intervention: non-pharmacological and non-biological pharmacological treatments; Comparator: active comparator or placebo; Outcomes: all relevant efficacy and safety outcomes. Type of studies included were: randomised controlled trials (RCTs), observational studies (for efficacy of non-pharmacological treatments, and safety), qualitative studies. Cohen's effect size (ES) was calculated for non-pharmacological and risk ratio (RR) for pharmacological treatments. RESULTS Of 107 publications included, 63 addressed non-pharmacological interventions, including education (n=8) and exercise (n=20). The ES for education on disease activity, function, mobility was small to moderate (eg. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), ES: 0.06-0.59). Exercise had moderate to high ES on these outcomes (eg. BASDAI, ES 0.14-1.43). Six RCTs on targeted synthetic disease-modifying antirheumatic drugs (DMARDs) showed efficacy of tofacitinib, upadacitinib and filgotinib (phase 2 only) in r-axSpA (range RR vs placebo for ASAS20: 1.91-3.10), while apremilast and nilotinib were not efficacious. Studies on conventional synthetic DMARDs (n=3), non-steroidal anti-inflammatory drugs (NSAIDs, n=8) and other drugs (n=12) did not provide new evidence on efficacy/safety (efficacy of NSAIDs confirmed; limited efficacy of short-term glucocorticoids in one RCT). CONCLUSIONS Education, exercise and NSAIDs confirmed to be efficacious in axSpA. JAKi were proved efficacious in r-axSpA.
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Affiliation(s)
- Augusta Ortolan
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands .,Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Louise Falzon
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Robert Bm Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Center, Duivendrecht, The Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Elena Nikiphorou
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, King's College Hospital, London, UK.,Centre for Rheumatic Diseases, King's College London, London, UK
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3
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Ankylosing spondylitis: an autoimmune or autoinflammatory disease? Nat Rev Rheumatol 2021; 17:387-404. [PMID: 34113018 DOI: 10.1038/s41584-021-00625-y] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 12/20/2022]
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disorder of unknown aetiology. Unlike other systemic autoimmune diseases, in AS, the innate immune system has a dominant role characterized by aberrant activity of innate and innate-like immune cells, including γδ T cells, group 3 innate lymphoid cells, neutrophils, mucosal-associated invariant T cells and mast cells, at sites predisposed to the disease. The intestine is involved in disease manifestations, as it is at the forefront of the interaction between the mucosal-associated immune cells and the intestinal microbiota. Similarly, biomechanical factors, such as entheseal micro-trauma, might also be involved in the pathogenesis of the articular manifestation of AS, and sentinel immune cells located in the entheses could provide links between local damage, genetic predisposition and the development of chronic inflammation. Although these elements might support the autoinflammatory nature of AS, studies demonstrating the presence of autoantibodies (such as anti-CD74, anti-sclerostin and anti-noggin antibodies) and evidence of activation and clonal expansion of T cell populations support an autoimmune component to the disease. This Review presents the evidence for autoinflammation and the evidence for autoimmunity in AS and, by discussing the pathophysiological factors associated with each, aims to reconcile the two hypotheses.
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4
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Mauro D, Simone D, Bucci L, Ciccia F. Novel immune cell phenotypes in spondyloarthritis pathogenesis. Semin Immunopathol 2021; 43:265-277. [PMID: 33569634 PMCID: PMC7990868 DOI: 10.1007/s00281-021-00837-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/06/2021] [Indexed: 02/08/2023]
Abstract
Spondyloarthritis (SpA) is a heterogeneous group of chronic inflammatory diseases of unknown etiology. Over time, the plethora of cellular elements involved in its pathogenesis has progressively enriched together with the definition of specific cytokine pathways. Recent evidence suggests the involvement of new cellular mediators of inflammation in the pathogenesis of SpA or new subgroups of known cellular mediators. The research in this sense is ongoing, and it is clear that this challenge aimed at identifying new cellular actors involved in the perpetuation of the inflammatory process in AxSpA is not a mere academic exercise but rather aims to define a clear cellular hierarchy. Such a definition could pave the way for new targeted therapies, which could interfere with the inflammatory process and specific pathways that trigger immune system dysregulation and stromal cell activity, ultimately leading to significant control of the inflammation and new bone formation in a significant number of patients. In this review, we will describe the recent advances in terms of new cellular actors involved in the pathogenesis of SpA, focusing our attention on stromal cells and innate and adaptive immunity cells.
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Affiliation(s)
- Daniele Mauro
- Dipartimento di Medicina di Precisione, Section of Rheumatology, Università degli Studi della Campania L. Vanvitelli, Naples, Italy
| | - Davide Simone
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Laura Bucci
- Dipartimento di Medicina di Precisione, Section of Rheumatology, Università degli Studi della Campania L. Vanvitelli, Naples, Italy
| | - Francesco Ciccia
- Dipartimento di Medicina di Precisione, Section of Rheumatology, Università degli Studi della Campania L. Vanvitelli, Naples, Italy.
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5
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Regan-Komito D, Swann JW, Demetriou P, Cohen ES, Horwood NJ, Sansom SN, Griseri T. GM-CSF drives dysregulated hematopoietic stem cell activity and pathogenic extramedullary myelopoiesis in experimental spondyloarthritis. Nat Commun 2020; 11:155. [PMID: 31919358 PMCID: PMC6952438 DOI: 10.1038/s41467-019-13853-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
Dysregulated hematopoiesis occurs in several chronic inflammatory diseases, but it remains unclear how hematopoietic stem cells (HSCs) in the bone marrow (BM) sense peripheral inflammation and contribute to tissue damage in arthritis. Here, we show the HSC gene expression program is biased toward myelopoiesis and differentiation skewed toward granulocyte-monocyte progenitors (GMP) during joint and intestinal inflammation in experimental spondyloarthritis (SpA). GM-CSF-receptor is increased on HSCs and multipotent progenitors, favoring a striking increase in myelopoiesis at the earliest hematopoietic stages. GMP accumulate in the BM in SpA and, unexpectedly, at extramedullary sites: in the inflamed joints and spleen. Furthermore, we show that GM-CSF promotes extramedullary myelopoiesis, tissue-toxic neutrophil accumulation in target organs, and GM-CSF prophylactic or therapeutic blockade substantially decreases SpA severity. Surprisingly, besides CD4+ T cells and innate lymphoid cells, mast cells are a source of GM-CSF in this model, and its pathogenic production is promoted by the alarmin IL-33.
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Affiliation(s)
- Daniel Regan-Komito
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, UK
| | - James W Swann
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, UK
| | - Philippos Demetriou
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, UK
| | - E Suzanne Cohen
- Biopharmaceutical Research Division, AstraZeneca, Cambridge, UK
| | - Nicole J Horwood
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, UK
- Norwich Medical School, University of East Anglia, Bob Champion Research and Education Building, James Watson Road, Norwich Research Park, Norwich, UK
| | - Stephen N Sansom
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, UK
| | - Thibault Griseri
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, UK.
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6
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Nakamura A, Talukdar A, Nakamura S, Pathan E, Haroon N. Bone formation in axial spondyloarthritis: Is disease modification possible? Best Pract Res Clin Rheumatol 2019; 33:101491. [DOI: 10.1016/j.berh.2020.101491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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7
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Samaha MM, Said E, Salem HA. Nilotinib enhances β-islets integrity and secretory functions in a rat model of STZ-induced diabetes mellitus. Eur J Pharmacol 2019; 860:172569. [DOI: 10.1016/j.ejphar.2019.172569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
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8
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Berger MG, Pereira B, Rousselot P, Cony-Makhoul P, Gardembas M, Legros L, Escoffre-Barbe M, Nicolini FE, Saugues S, Lambert C, Réa D, Guerci-Bresler A, Giraudier S, Guilhot J, Saussele S, Mahon FX. Longer treatment duration and history of osteoarticular symptoms predispose to tyrosine kinase inhibitor withdrawal syndrome. Br J Haematol 2019; 187:337-346. [PMID: 31271217 DOI: 10.1111/bjh.16083] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/07/2019] [Indexed: 01/07/2023]
Abstract
The effectiveness of tyrosine kinase inhibitors (TKIs) has made it possible to consider treatment discontinuation in chronic myeloid leukaemia (CML) patients that achieve an excellent response. However, a few of the patients included in the Europe Stop Tyrosine Kinase Inhibitors (EURO-SKI) trial reported musculoskeletal pain shortly after stopping TKIs, considered as a withdrawal syndrome (WS). To identify factors that may predispose to TKI WS, we analysed the pharmacovigilance declarations for the 6 months after stopping TKIs in a large cohort of CML (n = 427) that combined the French patients included in the STop IMatinib 2 (STIM2; n = 224) and EURO-SKI (n = 203) trials. Among these patients, 23% (99/427) developed TKI WS after stopping imatinib (77/373; 20·4%), nilotinib (12/29; 41·4%) or dasatinib (10/25; 40%). WS concerned mainly the upper body joints, and required multiple symptomatic treatments in 30% of patients. Univariate and multivariate analyses identified two risk factors: duration of TKI treatment [risk ratio (RR) = 1·68 (1·02-2·74)] with a 93-month cut-off time, and history of osteoarticular symptoms [RR = 1·84 (1·04-3·28)]. These findings confirm that WS is a TKI class effect. CML patients should be carefully screened before treatment initiation to identify pre-existent osteoarticular symptoms. Moreover, before TKI discontinuation, patients should be informed of the possibility of WS, particularly after a long treatment period.
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Affiliation(s)
- Marc G Berger
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Biologique, Clermont-Ferrand Cedex, France.,Service d'Hématologie Clinique Adulte et Thérapie Cellulaire, CHU Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, Cedex, France.,Université Clermont Auvergne, EA 7453 CHELTER, Clermont-Ferrand, Cedex, France
| | - Bruno Pereira
- Délégation de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Rousselot
- Service d'Hématologie et d'Oncologie, CH de Versailles, Le Chesnay, France
| | - Pascale Cony-Makhoul
- Service Hématologie Clinique, Centre Hospitalier Annecy Genevois, Pringy, France
| | | | - Laurence Legros
- Service d'Hématologie Clinique, Hôpital Paul-Brousse (AP-HP), Villejuif, France
| | | | | | - Sandrine Saugues
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Biologique, Clermont-Ferrand Cedex, France
| | - Céline Lambert
- Délégation de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Delphine Réa
- Groupe Hospitalier Saint-Louis, Service d'Hématologie, Lariboisière, Fernand-Widal (AP-HP), Paris, France
| | | | | | | | - Susanne Saussele
- III Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
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9
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Chen S, Noordenbos T, Blijdorp I, van Mens L, Ambarus CA, Vogels E, te Velde A, Alsina M, Cañete JD, Yeremenko N, Baeten D. Histologic evidence that mast cells contribute to local tissue inflammation in peripheral spondyloarthritis by regulating interleukin-17A content. Rheumatology (Oxford) 2018; 58:617-627. [DOI: 10.1093/rheumatology/key331] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/08/2018] [Indexed: 01/09/2023] Open
Abstract
Abstract
Objectives
Synovial mast cells contain IL-17A, a key driver of tissue inflammation in SpA. A recent in vitro study showed that tissue-derived mast cells can capture and release exogenous IL-17A. The present study aimed to investigate if this mechanism could contribute to tissue inflammation in SpA.
Methods
Potential activation of mast cells by IL-17A was assessed by gene expression analysis of the Laboratory of Allergic Diseases 2 (LAD2) mast cell line. The presence of IL-17A-positive mast cells was assessed by immunohistochemistry in synovial tissue obtained before and after secukinumab treatment, as well as in skin and gut tissues from SpA-related conditions.
Results
IL-17A did not induce a pro-inflammatory response in human LAD2 mast cells according to the canonical IL-17A signalling pathway. In SpA synovial tissue, the percentage of IL-17A-positive mast cells increased upon treatment with secukinumab. IL-17A-positive mast cells were also readily detectable in non-inflamed barrier tissues such as skin and gut. In non-inflamed dermis and gut submucosa, IL-17A-positive mast cells are the most prevalent IL-17A-positive cells in situ. Compared with non-inflamed tissues, both total mast cells and IL-17A-positive mast cells were increased in psoriatic skin dermis and in submucosa from inflammatory bowel disease gut. In contrast, the proportion of IL-17A-positive mast cells was strikingly lower in the inflamed compared with non-inflamed gut lamina propria.
Conclusion
IL-17A-positive mast cells are present across SpA target tissues and correlate inversely with inflammation, indicating that their IL-17A content can be regulated. Tissue-resident mast cells may act as IL-17A-loaded sentinel cells, which release IL-17A to amplify tissue inflammation.
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Affiliation(s)
- Sijia Chen
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Department of Experimental Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Troy Noordenbos
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Department of Experimental Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Iris Blijdorp
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Department of Experimental Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Leonieke van Mens
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Carmen A Ambarus
- Department of Pathology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Esther Vogels
- Tytgat Institute for Liver and Intestinal Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Anje te Velde
- Tytgat Institute for Liver and Intestinal Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Mercé Alsina
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Juan D Cañete
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Nataliya Yeremenko
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Department of Experimental Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Dominique Baeten
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Department of Experimental Immunology, University of Amsterdam, Amsterdam, The Netherlands
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Omarjee L, Jaquinandi V, Mahe G. The use of the tyrosine kinase inhibitor Nilotinib in Spondyloarthritis: does targeting inflammatory pathways with a treatment lead to vascular toxicity? J Transl Med 2017; 15:255. [PMID: 29246242 PMCID: PMC5732514 DOI: 10.1186/s12967-017-1334-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 10/30/2017] [Indexed: 12/17/2022] Open
Abstract
Spondylarthritis (SpA) is an inflammatory rheumatic disease associated with increased incidence of major adverse cardiovascular events (MACEs). Recently, Paramarta et al. proposed the use of the tyrosine kinase inhibitor Nilotinib in Spondyloarthritis to target certain inflammatory pathways. However, Nilotinib, which is highly effective for the treatment of patients with chronic myeloid leukaemia (CML), is also associated with an increased risk of MACEs. The authors suggest that Nilotinib may be effective in peripheral SpA by modulating inflammation, but not in axial SpA. Considering the vascular toxicity of Nilotinib and the acceleration of atherosclerosis in SpA patients, we suggest taking MACEs as an end-point in future trials.
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Affiliation(s)
- Loukman Omarjee
- Vascular Medicine Department, CHU de Rennes, 35033, Rennes Cedex 9, France. .,Univ Rennes, CHU Rennes, INSERM, CIC 1414, 35000, Rennes, France. .,Department of Vascular Medicine, Centre Hospitalier de Redon, 35600, Redon, France. .,Vascular Medicine Department, Pôle imagerie médicale et explorations fonctionnelles, Hôpital Pontchaillou, CHU de Rennes, 2 rue Henri Le Guilloux, Rennes, 35033, France.
| | - Vincent Jaquinandi
- Vascular Medicine Department, CHU de Rennes, 35033, Rennes Cedex 9, France.,Univ Rennes, CHU Rennes, INSERM, CIC 1414, 35000, Rennes, France
| | - Guillaume Mahe
- Vascular Medicine Department, CHU de Rennes, 35033, Rennes Cedex 9, France.,Univ Rennes, CHU Rennes, INSERM, CIC 1414, 35000, Rennes, France
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11
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Mahon FX. Treatment-free remission in CML: who, how, and why? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:102-109. [PMID: 29222243 PMCID: PMC6142562 DOI: 10.1182/asheducation-2017.1.102] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chronic myeloid leukemia (CML) is the best example of successful targeted therapy. Today, the overall survival of patients with CML treated by using tyrosine kinase inhibitors (TKIs) is very close to that of the healthy population. The current question is: how can we further ameliorate the clinical outcome of patients with CML? Clinical trials have shown that some patients with CML in the chronic phase who achieve sustained deep molecular responses on TKI therapy can safely suspend therapy with no evidence of relapse. The long follow-up studies and the number of eligible patients have now validated the concept of treatment-free remission (ie, the ability to maintain a molecular response after stopping therapy). It should be considered as the future criterion to evaluate the success of clinical trials, especially if we want to take into account the quality of life of patients in addition to the economic aspect. Because post-TKI discontinuation follow-ups have been increasing over time with no evidence of relapse in some patients, the next step for the coming decade will be to address the topic of CML cure.
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Affiliation(s)
- Francois-Xavier Mahon
- Institut Bergonié, Cancer Centre, Laboratory of Mammary and Leukemic Oncogenesis: Genetic Diversity and Resistance to Treatment, INSERM U1218, University of Bordeaux, Bordeaux, France
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12
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Abstract
Abstract
Chronic myeloid leukemia (CML) is the best example of successful targeted therapy. Today, the overall survival of patients with CML treated by using tyrosine kinase inhibitors (TKIs) is very close to that of the healthy population. The current question is: how can we further ameliorate the clinical outcome of patients with CML? Clinical trials have shown that some patients with CML in the chronic phase who achieve sustained deep molecular responses on TKI therapy can safely suspend therapy with no evidence of relapse. The long follow-up studies and the number of eligible patients have now validated the concept of treatment-free remission (ie, the ability to maintain a molecular response after stopping therapy). It should be considered as the future criterion to evaluate the success of clinical trials, especially if we want to take into account the quality of life of patients in addition to the economic aspect. Because post-TKI discontinuation follow-ups have been increasing over time with no evidence of relapse in some patients, the next step for the coming decade will be to address the topic of CML cure.
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13
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Clavel G, Boissier MC, Sigaux J, Semerano L. Developments with experimental and investigational drugs for axial spondyloarthritis. Expert Opin Investig Drugs 2017; 26:833-842. [DOI: 10.1080/13543784.2017.1337744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Gaëlle Clavel
- UMR 1125, Inserm, Bobigny, France
- Department of Internal Medicine, Fondation Rothschild, Paris, France
| | - Marie-Christophe Boissier
- UMR 1125, Inserm, Bobigny, France
- Sorbonne Paris Cité - Université Paris 13, Bobigny, France
- Service de Rhumatologie, Assistance Publique–Hôpitaux de Paris (AP-HP) Groupe hospitalier Avicenne - Jean Verdier - René Muret, Bobigny, France
| | - Johanna Sigaux
- UMR 1125, Inserm, Bobigny, France
- Department of Rheumatology, Nice University Hospital, Nice, France
| | - Luca Semerano
- UMR 1125, Inserm, Bobigny, France
- Sorbonne Paris Cité - Université Paris 13, Bobigny, France
- Service de Rhumatologie, Assistance Publique–Hôpitaux de Paris (AP-HP) Groupe hospitalier Avicenne - Jean Verdier - René Muret, Bobigny, France
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Wendling D, Prati C. Targeted synthetic disease-modifying antirheumatic drugs in spondyloarthritis. Immunotherapy 2017; 9:221-223. [DOI: 10.2217/imt-2017-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Daniel Wendling
- EA 4266, Université de Bourgogne Franche-Comté, Besançon; &, CHRU de Besançon (University Teaching Hospital), Boulevard Fleming, F-25030, Besançon, France
| | - Clément Prati
- EA 4267, FHU INCREASE, Université de Bourgogne Franche-Comté, Besançon; &, Department of Rheumatology, CHRU de Besançon (University Teaching Hospital), Boulevard Fleming, F-25030, Besançon, France
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Akkoc N, Can G, D’Angelo S, Padula A, Olivieri I. Therapies of Early, Advanced, and Late Onset Forms of Axial Spondyloarthritis, and the Need for Treat to Target Strategies. Curr Rheumatol Rep 2017; 19:8. [DOI: 10.1007/s11926-017-0633-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Toussirot E. New treatment options and emerging drugs for axial spondyloarthritis: biological and targeted synthetic agents. Expert Opin Pharmacother 2017; 18:275-282. [DOI: 10.1080/14656566.2017.1284793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431, University Hospital of Besançon, Clinical Investigation Center in Biotherapy, Besançon, France
- Fédération Hospitalo-Universitaire INCREASE, University Hospital of Besançon, Besançon, France
- Department of Rheumatology, University Hospital of Besançon, Besançon, France
- Department of Therapeutics and UPRES EA 4266: ‘Pathogenic agents and Inflammation’, University of Bourgogne Franche-Comté, Besançon, France
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