ImmUniverse Consortium: Multi-omics integrative approach in personalized medicine for immune-mediated inflammatory diseases

Association between red blood cell distribution width-to-albumin ratio and depression: a cross-sectional analysis among US adults, 2011-2018

BACKGROUND

Red blood cell distribution width (RDW)-to-albumin ratio (RAR) is a novel index. Its relationship with depression, a common and complex psychiatric disorder, remains unclear. This study utilized the National Health and Nutrition Examination Survey (NHANES) database to investigate this relationship.

METHODS

Multivariate logistic regression, restricted cubic spline (RCS) regression, receiver operating characteristic (ROC) analysis, and sensitivity analyses were used to examine the relationship between RAR and depression based on NHANES data from 2011-2018. The study also used subgroup analyses and interaction tests to explore whether the relationship was stable across populations.

RESULTS

RAR was positively associated with depression in 18,150 participants aged ≥ 20 years. In fully adjusted models, each one-unit increase in RAR was associated with a 22% increase in the likelihood of depression [1.22 (1.05, 1.41)]. Participants in the highest quartile of RAR had a 30% higher risk of depression than those in the lowest quartile of RAR [1.30 (1.04, 1.63)]. Subgroup analyses revealed that the association between RAR and depression was significantly stronger among men, alcohol-drinking and high-income groups.

CONCLUSIONS

Higher baseline RAR was associated with an increased risk of depression in US adults and was more informative than RDW, albumin, and hemoglobin-to-RDW ratio (HRR). Further large-scale prospective studies are needed to analyze the role of RAR in depression. These findings emphasize that RAR can be a simple, reliable and cost-effective predictor of depression in clinical practice.

Complications of invasive oral procedures in patients with immune-mediated inflammatory disorders treated with biological and conventional disease-modifying antirheumatic drugs or glucocorticoids: a scoping review of the literature

OBJECTIVES

By a scoping review, to evaluate whether patients with immune-mediated inflammatory disorders (IMIDs) treated with biological and conventional disease-modifying antirheumatic drugs (b/cDMARDs) and/or glucocorticoids (GCs) experience complications after invasive oral procedures.

MATERIALS AND METHODS

Primary search was conducted on PubMed/MEDLINE database, Google Scholar, Embase and Web of Science up to December 31, 2023. The PICO question was "Does a patient with IMIDs and treated with b/cDMARDs in mono/bi or combination therapies have delayed oral wound healing or infectious complications after an invasive oral procedure?". To be included, references had to be primary studies written in English or French. Qualitative assessment was performed.

RESULTS

From 1,494 initial articles, 59 full-text articles were selected, including 47 case reports and case series, 7 comparative non-randomized studies, 1 randomized clinical trial, 2 case-case studies, 1 case-control study, and 1 prospective cohort study. Most reports involved patients with rheumatoid arthritis on methotrexate and/or anti-TNF. Complications (medication-related osteonecrosis of the jaw, delayed healing, local infection) occurred predominantly after tooth extractions, particularly affecting women, patients over 50 with bisphosphonate use, unhealthy lifestyle habits, or diabetes. They were generally managed with prolonged antibiotic and antiseptic courses, and surgical interventions.

CONCLUSIONS

Local infectious complication or jaw osteonecrosis could occur post-invasive procedures, especially tooth extractions, in IMIDs patients on b/cDMARDs and/or GCs, often in patients with comorbidities and/or concurrent medications such as bone-modifying drugs.

CLINICAL RELEVANCE

It is essential for dentists to be alert to the existence of local or focal infectious complications after tooth extraction in patients with IMIDs on immunosuppressive therapy.

The paradigm shift in drug development for atopic dermatitis: Addressing the variables of the equation leading to disease modification

The recent development of new therapies for atopic dermatitis (AD) has greatly benefited from the advances in understanding the mechanisms underlying this disease. This progress now allows one to envisage pushing the therapeutic boundaries beyond the simple symptomatic treatment of the exacerbations of AD and considering new therapeutic strategies aimed to allow an off-therapy long-term and deep remission, that is, disease modification. Owing to the complexity of the phenotype and underlying mechanisms of AD, it is expected that this will not fit to the current one-size-fits-all model in drug development. Thus, aiming at disease modification will lead to a paradigm shift in drug development strategy in AD requiring the consideration of a precision medicine approach with a phenotype-endotype (biomarker)-based stratification as well as a consensus definition of specific study endpoints for the clinical development program. This review addresses the scientific rationale for this strategy, some general aspects of the design of confirmatory clinical trials, and the variables along the Population, Intervention, Comparator, and Outcome framework to be addressed for reaching the ultimate goal of disease modification in AD.

Dynamic changes in extracellular vesicle-associated miRNAs elicited by ultrasound in inflammatory bowel disease patients

Blood-based biomarkers that reliably indicate disease activity in the intestinal tract are an important unmet need in the management of patients with IBD. Extracellular vesicles (EVs) are cell-derived membranous microparticles, which reflect the cellular and functional state of their site of site of origin. As ultrasound waves may lead to molecular shifts of EV contents, we hypothesized that application of ultrasound waves on inflamed intestinal tissue in IBD may amplify the inflammation-specific molecular shifts in EVs like altered EV-miRNA expression, which in turn can be detected in the peripheral blood. 26 patients with IBD were included in the prospective clinical study. Serum samples were collected before and 30 min after diagnostic transabdominal ultrasound. Differential miRNA expression was analyzed by sequencing. Candidate inducible EV-miRNAs were functionally assessed in vitro by transfection of miRNA mimics and qPCR of predicted target genes. Serum EV-miRNA concentration at baseline correlated with disease severity, as determined by clinical activity scores and sonographic findings. Three miRNAs (miR-942-5p, mir-5588, mir-3195) were significantly induced by sonography. Among the significantly regulated EV-miRNAs, miR-942-5p was strongly induced in higher grade intestinal inflammation and correlated with clinical activity in Crohn's disease. Prediction of target regulation and transfection of miRNA mimics inferred a role of this EV-miRNA in regulating barrier function in inflammation. Induction of mir-5588 and mir-3195 did not correlate with inflammation grade. This proof-of-concept trial highlights the principle of induced molecular shifts in EVs from inflamed tissue through transabdominal ultrasound. These inducible EVs and their molecular cargo like miRNA could become novel biomarkers for intestinal inflammation in IBD.

Integrated analyses revealed the potential role and immune link of mitochondrial dysfunction between periodontitis and type 2 diabetes mellitus

There is a reciprocal comorbid relationship between periodontitis and type 2 diabetes mellitus (T2DM). Recent studies have suggested that mitochondrial dysfunction (MD) could be the key driver underlying this comorbidity. The aim of this study is to provide novel understandings into the potential molecular mechanisms between MD and the comorbidity, and identify potential therapeutic targets for personalized clinical management. MD-related differentially expressed genes (MDDEGs) were identified. Enrichment analyses and PPI network analysis were then conducted. Six algorithms were used to explore the hub MDDEGs, and these were validated by ROC analysis and qRT-PCR. Co-expression and potential drug targeting analyses were then performed. Potential biomarkers were identified using LASSO regression. The immunocyte infiltration levels in periodontitis and T2DM were evaluated via CIBERSORTx and validated in mouse models. Subsequently, MD-related immune-related genes (MDIRGs) were screened by WGCNA. The in vitro experiment verified that MD was closely associated with this comorbidity. GO and KEGG analyses demonstrated that the connection between periodontitis and T2DM was mainly enriched in immuno-inflammatory pathways. In total, 116 MDDEGs, eight hub MDDEGs, and two biomarkers were identified. qRT-PCR revealed a distinct hub MDDEG expression pattern in the comorbidity group. Altered immunocytes in disease samples were identified, and their correlations were explored. The in vivo examination revealed higher infiltration levels of inflammatory immunocytes. The findings of this study provide insight into the mechanism underlying the gene-mitochondria-immunocyte network and provide a novel reference for future research into the function of mitochondria in periodontitis and T2DM.

Multi-Omics Approach to Improved Diagnosis and Treatment of Atopic Dermatitis and Psoriasis

Psoriasis and atopic dermatitis fall within the category of cutaneous immune-mediated inflammatory diseases (IMIDs). The prevalence of IMIDs is increasing in industrialized societies, influenced by both environmental changes and a genetic predisposition. However, the exact immune factors driving these chronic, progressive diseases are not fully understood. By using multi-omics techniques in cutaneous IMIDs, it is expected to advance the understanding of skin biology, uncover the underlying mechanisms of skin conditions, and potentially devise precise and personalized approaches to diagnosis and treatment. We provide a narrative review of the current knowledge in genomics, epigenomics, and proteomics of atopic dermatitis and psoriasis. A literature search was performed for articles published until 30 November 2023. Although there is still much to uncover, recent evidence has already provided valuable insights, such as proteomic profiles that permit differentiating psoriasis from mycosis fungoides and β-defensin 2 correlation to PASI and its drop due to secukinumab first injection, among others.

Omics and Multi-Omics in IBD: No Integration, No Breakthroughs

The recent advent of sophisticated technologies like sequencing and mass spectroscopy platforms combined with artificial intelligence-powered analytic tools has initiated a new era of "big data" research in various complex diseases of still-undetermined cause and mechanisms. The investigation of these diseases was, until recently, limited to traditional in vitro and in vivo biological experimentation, but a clear switch to in silico methodologies is now under way. This review tries to provide a comprehensive assessment of state-of-the-art knowledge on omes, omics and multi-omics in inflammatory bowel disease (IBD). The notion and importance of omes, omics and multi-omics in both health and complex diseases like IBD is introduced, followed by a discussion of the various omics believed to be relevant to IBD pathogenesis, and how multi-omics "big data" can generate new insights translatable into useful clinical tools in IBD such as biomarker identification, prediction of remission and relapse, response to therapy, and precision medicine. The pitfalls and limitations of current IBD multi-omics studies are critically analyzed, revealing that, regardless of the types of omes being analyzed, the majority of current reports are still based on simple associations of descriptive retrospective data from cross-sectional patient cohorts rather than more powerful longitudinally collected prospective datasets. Given this limitation, some suggestions are provided on how IBD multi-omics data may be optimized for greater clinical and therapeutic benefit. The review concludes by forecasting the upcoming incorporation of multi-omics analyses in the routine management of IBD.

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

BACKGROUND

The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019.

METHODS

We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends.

FINDINGS

In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of -0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = -0.41), inflammatory bowel disease (AAPC = -0.72), multiple sclerosis (AAPC = -0.26), psoriasis (AAPC = -0.77), and atopic dermatitis (AAPC = -0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR.

INTERPRETATION

The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively.

FUNDING

The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).

Disease modification in inflammatory skin disorders: opportunities and challenges

Progress in understanding of the mechanisms underlying chronic inflammatory skin disorders, such as atopic dermatitis and psoriasis vulgaris, has led to new treatment options with the primary goal of alleviating symptoms. In addition, this knowledge has the potential to inform on new strategies aimed at inducing deep and therapy-free remission, that is, disease modification, potentially impacting on associated comorbidities. However, to reach this goal, key areas require further exploration, including the definitions of disease modification and disease activity index, further understanding of disease mechanisms and systemic spillover effects, potential windows of opportunity, biomarkers for patient stratification and successful intervention, as well as appropriate study design. This Perspective article assesses the opportunities and challenges in the discovery and development of disease-modifying therapies for chronic inflammatory skin disorders.