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Lapuente JP, Gómez G, Marco-Brualla J, Fernández P, Desportes P, Sanz J, García-Gil M, Bermejo F, San Martín JV, Algaba A, De Gregorio JC, Lapuente D, De Gregorio A, Lapuente B, Gómez S, Andrés MDLV, Anel A. Evaluation in a Cytokine Storm Model in Vivo of the Safety and Efficacy of Intravenous Administration of PRS CK STORM (Standardized Conditioned Medium Obtained by Coculture of Monocytes and Mesenchymal Stromal Cells). Biomedicines 2022; 10:biomedicines10051094. [PMID: 35625831 PMCID: PMC9138962 DOI: 10.3390/biomedicines10051094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Our research group has been developing a series of biological drugs produced by coculture techniques with M2-polarized macrophages with different primary tissue cells and/or mesenchymal stromal cells (MSC), generally from fat, to produce anti-inflammatory and anti-fibrotic effects, avoiding the overexpression of pro-inflammatory cytokines by the innate immune system at a given time. One of these products is the drug PRS CK STORM, a medium conditioned by allogenic M2-polarized macrophages, from coculture, with those macrophages M2 with MSC from fat, whose composition, in vitro safety, and efficacy we studied. In the present work, we publish the results obtained in terms of safety (pharmacodynamics and pharmacokinetics) and efficacy of the intravenous application of this biological drug in a murine model of cytokine storm associated with severe infectious processes, including those associated with COVID-19. The results demonstrate the safety and high efficacy of PRS CK STORM as an intravenous drug to prevent and treat the cytokine storm associated with infectious processes, including COVID-19.
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Affiliation(s)
- Juan Pedro Lapuente
- R4T Molecular and Cell Biology Research Laboratories, Fuenlabrada Hospital, 28942 Madrid, Spain; (G.G.); (P.F.); (J.C.D.G.); (D.L.); (A.D.G.); (B.L.); (S.G.); (M.d.l.V.A.)
- Correspondence: (J.P.L.); (A.A.)
| | - Gonzalo Gómez
- R4T Molecular and Cell Biology Research Laboratories, Fuenlabrada Hospital, 28942 Madrid, Spain; (G.G.); (P.F.); (J.C.D.G.); (D.L.); (A.D.G.); (B.L.); (S.G.); (M.d.l.V.A.)
| | - Joaquín Marco-Brualla
- Group Immunity, Cancer and Stem Cells, Faculty of Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Pablo Fernández
- R4T Molecular and Cell Biology Research Laboratories, Fuenlabrada Hospital, 28942 Madrid, Spain; (G.G.); (P.F.); (J.C.D.G.); (D.L.); (A.D.G.); (B.L.); (S.G.); (M.d.l.V.A.)
| | - Paula Desportes
- GMP Facility, Peaches Biotech, 28050 Madrid, Spain; (P.D.); (J.S.)
| | - Jara Sanz
- GMP Facility, Peaches Biotech, 28050 Madrid, Spain; (P.D.); (J.S.)
| | | | - Fernando Bermejo
- Digestive Department, Fuenlabrada Hospital, 28942 Madrid, Spain;
- Medicine Department, University Rey Juan Carlos, 28942 Madrid, Spain
| | | | - Alicia Algaba
- Clinical Assay Department, Fuelabrada Hospital, 28942 Madrid, Spain;
| | - Juan Carlos De Gregorio
- R4T Molecular and Cell Biology Research Laboratories, Fuenlabrada Hospital, 28942 Madrid, Spain; (G.G.); (P.F.); (J.C.D.G.); (D.L.); (A.D.G.); (B.L.); (S.G.); (M.d.l.V.A.)
| | - Daniel Lapuente
- R4T Molecular and Cell Biology Research Laboratories, Fuenlabrada Hospital, 28942 Madrid, Spain; (G.G.); (P.F.); (J.C.D.G.); (D.L.); (A.D.G.); (B.L.); (S.G.); (M.d.l.V.A.)
| | - Almudena De Gregorio
- R4T Molecular and Cell Biology Research Laboratories, Fuenlabrada Hospital, 28942 Madrid, Spain; (G.G.); (P.F.); (J.C.D.G.); (D.L.); (A.D.G.); (B.L.); (S.G.); (M.d.l.V.A.)
| | - Belén Lapuente
- R4T Molecular and Cell Biology Research Laboratories, Fuenlabrada Hospital, 28942 Madrid, Spain; (G.G.); (P.F.); (J.C.D.G.); (D.L.); (A.D.G.); (B.L.); (S.G.); (M.d.l.V.A.)
| | - Sergio Gómez
- R4T Molecular and Cell Biology Research Laboratories, Fuenlabrada Hospital, 28942 Madrid, Spain; (G.G.); (P.F.); (J.C.D.G.); (D.L.); (A.D.G.); (B.L.); (S.G.); (M.d.l.V.A.)
| | - María de las Viñas Andrés
- R4T Molecular and Cell Biology Research Laboratories, Fuenlabrada Hospital, 28942 Madrid, Spain; (G.G.); (P.F.); (J.C.D.G.); (D.L.); (A.D.G.); (B.L.); (S.G.); (M.d.l.V.A.)
| | - Alberto Anel
- Group Immunity, Cancer and Stem Cells, Faculty of Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
- Correspondence: (J.P.L.); (A.A.)
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Cytokine Profile and Anti-Inflammatory Activity of a Standardized Conditioned Medium Obtained by Coculture of Monocytes and Mesenchymal Stromal Cells (PRS CK STORM). Biomolecules 2022; 12:biom12040534. [PMID: 35454123 PMCID: PMC9029939 DOI: 10.3390/biom12040534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Intercellular communication between monocytes/macrophages and cells involved in tissue regeneration, such as mesenchymal stromal cells (MSCs) and primary tissue cells, is essential for tissue regeneration and recovery of homeostasis. Typically, in the final phase of the inflammation-resolving process, this intercellular communication drives an anti-inflammatory immunomodulatory response. To obtain a safe and effective treatment to counteract the cytokine storm associated with a disproportionate immune response to severe infections, including that associated with COVID-19, by means of naturally balanced immunomodulation, our group has standardized the production under GMP-like conditions of a secretome by coculture of macrophages and MSCs. To characterize this proteome, we determined the expression of molecules related to cellular immune response and tissue regeneration, as well as its possible toxicity and anti-inflammatory potency. The results show a specific molecular pattern of interaction between the two cell types studied, with an anti-inflammatory and regenerative profile. In addition, the secretome is not toxic by itself on human PBMC or on THP-1 monocytes and prevents lipopolysaccharide (LPS)-induced growth effects on those cell types. Finally, PRS CK STORM prevents LPS-induced TNF-A and IL-1Β secretion from PBMC and from THP-1 cells at the same level as hydrocortisone, demonstrating its anti-inflammatory potency.
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Smet A, Breugelmans T, Michiels J, Lamote K, Arras W, De Man JG, Heyndrickx L, Hauner A, Huizing M, Malhotra-Kumar S, Lammens M, Hotterbeekx A, Kumar-Singh S, Verstraeten A, Loeys B, Verhoeven V, Jacobs R, Dams K, Coenen S, Ariën KK, Jorens PG, De Winter BY. A dynamic mucin mRNA signature associates with COVID-19 disease presentation and severity. JCI Insight 2021; 6:e151777. [PMID: 34448730 PMCID: PMC8525642 DOI: 10.1172/jci.insight.151777] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/25/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection induces mucin overexpression, further promoting disease. Given that mucins are critical components of innate immunity, unraveling their expression profiles that dictate the course of disease could greatly enhance our understanding and management of COVID-19. METHODS Using validated RT-PCR assays, we assessed mucin mRNA expression in the blood of patients with symptomatic COVID-19 compared with symptomatic patients without COVID-19 and healthy controls and correlated the data with clinical outcome parameters. Additionally, we analyzed mucin expression in mucus and lung tissue from patients with COVID-19 and investigated the effect of drugs for COVID-19 treatment on SARS-CoV-2–induced mucin expression in pulmonary epithelial cells. RESULTS We identified a dynamic blood mucin mRNA signature that clearly distinguished patients with symptomatic COVID-19 from patients without COVID-19 based on expression of MUC1, MUC2, MUC4, MUC6, MUC13, MUC16, and MUC20 (AUCROC of 91.8%; sensitivity and specificity of 90.6% and 93.3%, respectively) and that discriminated between mild and critical COVID-19 based on the expression of MUC16, MUC20, and MUC21 (AUCROC of 89.1%; sensitivity and specificity of 90.0% and 85.7%, respectively). Differences in the transcriptional landscape of mucins in critical cases compared with mild cases identified associations with COVID-19 symptoms, respiratory support, organ failure, secondary infections, and mortality. Furthermore, we identified different mucins in the mucus and lung tissue of critically ill COVID-19 patients and showed the ability of baricitinib, tocilizumab, favipiravir, and remdesivir to suppress expression of SARS-CoV-2–induced mucins. CONCLUSION This multifaceted blood mucin mRNA signature showed the potential role of mucin profiling in diagnosing, estimating severity, and guiding treatment options in patients with COVID-19. FUNDING The Antwerp University Research and the Research Foundation Flanders COVID-19 funds.
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Affiliation(s)
- Annemieke Smet
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Tom Breugelmans
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Johan Michiels
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Kevin Lamote
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Wout Arras
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Joris G De Man
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Leo Heyndrickx
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Anne Hauner
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Manon Huizing
- Biobank Antwerpen, Antwerp University Hospital, Edegem, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Martin Lammens
- Department of Histopathology, Antwerp University Hospital, Edegem, Belgium
| | - An Hotterbeekx
- Laboratory of Cell Biology and Histology, Molecular Pathology Group, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Samir Kumar-Singh
- Laboratory of Cell Biology and Histology, Molecular Pathology Group, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Aline Verstraeten
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Bart Loeys
- Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rita Jacobs
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Karolien Dams
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Samuel Coenen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kevin K Ariën
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Philippe G Jorens
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Critical Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, and.,Infla-med, Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Division of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
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Kelly SB, Stojanovska V, Zahra VA, Moxham A, Miller SL, Moss TJM, Hooper SB, Nold MF, Nold-Petry CA, Dean JM, Bennet L, Polglase GR, Gunn AJ, Galinsky R. Interleukin-1 blockade attenuates white matter inflammation and oligodendrocyte loss after progressive systemic lipopolysaccharide exposure in near-term fetal sheep. J Neuroinflammation 2021; 18:189. [PMID: 34465372 PMCID: PMC8408978 DOI: 10.1186/s12974-021-02238-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background Increased systemic and tissue levels of interleukin (IL)-1β are associated with greater risk of impaired neurodevelopment after birth. In this study, we tested the hypothesis that systemic IL-1 receptor antagonist (Ra) administration would attenuate brain inflammation and injury in near-term fetal sheep exposed to lipopolysaccharide (LPS). Methods Chronically instrumented near-term fetal sheep at 0.85 of gestation were randomly assigned to saline infusion (control, n = 9), repeated LPS infusions (0 h = 300 ng, 24 h = 600 ng, 48 h = 1200 ng, n = 8) or repeated LPS plus IL-1Ra infusions (13 mg/kg infused over 4 h) started 1 h after each LPS infusion (n = 9). Sheep were euthanized 4 days after starting infusions for histology. Results LPS infusions increased circulating cytokines and were associated with electroencephalogram (EEG) suppression with transiently reduced mean arterial blood pressure, and increased carotid artery perfusion and fetal heart rate (P < 0.05 vs. control for all). In the periventricular and intragyral white matter, LPS-exposure increased IL-1β immunoreactivity, numbers of caspase 3+ cells and microglia, reduced astrocyte and olig-2+ oligodendrocyte survival but did not change numbers of mature CC1+ oligodendrocytes, myelin expression or numbers of neurons in the cortex and subcortical regions. IL-1Ra infusions reduced circulating cytokines and improved recovery of EEG activity and carotid artery perfusion. Histologically, IL-1Ra reduced microgliosis, IL-1β expression and caspase-3+ cells, and improved olig-2+ oligodendrocyte survival. Conclusion IL-1Ra improved EEG activity and markedly attenuated systemic inflammation, microgliosis and oligodendrocyte loss following LPS exposure in near-term fetal sheep. Further studies examining the long-term effects on brain maturation are now needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02238-4.
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Affiliation(s)
- Sharmony B Kelly
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Vanesa Stojanovska
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia
| | - Valerie A Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia
| | - Alison Moxham
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Timothy J M Moss
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Marcel F Nold
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Australia
| | - Claudia A Nold-Petry
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Justin M Dean
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Alistair J Gunn
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia. .,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
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Masson Regnault M, Frouin E, Jéru I, Delwail A, Charreau S, Barbarot S, Néel A, Masseau A, Puéchal X, Kyndt X, Gayet S, Lifermann F, Asli B, Balguerie X, Blanchard-Delaunay C, Aubin F, Rizzi R, Rongioletti F, Boyé T, Gusdorf L, Bessis D, Morel F, Hainaut E, Lipsker D, Lecron JC. Cytokine Signature in Schnitzler Syndrome: Proinflammatory Cytokine Production Associated to Th Suppression. Front Immunol 2020; 11:588322. [PMID: 33324407 PMCID: PMC7726442 DOI: 10.3389/fimmu.2020.588322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022] Open
Abstract
Background Schnitzler syndrome (SchS) is a rare autoinflammatory disease characterized by urticarial exanthema, bone and joint alterations, fever and monoclonal IgM gammopathy. Overactivation of the interleukin(IL)-1 system is reported, even though the exact pathophysiological pathways remain unknown. Objective To determine ex vivo cytokine profiles of Peripheral Blood Mononuclear Cells (PBMCs) from SchS patients prior to treatment and after initiation of anti-IL-1 therapy (anakinra). The sera cytokine profile was studied in parallel. Methods We collected blood samples from thirty-six untreated or treated SchS. PBMCs were cultured with and without LPS or anti-CD3/CD28. Cytokine levels were evaluated in serum and cell culture supernatants using Luminex technology. Results Spontaneous TNFα, IL-6, IL-1β, IL-1α, and IL-1RA release by PBMCs of SchS patients were higher than in controls. LPS-stimulation further induced the secretion of these cytokines. In contrast, after T-cell stimulation, TNFα, IL-10, IFNγ, IL-17A, and IL-4 production decreased in SchS patients compared to healthy controls, but less in treated patients. Whereas IL-1β serum level was not detected in most sera, IL-6, IL-10, and TNFα serum levels were higher in patients with SchS and IFNγ and IL-4 levels were lower. Of note, IL-6 decreased after treatment in SchS (p = 0.04). Conclusion Our data strengthen the hypothesis of myeloid inflammation in SchS, mediated in particular by IL-1β, TNFα, and IL-6, associated with overproduction of the inhibitors IL-1RA and IL-10. In contrast, we observed a loss of Th1, Th2, and Th17 cell functionalities that tends to be reversed by anakinra.
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Affiliation(s)
- Marie Masson Regnault
- Centre Hospitalo-Universitaire de Poitiers, Service de Dermatologie, Poitiers, France.,Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France
| | - Eric Frouin
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France.,Centre Hospitalo-universitaire, Service de Anatomopathologie, Poitiers, France
| | - Isabelle Jéru
- Sorbonne Université, Inserm UMR 933, Childhood Genetic Disorders, Hôpital Trousseau, Paris, France
| | - Adriana Delwail
- ImageUP, Plate-forme d'Imagerie et Laboratoire Signalisation et Transport Ioniques Membranaires ERL CNRS 7003/EA 7349, Université de Poitiers, Poitiers, France
| | - Sandrine Charreau
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France
| | - Sébastien Barbarot
- Centre Hospitalo-universitaire de Nantes, Service de Dermatologie, Nantes, France
| | - Antoine Néel
- CHU Nantes, Service de Médecine Interne, Nantes, France.,CHU Nantes, Université de Nantes, Inserm, Centre de Recherche en Transplantation et Immunologie, UMR 1064, ITUN, Nantes, France
| | | | - Xavier Puéchal
- Centre de Référence Maladies Systémiques et Auto-Immunes Rares, Université Paris Descartes, APHP, Hôpital Cochin, Paris, France
| | - Xavier Kyndt
- Centre Hospitalier de Valenciennes, Service de Médecine Interne, Valenciennes, France
| | - Stephane Gayet
- Service de Medecine Interne, Centre hospitalo-Universitaire La Timone, Marseille, France
| | - François Lifermann
- Centre Hospitalier de Dax, Service de Médecine Interne Hématologie, Dax, France
| | - Bouchra Asli
- Centre Hospitalier Edouard Herriot-Lyon, Service de Médecine Interne, Lyon, France
| | - Xavier Balguerie
- Centre Hospitalier de Rouen, Service de Dermatologie, Rouen, France
| | | | - François Aubin
- Centre Hospitalier de Besançon, Service de Dermatologie, Besançon, France
| | - Rita Rizzi
- Department of Hematology, University of Bari Medical School, Bari, Italy
| | - Franco Rongioletti
- Department of Medical Sciences and Public Health, Unit of Dermatology, University of Cagliari, Cagliari, Italy
| | - Thierry Boyé
- Service de Dermatologie, Hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - Laurence Gusdorf
- Centre Hospitalier Universitaire de Reims, Service de Dermatologie et Vénéréologie, Reims, France
| | - Didier Bessis
- Centre Hospitalier Universitaire de Montpellier, Hôpital Saint-Eloi, Service de Dermatologie et Vénéréologie, Montpellier, France
| | - Franck Morel
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France
| | - Ewa Hainaut
- Centre Hospitalo-Universitaire de Poitiers, Service de Dermatologie, Poitiers, France.,Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France
| | - Dan Lipsker
- Faculté de Médecine, Université de Strasbourg et Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Claude Lecron
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France.,CHU de Poitiers, Laboratoire Immunologie-Inflammation, Poitiers, France
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Darrieutort-Laffite C, Ansquer C, Aubert H, Kraeber-Bodéré F, Masseau A, Agard C, Hamidou M, Bernier C, Berthelot JM, Le Goff B, Barbarot S, Néel A. Rheumatic involvement and bone scan features in Schnitzler syndrome: initial and follow-up data from a single-center cohort of 25 patients. Arthritis Res Ther 2020; 22:272. [PMID: 33208192 PMCID: PMC7677784 DOI: 10.1186/s13075-020-02318-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To report on the characteristics and long-term course of rheumatic manifestations in Schnitzler syndrome (SchS). Methods A retrospective cohort study of patients with SchS followed between 2000 and 2020. Inclusion criteria included a diagnosis of SchS (Strasbourg criteria). All available bone scans were reviewed and scored according to the intensity and number of pathological sites. The scintigraphic score was compared with the clinical activity score, CRP level, and treatments. Results Twenty-five patients were included. Median age at diagnosis was 68 years. Eighty patients (72%) had SchS-related rheumatic pain. Most patients had a long-standing isolated rash before constitutional and/or rheumatic symptoms appeared. The monoclonal component level was usually very low (IgMκ in 22/25). Rheumatic pain predominated around the knees. Bone scans revealed abnormal tracer uptake in 15/18 (85%). The scintigraphic score correlated with clinical activity (r = 0.4, p < 0.02) and CRP level (r = 0.47, p < 0.01). The scintigraphic score was lower in patients receiving corticosteroids or IL1Ra (interleukin 1 receptor antagonist) than in untreated patients (median scores:2, 0, and 13, respectively; p < 0.05). Two patients developed Waldenström macroglobulinemia. Of the 22 surviving patients, median age at follow-up was 76 years. IL1Ra was used in 13 patients, with dramatic efficacy on both symptoms and bone scan features. Conclusions Rheumatic manifestations are very prevalent in SchS. However, bone pain can be misleading and contribute to misdiagnosis. Bone scan abnormalities are very prevalent and correlate with disease activity and treatments. IL1-Ra has a dramatic and durable efficacy but may not be required in every patient early on.
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Affiliation(s)
| | | | - Hélène Aubert
- Department of Dermatology, CHU Nantes, Nantes, France
| | | | - Agathe Masseau
- Department of Internal Medicine Interne, CHU Nantes, Nantes, France
| | - Christian Agard
- Department of Internal Medicine Interne, CHU Nantes, Nantes, France
| | - Mohamed Hamidou
- Department of Internal Medicine Interne, CHU Nantes, Nantes, France
| | | | - Jean-Marie Berthelot
- Department of Rheumatology, CHU Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - Benoit Le Goff
- Department of Rheumatology, CHU Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | | | - Antoine Néel
- Department of Internal Medicine Interne, CHU Nantes, Nantes, France
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Luo W, Ige OO, Beacon TH, Su RC, Huang S, Davie JR, Lakowski TM. The treatment of SARS-CoV2 with antivirals and mitigation of the cytokine storm syndrome: the role of gene expression. Genome 2020; 64:400-415. [PMID: 33197212 DOI: 10.1139/gen-2020-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the absence of a vaccine, the treatment of SARS-CoV2 has focused on eliminating the virus with antivirals or mitigating the cytokine storm syndrome (CSS) that leads to the most common cause of death: respiratory failure. Herein we discuss the mechanisms of antiviral treatments for SARS-CoV2 and treatment strategies for the CSS. Antivirals that have shown in vitro activity against SARS-CoV2, or the closely related SARS-CoV1 and MERS-CoV, are compared on the enzymatic level and by potency in cells. For treatment of the CSS, we discuss medications that reduce the effects or expression of cytokines involved in the CSS with an emphasis on those that reduce IL-6 because of its central role in the development of the CSS. We show that some of the medications covered influence the activity or expression of enzymes involved in epigenetic processes and specifically those that add or remove modifications to histones or DNA. Where available, the latest clinical data showing the efficacy of the medications is presented. With respect to their mechanisms, we explain why some medications are successful, why others have failed, and why some untested medications may yet prove useful.
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Affiliation(s)
- Wenxia Luo
- Pharmaceutical Analysis Laboratory, College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0T5, Canada
| | - Olufola O Ige
- Pharmaceutical Analysis Laboratory, College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0T5, Canada
| | - Tasnim H Beacon
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Ruey-Chyi Su
- National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Winnipeg, MB R3E 3R2, Canada
| | - Shujun Huang
- Pharmaceutical Analysis Laboratory, College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0T5, Canada
| | - James R Davie
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Ted M Lakowski
- Pharmaceutical Analysis Laboratory, College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0T5, Canada
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8
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Delcuve GP, Lakowski TM, Su RC, Beacon TH, Davie JR. SARS-CoV-2 multifaceted interaction with human host. Part I: What we have learnt and done so far, and the still unknown realities. IUBMB Life 2020; 72:2313-2330. [PMID: 32918855 DOI: 10.1002/iub.2380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022]
Abstract
SARS-CoV-2, the causing agent of the ongoing COVID-19 pandemic, is a beta-coronavirus which has 80% genetic homology with SARS-CoV, but displays increased virulence and transmissibility. Initially, SARS-CoV-2 was considered a respiratory virus generally causing a mild disease, only severe and fatal in the elderly and individuals with underlying conditions. Severe illnesses and fatalities were attributed to a cytokine storm, an excessive response from the host immune system. However, with the number of infections over 10 millions and still soaring, the insidious and stealthy nature of the virus has emerged, as it causes a vast array of diverse unexpected symptoms among infected individuals, including the young and healthy. It has become evident that besides infecting the respiratory tract, SARS-CoV-2 can affect many organs, possibly through the infection of the endothelium. This review presents an overview of our learning curve with the novel virus emergence, transmission, pathology, biological properties and host-interactions. It also briefly describes remedial measures taken until an effective vaccine is available, that is non-pharmaceutical interventions to reduce the viral spread and the repurposing of existing drugs, approved or in development for other conditions to eliminate the virus or mitigate the cytokine storm.
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Affiliation(s)
- Geneviève P Delcuve
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ted M Lakowski
- College of Pharmacy, Pharmaceutical Analysis Laboratory, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruey-Chyi Su
- National HIV and Retrovirology Laboratory, JC Wilt Infectious Disease Research Centre, Winnipeg, Manitoba, Canada
| | - Tasnim H Beacon
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James R Davie
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
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Tegtmeyer K, Atassi G, Zhao J, Maloney NJ, Lio PA. Off-Label studies on anakinra in dermatology: a review. J DERMATOL TREAT 2020; 33:73-86. [PMID: 32279586 DOI: 10.1080/09546634.2020.1755417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose: Anakinra (Kineret®) is an interleukin-1 receptor antagonist (IL-1Ra) FDA approved for use in rheumatoid arthritis and in neonatal-onset multisystem inflammatory disease (NOMID). It has been used off-label for a variety of dermatologic conditions. A review of the available studies and cases of these off-label uses would be valuable to the dermatologist considering alternative treatments for these oftentimes poorly studied conditions.Materials and methods: The PubMed/MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov databases were searched with the term 'anakinra.' Results were manually screened to identify published data on off-label uses of anakinra in dermatologic conditions and systemic conditions with prominent dermatologic manifestations.Results: Anakinra appears to show efficacy for numerous dermatologic conditions, with the strongest evidence for hidradenitis suppurativa, Bechet's disease, Muckle-Wells syndrome, and SAPHO syndrome. Case reports and case series data are available for numerous other dermatologic conditions.Conclusion: Anakinra is a potential option for patients with certain difficult-to-treat dermatologic diseases, given its relatively benign adverse effect profile and its effectiveness in a wide array of conditions. Overall, anakinra appears to be a promising option in the treatment of numerous dermatologic inflammatory conditions refractory to first line therapies, but further and higher-quality data is needed to clarify its therapeutic role.
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Affiliation(s)
- Kyle Tegtmeyer
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Giancarlo Atassi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey Zhao
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nolan J Maloney
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter A Lio
- Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Medical Dermatology Associates of Chicago, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ushach I, Arrevillaga-Boni G, Heller GN, Pone E, Hernandez-Ruiz M, Catalan-Dibene J, Hevezi P, Zlotnik A. Meteorin-like/Meteorin-β Is a Novel Immunoregulatory Cytokine Associated with Inflammation. THE JOURNAL OF IMMUNOLOGY 2018; 201:3669-3676. [PMID: 30464051 DOI: 10.4049/jimmunol.1800435] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/17/2018] [Indexed: 12/20/2022]
Abstract
We have described a novel cytokine encoded by a gene called Meteorin-like (Metrnl). Metrnl is a small (∼28 kDa) secreted protein expressed by activated macrophages and barrier tissues (mucosa and skin). Metrnl production by bone marrow macrophages is induced by several cytokines including TNF-α, IL-17α, IL-12, and IL-4 and inhibited by IFN-γ and TGF-β. Metrnl expression in macrophages is also induced by LPS, and its levels in circulation are associated with inflammatory responses in vivo. Furthermore, Metrnl regulates the production of several cytokines and chemokines in macrophages. We have produced a Metrnl-/- mouse, which is viable and shows normal development. However, it exhibits dysregulated cytokine production, alterations in IgG production, and is highly susceptible to LPS in a sepsis model. Furthermore, older Metrnl-/- mice develop inflammatory lesions, suggesting that Metrnl participates in the control of inflammatory responses. Taken together, these observations indicate that Metrnl encodes a novel immunoregulatory cytokine associated with inflammatory responses that we have designated Meteorin-β.
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Affiliation(s)
- Irina Ushach
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA 92697.,Institute for Immunology, University of California, Irvine, Irvine, CA 92697; and
| | - Gerardo Arrevillaga-Boni
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA 92697.,Institute for Immunology, University of California, Irvine, Irvine, CA 92697; and
| | - Gina N Heller
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA 92697.,Institute for Immunology, University of California, Irvine, Irvine, CA 92697; and
| | - Egest Pone
- Department of Pharmaceutical Sciences, University of California, Irvine, Irvine, CA 92697
| | - Marcela Hernandez-Ruiz
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA 92697.,Institute for Immunology, University of California, Irvine, Irvine, CA 92697; and
| | - Jovani Catalan-Dibene
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA 92697.,Institute for Immunology, University of California, Irvine, Irvine, CA 92697; and
| | - Peter Hevezi
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA 92697.,Institute for Immunology, University of California, Irvine, Irvine, CA 92697; and
| | - Albert Zlotnik
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA 92697; .,Institute for Immunology, University of California, Irvine, Irvine, CA 92697; and
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11
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Soudet S, Fajgenbaum D, Delattre C, Forestier A, Hachulla E, Hatron PY, Launay D, Terriou L. Schnitzler syndrome co-occurring with idiopathic multicentric Castleman disease that responds to anti-IL-1 therapy: A case report and clue to pathophysiology. Curr Res Transl Med 2018; 66:83-86. [PMID: 30108026 DOI: 10.1016/j.retram.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/17/2018] [Accepted: 06/10/2018] [Indexed: 01/09/2023]
Abstract
Patients with HHV-8-negative/idiopathic multicentric Castleman disease (iMCD) experience systemic inflammatory symptoms and polyclonal lymphoproliferation due to an unknown etiology. Schnitzler's syndrome (SS) is characterized by recurrent urticarial rash, monoclonal IgM gammopathy, and other clinical signs of inflammation. To our knowledge, we report the first case of iMCD associated with SS and the fourth case of anakinra inducing a complete response for an iMCD patient. A forty-four year old woman with a history of a recurrent urticarial rash, presented to our hospital complaining of 6 months of night sweats, fever, chronic urticaria, iliac bone pain, and generalized lymphadenopathy. An IgM Kappa monoclonal component was measured at 7.8g/L. A lymph node biopsy revealed histopathological features consistent with the plasma cell variant of iMCD. She was diagnosed with SS and iMCD. Anti-IL-1 treatment with anakinra (100mg/day) was introduced. Within 48h, we observed improvement in the fever and the urticarial rash. By one month, we considered the patient in complete remission. Two years later, the remission is persistent while the patient is still under therapy. Though this is only the fourth reported case of anakinra in iMCD, this is yet another case demonstrating the effectiveness of anti-IL-1 blockade in SS. We hypothesize that uncontrolled cytokine production is responsible for both the SS and the iMCD. The etiologies of SS and iMCD are unknown, and future research is necessary.
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Affiliation(s)
- Simon Soudet
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France.
| | - David Fajgenbaum
- Department of Medicine, Division of Translational Medicine & Human Genetics, Leonard Davis Institute of Health Economics, Orphan Disease Center, University of Pennsylvania, Philadelphia, USA
| | | | - Alexandra Forestier
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
| | - Eric Hachulla
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France; University Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France
| | - Pierre Yves Hatron
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France; University Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France
| | - David Launay
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France; University Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; INSERM, U995, Lille, France; Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France
| | - Louis Terriou
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
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12
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Rubbert-Roth A, Furst DE, Nebesky JM, Jin A, Berber E. A Review of Recent Advances Using Tocilizumab in the Treatment of Rheumatic Diseases. Rheumatol Ther 2018; 5:21-42. [PMID: 29502236 PMCID: PMC5935615 DOI: 10.1007/s40744-018-0102-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Indexed: 12/20/2022] Open
Abstract
Tocilizumab (TCZ) is the first humanized anti-interleukin-6 (IL-6) receptor monoclonal antibody approved for the treatment of patients with rheumatoid arthritis (RA), Castleman's disease, polyarticular and systemic juvenile idiopathic arthritis, and, most recently, giant cell arteritis as well as for the treatment of chimeric antigen receptor T cell therapy-induced cytokine release syndrome. The global clinical development program for TCZ provides a wealth of clinical data on intravenous TCZ, and more recent studies in patients with RA have provided evidence characterizing the role of intravenous TCZ as monotherapy in early disease and led to the introduction of a subcutaneous formulation of TCZ. In addition, recently published open-label extension and observational studies continue to support the long-term efficacy and safety of TCZ in both clinical trial and real-world settings. Given the involvement of IL-6-mediated signaling in inflammatory disorders, TCZ is also being investigated in other immunological diseases. In particular, a phase 2 trial on the safety and efficacy of subcutaneous TCZ in adults with systemic sclerosis shows clinically relevant improvements in skin sclerosis and lung function in these patients. Another anti-IL-6 receptor agent, sarilumab, targeting the IL6 receptor alpha subunit, was recently approved for the treatment of patients with RA, although long-term data for this biologic are not yet published. In this article we review the placement of TCZ in current treatment guidelines; recent clinical trial data, including quality of life in patients with RA; recent updates to the TCZ safety profile; recent investigations of TCZ in other immunological diseases; and the clinical development of other novel IL-6-targeted agents.
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Affiliation(s)
- Andrea Rubbert-Roth
- Kantonsspital St Gallen, St Gallen, Switzerland.
- Clinic for Rheumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
| | - Daniel E Furst
- University of California, Los Angeles, Los Angeles, CA, USA
- University of Washington, Seattle, WA, USA
- University of Florence, Florence, Italy
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13
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Abstract
Interleukin (IL)-1 is a pro-inflammatory cytokine that induces local and systemic inflammation aimed to eliminate microorganisms and tissue damage. However, an increasing number of clinical conditions have been identified in which IL-1 production is considered inappropriate and IL-1 is part of the disease etiology. In autoinflammatory diseases, gout, Schnitzler's syndrome, and adult-onset Still's disease, high levels of inappropriate IL-1 production have been shown to be a key process in the etiology of the disease. In these conditions, blocking IL-1 has proven very effective in clinical studies. In other diseases, IL-1 has shown to be present in disease process but is not the central driving force of inflammation. In these conditions, including type 1 and 2 diabetes mellitus, acute coronary syndrome, amyotrophic lateral sclerosis, and several neoplastic diseases, the benefits of IL-1 blockade are minimal or absent.
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14
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Bonnekoh H, Scheffel J, Kambe N, Krause K. The role of mast cells in autoinflammation. Immunol Rev 2018; 282:265-275. [DOI: 10.1111/imr.12633] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Hanna Bonnekoh
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC2); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Jörg Scheffel
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC2); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Naotomo Kambe
- Department of Dermatology; Kansai Medical University; Hirakata Japan
- Allergy Center; Kansai Medical University; Hirakata Japan
| | - Karoline Krause
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC2); Charité - Universitätsmedizin Berlin; Berlin Germany
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Abstract
PURPOSE OF REVIEW Blockade of interleukin (IL)-1 signaling is one of the oldest biologic therapies, yet the use of these agents is on the rise as the role of IL-1 activation is being recognized in a wide spectrum of inflammatory disorders. This review will cover established and emerging uses of IL-1 antagonism in rheumatic diseases. RECENT FINDINGS Expanding off-label indications for IL-1 blockade include neutrophil-dominant skin diseases, including pyoderma gangrenosum, hidradenitis supperativa, and pustular psoriasis. There is also increasing evidence for the use of IL-1 blockade in heart failure associated with rheumatic diseases. Somatic mosaicism in NLRP3 may explain the onset of later-in-life presentations of periodic fevers which are responsive to IL-1 blockade. Of importance, clinical response to anti-IL-1 therapy does not always denote protection from autoinflammatory disease complications such as macrophage activation syndrome or amyloidosis. SUMMARY Indications for IL-1 blocking therapies will likely continue to broaden, but given the rarity of many rheumatic diseases which respond to such treatment, rigorous, large clinical trials for each indication are unlikely to occur. Thus, recommended use of these medications will often fall to the discretion of the astute physician. However, medication cost and hurdles of insurance approval, rather than drug efficacy, may be the primary limitation for more widespread use.
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Krause K, Tsianakas A, Wagner N, Fischer J, Weller K, Metz M, Church MK, Maurer M. Efficacy and safety of canakinumab in Schnitzler syndrome: A multicenter randomized placebo-controlled study. J Allergy Clin Immunol 2016; 139:1311-1320. [PMID: 27658762 DOI: 10.1016/j.jaci.2016.07.041] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Schnitzler syndrome is an adult-onset autoinflammatory disease characterized by urticarial exanthema and monoclonal gammopathy accompanied by systemic symptoms such as fever, bone, and muscle pain. Up to now, approved treatment options are not available. OBJECTIVE We assessed effects of the anti-IL-1β mAb canakinumab on the clinical signs and symptoms of Schnitzler syndrome. METHODS In this phase II, randomized placebo-controlled multicenter study, 20 patients with active disease enrolled in 4 German study centers. Patients were randomly assigned to receive single subcutaneous canakinumab 150 mg or placebo injections for 7 days, followed by a 16-week open-label phase with canakinumab injections on confirmed relapse of symptoms. The primary end point was the proportion of patients with complete clinical response evaluated by physician global assessment at day 7. Key secondary end points included changes in patient-reported disease activity (Schnitzler activity score), inflammation markers (C-reactive protein and serum amyloid A), and quality-of-life assessments (Dermatology Life Quality Index and 36-item short form health survey). RESULTS The proportion of patients with complete clinical response at day 7 was significantly higher (P = .001) in the canakinumab-treated group (n = 5 of 7) than in the placebo group (n = 0 of 13). Levels of inflammation markers C-reactive protein and serum amyloid A and quality-of-life scores were significantly reduced in canakinumab-treated but not in placebo-treated individuals. Positive effects continued up to 16 weeks. Adverse events were manageable and included respiratory tract infections, gastrointestinal symptoms, and hypertension. CONCLUSIONS In this first placebo-controlled study, canakinumab was effective in patients with Schnitzler syndrome, and thus canakinumab may be further evaluated as a therapeutic option for this rare disease.
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Affiliation(s)
- Karoline Krause
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany; Autoinflammation Reference Center Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Nicola Wagner
- Department of Dermatology, Klinikum Darmstadt, Darmstadt, Germany
| | - Jörg Fischer
- Department of Dermatology and Allergy, Universitätsklinik Tübingen, Tübingen, Germany
| | - Karsten Weller
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin K Church
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany; Autoinflammation Reference Center Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Un syndrome de Schnitzler révélé par une maladie de Castleman : cas clinique et description histologique. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Noster R, de Koning HD, Maier E, Prelog M, Lainka E, Zielinski CE. Dysregulation of proinflammatory versus anti-inflammatory human T H17 cell functionalities in the autoinflammatory Schnitzler syndrome. J Allergy Clin Immunol 2016; 138:1161-1169.e6. [PMID: 27040374 DOI: 10.1016/j.jaci.2015.12.1338] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/22/2015] [Accepted: 12/01/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND TH17 cells have so far been considered to be crucial mediators of autoimmune inflammation. Two distinct types of TH17 cells have been described recently, which differed in their polarization requirement for IL-1β and in their cytokine repertoire. Whether these distinct TH17 phenotypes translate into distinct TH17 cell functions with implications for human health or disease has not been addressed yet. OBJECTIVE We hypothesized the existence of proinflammatory and anti-inflammatory human TH17 cell functions based on the differential expression of IL-10, which is regulated by IL-1β. Considering the crucial role of IL-1β in the pathogenesis of autoinflammatory syndromes, we hypothesized that IL-1β mediates the loss of anti-inflammatory TH17 cell functionalities in patients with Schnitzler syndrome, an autoinflammatory disease. METHODS To assess proinflammatory versus anti-inflammatory TH17 cell functions, we performed suppression assays and tested the effects of IL-1β dependent and independent TH17 subsets on modulating proinflammatory cytokine secretion by monocytes. Patients with Schnitzler syndrome were analyzed for changes in TH17 cell functions before and during therapy with IL-1β-blocking drugs. RESULTS Both TH17 cell subsets differ in their ability to suppress T-cell proliferation and their ability to modulate proinflammatory cytokine production by antigen-presenting cells because of their differential IL-10 expression properties. In patients with Schnitzler syndrome, systemic overproduction of IL-1β translates into a profound loss of anti-inflammatory TH17 cell functionalities, which can be reversed by anti-IL-1β treatment. CONCLUSION IL-1β signaling determines the differential expression pattern of IL-10, which is necessary and sufficient to induce proinflammatory versus anti-inflammatory TH17 cell functions. Our data introduce TH17 cell subsets as novel players in autoinflammation and thus novel therapeutic targets in autoinflammatory syndromes including other IL-1β mediated diseases. This demonstrates for the first time alterations in the adaptive immune system in patients with autoinflammatory syndromes.
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Affiliation(s)
- Rebecca Noster
- Department of Dermatology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heleen D de Koning
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands; Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, The Netherlands
| | - Elisabeth Maier
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Martina Prelog
- Department of Pediatrics, University of Wuerzburg, Wuerzberg, Germany
| | - Elke Lainka
- Pediatric Rheumatology, University Children's Hospital, Essen, Germany
| | - Christina E Zielinski
- Department of Dermatology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany.
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19
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de Koning HD, Schalkwijk J, Stoffels M, Jongekrijg J, Jacobs JFM, Verwiel E, Koenen HJPM, Preijers F, Holzinger D, Joosten I, van der Meer JWM, Simon A. The role of interleukin-1 beta in the pathophysiology of Schnitzler's syndrome. Arthritis Res Ther 2015. [PMID: 26198339 PMCID: PMC4511239 DOI: 10.1186/s13075-015-0696-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Schnitzler’s syndrome (SchS) is a disabling autoinflammatory disorder, characterized by a chronic urticarial rash, an M-protein, arthralgia, and other signs of systemic inflammation. Anti-interleukin-1 (IL-1) beta antibodies are highly effective, but the pathophysiology is still largely unknown. Here we studied the effect of in-vivo IL-1 inhibition on serum markers of inflammation and cellular immune responses. Methods Eight patients with SchS received monthly subcutaneous (s.c.) injections with 150 mg canakinumab for six months. Blood was drawn for measurement of serum markers of inflammation (12 times per patient) and for functional and phenotypic analysis of both freshly isolated and toll-like receptor (TLR)-ligand-stimulated peripheral blood mononuclear cells (PBMCs) (five times per patient). All data were compared to results of healthy controls. Results IL-6 levels in serum and in lysates of freshly isolated PBMCs and serum myeloid-related protein (MRP8)/14 and S100A12 levels correlated with disease activity. In vitro, LPS stimulation resulted in higher IL-6 and IL-1 beta production in PBMCs from symptomatic SchS patients compared to healthy controls, whereas patient cells were relatively hyporesponsive to poly:IC and Pam3Cys. The mRNA microarray of PBMCs showed distinct transcriptomes for controls, symptomatic patients and anti-IL-1-treated patients. Numbers of T- and B-cell subsets as well as M-protein concentrations were not affected by IL-1 inhibition. Free light chain levels were elevated in 4 out of 8 patients. Conclusions In conclusion, patient PBMCs are hyperresponsive to LPS, and clinical efficacy of IL-1 beta inhibition in patients with SchS is associated with in-vivo and ex-vivo suppression of inflammation. Interestingly, patient PBMCs showed divergent responses to TLR2/6, TLR3 and TLR4 ligands. Our data underscore that IL-1 beta plays a pivotal role in SchS. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0696-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heleen D de Koning
- Departments of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. .,Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands. .,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, The Netherlands.
| | - Joost Schalkwijk
- Departments of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands. .,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, The Netherlands.
| | - Monique Stoffels
- Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. .,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, The Netherlands.
| | - Johanna Jongekrijg
- Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Joannes F M Jacobs
- Laboratory Medicine - Laboratory for Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Eugène Verwiel
- Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Hans J P M Koenen
- Laboratory Medicine - Laboratory for Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Frank Preijers
- Laboratory Medicine - Laboratory for Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Dirk Holzinger
- Department of Paediatric Rheumatology and Immunology, University Hospital Muenster, Muenster, Germany. .,Institute of Immunology, University Hospital Muenster, Muenster, Germany.
| | - Irma Joosten
- Laboratory Medicine - Laboratory for Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Jos W M van der Meer
- Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. .,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, The Netherlands.
| | - Anna Simon
- Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. .,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, The Netherlands.
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de Koning HD, van Vlijmen-Willems IMJJ, Rodijk-Olthuis D, van der Meer JWM, Zeeuwen PLJM, Simon A, Schalkwijk J. Mast-cell interleukin-1β, neutrophil interleukin-17 and epidermal antimicrobial proteins in the neutrophilic urticarial dermatosis in Schnitzler's syndrome. Br J Dermatol 2015; 173:448-56. [PMID: 25904179 DOI: 10.1111/bjd.13857] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Schnitzler's syndrome (SchS) is an autoinflammatory disease characterized by a chronic urticarial rash, a monoclonal component and signs of systemic inflammation. Interleukin (IL)-1β is pivotal in the pathophysiology. OBJECTIVES Here we investigated the cellular source of proinflammatory mediators in the skin of patients with SchS. METHODS Skin biopsies of lesional and nonlesional skin from eight patients with SchS and healthy controls, and patients with cryopyrin-associated periodic syndrome (CAPS), delayed-pressure urticaria (DPU) and cold-contact urticaria (CCU) were studied. We studied in vivoIL-1β, IL-17 and antimicrobial protein (AMP) expression in resident skin cells and infiltrating cells. In addition we investigated the in vitro effect of IL-1β, IL-17 and polyinosinic-polycytidylic acid (poly:IC) stimulation on cultured epidermal keratinocytes. RESULTS Remarkably, we found IL-1β-positive dermal mast cells in both lesional and nonlesional skin of patients with SchS, but not in healthy control skin and CCU, and fewer in CAPS. IL-17-positive neutrophils were observed only in lesional SchS and DPU skin. In lesional SchS epidermis, mRNA and protein expression levels of AMPs were strongly increased compared with nonlesional skin and that of healthy controls. When exposed to IL-1β, poly:IC or IL-17, patient and control primary human keratinocytes produced AMPs in similar amounts. CONCLUSIONS Dermal mast cells of patients with SchS produce IL-1β. This presumably leads to activation of keratinocytes and neutrophil influx, and further amplification of inflammation by IL-17 (from neutrophils and mast cells) and epidermal AMP production leading to chronic histamine-independent neutrophilic urticarial dermatosis.
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Affiliation(s)
- H D de Koning
- Department of Dermatology, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.,Department of Internal Medicine, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, the Netherlands.,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, the Netherlands
| | | | - D Rodijk-Olthuis
- Department of Dermatology, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands
| | - J W M van der Meer
- Department of Internal Medicine, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, the Netherlands
| | - P L J M Zeeuwen
- Department of Dermatology, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, the Netherlands.,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, the Netherlands
| | - A Simon
- Department of Internal Medicine, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, the Netherlands
| | - J Schalkwijk
- Department of Dermatology, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, the Netherlands.,Nijmegen Center for Immunodeficiency and Autoinflammation, Nijmegen, the Netherlands
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21
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Dinarello CA. An expanding role for interleukin-1 blockade from gout to cancer. Mol Med 2014; 20 Suppl 1:S43-58. [PMID: 25549233 PMCID: PMC4374514 DOI: 10.2119/molmed.2014.00232] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 01/08/2023] Open
Abstract
There is an expanding role for interleukin (IL)-1 in diseases from gout to cancer. More than any other cytokine family, the IL-1 family is closely linked to innate inflammatory and immune responses. This linkage is because the cytoplasmic segment of all members of the IL-1 family of receptors contains a domain, which is highly homologous to the cytoplasmic domains of all toll-like receptors (TLRs). This domain, termed "toll IL-1 receptor (TIR) domain," signals as does the IL-1 receptors; therefore, inflammation due to the TLR and the IL-1 families is nearly the same. Fundamental responses such as the induction of cyclo-oxygenase type 2, increased surface expression of cellular adhesion molecules and increased gene expression of a broad number of inflammatory molecules characterizes IL-1 signal transduction as it does for TLR agonists. IL-1β is the most studied member of the IL-1 family because of its role in mediating autoinflammatory disease. However, a role for IL-1α in disease is being validated because of the availability of a neutralizing monoclonal antibody to human IL-1α. There are presently three approved therapies for blocking IL-1 activity. Anakinra is a recombinant form of the naturally occurring IL-1 receptor antagonist, which binds to the IL-1 receptor and prevents the binding of IL-1β as well as IL-1α. Rilonacept is a soluble decoy receptor that neutralizes primarily IL-1β but also IL-1α. Canakinumab is a human monoclonal antibody that neutralizes only IL-1β. Thus, a causal or significant contributing role can be established for IL-1β and IL-1α in human disease.
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Affiliation(s)
- Charles Anthony Dinarello
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, United States of America; and Department of Medicine, Radboud University, Nijmegen, the Netherlands
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22
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Abstract
Schnitzler’s syndrome is an autoinflammatory disorder characterized by the association of a monoclonal IgM (or IgG) gammopathy, a chronic urticarial rash, and signs and symptoms of systemic inflammation, including fever, arthralgias and bone pain. It was first described in 1972. This review summarizes the clinical features, efficacy of therapies, and follow-up data of the 281 cases that have been reported to date. Also, the results of skin histology, bone imaging, laboratory investigations, and studies of the pathogenesis will be discussed, including the pivotal role of interleukin-1 beta in this disorder.
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23
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Aouba A, Pressiat C, Pricopi M, Georgin-Lavialle S, Boue F, Lievre-Castilla MA, Marfaing-Koka A, Prevot S, Decottignies A. Complete Remission of Schnitzler Syndrome and Waldenström Macroglobulinemia under Rituximab-Cyclophosphamide-Dexamethasone. Dermatology 2014; 230:18-22. [DOI: 10.1159/000368349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 09/16/2014] [Indexed: 11/19/2022] Open
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25
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Néel A, Henry B, Barbarot S, Masseau A, Perrin F, Bernier C, Kyndt X, Puechal X, Weiller PJ, Decaux O, Ninet J, Hot A, Aouba A, Astudillo L, Berthelot JM, Bonnet F, Brisseau JM, Cador B, Closs-Prophette F, Dejoie T, de Korwin JD, Dhote R, Fior R, Grosbois B, Hachulla E, Hatron PY, Jardel H, Launay D, Lorleac'h A, Pottier P, Moulis G, Serratrice J, Smail A, Hamidou M. Long-term effectiveness and safety of interleukin-1 receptor antagonist (anakinra) in Schnitzler's syndrome: a French multicenter study. Autoimmun Rev 2014; 13:1035-41. [PMID: 25220180 DOI: 10.1016/j.autrev.2014.08.031] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/03/2014] [Indexed: 02/07/2023]
Abstract
The aim of this study is to assess the long-term effectiveness and safety of IL1Ra in Schnitzler syndrome (SchS). Between 2010 and 2012, we performed a nationwide survey among French internal medicine departments to identify SchS patients. We retrospectively analyzed the long-term efficacy and safety of IL1Ra and the outcome of patients that did not receive this treatment. Forty-two patients were included in the study, 29 of whom received IL1Ra. The mean age at disease onset was 59.9years. Disease manifestations included urticaria (100%), fever (76%), bone/joint pain (86%), bone lesions (76%), anemia (67%), and weight loss (60%). The monoclonal gammopathy was overwhelmingly IgM kappa (83%). The mean follow-up was 9.5years (range: 1.6-35). Two patients developed Waldenström's macroglobulinemia and one developed AA amyloidosis. All of the 29 patients who received IL1Ra responded dramatically. After a median follow-up of 36months (range: 2-79), the effectiveness remained unchanged. All patients remained on anti-IL-1 therapy. Twenty-four patients (83%) went into complete remission and five (17%) into partial remission. Three patients experienced grade 3-4 neutropenia. Six patients developed severe infections. No lymphoproliferative diseases occurred while on IL1Ra. When last seen, all patients without anakinra had an active disease with variable impact on their quality of life. Their median corticosteroids dosage was 6mg/d (range: 5-25). IL1Ra is effective in SchS, with a sharp corticosteroid-sparing effect. Treatment failures should lead to reconsider the diagnosis. Long-term follow-up revealed no loss of effectiveness and a favorable tolerance profile. The long-term effects on the risk of hemopathy remain unknown.
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Affiliation(s)
- Antoine Néel
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France.
| | - Benoit Henry
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France
| | | | - Agathe Masseau
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France
| | - François Perrin
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France
| | - Claire Bernier
- CHU de Nantes, Service de Dermatologie, F 44093 Nantes, France
| | - Xavier Kyndt
- CH de Valenciennes, Service de Médecine Interne-Néphrologie, F 59322 Valenciennes, France
| | - Xavier Puechal
- CHU Cochin (AP-HP), Département de Médecine Interne, F 75014 Paris, France
| | - Pierre-Jean Weiller
- CHU la Timone (AP-HM; Aix-Marseille Université), Service de Médecine Interne, F 13385 Marseille, France
| | - Olivier Decaux
- CHU de Rennes, Service de Médecine Interne, F 35033 Rennes, France; Université Rennes 1, UMR CNRS 6290 IGRD, 35042 Rennes, France
| | - Jacques Ninet
- CHU Edouard Herriot (HCL), Service de Médecine Interne, F 69437 Lyon, France
| | - Arnaud Hot
- CHU Edouard Herriot (HCL), Service de Médecine Interne, F 69437 Lyon, France
| | - Achille Aouba
- CHU Antoine Béclère (AP-HP), Service de Médecine Interne et Immunologie Clinique, F 92140 Clamart, France
| | | | | | - Fabrice Bonnet
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, F 33075 Bordeaux, France
| | | | - Bérangère Cador
- CHU de Rennes, Service de Médecine Interne, F 35033 Rennes, France
| | | | - Thomas Dejoie
- CHU de Nantes, Laboratoire de Biochimie, F 44093 Nantes, France
| | | | - Robin Dhote
- CHU Avicenne (AP-HP), Service de Médecine Interne, F 93009 Bobigny, France
| | - Renato Fior
- CHU Antoine Béclère (AP-HP), Service de Médecine Interne et Immunologie Clinique, F 92140 Clamart, France
| | - Bernard Grosbois
- CHU de Rennes, Service de Médecine Interne, F 35033 Rennes, France; Université Rennes 1, UMR CNRS 6290 IGRD, 35042 Rennes, France
| | - Eric Hachulla
- CHRU de Lille, Service de Médecine Interne et Immunologie Clinique, F 59037 Lille, France; Faculté de Médecine, Université Lille Nord de France, F59037 Lille, France; EA2686, IMPRT IFR 114, F 59037 Lille, France
| | - Pierre-Yves Hatron
- CHRU de Lille, Service de Médecine Interne et Immunologie Clinique, F 59037 Lille, France; Faculté de Médecine, Université Lille Nord de France, F59037 Lille, France
| | - Henry Jardel
- CH Bretagne Atlantique, Service de Médecine Interne, F 56017 Vannes, France
| | - David Launay
- CHRU de Lille, Service de Médecine Interne et Immunologie Clinique, F 59037 Lille, France; Faculté de Médecine, Université Lille Nord de France, F59037 Lille, France; EA2686, IMPRT IFR 114, F 59037 Lille, France
| | - Adrien Lorleac'h
- CH Bretagne Sud, Service de Médecine Interne et Maladies Infectieuses, F 56100 Lorient, France
| | - Pierre Pottier
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France; Faculté de Médecine, Université de Nantes, F44093 Nantes, France
| | - Guillaume Moulis
- CHU d'Amiens, Service de Médecine Interne, F 80054 Amiens, France
| | - Jacques Serratrice
- CHU la Timone (AP-HM; Aix-Marseille Université), Service de Médecine Interne, F 13385 Marseille, France
| | - Amar Smail
- CHU d'Amiens, Service de Médecine Interne, F 80054 Amiens, France
| | - Mohamed Hamidou
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France; Faculté de Médecine, Université de Nantes, F44093 Nantes, France
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Niederhauser BD, Dingli D, Kyle RA, Ringler MD. Imaging findings in 22 cases of Schnitzler syndrome: characteristic para-articular osteosclerosis, and the "hot knees" sign differential diagnosis. Skeletal Radiol 2014; 43:905-15. [PMID: 24652142 DOI: 10.1007/s00256-014-1857-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Schnitzler syndrome is characterized by chronic urticaria, monoclonal gammopathy, and a risk of developing lymphoproliferative disorders. Patients frequently present with bone pain, fever, arthralgia, and lymphadenopathy. The purpose of this study is to retrospectively review and evaluate potentially attributable imaging abnormalities in a series of patients with clinically diagnosed Schnitzler syndrome. MATERIALS AND METHODS Clinical and pathological chart review identified 22 patients meeting Strasbourg criteria for Schnitzler syndrome. Imaging of these patients was retrospectively reviewed by a musculoskeletal radiologist and a radiology fellow to determine and characterize significant "positive" findings that could potentially be attributed to their primary disease process. RESULTS Evidence of abnormal bone remodeling was present in 64% (14/22) of patients with 40 bone abnormalities. Lesions were predominantly or entirely sclerotic and most commonly involved the distal femora (n = 11), proximal tibiae (nine), and innominate bones (six). Patterns of involvement were variable, but typically eccentrically intramedullary, cortical, and juxta-articular. Skeletal surveys and targeted radiographs identified only 37% (10/27) of abnormal bones subsequently "positive" by additional modalities. PET and bone scans were all positive in patients with bone sclerosis (13/13 and 17/17 bone sites, respectively). CONCLUSIONS Schnitzler syndrome often presents with characteristic osteosclerosis, most commonly around the knees and in the pelvis. In patients with a suggestive clinical history, the radiologist could direct an appropriate imaging strategy or might to be the first to suggest the diagnosis. Bone scan may be the most appropriate initial screening tool in suspected cases.
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27
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The inflammasomes in autoinflammatory diseases with skin involvement. J Invest Dermatol 2014; 134:1805-1810. [PMID: 24599175 DOI: 10.1038/jid.2014.76] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 01/13/2023]
Abstract
During the past years, significant progress in the understanding of the complexity, regulation, and relevance of innate immune responses underlying several inflammatory conditions with neutrophilic skin involvement has been made. These diseases belong to the novel class of autoinflammatory diseases, and several are caused by mutations in genes regulating the function of innate immune complexes, termed inflammasomes, leading to enhanced secretion of the proinflammatory cytokine IL-1β. Consequently, targeting of IL-1β has proven successful in the treatment of these diseases, and the identification of related pathogenic mechanisms in other more common skin diseases characterized by autoinflammation and neutrophilic tissue damage also provides extended opportunities for therapy by interfering with IL-1 signaling.
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Abstract
IL-1 is a master cytokine of local and systemic inflammation. With the availability of specific IL-1 targeting therapies, a broadening list of diseases has revealed the pathologic role of IL-1-mediated inflammation. Although IL-1, either IL-1α or IL-1β, was administered to patients in order to improve bone marrow function or increase host immune responses to cancer, these patients experienced unacceptable toxicity with fever, anorexia, myalgias, arthralgias, fatigue, gastrointestinal upset and sleep disturbances; frank hypotension occurred. Thus it was not unexpected that specific pharmacological blockade of IL-1 activity in inflammatory diseases would be beneficial. Monotherapy blocking IL-1 activity in a broad spectrum of inflammatory syndromes results in a rapid and sustained reduction in disease severity. In common conditions such as heart failure and gout arthritis, IL-1 blockade can be effective therapy. Three IL-1blockers have been approved: the IL-1 receptor antagonist, anakinra, blocks the IL-1 receptor and therefore reduces the activity of IL-1α and IL-1β. A soluble decoy receptor, rilonacept, and a neutralizing monoclonal anti-interleukin-1β antibody, canakinumab, are also approved. A monoclonal antibody directed against the IL-1 receptor and a neutralizing anti-IL-1α are in clinical trials. By specifically blocking IL-1, we have learned a great deal about the role of this cytokine in inflammation but equally important, reducing IL-1 activity has lifted the burden of disease for many patients.
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Key Words
- AOSD
- Autoimmune
- Autoinflammatory
- C-reactive protein
- CAPS
- CRP
- DIRA
- FCAS
- FMF
- HIDS
- Inflammation
- NLRP12
- NLRP3
- NOMID
- PAPA
- PASH
- PFAPA
- SAPHO
- SJIA
- TNF receptor associated periodic syndrome
- TRAPS
- adult onset Still's disease
- cryopyrin autoinflammatory periodic syndromes
- deficiency of IL-1Ra
- familial Mediterranean fever
- familial cold autoinflammatory syndrome
- hyper IgD syndrome
- neonatal onset multi-inflammatory diseases
- nucleotide-binding domain and leucine-rich repeat pyrin containing 12
- nucleotide-binding domain and leucine-rich repeat pyrin containing 3
- periodic fever, aphthous stomatitis, pharyngitis, and adenitis
- pyoderma-gangrenosum, acne, and suppurativa hidradenitis
- pyogenic arthritis, pyoderma gangrenosum, and acne
- synovitis, acne, pustulosis, hyperostosis and osteitis
- systemic-onset juvenile idiopathic arthritis
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Affiliation(s)
- Charles A Dinarello
- Department of Medicine, University of Colorado Denver, Aurora, CO, United States; Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos W M van der Meer
- Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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