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de Moel EC, Trouw LA, Terao C, Govind N, Tikly M, El-Gabalawy H, Smolik I, Bang H, Huizinga TWJ, Toes REM, van der Woude D. Geo-epidemiology of autoantibodies in rheumatoid arthritis: comparison between four ethnically diverse populations. Arthritis Res Ther 2023; 25:37. [PMID: 36890568 PMCID: PMC9993621 DOI: 10.1186/s13075-023-03009-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/08/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) occurs across the globe in different ethnic populations. Most RA patients harbor anti-modified protein antibodies (AMPA); however, it is unclear whether differences exist in autoantibody responses at different geographic locations and between different ethnic groups, which could provide new clues regarding factors underlying autoantibody development. We therefore investigated AMPA prevalence and association with HLA DRB1 alleles and smoking in four ethnically diverse populations on four different continents. METHODS Anti-carbamylated (anti-CarP), anti-malondialdehyde acetaldehyde (anti-MAA), and anti-acetylated protein antibodies (anti-AcVim) IgG were determined in anti-citrullinated protein antibody-positive Dutch (NL, n = 103), Japanese (JP, n = 174), First Nations Peoples in Canada (FN, n = 100), and black South African (SA, n = 67) RA patients. Ethnicity-matched local healthy controls were used to calculate cut-offs. Risk factors associated with AMPA seropositivity in each cohort were identified using logistic regression. RESULTS Median AMPA levels were higher in First Nations Peoples in Canada and especially South African patients, as reflected by percentage seropositivity: NL, JP, FN, and SA: anti-CarP: 47%, 43%, 58%, and 76% (p < 0.001); anti-MAA: 29%, 22%, 29%, and 53% (p < 0.001); and anti-AcVim: 20%, 17%, 38%, and 28% (p < 0.001). Total IgG levels also differed markedly, and when autoantibody levels were normalized to total IgG, differences between cohorts became less pronounced. Although there were some associations with AMPA and HLA risk alleles and smoking, none was consistent across all four cohorts. CONCLUSIONS AMPA against various post-translational modifications could consistently be detected on different continents across ethnically diverse RA populations. Differences in AMPA levels corresponded to differences in total serum IgG levels. This suggests that, despite differences in risk factors, a common pathway may be involved in AMPA development across geographic locations and ethnicities.
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Affiliation(s)
- Emma C de Moel
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - Leendert A Trouw
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - Chikashi Terao
- Department of Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nimmisha Govind
- Division of Rheumatology, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed Tikly
- Division of Rheumatology, University of the Witwatersrand, Johannesburg, South Africa
| | - Hani El-Gabalawy
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Irene Smolik
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - René E M Toes
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
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Selvaraja M, Too CL, Tan LK, Koay BT, Abdullah M, Shah AM, Arip M, Amin-Nordin S. Human leucocyte antigens profiling in Malay female patients with systemic lupus erythematosus: are we the same or different? Lupus Sci Med 2022; 9:9/1/e000554. [PMID: 35105721 PMCID: PMC8808435 DOI: 10.1136/lupus-2021-000554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE SLE is a heterogeneous autoimmune disease, in terms of clinical presentation, incidence and severity across diverse ethnic populations. We investigated the human leucocyte antigens (HLA) profile (ie, HLA-A, HLA-B and HLA-C, HLA-DRB1, HLA-DQA1, HLA-DQB1, HLA-DPA1 and HLA-DPB1) in Malaysian Malay female patients with SLE and determined the generalisability of the published HLA risk factors across different ethnic populations globally including Malaysia. METHODS One hundred Malay female patients with SLE were recruited between January 2016 and October 2017 from a nephrology clinic. All patients were genotyped for HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQA1, HLA-DQB1, HLA-DPA1 and HLA-DPB1 alleles using PCR sequence-specific oligonucleotides method on Luminex platform. A total of 951 HLA genotyped population-based Malay control subjects was used for association testing by means of OR with 95% CIs. RESULTS Our findings convincingly validated common associations between HLA-A*11 (OR=1.65, p=3.36×10-3, corrected P (Pc)=4.03×10-2) and DQB1*05:01 (OR=1.56, p=2.02×10-2, Pc=non-significant) and SLE susceptibility in the Malay population. In contrast, DQB1*03:01 (OR=0.51, p=4.06×10-4, Pc=6.50×10-3) were associated with decreased risk of SLE in Malay population. Additionally, we also detected novel associations of susceptibility HLA genes (ie, HLA-B*38:02, DPA1*02:02, DPB1*14:01) and protective HLA genes (ie, DPA1*01:03). When comparing the current data with data from previously published studies from Caucasian, African and Asian populations, DRB1*15 alleles, DQB1*03:01 and DQA1*01:02 were corroborated as universal susceptibility and protective genes. CONCLUSIONS This study reveals multiple HLA alleles associated with susceptibility and protection against risk of developing SLE in Malay female population with renal disorders. In addition, the published data from different ethnic populations together with our study further support the notion that the genetic effects from association with DRB1*15:01/02, DQB1*03:01 and DQA1*01:02 alleles are generalised to multiple ethnic populations of Caucasian, African and Asian descents.
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Affiliation(s)
- Malarvili Selvaraja
- Faculty of Pharmaceutical Sciences, No 1, Jalan Gading, UCSI Heights, Taman Connaught, UCSI University, Cheras, Kuala Lumpur, Malaysia.,Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Chun Lai Too
- Immunogenetic Unit, Allergy and Immunology Research Centre, Ministry of Health Malaysia, National Institutes of Health Complex, Institute for Medical Research, Shah Alam, Selangor, Malaysia .,Department of Medicine, Division of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Lay Kim Tan
- Immunogenetic Unit, Allergy and Immunology Research Centre, Ministry of Health Malaysia, National Institutes of Health Complex, Institute for Medical Research, Shah Alam, Selangor, Malaysia
| | - Bee Tee Koay
- Transplantation Immunology Unit, Allergy and Immunology Research Centre, Ministry of Health Malaysia, National Institutes of Health Complex, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Maha Abdullah
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Anim Md Shah
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masita Arip
- Allergy and Immunology Research Centre, Ministry of Health. National Institutes of Health Complex, Institute for Medical Research, Shah Alam, Selangor, Malaysia
| | - Syafinaz Amin-Nordin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Wan X, Wang Y, Jin P, Zhang J, Liu L, Wang Z, Hu Y. Influence of HLA Class II Alleles and DRB1-DQB1 Haplotypes on Rheumatoid Arthritis Susceptibility and Autoantibody Status in the Chinese Han Population. Immunol Invest 2021; 51:1198-1210. [PMID: 33929277 DOI: 10.1080/08820139.2021.1918708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human leukocyte antigen (HLA) class II alleles are considered to play a key role in the progress of rheumatoid arthritis (RA). This study was carried out to investigate the presence of HLA class II alleles and their influence on disease risk and autoantibody status in Chinese Han patients with RA. Here, HLA-DRB1, DQB1 and DPB1 genotyping was performed in 125 RA patients and 120 healthy controls by using the next-generation sequencing (NGS). Strong positive associations were shown between high-resolution typed HLA-DRB1*04:05:01, DRB1*10:01:01, DQB1*04:01:01, DPB1*02:01:02 and RA patients. Moreover, the haplotypes HLA-DRB1*04:05:01~ DQB1*04:01:01 and HLA-DRB1*10:01:01~ DQB1*05:01:01 were found to be more frequent in RA populations than in healthy controls. These possible susceptible HLA alleles (HLA-DRB1*04:05:01, DRB1*10:01:01, DQB1*04:01:01 and DPB1*02:01:02) also showed higher frequencies in seropositive RA patients as compared to normal controls. The present study provided evidence that alleles HLA-DRB1*04:05:01, DRB1*10:01:01, DQB1*04:01:01 and DPB1*02:01:02 constituted RA risk alleles, and haplotypes HLA-DRB1*04:05:01~ DQB1*04:01:01, HLA-DRB1*10:01:01~ DQB1*05:01:01 also showed prevalence in Chinese Han patients with RA. Serological results preliminary demonstrated patients carrying RA-risk HLA alleles might elevate the serum level of anti-citrullinated protein antibodies and rheumatoid factor and affect RA progression.
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Affiliation(s)
- Xin Wan
- Department of Medical Laboratory Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ying Wang
- Department of Medical Laboratory Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Peipei Jin
- Department of Medical Laboratory Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ju Zhang
- Department of Medical Laboratory Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Liu Liu
- Department of Medical Laboratory Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Zhangfei Wang
- Department of Medical Laboratory Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yue Hu
- Department of Prenatal Diagnosis Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Tan LK, Too CL, Diaz-Gallo LM, Wahinuddin S, Lau IS, Heselynn H, Nor-Shuhaila S, Gun SC, Eashwary M, Mohd-Shahrir MS, Ainon MM, Azmillah R, Muhaini O, Shahnaz M, Alfredsson L, Klareskog L, Padyukov L. The spectrum of association in HLA region with rheumatoid arthritis in a diverse Asian population: evidence from the MyEIRA case-control study. Arthritis Res Ther 2021; 23:46. [PMID: 33514426 DOI: 10.1186/s13075-021-02431-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/19/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fine-mapping of human leukocyte antigen (HLA) region for rheumatoid arthritis (RA) risk factors has identified several HLA alleles and its corresponding amino acid residues as independent signals (i.e., HLA-A, HLA-B, HLA-DPB1, and HLA-DQA1 genes), in addition to the well-established genetic factor in HLA-DRB1 gene. However, this was mainly performed in the Caucasian and East Asian populations, and data from different Asian regions is less represented. We aimed to evaluate whether there are independent RA risk variants in both anti-citrullinated protein antibody (ACPA)-positive and ACPA-negative RA patients from the multi-ethnic Malaysian population, using the fine-mapping of HLA region strategy. METHODS We imputed the classical HLA alleles, amino acids, and haplotypes using the Immunochip genotyping data of 1260 RA cases (i.e., 530 Malays, 259 Chinese, 412 Indians, and 59 mixed ethnicities) and 1571 controls (i.e., 981 Malays, 205 Chinese, 297 Indians, and 87 mixed ethnicities) from the Malaysian Epidemiological Investigation of Rheumatoid Arthritis (MyEIRA) population-based case-control study. Stepwise logistic regression was performed to identify the independent genetic risk factors for RA within the HLA region. RESULTS We confirmed that the HLA-DRB1 amino acid at position 11 with valine residue conferred the strongest risk effect for ACPA-positive RA (OR = 4.26, 95% CI = 3.30-5.49, PGWAS = 7.22 × 10-29) in the Malays. Our study also revealed that HLA-DRB1 amino acid at position 96 with histidine residue was negatively associated with the risk of developing ACPA-positive RA in the Indians (OR = 0.48, 95% CI = 0.37-0.62, PGWAS = 2.58 × 10-08). Interestingly, we observed that HLA-DQB1*03:02 allele was inversely related to the risk of developing ACPA-positive RA in the Malays (OR = 0.17, 95% CI = 0.09-0.30, PGWAS = 1.60 × 10-09). No association was observed between the HLA variants and risk of developing ACPA-negative RA in any of the three major ethnic groups in Malaysia. CONCLUSIONS Our results demonstrate that the RA-associated genetic factors in the multi-ethnic Malaysian population are similar to those in the Caucasian population, despite significant differences in the genetic architecture of HLA region across populations. A novel and distinct independent association between the HLA-DQB1*03:02 allele and ACPA-positive RA was observed in the Malays. In common with the Caucasian population, there is little risk from HLA region for ACPA-negative RA.
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Yeap SS, Gun SC, Das Gupta E, Veerapen K. Rheumatology in Malaysia. Rheumatol Int 2020; 40:829-836. [PMID: 32285145 DOI: 10.1007/s00296-020-04577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
Malaysia is a developing country in the South-East Asian region with a significant burden of disability from musculoskeletal disease. Rheumatology in Malaysia is a relatively young speciality. Currently, there is approximately 1 rheumatologist per 390,000 population, mostly concentrated in the urban areas. This article aims to give a brief overview of the research in rheumatology, the healthcare system, and rheumatology training and education in Malaysia. From 1950 until mid-2019, there were 547 publications about rheumatological conditions from Malaysia, with a 27-fold increase in the numbers from the period before 1980 compared to 2010-2019. Although there is universal access to healthcare through the public (government funded) hospitals and clinics, as well as a system of private healthcare, funding for expensive biological therapies remain patchy and scarce, leading to significant under-utilization of such treatments in rheumatology patients. Training in rheumatology in Malaysia is well established with a formalised training curriculum introduced in 2004, followed by the introduction of training in musculoskeletal ultrasound in 2006. To improve care for patients with musculoskeletal conditions, there has been regular continuing educational meetings and courses, not just for rheumatologists, but also for other medical professionals, as not all areas in Malaysia have easy access to rheumatology services. Thus overall, despite the small number of rheumatologists, rheumatology in Malaysia has made encouraging progress over the past 2 decades, but improvements in patient care, training, education and research need to continue in the future.
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Affiliation(s)
- Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, 47500, Subang Jaya, Selangor, Malaysia.
| | - Suk Chyn Gun
- Department of Medicine, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Esha Das Gupta
- Department of Internal Medicine, International Medical University, Seremban Campus, Seremban, Negeri Sembilan, Malaysia
| | - Kiran Veerapen
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Nurul-Aain AF, Tan LK, Heselynn H, Nor-Shuhaila S, Eashwary M, Wahinuddin S, Lau IS, Gun SC, Mohd-Shahrir MS, Ainon MM, Azmillah R, Muhaini O, Shahnaz M, Too CL. HLA-A, -B, -C, -DRB1 and -DQB1 alleles and haplotypes in 271 Southeast Asia Indians from Peninsular Malaysia. Hum Immunol 2020; 81:263-4. [PMID: 32312605 DOI: 10.1016/j.humimm.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 11/21/2022]
Abstract
A total of 271 Southeast Asia Indians from Peninsular Malaysia were genotyped for HLA-A, -B, -C, -DRB1, and -DQB1 loci using polymerase chain reaction sequence-specific oligonucleotide probe hybridization methods. In this report, HLA-B and HLA-DQB1 was in Hardy-Weinberg proportions (HWEP) (p > 0.05). We observed significant deviation from the HWEP for HLA-A (p < 0.05), HLA-C (p < 0.01) and HLA-DRB1 (p < 0.01) loci. This genotype data is available in Allele Frequencies Network Database (AFND) Dos Santos et al. (2016).
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Rahajoe PS, de Smit M, Schuurmans G, Raveling-Eelsing E, Kertia N, Vissink A, Westra J. Increased IgA anti-citrullinated protein antibodies in the periodontal inflammatory exudate of healthy individuals compared to rheumatoid arthritis patients. J Clin Periodontol 2020; 47:552-560. [PMID: 32141631 PMCID: PMC7318198 DOI: 10.1111/jcpe.13277] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Aim To assess rheumatoid arthritis (RA)‐associated autoantibodies in the gingivocrevicular fluid (GCF) of RA patients and healthy controls with or without periodontal disease, as chronic mucosal inflammation in periodontal disease is hypothesized to contribute to the formation of these autoantibodies. Materials and methods Anti‐citrullinated protein antibodies (ACPA), rheumatoid factor (RF), and their IgA isotypes were assessed in the serum and GCF of RA patients (n = 72) and healthy controls (HC, n = 151). The presence and levels of these antibodies were studied in relation to interleukin (IL)‐8 and periodontal disease. Results In contrast to the HC, the levels of ACPA and RF in the serum and GCF of the RA patients were strongly correlated (p < .0001). The HC with high levels of IgA‐ACPA (n = 27) also had significantly higher levels of total IgG, total IgA, and IL‐8 in the GCF than the HC with low levels of IgA‐ACPA in the GCF (n = 124). Periodontal inflammation and smoking were seen more frequently in the group with high levels of IgA‐ACPA compared to the group with low IgA‐ACPA. Conclusion The IgA‐ACPA in the GCF of HC may be associated with periodontal inflammation and smoking, and could be involved in the progression to RA.
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Affiliation(s)
| | - Menke de Smit
- Department of Oral Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerbrich Schuurmans
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth Raveling-Eelsing
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nyoman Kertia
- Department of Rheumatology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Arjan Vissink
- Department of Oral Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johanna Westra
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Raslan HM, Attia HR, Hamed Ibrahim M, Mahmoud Hassan E, Salama II, Ismail S, Abdelmotaleb E, El Menyawi MM, Amr KS. Association of anti-cyclic citrullinated peptide antibodies and rheumatoid factor isotypes with HLA-DRB1 shared epitope alleles in Egyptian rheumatoid arthritis patients. Int J Rheum Dis 2020; 23:647-653. [PMID: 32167241 DOI: 10.1111/1756-185x.13819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The most common genetic risk factor for rheumatoid arthritis (RA) is human leucocyte antigen DRB1 (HLA-DRB1) shared epitope (SE). AIM To investigate the relationship between anti-cyclic citrullinated peptide (anti-CCP), rheumatoid factor (RF), immunoglobulin (Ig)G, IgM and IgA and HLA-DRB1 SE among Egyptian patients with RA. METHODS Serum levels of anti-CCP antibodies and RFIgG, RFIgM, RFIgA were assayed using enzyme-linked immunosorbent assay for 157 Egyptian RA patients and 150 healthy controls attending the outpatient clinics of National Research Center and Kasr El Aini Hospital. HLA-DRB1 genotyping was performed by the DynalAllSetTM polymerase chain reaction (PCR) single specific primer low-resolution typing kits. Amplified PCR product was checked using 3% agarose gel. RESULTS HLA-DRB1-SE was found among 129 (82.2%) RA patients and 67 (44.7%) controls (odds ratio [OR] 5.7, CI 3.4-9.6, P < .0001). The risk of RA development was higher with the presence of SE two alleles (OR 11.6, P < .0001), while the OR for 1 copy SE allele was 4.4 (P < .0001). HLA-DRB1-SE was significantly associated with positive as well as negative anti-CCP and RF isotypes. The stronger association was with anti-CCP positivity with OR 11 (5.1-23.6), P < .0001. Furthermore, the risk of development of positive anti-CCP and RF isotypes was higher with the presence of 2 copies of SE alleles than with 1 copy. CONCLUSION The prevalence of HLA-DRB1-SE is high in Egyptian RA patients. The role of SE in RA patients is most probably related to the development of anti-CCP positive RA rather than the development of anti-CCP positivity.
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Affiliation(s)
- Hala M Raslan
- Internal Medicine Department, National Research Center, Cairo, Egypt
| | - Hanaa R Attia
- Clinical and Chemical Pathology Department, National Research Center, Cairo, Egypt
| | - Mona Hamed Ibrahim
- Clinical and Chemical Pathology Department, National Research Center, Cairo, Egypt
| | - Eman Mahmoud Hassan
- Clinical and Chemical Pathology Department, National Research Center, Cairo, Egypt
| | - Iman I Salama
- Community Medicine Research Department, National Research Center, Cairo, Egypt
| | - Sherif Ismail
- Internal Medicine Department, National Research Center, Cairo, Egypt
| | - Eman Abdelmotaleb
- Medical Molecular Genetic Department, National Research Center, Cairo, Egypt
| | | | - Khalda S Amr
- Medical Molecular Genetic Department, National Research Center, Cairo, Egypt
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9
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Too CL, Tan LK, Heselynn H, Nor-Shuhaila S, Eashwary M, Wahinuddin S, Lau IS, Gun SC, Mohd-Shahrir MS, Ainon MM, Azmillah R, Muhaini O, Shahnaz M. HLA-A, -B, -C, -DRB1 and -DQB1 alleles and haplotypes in 194 Southeast Asia Chinese from Peninsular Malaysia. Hum Immunol 2019; 80:906-907. [PMID: 31558331 DOI: 10.1016/j.humimm.2019.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 01/10/2023]
Abstract
A total of 194 Southeast Asia Chinese from Peninsular Malaysia were genotyped for HLA-A, -B, -C -DRB1, and -DQB1 loci using polymerase chain reaction sequence-specific oligonucleotide probe hybridization methods. In this report, the HLA-B, HLA-DRB1 and HLA-DQB1 were in Hardy-Weinberg proportions (HWEP) (p > 0.05). We observed significant deviation from HWEP in HLA-A (p < 0.05) and HLA-C (p < 0.01) loci. This genotype data was available in Allele Frequencies Network Database (AFND) Dos Santos et al. (2016).
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Affiliation(s)
- Chun-Lai Too
- Allergy and Immunology Research Center, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia; Department of Medicine, Division of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Lay-Kim Tan
- Allergy and Immunology Research Center, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Hussein Heselynn
- Department of Medicine, Putrajaya Hospital, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Shahril Nor-Shuhaila
- Department of Medicine, Putrajaya Hospital, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Mageswaran Eashwary
- Department of Medicine, Putrajaya Hospital, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Sulaiman Wahinuddin
- Department of Medicine, Hospital Raja Perempuan Bainun, Ministry of Health Malaysia, Perak, Malaysia; Faculty of Medicine, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Perak, Malaysia
| | - Ing Soo Lau
- Department of Medicine, Selayang Hospital, Ministry of Health Malaysia, Selayang, Selangor, Malaysia
| | - Suk Chyn Gun
- Department of Medicine, Hospital Tuanku Ja'afar Seremban, Ministry of Health Malaysia, Seremban, Negeri Sembilan, Malaysia
| | | | - Mohd-Mokhtar Ainon
- Department of Medicine, Tengku Ampuan Afzan Hospital, Ministry of Health Malaysia, Kuantan, Pahang, Malaysia
| | - Rosman Azmillah
- Department of Medicine, Selayang Hospital, Ministry of Health Malaysia, Selayang, Selangor, Malaysia
| | - Othman Muhaini
- Department of Medicine, Taiping Hospital, Ministry of Health Malaysia, Perak, Malaysia
| | - Murad Shahnaz
- Allergy and Immunology Research Center, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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Zhao M, Mauer L, Sayles H, Cannon GW, Reimold A, Kerr GS, Baker JF, Thiele GM, England BR, Mikuls TR. HLA-DRB1 Haplotypes, Shared Epitope, and Disease Outcomes in US Veterans with Rheumatoid Arthritis. J Rheumatol 2019; 46:685-693. [PMID: 30824656 DOI: 10.3899/jrheum.180724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate associations of HLA-DRB1 haplotypes and shared epitope (SE) with rheumatoid arthritis (RA) severity and all-cause mortality in RA. METHODS Patients with RA from the Veterans Affairs Rheumatoid Arthritis (VARA) registry were followed from enrollment until death or December 31, 2013. Clinical characteristics, DNA, and serum were collected at enrollment. Radiographic damage, the presence or absence of subcutaneous nodules, disease activity measures, and functional status were assessed at enrollment and updated during followup. Sixteen HLA-DRB1 haplotypes and SE status were determined from banked DNA. Associations between HLA-DRB1 haplotypes, RA disease characteristics, and mortality were assessed in multivariable regression models. RESULTS Within VARA, 1443 participants had genotyping and accrued 6150 patient-years of followup. Haplotypes VKA, VRA, LRA, SRA, SRE, SKR, and SEA, and SE alleles were significantly associated with seropositivity for rheumatoid factor (RF) and/or anticyclic citrullinated peptide (anti-CCP). Haplotypes VKA and SKR were associated with higher RF concentrations, while VRA, DRE, and GRQ were associated with lower RF concentrations. Haplotypes VKA, VRA, and LRA were associated with higher concentrations of anti-CCP antibody, while haplotypes SRA, SRE, LEA, SKR, and SEA were significantly associated with lower anti-CCP concentrations. Haplotype VKA (OR 1.39, 95% CI 1.08-1.80) was associated with increased frequency of radiographic damage at enrollment but none of the haplotypes were associated with the presence of subcutaneous nodules. Haplotypes SKA (HR 1.52, 95% CI 1.26-1.83) was associated with higher mortality. CONCLUSION HLA-DRB1 haplotypes are independently and variably associated with seropositivity, autoantibody concentrations, and outcomes in RA.
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Affiliation(s)
- Ming Zhao
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Lilli Mauer
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Harlan Sayles
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Grant W Cannon
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Andreas Reimold
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Gail S Kerr
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Joshua F Baker
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Geoffrey M Thiele
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Bryant R England
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA.,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC
| | - Ted R Mikuls
- From the Veterans Affairs (VA) Nebraska-Iowa Health Care System; Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA. .,M. Zhao, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; L. Mauer, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; H. Sayles, MS, Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC, and Department of Biostatistics, College of Public Health, UNMC; G.W. Cannon, MD, VA Salt Lake City and University of Utah; A. Reimold, MD, Dallas VA and University of Texas Southwestern; G.S. Kerr, MD, Washington DC VAMC, Georgetown University and Howard University; J.F. Baker, MD, MSCE, Corporal Michael J. Crescenz VA and University of Pennsylvania; G.M. Thiele, PhD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; B.R. England, MD, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC; T.R. Mikuls, MD, MSPH, VA Nebraska-Iowa Healthcare System, and Division of Rheumatology and Immunology, Department of Internal Medicine, UNMC.
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Begum M, Sattar H, Haq SA, Islam MN, Saha SK, Hassan MM, Saha R, Kabir MS. Study on association of human leukocyte antigen‐
DRB
1 alleles amongst Bangladeshi patients with rheumatoid arthritis. Int J Rheum Dis 2018; 21:1543-1547. [DOI: 10.1111/1756-185x.13291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maksuma Begum
- Department of Microbiology Shaheed Monsur Ali Medical College Dhaka Bangladesh
| | - Humayun Sattar
- Department of Microbiology Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Syed A. Haq
- Department of Rheumatology Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Md. Nazrul Islam
- Department of Rheumatology Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Sushanta K. Saha
- Department of Rheumatology Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - M. Masudul Hassan
- Department of Rheumatology Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Ritu Saha
- Department of Microbiology BashundharaAd‐din Medical College Dhaka Bangladesh
| | - Md. Shahriar Kabir
- Medical Oncology National Institute of Cancer Research and Hospital Dhaka Bangladesh
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12
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Tan BE, Lim AL, Kan SL, Lim CH, Tsang EEL, Ch'ng SS, Mohd Noor N, Mohd Jamid N, Teh CL, Joshua Thundyil R, Loh YL, Chong HC, Ong SG, Mohamed Ismail A, Lee YYL, Gun SC. Real-world clinical experience of biological disease modifying anti-rheumatic drugs in Malaysia rheumatoid arthritis patients. Rheumatol Int 2017; 37:1719-25. [PMID: 28695274 DOI: 10.1007/s00296-017-3772-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/29/2017] [Indexed: 12/19/2022]
Abstract
The effect of biologic disease modifying anti-rheumatic drugs (bDMARDs) in treating rheumatoid arthritis (RA) in real-world clinical practice remains unknown in Southeast Asia. We aimed to assess the efficacy and safety of bDMARDs among Malaysian RA patients treated in routine clinical practice. A retrospective medical chart review of RA patients from 11 government hospitals were conducted from January 2003 to January 2014. A standardized questionnaire was used to abstract patient's demographic, clinical and treatment data. Level of disease activity was measured by DAS28 collected at baseline, 3, 6 and 12 months. Three hundred and one patients were available for analysis, mean age 41 (SD, 10.8) years, mean RA duration 12.3 (SD, 6.9) years and 98% had history of two or more conventional-synthetic DMARDs. There were 467 bDMARD courses prescribed with mean bDMARDs duration use of 12.9 months (SD 14.7). Tumour necrosis factor alpha inhibitors were the most common prescribed bDMARDs (77.1%), followed by Tocilizumab (14.6%) and Rituximab (8.4%). We observed significant improvement in mean DAS28 values from baseline to 3, 6 and 12 months (p < 0.001). Overall, 16.9% achieved DAS28 remission at 6 months. A third (35.6%) of patients reported adverse events, three commonest being infections (46.5%), allergy (22.9%) and laboratory abnormalities (12.9%). 3.7% of our patients had tuberculosis. Biologic DMARDs were effective in treating RA in real-world practice in Malaysia, despite a lower remission rate compared to developed countries. Except for higher rates of tuberculosis, the AEs were similar to the published reports.
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Too CL, Murad S, Hansson M, Alm LM, Dhaliwal JS, Holmdahl R, Jakobsson PJ, Alfredsson L, Klareskog L, Rönnelid J, Padyukov L. Differences in the Spectrum of Anti-Citrullinated Protein Antibody Fine Specificities Between Malaysian and Swedish Patients With Rheumatoid Arthritis: Implications for Disease Pathogenesis. Arthritis Rheumatol 2016; 69:58-69. [PMID: 27483449 PMCID: PMC6681166 DOI: 10.1002/art.39827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 07/21/2016] [Indexed: 01/19/2023]
Abstract
Objective Antibodies to the citrullinated protein antigens (ACPAs) are important in the diagnosis and pathogenesis of rheumatoid arthritis (RA). However, the prevalence of ACPAs with different fine specificities in different populations is unclear. This study sought to examine the fine specificity of the antibody responses toward citrullinated proteins in RA patients from Malaysia, an area where genetic and environmental determinants of RA are different from those in more frequently studied cohorts of Caucasian subjects. Methods A multiplex analytic microarray system was used to analyze the occurrence of antibodies to 10 different citrullinated peptides (filaggrin [fil307–324], vimentin [Vim2–17, Vim60–75], fibrinogen [Fibα563–583, Fibα580–600, Fibβ36–52, Fibβ62–81a, Fibβ62–81b], enolase [Eno5–21], and type II collagen [CitCII355–378]) in serum samples from 4,089 RA patients (1,231 Malaysian and 2,858 Swedish) and 827 healthy control subjects (249 Malaysian and 578 Swedish). The positive reaction threshold for each peptide was set separately for each population based on a specificity of 98%. Results Distinct differences in the frequencies of 5 ACPA fine specificities (Vim60–75, Vim2–17, Fibβ62–81b, Eno5–21, and CitCII355–378) were found between the Malaysian and Swedish RA populations, despite a nearly identical percentage of patients in each population who were positive for anti–cyclic citrullinated peptide 2 antibodies. In Malaysian RA patients compared with Swedish RA patients, the frequencies of antibodies to Vim60–75 (54% versus 44%, corrected P [Pcorr] = 1.06 × 10−8) and CitCII355–378 (17% versus 13%, Pcorr = 0.02) were significantly higher, while the frequencies of antibodies to Vim2–17 (25% versus 32%, Pcorr = 1.91 × 10−4), Fibβ62–81b (15% versus 30%, Pcorr = 2.47 × 10−22), and Eno5–21 (23% versus 50%, Pcorr = 3.64 × 10−57) were significantly lower. Conclusion Serum ACPA fine specificities differ between RA patients in different populations, although the total proportions of individuals positive for ACPAs are similar. Differing patterns of ACPA fine specificity could be attributed to variations in genetic and/or environmental factors.
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Affiliation(s)
- Chun Lai Too
- Institute for Medical Research, Kuala Lumpur, Malaysia, and Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Monika Hansson
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Rikard Holmdahl
- Karolinska Institutet, Stockholm, Sweden, and Southern Medical University, Guangzhou, China
| | | | - Lars Alfredsson
- Karolinska Institutet and Center for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Lars Klareskog
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Leonid Padyukov
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Othman MA, Ghazali WSW, Yahya NK, Wong KK. Correlation of Demographic and Clinical Characteristics with Rheumatoid Factor Seropositivity in Rheumatoid Arthritis Patients. Malays J Med Sci 2016; 23:52-59. [PMID: 28090179 PMCID: PMC5181992 DOI: 10.21315/mjms2016.23.6.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/02/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The rheumatoid factor (RF) blood test is the most commonly adopted test for the diagnosis of rheumatoid arthritis (RA). RA patients who are seropositive for RF might face a greater likelihood of developing more aggressive symptoms. METHODS Our goal was to study the demographic and clinical characteristics, as well as their correlation with RF seropositivity, among a series of 80 RA patients aged ≥ 18 years who attend Hospital Universiti Sains Malaysia (HUSM). RESULTS Of the 80 RA patients included in this study, 66 (82.5%) were female and 14 (17.5%) were male. No significant associations between RF seropositivity and demographic and/or clinical characteristics or other laboratory investigations were observed, including gender, morning stiffness, individual joint involvement (from multiple sites of the body), and erythrocyte sedimentation rate (ESR) measurement. However, a significant association between RF seropositivity and patients aged ≥ 50 was found (P = 0.032). CONCLUSION RF seropositivity was found to be more common in much older RA patients.
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Affiliation(s)
- Maizatul Akmal Othman
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Wan Syamimee Wan Ghazali
- Department of Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nurul Khaiza Yahya
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Kah Keng Wong
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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15
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Sandal I, Karydis A, Luo J, Prislovsky A, Whittington KB, Rosloniec EF, Dong C, Novack DV, Mydel P, Zheng SG, Radic MZ, Brand DD. Bone loss and aggravated autoimmune arthritis in HLA-DRβ1-bearing humanized mice following oral challenge with Porphyromonas gingivalis. Arthritis Res Ther 2016; 18:249. [PMID: 27784339 PMCID: PMC5081677 DOI: 10.1186/s13075-016-1143-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/30/2016] [Indexed: 12/21/2022] Open
Abstract
Background The linkage between periodontal disease and rheumatoid arthritis is well established. Commonalities among the two are that both are chronic inflammatory diseases characterized by bone loss, an association with the shared epitope susceptibility allele, and anti-citrullinated protein antibodies. Methods To explore immune mechanisms that may connect the two seemingly disparate disorders, we measured host immune responses including T-cell phenotype and anti-citrullinated protein antibody production in human leukocyte antigen (HLA)-DR1 humanized C57BL/6 mice following exposure to the Gram-negative anaerobic periodontal disease pathogen Porphyromonas gingivalis. We measured autoimmune arthritis disease expression in mice exposed to P. gingivalis, and also in arthritis-resistant mice by flow cytometry and multiplex cytokine-linked and enzyme-linked immunosorbent assays. We also measured femoral bone density by microcomputed tomography and systemic cytokine production. Results Exposure of the gingiva of DR1 mice to P. gingivalis results in a transient increase in the percentage of Th17 cells, both in peripheral blood and cervical lymph nodes, a burst of systemic cytokine activity, a loss in femoral bone density, and the generation of anti-citrullinated protein antibodies. Importantly, these antibodies are not produced in response to P. gingivalis treatment of wild-type C57BL/6 mice, and P. gingivalis exposure triggered expression of arthritis in arthritis-resistant mice. Conclusions Exposure of gingival tissues to P. gingivalis has systemic effects that can result in disease pathology in tissues that are spatially removed from the initial site of infection, providing evidence for systemic effects of this periodontal pathogen. The elicitation of anti-citrullinated protein antibodies in an HLA-DR1-restricted fashion by mice exposed to P. gingivalis provides support for the role of the shared epitope in both periodontal disease and rheumatoid arthritis. The ability of P. gingivalis to induce disease expression in arthritis-resistant mice provides support for the idea that periodontal infection may be able to trigger autoimmunity if other disease-eliciting factors are already present.
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Affiliation(s)
- Indra Sandal
- Research Service, Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, USA
| | - Anastasios Karydis
- Department of Periodontology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Jiwen Luo
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Amanda Prislovsky
- Research Service, Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, USA
| | - Karen B Whittington
- Research Service, Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, USA
| | - Edward F Rosloniec
- Research Service, Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, USA.,Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.,Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Chen Dong
- Institute for Immunology, Tsinghua University, Beijing, 100084, China
| | - Deborah V Novack
- Musculoskeletal Research Center, Departments of Medicine and Pathology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Piotr Mydel
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Song Guo Zheng
- Division of Rheumatology, Department of Medicine, Pennsylvania State University Hershey College of Medicine, Hershey, PA, 17033, USA
| | - Marko Z Radic
- Department of Microbiology Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - David D Brand
- Research Service, Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, USA. .,Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA. .,Department of Microbiology Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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16
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Mariaselvam CM, Fortier C, Charron D, Krishnamoorthy R, Tamouza R, Negi VS. HLA class II alleles influence rheumatoid arthritis susceptibility and autoantibody status in South Indian Tamil population. HLA 2016; 88:253-258. [DOI: 10.1111/tan.12910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/05/2016] [Accepted: 09/19/2016] [Indexed: 12/13/2022]
Affiliation(s)
- C. M. Mariaselvam
- Department of Clinical Immunology; Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER); Puducherry India
- INSERM, UMRS 1160, Saint Louis Hospital; Paris France
| | - C. Fortier
- Jean Dausset Laboratory of Immunology and Immunogenetics and LabExTransplantex; Saint Louis Hospital; Paris France
| | - D. Charron
- INSERM, UMRS 1160, Saint Louis Hospital; Paris France
- Jean Dausset Laboratory of Immunology and Immunogenetics and LabExTransplantex; Saint Louis Hospital; Paris France
| | | | - R. Tamouza
- INSERM, UMRS 1160, Saint Louis Hospital; Paris France
- Jean Dausset Laboratory of Immunology and Immunogenetics and LabExTransplantex; Saint Louis Hospital; Paris France
| | - V. S. Negi
- Department of Clinical Immunology; Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER); Puducherry India
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Heyder T, Kohler M, Tarasova NK, Haag S, Rutishauser D, Rivera NV, Sandin C, Mia S, Malmström V, Wheelock ÅM, Wahlström J, Holmdahl R, Eklund A, Zubarev RA, Grunewald J, Ytterberg AJ. Approach for Identifying Human Leukocyte Antigen (HLA)-DR Bound Peptides from Scarce Clinical Samples. Mol Cell Proteomics 2016; 15:3017-29. [PMID: 27452731 DOI: 10.1074/mcp.m116.060764] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 01/30/2023] Open
Abstract
Immune-mediated diseases strongly associating with human leukocyte antigen (HLA) alleles are likely linked to specific antigens. These antigens are presented to T cells in the form of peptides bound to HLA molecules on antigen presenting cells, e.g. dendritic cells, macrophages or B cells. The identification of HLA-DR-bound peptides presents a valuable tool to investigate the human immunopeptidome. The lung is likely a key player in the activation of potentially auto-aggressive T cells prior to entering target tissues and inducing autoimmune disease. This makes the lung of exceptional interest and presents an ideal paradigm to study the human immunopeptidome and to identify antigenic peptides.Our previous investigation of HLA-DR peptide presentation in the lung required high numbers of cells (800 × 10(6) bronchoalveolar lavage (BAL) cells). Because BAL from healthy nonsmokers typically contains 10-15 × 10(6) cells, there is a need for a highly sensitive approach to study immunopeptides in the lungs of individual patients and controls.In this work, we analyzed the HLA-DR immunopeptidome in the lung by an optimized methodology to identify HLA-DR-bound peptides from low cell numbers. We used an Epstein-Barr Virus (EBV) immortalized B cell line and bronchoalveolar lavage (BAL) cells obtained from patients with sarcoidosis, an inflammatory T cell driven disease mainly occurring in the lung. Specifically, membrane complexes were isolated prior to immunoprecipitation, eluted peptides were identified by nanoLC-MS/MS and processed using the in-house developed ClusterMHCII software. With the optimized procedure we were able to identify peptides from 10 × 10(6) cells, which on average correspond to 10.9 peptides/million cells in EBV-B cells and 9.4 peptides/million cells in BAL cells. This work presents an optimized approach designed to identify HLA-DR-bound peptides from low numbers of cells, enabling the investigation of the BAL immunopeptidome from individual patients and healthy controls in order to identify disease-associated peptides.
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Affiliation(s)
- Tina Heyder
- From the ‡Respiratory Medicine Unit, Department of Medicine and Center for Molecular Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; §Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Maxie Kohler
- From the ‡Respiratory Medicine Unit, Department of Medicine and Center for Molecular Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nataliya K Tarasova
- §Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Sabrina Haag
- ¶Division of Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Dorothea Rutishauser
- §Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Natalia V Rivera
- From the ‡Respiratory Medicine Unit, Department of Medicine and Center for Molecular Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Charlotta Sandin
- ‖Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sohel Mia
- ‖Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Vivianne Malmström
- ‖Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Åsa M Wheelock
- From the ‡Respiratory Medicine Unit, Department of Medicine and Center for Molecular Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jan Wahlström
- From the ‡Respiratory Medicine Unit, Department of Medicine and Center for Molecular Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Rikard Holmdahl
- ¶Division of Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Anders Eklund
- From the ‡Respiratory Medicine Unit, Department of Medicine and Center for Molecular Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Roman A Zubarev
- §Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Grunewald
- From the ‡Respiratory Medicine Unit, Department of Medicine and Center for Molecular Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - A Jimmy Ytterberg
- §Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden; ‖Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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18
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Tan LK, Mohd-Farid B, Salsabil S, Heselynn H, Wahinuddin S, Lau IS, Gun SC, Nor-Suhaila S, Eashwary M, Mohd-Shahrir MS, Ainon MM, Azmillah R, Muhaini O, Shahnaz M, Too CL. HLA-A, -B, -C, -DRB1 and -DQB1 alleles and haplotypes in 951 Southeast Asia Malays from Peninsular Malaysia. Hum Immunol 2016; 77:818-819. [PMID: 27370684 DOI: 10.1016/j.humimm.2016.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/26/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
A total of 951 Southeast Asia Malays from Peninsular Malaysia were genotyped for HLA-A, -B, -C -DRB1, and -DQB1 loci using polymerase chain reaction sequence-specific oligonucleotide probe hybridization methods. In this report, there were significant deviation from Hardy-Weinberg proportions for the HLA-A (p<0.0001), -B (p<0.0001), -DRB1 (p<0.0001) and -DQB1 (p<0.01) loci. Minor deviations from HWEP were detected for HLA-C (p=0.01). This genotype data was available in Allele Frequencies Network Database (AFND) Gonzalez-Galarza et al. (2015).
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Affiliation(s)
- Lay-Kim Tan
- Allergy and Immunology Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia.
| | - Baharin Mohd-Farid
- Allergy and Immunology Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Sulaiman Salsabil
- Allergy and Immunology Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Hussein Heselynn
- Department of Medicine, Putrajaya Hospital, Wilayah Persekutuan Putrajaya, Malaysia
| | - Sulaiman Wahinuddin
- Department of Medicine, Hospital Raja Perempuan Bainun, Ipoh, Perak, Malaysia; Universiti Kuala Lumpur, Royal College of Medicine Perak, No 3, Jalan Greentown, 30450 Ipoh, Perak, Malaysia
| | - Ing-Soo Lau
- Department of Medicine, Hospital Selayang, Selangor, Malaysia
| | - Suk-Chyn Gun
- Department of Medicine, Hospital Tunku Ja'afar Seremban, Negari Sembilan, Malaysia
| | - Sharil Nor-Suhaila
- Department of Medicine, Putrajaya Hospital, Wilayah Persekutuan Putrajaya, Malaysia
| | - M Eashwary
- Department of Medicine, Putrajaya Hospital, Wilayah Persekutuan Putrajaya, Malaysia
| | | | - Mohd-Mokhtar Ainon
- Department of Medicine, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia
| | - Rosman Azmillah
- Department of Medicine, Hospital Selayang, Selangor, Malaysia
| | - Othman Muhaini
- Department of Medicine, Hospital Raja Perempuan Bainun, Ipoh, Perak, Malaysia
| | - Murad Shahnaz
- Allergy and Immunology Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Chun-Lai Too
- Allergy and Immunology Research Center, Institute for Medical Research, Kuala Lumpur, Malaysia; Rheumatology Unit, Department of Medicine, CMM L8:O4, Karolinska University Hospital and Karolinska Institutet, 17176 Stockholm, Sweden.
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Kim K, Jiang X, Cui J, Lu B, Costenbader KH, Sparks JA, Bang SY, Lee HS, Okada Y, Raychaudhuri S, Alfredsson L, Bae SC, Klareskog L, Karlson EW. Interactions between amino acid-defined major histocompatibility complex class II variants and smoking in seropositive rheumatoid arthritis. Arthritis Rheumatol 2016; 67:2611-23. [PMID: 26098791 DOI: 10.1002/art.39228] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/02/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To define the interaction between cigarette smoking and HLA polymorphisms in seropositive rheumatoid arthritis (RA), in the context of a recently identified amino acid-based HLA model for RA susceptibility. METHODS We imputed Immunochip data on HLA amino acids and classical alleles from 3 case-control studies (the Swedish Epidemiological Investigation of Rheumatoid Arthritis [EIRA] study [1,654 cases and 1,934 controls], the Nurses' Health Study [NHS] [229 cases and 360 controls], and the Korean RA Cohort Study [1,390 cases and 735 controls]). We examined the interaction effects of heavy smoking (>10 pack-years) and the genetic risk score (GRS) of multiple RA-associated amino acid positions (positions 11, 13, 71, and 74 in HLA-DRβ1, position 9 in HLA-B, and position 9 in HLA-DPβ1), as well as the interaction effects of heavy smoking and the GRS of HLA-DRβ1 4-amino acid haplotypes (assessed via attributable proportion due to interaction [AP] using the additive interaction model). RESULTS Heavy smoking and all investigated HLA amino acid positions and haplotypes were associated with RA susceptibility in the 3 populations. In the interaction analysis, we found a significant deviation from the expected additive joint effect between heavy smoking and the HLA-DRβ1 4-amino acid haplotype (AP 0.416, 0.467, and 0.796, in the EIRA, NHS, and Korean studies, respectively). We further identified the key interacting variants as being located at HLA-DRβ1 amino acid positions 11 and 13 but not at any of the other RA risk-associated amino acid positions. For residues in positions 11 and 13, there were similar patterns between RA risk effects and interaction effects. CONCLUSION Our findings of significant gene-environment interaction effects indicate that a physical interaction between citrullinated autoantigens produced by smoking and HLA-DR molecules is characterized by the HLA-DRβ1 4-amino acid haplotype, primarily by positions 11 and 13.
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Affiliation(s)
- Kwangwoo Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Broad Institute, Cambridge, Massachusetts
| | - Xia Jiang
- Karolinska Institute, Stockholm, Sweden
| | - Jing Cui
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Broad Institute, Cambridge, Massachusetts
| | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - So-Young Bang
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Hye-Soon Lee
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Yukinori Okada
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, Broad Institute, Cambridge, Massachusetts, Tokyo Medical and Dental University, Tokyo, Japan, and RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Soumya Raychaudhuri
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, Broad Institute, Cambridge, Massachusetts, and Manchester Academic Health Sciences Centre, Manchester, UK
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Lars Klareskog
- Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Elizabeth W Karlson
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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20
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Too CL, Muhamad NA, Ilar A, Padyukov L, Alfredsson L, Klareskog L, Murad S, Bengtsson C. Occupational exposure to textile dust increases the risk of rheumatoid arthritis: results from a Malaysian population-based case-control study. Ann Rheum Dis 2015; 75:997-1002. [PMID: 26681695 PMCID: PMC4893106 DOI: 10.1136/annrheumdis-2015-208278] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/18/2015] [Indexed: 12/16/2022]
Abstract
Objectives Lung exposures including cigarette smoking and silica exposure are associated with the risk of rheumatoid arthritis (RA). We investigated the association between textile dust exposure and the risk of RA in the Malaysian population, with a focus on women who rarely smoke. Methods Data from the Malaysian Epidemiological Investigation of Rheumatoid Arthritis population-based case–control study involving 910 female early RA cases and 910 female age-matched controls were analysed. Self-reported information on ever/never occupationally exposed to textile dust was used to estimate the risk of developing anti-citrullinated protein antibody (ACPA)-positive and ACPA-negative RA. Interaction between textile dust and the human leucocyte antigen DR β-1 (HLA-DRB1) shared epitope (SE) was evaluated by calculating the attributable proportion due to interaction (AP), with 95% CI. Results Occupational exposure to textile dust was significantly associated with an increased risk of developing RA in the Malaysian female population (OR 2.8, 95% CI 1.6 to 5.2). The association between occupational exposure to textile dust and risk of RA was uniformly observed for the ACPA-positive RA (OR 2.5, 95% CI 1.3 to 4.8) and ACPA-negative RA (OR 3.5, 95% CI 1.7 to 7.0) subsets, respectively. We observed a significant interaction between exposure to occupational textile dust and HLA-DRB1 SE alleles regarding the risk of ACPA-positive RA (OR for double exposed: 39.1, 95% CI 5.1 to 297.5; AP: 0.8, 95% CI 0.5 to 1.2). Conclusions This is the first study demonstrating that textile dust exposure is associated with an increased risk for RA. In addition, a gene–environment interaction between HLA-DRB1 SE and textile dust exposure provides a high risk for ACPA-positive RA.
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Affiliation(s)
- Chun Lai Too
- Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia
- Rheumatology Unit, Department of Medicine, Center for Molecular Medicine L8:O4, Karolinska University Hospital, Stockholm, Sweden
| | - Nor Asiah Muhamad
- Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Anna Ilar
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Center for Molecular Medicine L8:O4, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Klareskog
- Rheumatology Unit, Department of Medicine, Center for Molecular Medicine L8:O4, Karolinska University Hospital, Stockholm, Sweden
| | - Shahnaz Murad
- Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Camilla Bengtsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Louthrenoo W, Kasitanon N, Wangkaew S, Kuwata S, Takeuchi F. Distribution of HLA-DR alleles among Thai patients with rheumatoid arthritis. Hum Immunol 2015; 76:113-7. [DOI: 10.1016/j.humimm.2015.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 09/01/2014] [Accepted: 01/15/2015] [Indexed: 12/09/2022]
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Chun-Lai T, Murad S, Erlandsson MC, Hussein H, Sulaiman W, Dhaliwal JS, Bokarewa MI. Recognizing rheumatoid arthritis: oncoprotein survivin opens new possibilities: a population-based case-control study. Medicine (Baltimore) 2015; 94:e468. [PMID: 25634192 PMCID: PMC4602940 DOI: 10.1097/md.0000000000000468] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Survivin is a biomarker of cancer known for its anti-apoptotic and cell-cycle regulating properties. In the context of non-cancer pathology, high levels of survivin may be measured in blood and synovial fluid of patients with rheumatoid arthritis (RA) and associate with early joint damage and poor therapy response. The aim of the study was to investigate the value of survivin measurements in blood for diagnosis of RA in the frame of the Malaysian epidemiological investigation of rheumatoid arthritis (MyEIRA) study. The study enrolled RA patients from eight rheumatology centres in Peninsular Malaysia. The healthy controls matched by age, gender and ethnicity were recruited on the community basis from the residential area of the patients. Levels of survivin were measured in blood of RA patients (n = 1233) and controls (n = 1566) by an enzyme-linked immuno-sorbent assay (ELISA). The risk for RA was calculated as odds ratio (OR) and 95% confidence intervals in the individuals with high levels of survivin. The risk was calculated in relation to antibodies against cyclic citrullinated peptides (ACPA), detected by ELISA and HLA-DRB1 shared epitope (SE) alleles, identified by the polymerase chain reaction using sequence specific oligonucleotide method. High levels of survivin were detected in 625 of 1233 (50.7%) RA cases and in 85 of 1566 (5.4%) controls, indicating its high specificity for RA. Survivin was association with an increase in RA risk in the patients having neither SE-alleles nor ACPA (OR = 5.40, 95% CI 3.81-7.66). For the patients combining survivin, SE, and ACPA, the estimated risk for RA was 16-folds higher compared to the survivin negative patients with SE and ACPA(OR = 16.21, 95% CI 5.70-46.18). To conclude, detection of survivin in blood provides a simple test to improve diagnostic and to increase predictability for RA.
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Affiliation(s)
- Too Chun-Lai
- From the Allergy and Immunology Research Center, Institute of Medical Research, Kuala Lumpur, Malaysia (TCL, SM, JSD); Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm (TCL); Department of Rheumatology and Inflammation Research, Institute of Medicine, the University of Gothenburg, Göteborg, Sweden (ME, MIB); Department of Medicine, Putrajaya Hospital, Putrajaya (HH); and Department of Medicine, Raja Perempuan Bainun Hospital, Ipoh, Perak, Malaysia (WS)
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23
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Yahya A, Bengtsson C, Larsson P, Too CL, Mustafa AN, Abdullah NA, Muhamad NA, Klareskog L, Murad S, Alfredsson L. Silica exposure is associated with an increased risk of developing ACPA-positive rheumatoid arthritis in an Asian population: evidence from the Malaysian MyEIRA case-control study. Mod Rheumatol 2014; 24:271-4. [PMID: 24593203 DOI: 10.3109/14397595.2013.854076] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Silica exposure has been associated with an increased risk of developing rheumatoid arthritis (RA), especially among smokers. In this study, we aimed at examining the association between silica exposure (and its interaction with smoking) and the risk of RA in the Malaysian population. METHODS In total, 149 cases and 213 matched controls, all men, were included between August 2005 and December 2009. A case was defined as a person with early diagnosed RA using the 1987 American College of Rheumatology criteria for RA. Controls were randomly selected matched on sex, age and residential area. Silica exposure was defined as exposure to stone dust, rock drilling or stone crushing, and smoking status was categorized as ever/never cigarette smoking. RESULTS An increased risk of anti-citrullinated protein antibody (ACPA)-positive RA (OR = 2.4, 95 % CI 1.0-5.6) was observed among those exposed to silica. Ever-smokers exposed to silica had a particularly high risk of developing ACPA-positive RA (OR = 7.5, 95 % CI 2.3-24.2), compared with never-smokers not exposed to silica. No association was found regarding ACPA-negative RA. CONCLUSION Our data demonstrate that exposure to both silica and cigarette smoke comprise risks for developing RA in the Malaysian genetic context. The findings expand a link between environmental lung exposures and ACPA-positive RA to Asian populations.
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Affiliation(s)
- Abqariyah Yahya
- Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
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24
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Thanapati S, Hande A, Das R, Gurav Y, Tripathy AS. Association of human leukocyte antigen class II allele and haplotypes in chikungunya viral infection in a western Indian population. Trans R Soc Trop Med Hyg 2014; 108:277-82. [DOI: 10.1093/trstmh/tru030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nogueira L, Cornillet M, Singwe-Ngandeu M, Viatte S, Bas S, Gabay C, Serre G. In Black Africans with rheumatoid arthritis, ACPA recognize citrullinated fibrinogen and the derived peptides α36-50Cit38,42 and β60-74Cit60,72,74, like in Caucasians. Clin Immunol 2014; 152:58-64. [PMID: 24589748 DOI: 10.1016/j.clim.2014.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 12/20/2022]
Abstract
Well documented in Caucasians and Asians, the diagnostic value of anti-CCP2 antibodies has been confirmed in Black African populations. However, autoantibodies to other citrullinated peptides/proteins and their fine specificities have not yet been studied. Here, we show that in Cameroonian patients, anti-citrullinated fibrinogen autoantibodies (AhFibA) are sensitive (73%) diagnostic markers for RA. We also determine that autoantibodies directed to α36-50Cit38,42 or β60-74Cit60,72,74 peptides which bear the immunodominant epitopes of citrullinated fibrin, are present in similar proportions in Black Africans and Caucasians with 25/56 (45%) and 41/56 (73%) positive RA-sera in Cameroonians, respectively. They also account for almost all the AhFibA reactivities since 38/41 (93%) AhFibA-positive sera contain anti-α36-50Cit38,42 and/or anti-β60-74Cit60,72,74 autoantibodies. Finally, HLA-DRB1 SE alleles were associated with higher titres of AhFibA and anti-β60-74Cit60,72,74 autoantibodies. In the genetic and environmental backgrounds of Black Africans, AhFibA are a hallmark of RA like in Caucasians, moreover they recognize the same fibrin epitopes.
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Affiliation(s)
- Leonor Nogueira
- "Epidermis Differentiation and Rheumatoid Autoimmunity" Laboratory, UMR CNRS 5165, INSERM U1056, Toulouse III University, Toulouse, France; Laboratory of Cell Biology and Cytology, Toulouse University Hospital, Toulouse, France.
| | - Martin Cornillet
- "Epidermis Differentiation and Rheumatoid Autoimmunity" Laboratory, UMR CNRS 5165, INSERM U1056, Toulouse III University, Toulouse, France; Laboratory of Cell Biology and Cytology, Toulouse University Hospital, Toulouse, France
| | | | - Sebastien Viatte
- Arthritis Research UK Center for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Sylvette Bas
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland; Department of Genetics and Laboratory Medicine, Geneva, Switzerland
| | - Cem Gabay
- Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland; Department of Pathology & Immunology, University of Geneva, School of Medicine, Geneva, Switzerland
| | - Guy Serre
- "Epidermis Differentiation and Rheumatoid Autoimmunity" Laboratory, UMR CNRS 5165, INSERM U1056, Toulouse III University, Toulouse, France; Laboratory of Cell Biology and Cytology, Toulouse University Hospital, Toulouse, France
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Yang M, Kuang X, Li J, Pan Y, Tan M, Lu B, Cheng Q, Wu L, Pang G. Meta-analysis of the association of HLA-DRB1 with rheumatoid arthritis in Chinese populations. BMC Musculoskelet Disord 2013; 14:307. [PMID: 24161032 PMCID: PMC4231398 DOI: 10.1186/1471-2474-14-307] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 10/21/2013] [Indexed: 11/10/2022] Open
Abstract
Background Individual studies have reported different results regarding the association of HLA alleles with RA in Chinese populations. This study was performed to systematically summarize results on the association of HLA-DRB1 with rheumatoid arthritis (RA) in China. Methods We examined the case–control studies concerned about the relationship between HLA-DRB1and RA and differences of clinical and laboratory parameters between the HLA-DR4 (DR4)+ and DR4- in RA patients in Chinese populations. Odds ratios (ORs) and weighted mean difference (WMD) with corresponding 95% confidence intervals (CI) was used to describe the relationship. Results 22 studies with 1690 cases and 1793 controls were included. Chinese populations with RA had significantly higher frequencies of HLA-DRB1*04, *0401, *0404, *0405 and *0410 than controls (ORDRB1*04 =4.19, 95% CI =3.44–5.11, p<0.00001; ORDRB1*0401 =2.53, 95% CI =1.54–4.16, p=0.0003; ORDRB1*0404 =2.28, 95% CI =1.28–4.06, p=0.005; ORDRB1*0405=3.71, 95% CI =2.52–5.45, p<0.00001; ORDRB1*0410 =2.99, 95% CI =1.25–7.14, p=0.01respectively). As to laboratory parameters, Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Rheumatoid factor (RF), Anti-cyclic citrullinated peptide antibodies (Anti-CCP ) in patients with DR4+ were higher than patients with DR4- (WMD=0.26, 95% CI =0.15–0.37, p<0.00001; WMD = 0.26, 95% CI =0.12–0.41, p=0.0005; WMD = 0.44, 95% CI =0.23–0.65, p<0.00001; WMD = 0.58, 95% CI =0.24–0.91, p=0.0007 respectively). As to clinical features, there was no difference in duration of morning stiffness, number of swollen joints, number of joint tenderness, X-ray phases and joint function between the DR4+ and DR4- in RA patients. Conclusions It was found that HLA-DRB1*04, *0401, *0404, *0405 and *0410 are risk factors for RA in Chinese populations. ESR, CRP, RF, Anti-CCP are different between the DR4+ and DR4- in RA patients in Chinese populations, while there’s no difference for indexes of clinical features.
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Affiliation(s)
| | | | - Jianmin Li
- Department of Dermatology, the third affiliated hospital of Guangxi Medical University, 13 Dancun Road, Nanning 530031, Guangxi, People's Republic of China.
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Liu X, Guo J, Jia Y, Zhao Y, Liu X, Cheng F, Li X, Zheng Y, Shi X, Li H, Huang C, Cheng Y, Lai B, Huang Y, Wang T, Ding B, Li Z. HLA-DRB1 shared epitope-dependent DR-DQ haplotypes are associated with both anti-CCP-positive and -negative rheumatoid arthritis in Chinese Han. PLoS One 2013; 8:e71373. [PMID: 23951149 PMCID: PMC3741114 DOI: 10.1371/journal.pone.0071373] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 07/02/2013] [Indexed: 01/29/2023] Open
Abstract
The association between Human Leukocyte Antigen (HLA) class II and rheumatoid arthritis (RA) has been extensively studied, but few reported DR-DQ haplotype. Here we investigated the association of HLA-DRB1, DQA1, DQB1, and DR-DQ haplotypes with RA susceptibility and with anti-CCP antibodies in 281 RA patients and 297 control in Han population. High-resolution genotyping were performed. The HLA-DRB1 shared epitope (SE)-encoding allele *0405 displayed the most significant RA association (P = 1.35×10−6). The grouped DRB1 SE alleles showed great association with RA (P = 3.88×10−13). The DRB1 DRRAA alleles displayed significant protective effects (P = 0.021). The SE-dependent DR-DQ haplotype SE-DQ3/4/5 remained strong association with both anti-CCP -positive (P = 3.71×10−13) and -negative RA (P = 3.89×10−5). Our study revealed that SE alleles and its haplotypes SE-DQ3/4/5 were highly associated with RA susceptibility in Han population. The SE-DQ3/4/5 haplotypes were associated with both anti-CCP positive RA and -negative RA.
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Affiliation(s)
- Xu Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Jianping Guo
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yuan Jia
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yi Zhao
- Department of Rheumatology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xia Liu
- Department of Rheumatology, China-Japan Friendship Hospital, Chaoyang District, Beijing, China
| | - Feng Cheng
- Institute of Vegetables and Flowers, Chinese Academy of Agricultural Sciences, Haidian District, Beijing, China
| | - Xiaoxia Li
- Department of Rheumatology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yi Zheng
- Department of Rheumatology, Chao-yang Hospital, Chaoyang District, Beijing, China
| | - Xuhua Shi
- Department of Rheumatology, Chao-yang Hospital, Chaoyang District, Beijing, China
| | - Haiyun Li
- Department of Rheumatology, Chao-yang Hospital, Chaoyang District, Beijing, China
| | - Cibo Huang
- Department of Rheumatology, Beijing Hospital of the Ministry of Health, Beijing, China
| | - Yongjing Cheng
- Department of Rheumatology, Beijing Hospital of the Ministry of Health, Beijing, China
| | - Bei Lai
- Department of Rheumatology, Beijing Hospital of the Ministry of Health, Beijing, China
| | - Yanhong Huang
- Department of Rheumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Tian Wang
- Department of Internal Medicine, Beijing Anzhen Hospital Capital Medical University, Beijing, China
| | - Bo Ding
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - ZhangGuo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- * E-mail: mailto:
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Yahya A, Bengtsson C, Larsson P, Too CL, Mustafa AN, Abdullah NA, Muhamad NA, Klareskog L, Murad S, Alfredsson L. Silica exposure is associated with an increased risk of developing ACPA-positive rheumatoid arthritis in an Asian population: evidence from the Malaysian MyEIRA case-control study. Mod Rheumatol 2013. [PMID: 23615838 DOI: 10.1007/s10165-013-0890-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 04/10/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES: Silica exposure has been associated with an increased risk of developing rheumatoid arthritis (RA), especially among smokers. In this study, we aimed at examining the association between silica exposure (and its interaction with smoking) and the risk of RA in the Malaysian population. METHODS: In total, 149 cases and 213 matched controls, all men, were included between August 2005 and December 2009. A case was defined as a person with early diagnosed RA using the 1987 American College of Rheumatology criteria for RA. Controls were randomly selected matched on sex, age and residential area. Silica exposure was defined as exposure to stone dust, rock drilling or stone crushing, and smoking status was categorized as ever/never cigarette smoking. RESULTS: An increased risk of anti-citrullinated protein antibody (ACPA)-positive RA (OR = 2.4, 95 % CI 1.0-5.6) was observed among those exposed to silica. Ever-smokers exposed to silica had a particularly high risk of developing ACPA-positive RA (OR = 7.5, 95 % CI 2.3-24.2), compared with never-smokers not exposed to silica. No association was found regarding ACPA-negative RA. CONCLUSION: Our data demonstrate that exposure to both silica and cigarette smoke comprise risks for developing RA in the Malaysian genetic context. The findings expand a link between environmental lung exposures and ACPA-positive RA to Asian populations.
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Affiliation(s)
- Abqariyah Yahya
- Institute of Environmental Medicine, Karolinska Institutet, Nobel väg 13, Box 210, 17177, Stockholm, Sweden,
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Fisher BA, Bang SY, Chowdhury M, Lee HS, Kim JH, Charles P, Venables P, Bae SC. Smoking, the HLA-DRB1 shared epitope and ACPA fine-specificity in Koreans with rheumatoid arthritis: evidence for more than one pathogenic pathway linking smoking to disease. Ann Rheum Dis 2013; 73:741-7. [PMID: 23505239 DOI: 10.1136/annrheumdis-2012-202535] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Data from North European rheumatoid arthritis (RA) populations has suggested a particularly strong association of gene-environment interaction between smoking and HLA-DRB1 shared epitope (SE) with antibodies to citrullinated α-enolase (CEP-1) and vimentin (cVim) peptides. We investigated this further by examining anticitrullinated peptide/protein antibody (ACPA) fine specificity in a Korean cohort, where there are notable differences in the RA-associated HLA-DRB1 alleles. METHODS Antibodies to fibrinogen (cFib), α-enolase (CEP-1) and vimentin (cVim) peptides and cyclic citrullinated peptide (CCP) were measured in 513 cases. The Mann-Whitney U test was used to compare antibody levels. Logistic regression generated ORs for RA in a case-control analysis with 1101 controls. Association of ACPA status and erosion in patients with RA was examined by logistic regression. RESULTS Anti-CCP, CEP-1, cVim and fibrinogen peptides were found in 86.7%, 63.9%, 45.5% and 74.7%, respectively. The number of ACPA and their levels were associated with SE, with evidence of a gene-dosage effect. There was a particular association of smoking with levels of anti-CEP-1. However, a gene-environment interaction was associated with all the ACPA positive subgroups, albeit the highest OR was seen with the anti-CCP+/cVim+ subset. In the absence of SE, smoking only conferred risk for anti-CCP negative subsets. The presence of erosions was not associated with the number of positive ACPA or specificity. CONCLUSIONS The SE governed the magnitude and diversity of the ACPA response, but its interaction with smoking did not exclusively segregate with any of the ACPA specificities studied here. Smoking was associated with RA by SE-dependent and independent effects.
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Affiliation(s)
- Benjamin A Fisher
- Rheumatology Research Group, University of Birmingham, , Birmingham, UK
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Too CL, Murad S, Dhaliwal JS, Larsson P, Jiang X, Ding B, Alfredsson L, Klareskog L, Padyukov L. Polymorphisms in peptidylarginine deiminase associate with rheumatoid arthritis in diverse Asian populations: evidence from MyEIRA study and meta-analysis. Arthritis Res Ther 2012; 14:R250. [PMID: 23164236 PMCID: PMC3674620 DOI: 10.1186/ar4093] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 11/14/2012] [Indexed: 12/20/2022] Open
Abstract
Introduction The majority of our knowledge regarding disease-related mechanisms of uncontrolled citrullination and anti-citrullinated protein antibody development in rheumatoid arthritis (RA) was investigated in Caucasian populations. However, peptidylarginine deiminase (PADI) type 4 gene polymorphisms are associated with RA in East Asian populations and weak or no association was found in Caucasian populations. This study explores the association between the PADI4 polymorphisms and RA risk in a multiethnic population residing in South East Asia with the goal of elucidating generalizability of association in non-Caucasian populations. Methods A total of 320 SNPs from the PADI locus (including PADI1, PADI2, PADI3, PADI4 and PADI6 genes) were genotyped in 1,238 RA cases and 1,571 control subjects from the Malaysian Epidemiological Investigation of Rheumatoid Arthritis (MyEIRA) case-control study. Additionally, we conducted meta-analysis of our data together with the previously published studies of RA from East Asian populations. Results The overall odds ratio (ORoverall) for the PADI4 (rs2240340) allelic model was 1.11 (95% confidence interval (CI) = 1.00 to 1.23, P = 0.04) and for the genotypic model was 1.20 (95% CI = 1.01 to 1.44, P = 0.04). Haplotype analysis for four selected PADI4 SNPs revealed a significant association of one with susceptibility (P = 0.001) and of another with a protective effect (P = 0.02). The RA susceptibility was further confirmed when combined meta-analysis was performed using these data together with data from five previously published studies from Asia comprising 5,192 RA cases and 4,317 control subjects (ORoverall = 1.23 (95% CI = 1.16 to 1.31, Pheterogeneity = 0.08) and 1.31 (95% CI = 1.20 to 1.44, Pheterogeneity = 0.32) in allele and genotype-based models, respectively). In addition, we also detected a novel association of PADI2 genetic variant rs1005753 with RA (ORoverall = 0.87 (95% CI = 0.77 to 0.99)). Conclusion Our study demonstrates an association between PADI4 and RA in the multiethnic population from South East Asia and suggests additional association with a PADI2 gene. The study thus provides further support for the notion that polymorphisms in genes for enzymes responsible for citrullination contribute to RA development in multiple populations of Asian descent.
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Sun C, Wei L, Luo F, Li Y, Li J, Zhu F, Kang P, Xu R, Xiao L, Liu Z, Xu P. HLA-DRB1 alleles are associated with the susceptibility to sporadic Parkinson's disease in Chinese Han population. PLoS One 2012; 7:e48594. [PMID: 23139797 PMCID: PMC3490875 DOI: 10.1371/journal.pone.0048594] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 09/26/2012] [Indexed: 12/19/2022] Open
Abstract
Immune disorders may play an important role in the pathogenesis of Parkinson's disease (PD). Recently, polymorphisms in the HLA-DR region have been found to be associated with sporadic PD in European ancestry populations. However, polymorphisms in the HLA complex are highly variable with ethnic and geographic origin. To explore the relationships between polymorphisms of the HLA-DR region and sporadic PD in Chinese Han population, we genotyped 567 sporadic PD patients and 746 healthy controls in two independent series for the HLA-DRB1 locus with Polymerase chain reaction-sequence based typing(PCR-SBT). The χ(2) test was used to evaluate the distribution of allele frequencies between the patients and healthy controls. The impact of HLA-DRB1 alleles on PD risk was estimated by unconditional logistic regression. We found a significant higher frequency of HLA-DRB1*0301 in sporadic PD patients than in healthy controls and a positive association, which was independent of onset age, between HLA-DRB1*0301 and PD risk. Conversely, a lower frequency of HLA-DRB1*0406 was found in sporadic PD patients than in healthy controls, with a negative association between HLA-DRB1*0406 and PD risk. Furthermore, a meta-analysis involving 195205 individuals was conducted to summarize the frequencies of these two alleles in populations from various ethnic regions, we found a higher frequency of HLA-DRB1*0301, but a lower frequency of HLA-DRB1*0406 in European ancestry populations than that in Asians, this was consistent with the higher prevalence of sporadic PD in European ancestry populations. Based on these results, we speculate that HLA-DRB1 alleles are associated with the susceptibility to sporadic PD in Chinese Han population, among them HLA-DRB1*0301 is a risk allele while the effect of HLA-DRB1*0406 deserves debate.
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Affiliation(s)
- Congcong Sun
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Lei Wei
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Feifei Luo
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Neurology, The Third People’s Hospital of Chengdu, Chengdu, People’s Republic of China
| | - Yi Li
- Department of Neurology, Department of Neurology, Red-Cross Hospital in Guangzhou, Guangzhou, People’s Republic of China
| | - Jiaobiao Li
- Department of Neurology, HeYuan City Hospital, Guangdong, People’s Republic of China
| | - Feiqi Zhu
- Department of Neurology, Yuebei People's Hospital of Shantou University Medical College, Guangdong, People’s Republic of China
| | - Ping Kang
- Department of Neurology, The First People’s Hospital of Shaoguan, Guangdong, People’s Republic of China
| | - Rensi Xu
- Department of Neurology, The First Affiliated Hospital of NanChang University, NanChang, People’s Republic of China
| | - LuLu Xiao
- Department of Tissue Typing Center, Nanfang Hospital of Southern Medical University, Guangzhou, People’s Republic of China
| | - Zhuolin Liu
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Pingyi Xu
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
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Guo J, Wu X, Too CL, Yin F, Lu X, He J, Li R, Liu X, Murad S, Padyukov L, Li Z. A replication study confirms the association of dendritic cell immunoreceptor (DCIR) polymorphisms with ACPA - negative RA in a large Asian cohort. PLoS One 2012; 7:e41228. [PMID: 22829930 DOI: 10.1371/journal.pone.0041228] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 06/19/2012] [Indexed: 01/08/2023] Open
Abstract
Objectives Dendritic cell immunoreceptor (DCIR) has been implicated in development of autoimmune disorders in rodent and DCIR polymorphisms were associated with anti-citrullinated proteins antibodies (ACPA)-negative rheumatoid arthritis (RA) in Swedish Caucasians. This study was undertaken to further investigate whether DCIR polymorphisms are also risk factors for the development of RA in four Asian populations originated from China and Malaysia. Methods We genotyped two DCIR SNPs rs2377422 and rs10840759 in Han Chinese population (1,193 cases, 1,278 controls), to assess their association with RA. Subsequently, rs2377422 was further genotyped in three independent cohorts of Malaysian-Chinese subjects (MY_Chinese, 254 cases, 206 controls), Malay subjects (MY_ Malay, 515 cases, 986 controls), and Malaysian-Indian subjects (MY_Indian, 378 cases, 285 controls), to seek confirmation of association in various ethnic groups. Meta-analysis was preformed to evaluate the contribution of rs2377422 polymorphisms to the development of ACPA-negative RA in distinct ethnic groups. Finally, we carried out association analysis of rs2377422 polymorphisms with DCIR mRNA expression levels. Results DCIR rs2377422 was found to be significantly associated with ACPA -negative RA in Han Chinese (OR 1.92, 95% CI 1.27–2.90, P = 0.0020). Meta-analysis confirms DCIR rs2377422 as a risk factor for ACPA-negative RA across distinct ethnic groups (ORoverall = 1.17, 95% CI 1.06–1.30, P = 0.003). The SNP rs2377422 polymorphism showed significant association with DCIR mRNA expression level, i.e. RA-risk CC genotype exhibit a significant increase in the expression of DCIR (P = 0.0023, Kruskal–Wallis). Conclusions Our data provide evidence for association between DCIR rs2377422 and RA in non-Caucasian populations and confirm the influence of DCIR polymorphisms on RA susceptibility, especially on ACPA-negative RA.
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Zhao H, Xu J, Zhang H, Sun J, Sun Y, Wang Z, Liu J, Ding Q, Lu S, Shi R, You L, Qin Y, Zhao X, Lin X, Li X, Feng J, Wang L, Trent J, Xu C, Gao Y, Zhang B, Gao X, Hu J, Chen H, Li G, Zhao J, Zou S, Jiang H, Hao C, Zhao Y, Ma J, Zheng S, Chen ZJ. A genome-wide association study reveals that variants within the HLA region are associated with risk for nonobstructive azoospermia. Am J Hum Genet 2012; 90:900-6. [PMID: 22541561 DOI: 10.1016/j.ajhg.2012.04.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 03/07/2012] [Accepted: 04/02/2012] [Indexed: 01/22/2023] Open
Abstract
A genome-wide association study of Han Chinese subjects was conducted to identify genetic susceptibility loci for nonobstructive azoospermia (NOA). In the discovery stage, 802 azoospermia cases and 1,863 controls were screened for genetic variants in the genome. Promising SNPs were subsequently confirmed in two independent sets of subjects: 818 azoospermia cases and 1,755 controls from northern China, and 606 azoospermia cases and 958 controls from central and southern China. We detected variants at human leukocyte antigen (HLA) regions that were independently associated with NOA (HLA-DRA, rs3129878, p(combine) = 3.70 × 10(-16), odds ratio [OR] = 1.37; C6orf10 and BTNL2, rs498422, p(combine) = 2.43 × 10(-12), OR = 1.42). These findings provide additional insight into the pathogenesis of NOA.
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Too CL, Yahya A, Murad S, Dhaliwal JS, Larsson PT, Muhamad NA, Abdullah NA, Mustafa AN, Klareskog L, Alfredsson L, Padyukov L, Bengtsson C. Smoking interacts with HLA-DRB1 shared epitope in the development of anti-citrullinated protein antibody-positive rheumatoid arthritis: results from the Malaysian Epidemiological Investigation of Rheumatoid Arthritis (MyEIRA). Arthritis Res Ther 2012; 14:R89. [PMID: 22537824 PMCID: PMC3446463 DOI: 10.1186/ar3813] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/10/2012] [Accepted: 04/26/2012] [Indexed: 12/26/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a multifactorial autoimmune disease in which genetic and environmental factors interact in the etiology. In this study, we investigated whether smoking and HLA-DRB1 shared-epitope (SE) alleles interact differently in the development of the two major subgroups of rheumatoid arthritis (RA), anti-citrullinated proteins antibody (ACPA)-positive and ACPA-negative disease, in a multiethnic population of Asian descent. Methods A case-control study comprising early diagnosed RA cases was carried out in Malaysia between 2005 and 2009. In total, 1,076 cases and 1,612 matched controls participated in the study. High-resolution HLA-DRB1 genotyping was performed for shared-epitope (SE) alleles. All participants answered a questionnaire on a broad range of issues, including smoking habits. The odds ratio (OR) of developing ACPA-positive and ACPA-negative disease was calculated for smoking and the presence of any SE alleles separately. Potential interaction between smoking history (defined as "ever" and "never" smoking) and HLA-DRB1 SE alleles also was calculated. Results In our multiethnic study, both the SE alleles and smoking were associated with an increased risk of developing ACPA-positive RA (OR SE alleles, 4.7; 95% confidence interval (CI), 3.6 to 6.2; OR smoking, 4.1; 95% CI, 1.9 to 9.2). SE-positive smokers had an odds ratio of ACPA-positive RA of 25.6 (95% CI, 10.4 to 63.4), compared with SE-negative never-smokers. The interaction between smoking and SE alleles was significant (attributable proportion due to interaction (AP) was 0.7 (95% CI, 0.5 to 1.0)). The HLA-DRB1*04:05 SE allele, which is common in Asian populations, but not among Caucasians, was associated with an increased risk of ACPA-positive RA, and this allele also showed signs of interaction with smoking (AP, 0.4; 95% CI, -0.1 to 0.9). Neither smoking nor SE alleles nor their combination was associated with an increased risk of ACPA-negative RA. Conclusions The risk of developing ACPA-positive RA is associated with a strong gene-environment interaction between smoking and HLA-DRB1 SE alleles in a Malaysian multiethnic population of Asian descent. This interaction seems to apply also between smoking and the specific HLA-DRB1*04:05 SE allele, which is common in Asian populations but not in Caucasians.
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Affiliation(s)
- Chun Lai Too
- Rheumatology Unit, Department of Medicine, Center of Molecular Medicine L8:04, Karolinska University Hospital, 17176 Stockholm, Sweden.
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