1
|
Karabayas M, Ibrahim HE, Roelofs AJ, Reynolds G, Kidder D, De Bari C. Vascular disease persistence in giant cell arteritis: are stromal cells neglected? Ann Rheum Dis 2024:ard-2023-225270. [PMID: 38684323 DOI: 10.1136/ard-2023-225270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/05/2024] [Indexed: 05/02/2024]
Abstract
Giant cell arteritis (GCA), the most common systemic vasculitis, is characterised by aberrant interactions between infiltrating and resident cells of the vessel wall. Ageing and breach of tolerance are prerequisites for GCA development, resulting in dendritic and T-cell dysfunction. Inflammatory cytokines polarise T-cells, activate resident macrophages and synergistically enhance vascular inflammation, providing a loop of autoreactivity. These events originate in the adventitia, commonly regarded as the biological epicentre of the vessel wall, with additional recruitment of cells that infiltrate and migrate towards the intima. Thus, GCA-vessels exhibit infiltrates across the vascular layers, with various cytokines and growth factors amplifying the pathogenic process. These events activate ineffective repair mechanisms, where dysfunctional vascular smooth muscle cells and fibroblasts phenotypically shift along their lineage and colonise the intima. While high-dose glucocorticoids broadly suppress these inflammatory events, they cause well known deleterious effects. Despite the emerging targeted therapeutics, disease relapse remains common, affecting >50% of patients. This may reflect a discrepancy between systemic and local mediators of inflammation. Indeed, temporal arteries and aortas of GCA-patients can show immune-mediated abnormalities, despite the treatment induced clinical remission. The mechanisms of persistence of vascular disease in GCA remain elusive. Studies in other chronic inflammatory diseases point to the fibroblasts (and their lineage cells including myofibroblasts) as possible orchestrators or even effectors of disease chronicity through interactions with immune cells. Here, we critically review the contribution of immune and stromal cells to GCA pathogenesis and analyse the molecular mechanisms by which these would underpin the persistence of vascular disease.
Collapse
Affiliation(s)
- Maira Karabayas
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Hafeez E Ibrahim
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Anke J Roelofs
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Gary Reynolds
- Centre for Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dana Kidder
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Cosimo De Bari
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
2
|
Bonacini M, Rossi A, Ferrigno I, Muratore F, Boiardi L, Cavazza A, Bisagni A, Cimino L, De Simone L, Ghidini A, Malchiodi G, Corbera-Bellalta M, Cid MC, Zerbini A, Salvarani C, Croci S. miR-146a and miR-146b regulate the expression of ICAM-1 in giant cell arteritis. J Autoimmun 2024; 144:103186. [PMID: 38428111 DOI: 10.1016/j.jaut.2024.103186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
Giant cell arteritis (GCA) is an inflammatory disease of large/medium-sized arteries. MiRNAs are small, non-coding RNAs that inhibit gene expression at post-transcriptional level. Several miRNAs have been shown to be dysregulated in temporal artery biopsies (TABs) from GCA patients, but their role is unknown. The aims of the present work were: to gain insight into the link between inflammation and miRNA up-regulation in GCA; to identify the role of miR-146a and miR-146b. Primary cultures from TABs were treated with IL-1β, IL-6, soluble IL-6R (sIL6R), IL-17, IL-22, IFNγ, LPS and PolyIC. Correlations between cytokine mRNA and miRNA levels were determined in inflamed TABs. Primary cultures from TABs, human aortic endothelial and smooth muscle cells and ex-vivo TAB sections were transfected with synthetic miR-146a and miR-146b to mimic miRNA activities. Cell viability, target gene expression, cytokine levels in culture supernatants were assayed. Treatment of primary cultures from TABs with IL-1β and IL-17 increased miR-146a expression while IL-1β, IL-6+sIL6R and IFNγ increased miR-146b expression. IFNγ and IL-1β mRNA levels correlated with miR-146a/b levels. Following transfection, cell viability decreased only in primary cultures from TABs. Moreover, transfection of miR-146a/b mimics increased ICAM-1 gene expression and production of the soluble form of ICAM-1 by primary cultures from TABs and by ex-vivo TABs. ICAM-1 expression was higher in inflamed than normal TABs and ICAM-1 levels correlated with miR-146a/b levels. Expression of miR-146a and miR-146b in GCA appeared to be driven by inflammatory cytokines (e.g. IL-1β, IFNγ). miR-146a and miR-146b seem responsible for the increase of soluble ICAM-1.
Collapse
Affiliation(s)
- Martina Bonacini
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Rossi
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Ferrigno
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Muratore
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Boiardi
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Cavazza
- Unit of Pathology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Bisagni
- Unit of Pathology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy; Unit of Ocular Immunology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca De Simone
- Unit of Ocular Immunology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Unit of Otolaryngology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Malchiodi
- Unit of Vascular Surgery, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marc Corbera-Bellalta
- Unit of Vasculitis Research, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Maria Cinta Cid
- Unit of Vasculitis Research, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Alessandro Zerbini
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Croci
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| |
Collapse
|
3
|
Palamidas DA, Chatzis L, Papadaki M, Gissis I, Kambas K, Andreakos E, Goules AV, Tzioufas AG. Current Insights into Tissue Injury of Giant Cell Arteritis: From Acute Inflammatory Responses towards Inappropriate Tissue Remodeling. Cells 2024; 13:430. [PMID: 38474394 DOI: 10.3390/cells13050430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Giant cell arteritis (GCA) is an autoimmune disease affecting large vessels in patients over 50 years old. It is an exemplary model of a classic inflammatory disorder with IL-6 playing the leading role. The main comorbidities that may appear acutely or chronically are vascular occlusion leading to blindness and thoracic aorta aneurysm formation, respectively. The tissue inflammatory bulk is expressed as acute or chronic delayed-type hypersensitivity reactions, the latter being apparent by giant cell formation. The activated monocytes/macrophages are associated with pronounced Th1 and Th17 responses. B-cells and neutrophils also participate in the inflammatory lesion. However, the exact order of appearance and mechanistic interactions between cells are hindered by the lack of cellular and molecular information from early disease stages and accurate experimental models. Recently, senescent cells and neutrophil extracellular traps have been described in tissue lesions. These structures can remain in tissues for a prolonged period, potentially favoring inflammatory responses and tissue remodeling. In this review, current advances in GCA pathogenesis are discussed in different inflammatory phases. Through the description of these-often overlapping-phases, cells, molecules, and small lipid mediators with pathogenetic potential are described.
Collapse
Affiliation(s)
- Dimitris Anastasios Palamidas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Loukas Chatzis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Maria Papadaki
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Ilias Gissis
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, 11473 Athens, Greece
| | - Konstantinos Kambas
- Laboratory of Molecular Genetics, Department of Immunology, Hellenic Pasteur Institute, 11521 Athens, Greece
| | - Evangelos Andreakos
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Andreas V Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
- Research Institute for Systemic Autoimmune Diseases, 11527 Athens, Greece
| |
Collapse
|
4
|
Veroutis D, Argyropoulou OD, Goules AV, Kambas K, Palamidas DA, Evangelou K, Havaki S, Polyzou A, Valakos D, Xingi E, Karatza E, Boki KA, Cavazza A, Kittas C, Thanos D, Ricordi C, Marvisi C, Muratore F, Galli E, Croci S, Salvarani C, Gorgoulis VG, Tzioufas AG. Senescent cells in giant cell arteritis display an inflammatory phenotype participating in tissue injury via IL-6-dependent pathways. Ann Rheum Dis 2024; 83:342-350. [PMID: 38050005 DOI: 10.1136/ard-2023-224467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Age is the strongest risk factor of giant cell arteritis (GCA), implying a possible pathogenetic role of cellular senescence. To address this question, we applied an established senescence specific multimarker algorithm in temporal artery biopsies (TABs) of GCA patients. METHODS 75(+) TABs from GCA patients, 22(-) TABs from polymyalgia rheumatica (PMR) patients and 10(-) TABs from non-GCA/non-PMR patients were retrospectively retrieved and analysed. Synovial tissue specimens from patients with inflammatory arthritis and aorta tissue were used as disease control samples. Senescent cells and their histological origin were identified with specific cellular markers; IL-6 and MMP-9 were investigated as components of the senescent associated secretory phenotype by triple costaining. GCA or PMR artery culture supernatants were applied to fibroblasts, HUVECs and monocytes with or without IL-6R blocking agent to explore the induction of IL-6-associated cellular senescence. RESULTS Senescent cells were present in GCA arteries at higher proportion compared with PMR (9.50% vs 2.66%, respectively, p<0.0001) and were mainly originated from fibroblasts, macrophages and endothelial cells. IL-6 was expressed by senescent fibroblasts, and macrophages while MMP-9 by senescent fibroblasts only. IL-6(+) senescent cells were associated with the extension of vascular inflammation (transmural inflammation vs adventitia limited disease: 10.02% vs 4.37%, respectively, p<0.0001). GCA but not PMR artery culture supernatant could induce IL-6-associated senescence that was partially inhibited by IL-6R blockade. CONCLUSIONS Senescent cells with inflammatory phenotype are present in GCA arteries and are associated with the tissue inflammatory bulk, suggesting a potential implication in disease pathogenesis.
Collapse
Affiliation(s)
- Dimitris Veroutis
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ourania D Argyropoulou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas V Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Research Institute for Systemic Autoimmune Diseases, Athens, Greece
- Joint Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kambas
- Laboratory of Molecular Genetics, Department of Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - Dimitris Anastasios Palamidas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Research Institute for Systemic Autoimmune Diseases, Athens, Greece
| | - Konstantinos Evangelou
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Havaki
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Polyzou
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Valakos
- Center of Basic Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Evangelia Xingi
- Light Microscopy Unit, Hellenic Pasteur Institute, Athens, Greece
| | - Elli Karatza
- Second Propaedeutic Department of Surgery, Laikon General Hospital, Athens, Greece
| | - Kyriaki A Boki
- Rheumatology Unit, Sismanoglion Hospital, Athens, Greece
| | - Alberto Cavazza
- Unit of Pathology, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Christos Kittas
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Thanos
- Center of Basic Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Caterina Ricordi
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, and University of Modena, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Marvisi
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, and University of Modena, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Muratore
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, and University of Modena, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Galli
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, and University of Modena, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Croci
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, and University of Modena, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Vassilis G Gorgoulis
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
- Molecular and Clinical Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Research Institute for Systemic Autoimmune Diseases, Athens, Greece
- Joint Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Center of stratified medicine in autoimmune and rheumatic diseases, Biomedical Research Foundation Academy of Athens, Athens, Greece
| |
Collapse
|
5
|
Paroli M, Caccavale R, Accapezzato D. Giant Cell Arteritis: Advances in Understanding Pathogenesis and Implications for Clinical Practice. Cells 2024; 13:267. [PMID: 38334659 PMCID: PMC10855045 DOI: 10.3390/cells13030267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
Giant cell arteritis (GCA) is a noninfectious granulomatous vasculitis of unknown etiology affecting individuals older than 50 years. Two forms of GCA have been identified: a cranial form involving the medium-caliber temporal artery causing temporal arteritis (TA) and an extracranial form involving the large vessels, mainly the thoracic aorta and its branches. GCA generally affects individuals with a genetic predisposition, but several epigenetic (micro)environmental factors are often critical for the onset of this vasculitis. A key role in the pathogenesis of GCA is played by cells of both the innate and adaptive immune systems, which contribute to the formation of granulomas that may include giant cells, a hallmark of the disease, and arterial tertiary follicular organs. Cells of the vessel wall cells, including vascular smooth muscle cells (VSMCs) and endothelial cells, actively contribute to vascular remodeling responsible for vascular stenosis and ischemic complications. This review will discuss new insights into the molecular and cellular pathogenetic mechanisms of GCA, as well as the implications of these findings for the development of new diagnostic biomarkers and targeted drugs that could hopefully replace glucocorticoids (GCs), still the backbone of therapy for this vasculitis.
Collapse
Affiliation(s)
- Marino Paroli
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy; (R.C.); (D.A.)
| | | | | |
Collapse
|
6
|
Greigert H, Ramon A, Genet C, Cladière C, Gerard C, Cuidad M, Corbera-Bellalta M, Alba-Rovira R, Arnould L, Creuzot-Garcher C, Martin L, Tarris G, Ghesquière T, Ouandji S, Audia S, Cid MC, Bonnotte B, Samson M. Neointimal myofibroblasts contribute to maintaining Th1/Tc1 and Th17/Tc17 inflammation in giant cell arteritis. J Autoimmun 2024; 142:103151. [PMID: 38039746 DOI: 10.1016/j.jaut.2023.103151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/23/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
Vascular smooth muscle cells (VSMCs) have been shown to play a role in the pathogenesis of giant cell arteritis (GCA) through their capacity to produce chemokines recruiting T cells and monocytes in the arterial wall and their ability to migrate and proliferate in the neointima where they acquire a myofibroblast (MF) phenotype, leading to vascular stenosis. This study aimed to investigate if MFs could also impact T-cell polarization. Confocal microscopy was used to analyze fresh fragments of temporal artery biopsies (TABs). Healthy TAB sections were cultured to obtain MFs, which were then treated or not with interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) and analyzed by immunofluorescence and RT-PCR. After peripheral blood mononuclear cells and MFs were co-cultured for seven days, T-cell polarization was analyzed by flow cytometry. In the neointima of GCA arteries, we observed a phenotypic heterogeneity among VSMCs that was consistent with a MF phenotype (α-SMA+CD90+desmin+MYH11+) with a high level of STAT1 phosphorylation. Co-culture experiments showed that MFs sustain Th1/Tc1 and Th17/Tc17 polarizations. The increased Th1 and Tc1 polarization was further enhanced following the stimulation of MFs with IFN-γ and TNF-α, which induced STAT1 phosphorylation in MFs. These findings correlated with increases in the production of IL-1β, IL-6, IL-12 and IL-23 by MFs. Our study showed that MFs play an additional role in the pathogenesis of GCA through their ability to maintain Th17/Tc17 and Th1/Tc1 polarizations, the latter being further enhanced in case of stimulation of MF with IFN-γ and TNF-α.
Collapse
Affiliation(s)
- Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Department of Vascular Medicine, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - André Ramon
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France; Department of Rheumatology, Dijon University Hospital, Dijon, France
| | - Coraline Genet
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Claudie Cladière
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Claire Gerard
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Marion Cuidad
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Marc Corbera-Bellalta
- Department of Autoimmune Diseases, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Roser Alba-Rovira
- Department of Autoimmune Diseases, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
| | | | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Thibault Ghesquière
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Sethi Ouandji
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Maria C Cid
- Department of Autoimmune Diseases, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Autoimmune and Autoinflammatory Diseases (MAIS), Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France.
| |
Collapse
|
7
|
Noriega-Álvarez E, Rodríguez-Alfonso B, Merino Argumánez C, Domínguez Gadea L, Peiró-Valgañón V. Decoding polymyalgia rheumatica, the role of Nuclear Medicine Imaging. Rev Esp Med Nucl Imagen Mol 2024; 43:63-72. [PMID: 38110086 DOI: 10.1016/j.remnie.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023]
Abstract
Polymyalgia rheumatica (PMR) is an inflammatory joint disease that presents in patients older than 50 years with prolonged morning pain and stiffness in the shoulder and hip joints and neck. The lack of specific clinical findings, laboratory signs, biomarkers and established imaging methods makes it difficult to diagnose patients with this disease. 18F-FDG PET/CT is a functional imaging technique that is an established tool in oncology and has also proven useful in the field of inflammatory diseases. The aim of this paper is to present literature evidence on the use of molecular imaging methods such as PET/CT for early diagnosis, assessment of disease activity and therapeutic response in PMR. At the same time, the advantages, disadvantages and contraindications of other methods are considered.
Collapse
Affiliation(s)
- E Noriega-Álvarez
- Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Guadalajara, Spain; Grupo de Trabajo de Patología Músculo-Esquelética de la SEMNIM, Spain.
| | - B Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Puerta de Hierro de Majadahonda, Madrid, Spain; Grupo de Trabajo de Patología Músculo-Esquelética de la SEMNIM, Spain
| | - C Merino Argumánez
- Servicio de Reumatología, Hospital Puerta de Hierro de Majadahonda, Madrid, Spain
| | - L Domínguez Gadea
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, Spain; Grupo de Trabajo de Patología Músculo-Esquelética de la SEMNIM, Spain
| | - V Peiró-Valgañón
- Departamento de Medicina Nuclear, Diagnóstico por la Imagen, Hospital Universitario de Fuenlabrada, Madrid, Spain; Grupo de Trabajo de Patología Músculo-Esquelética de la SEMNIM, Spain
| |
Collapse
|
8
|
Deshayes S, Baugé C, Dupont PA, Simard C, Rida H, de Boysson H, Manrique A, Aouba A. [ 18F]FDG PET-MR characterization of aortitis in the IL1rn -/- mouse model of giant-cell arteritis. EJNMMI Res 2023; 13:103. [PMID: 38019303 PMCID: PMC10687326 DOI: 10.1186/s13550-023-01039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/01/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Metabolic imaging is routinely used to demonstrate aortitis in patients with giant-cell arteritis. We aimed to investigate the preclinical model of aortitis in BALB/c IL1rn-/- mice using [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography-magnetic resonance (PET-MR), gamma counting and immunostaining. We used 15 first-generation specific and opportunistic pathogen-free (SOPF) 9-week-old IL1rn-/- mice, 15 wild-type BALB/cAnN mice and 5 s-generation specific pathogen-free (SPF) 9-week-old IL1rn-/-. Aortic [18F]FDG uptake was assessed as the target-to-background ratio (TBR) using time-of-flight MR angiography as vascular landmarks. RESULTS [18F]FDG uptake measured by PET or gamma counting was similar in the first-generation SOPF IL1rn-/- mice and the wild-type group (p > 0.05). However, the first-generation IL1rn-/- mice exhibited more interleukin-1β (p = 0.021)- and interleukin-6 (p = 0.019)-positive cells within the abdominal aorta than the wild-type mice. In addition, the second-generation SPF group exhibited significantly higher TBR (p = 0.0068) than the wild-type mice on the descending thoracic aorta, unlike the first-generation SOPF IL1rn-/- mice. CONCLUSIONS In addition to the involvement of interleukin-1β and -6 in IL1rn-/- mouse aortitis, this study seems to validate [18F]FDG PET-MR as a useful tool for noninvasive monitoring of aortitis in this preclinical model.
Collapse
Affiliation(s)
- Samuel Deshayes
- Department of Internal Medicine and Clinical Immunology, Normandie University, UNICAEN, CHU de Caen Normandie - Université Basse Normandie, Avenue de la Côte de Nacre, 14000, CAEN, France.
- Normandie University, UNICAEN, CHU de Caen Normandie, UR4650 PSIR, Caen, France.
| | - Caroline Baugé
- Normandie University, UNICAEN, CHU de Caen Normandie, UR4650 PSIR, Caen, France
| | | | - Christophe Simard
- Normandie University, UNICAEN, CHU de Caen Normandie, UR4650 PSIR, Caen, France
| | - Hanan Rida
- Normandie University, UNICAEN, CHU de Caen Normandie, UR4650 PSIR, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine and Clinical Immunology, Normandie University, UNICAEN, CHU de Caen Normandie - Université Basse Normandie, Avenue de la Côte de Nacre, 14000, CAEN, France
- Normandie University, UNICAEN, CHU de Caen Normandie, UR4650 PSIR, Caen, France
| | - Alain Manrique
- Normandie University, UNICAEN, CHU de Caen Normandie, UR4650 PSIR, Caen, France
- Department of Nuclear Medicine, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Achille Aouba
- Department of Internal Medicine and Clinical Immunology, Normandie University, UNICAEN, CHU de Caen Normandie - Université Basse Normandie, Avenue de la Côte de Nacre, 14000, CAEN, France.
- Normandie University, UNICAEN, CHU de Caen Normandie, UR4650 PSIR, Caen, France.
| |
Collapse
|
9
|
Parreau S, Molina E, Dumonteil S, Goulabchand R, Naves T, Bois MC, Akil H, Terro F, Fauchais AL, Liozon E, Jauberteau MO, Weyand CM, Ly KH. Use of high-plex data provides novel insights into the temporal artery processes of giant cell arteritis. Front Immunol 2023; 14:1237986. [PMID: 37744332 PMCID: PMC10512077 DOI: 10.3389/fimmu.2023.1237986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To identify the key coding genes underlying the biomarkers and pathways associated with giant cell arteritis (GCA), we performed an in situ spatial profiling of molecules involved in the temporal arteries of GCA patients and controls. Furthermore, we performed pharmacogenomic network analysis to identify potential treatment targets. Methods Using human formalin-fixed paraffin-embedded temporal artery biopsy samples (GCA, n = 9; controls, n = 7), we performed a whole transcriptome analysis using the NanoString GeoMx Digital Spatial Profiler. In total, 59 regions of interest were selected in the intima, media, adventitia, and perivascular adipose tissue (PVAT). Differentially expressed genes (DEGs) (fold-change > 2 or < -2, p-adjusted < 0.01) were compared across each layer to build a spatial and pharmacogenomic network and to explore the pathophysiological mechanisms of GCA. Results Most of the transcriptome (12,076 genes) was upregulated in GCA arteries, compared to control arteries. Among the screened genes, 282, 227, 40, and 5 DEGs were identified in the intima, media, adventitia, and PVAT, respectively. Genes involved in the immune process and vascular remodeling were upregulated within GCA temporal arteries but differed across the arterial layers. The immune-related functions and vascular remodeling were limited to the intima and media. Conclusion This study is the first to perform an in situ spatial profiling characterization of the molecules involved in GCA. The pharmacogenomic network analysis identified potential target genes for approved and novel immunotherapies.
Collapse
Affiliation(s)
- Simon Parreau
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
| | - Elsa Molina
- Stem Cell Genomics Core, Stem Cell Program, University of California, San Diego, La Jolla, CA, United States
- Next Generation Sequencing Core, Salk Institute for Biological Studies, La Jolla, CA, United States
| | - Stéphanie Dumonteil
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Radjiv Goulabchand
- Division of Internal Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Thomas Naves
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
| | - Melanie C. Bois
- Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Hussein Akil
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
| | - Faraj Terro
- Cell Biology, Dupuytren University Hospital, Limoges, France
| | - Anne-Laure Fauchais
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
| | - Eric Liozon
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | | | | | - Kim-Heang Ly
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
| |
Collapse
|
10
|
Samson M, Genet C, Corbera-Bellalta M, Greigert H, Espígol-Frigolé G, Gérard C, Cladière C, Alba-Rovira R, Ciudad M, Gabrielle PH, Creuzot-Garcher C, Tarris G, Martin L, Saas P, Audia S, Bonnotte B, Cid MC. Human monocyte-derived suppressive cells (HuMoSC) for cell therapy in giant cell arteritis. Front Immunol 2023; 14:1137794. [PMID: 36895571 PMCID: PMC9989212 DOI: 10.3389/fimmu.2023.1137794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction The pathogenesis of Giant Cell Arteritis (GCA) relies on vascular inflammation and vascular remodeling, the latter being poorly controlled by current treatments. Methods This study aimed to evaluate the effect of a novel cell therapy, Human Monocyte-derived Suppressor Cells (HuMoSC), on inflammation and vascular remodeling to improve GCA treatment. Fragments of temporal arteries (TAs) from GCA patients were cultured alone or in the presence of HuMoSCs or their supernatant. After five days, mRNA expression was measured in the TAs and proteins were measured in culture supernatant. The proliferation and migration capacity of vascular smooth muscle cells (VSMCs) were also analyzed with or without HuMoSC supernatant. Results Transcripts of genes implicated in vascular inflammation (CCL2, CCR2, CXCR3, HLADR), vascular remodeling (PDGF, PDGFR), angiogenesis (VEGF) and extracellular matrix composition (COL1A1, COL3A1 and FN1) were decreased in arteries treated with HuMoSCs or their supernatant. Likewise, concentrations of collagen-1 and VEGF were lower in the supernatants of TAs cultivated with HuMoSCs. In the presence of PDGF, the proliferation and migration of VSMCs were both decreased after treatment with HuMoSC supernatant. Study of the PDGF pathway suggests that HuMoSCs act through inhibition of mTOR activity. Finally, we show that HuMoSCs could be recruited in the arterial wall through the implication of CCR5 and its ligands. Conclusion Altogether, our results suggest that HuMoSCs or their supernatant could be useful to decrease vascular in flammation and remodeling in GCA, the latter being an unmet need in GCA treatment.
Collapse
Affiliation(s)
- Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Coraline Genet
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Marc Corbera-Bellalta
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Georgina Espígol-Frigolé
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Claire Gérard
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Claudie Cladière
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Roser Alba-Rovira
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Marion Ciudad
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | | | | | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Philippe Saas
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Centre d'investigation clinique (CIC)-1431, INSERM, Besançon University Hospital, Etablissement Français du Sang (EFS), Besançon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Maria C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| |
Collapse
|
11
|
Samson M, Genet C, Corbera-Bellalta M, Greigert H, Ramon A, Gerard C, Cladiere C, Gabrielle P, Creuzot-Garcher C, Tarris G, Martin L, Audia S, Cid M, Bonnotte B. Une nouvelle thérapie pour l’artérite à cellules géantes : les cellules monocytaires immunosuppressives (HuMoSC). Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
Jury M, Matthiesen I, Rasti Boroojeni F, Ludwig SL, Civitelli L, Winkler TE, Selegård R, Herland A, Aili D. Bioorthogonally Cross-Linked Hyaluronan-Laminin Hydrogels for 3D Neuronal Cell Culture and Biofabrication. Adv Healthc Mater 2022; 11:e2102097. [PMID: 35114074 DOI: 10.1002/adhm.202102097] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/31/2022] [Indexed: 12/13/2022]
Abstract
Laminins (LNs) are key components in the extracellular matrix of neuronal tissues in the developing brain and neural stem cell niches. LN-presenting hydrogels can provide a biologically relevant matrix for the 3D culture of neurons toward development of advanced tissue models and cell-based therapies for the treatment of neurological disorders. Biologically derived hydrogels are rich in fragmented LN and are poorly defined concerning composition, which hampers clinical translation. Engineered hydrogels require elaborate and often cytotoxic chemistries for cross-linking and LN conjugation and provide limited possibilities to tailor the properties of the materials. Here a modular hydrogel system for neural 3D cell cultures, based on hyaluronan and poly(ethylene glycol), that is cross-linked and functionalized with human recombinant LN-521 using bioorthogonal copper-free click chemistry, is shown. Encapsulated human neuroblastoma cells demonstrate high viability and grow into spheroids. Long-term neuroepithelial stem cells (lt-NES) cultured in the hydrogels can undergo spontaneous differentiation to neural fate and demonstrate significantly higher viability than cells cultured without LN. The hydrogels further support the structural integrity of 3D bioprinted structures and maintain high viability of bioprinted and syringe extruded lt-NES, which can facilitate biofabrication and development of cell-based therapies.
Collapse
Affiliation(s)
- Michael Jury
- Laboratory of Molecular Materials Division of Biophysics and Bioengineering Department of Physics, Chemistry and Biology Linköping University Linköping 581 83 Sweden
| | - Isabelle Matthiesen
- Division of Micro and Nanosystems KTH Royal Institute of Technology Stockholm 100 44 Sweden
| | - Fatemeh Rasti Boroojeni
- Laboratory of Molecular Materials Division of Biophysics and Bioengineering Department of Physics, Chemistry and Biology Linköping University Linköping 581 83 Sweden
| | - Saskia L. Ludwig
- Division of Micro and Nanosystems KTH Royal Institute of Technology Stockholm 100 44 Sweden
| | - Livia Civitelli
- Laboratory of Molecular Materials Division of Biophysics and Bioengineering Department of Physics, Chemistry and Biology Linköping University Linköping 581 83 Sweden
- Nuffield Department of Clinical Neurosciences John Radcliffe Hospital West Wing University of Oxford Oxford OX3 9DU UK
| | - Thomas E. Winkler
- Division of Micro and Nanosystems KTH Royal Institute of Technology Stockholm 100 44 Sweden
- Institute of Microtechnology Center of Pharmaceutical Engineering Technische Universität Braunschweig Braunschweig 38106 Germany
| | - Robert Selegård
- Laboratory of Molecular Materials Division of Biophysics and Bioengineering Department of Physics, Chemistry and Biology Linköping University Linköping 581 83 Sweden
| | - Anna Herland
- Division of Micro and Nanosystems KTH Royal Institute of Technology Stockholm 100 44 Sweden
- AIMES, Center for Integrated Medical and Engineering Science Department of Neuroscience Karolinska Institute Solna 171 65 Sweden
- Division of Nanobiotechnology Department of Protein Science, Science for Life Laboratory KTH Royal Institute of Technology Stockholm 17165 Sweden
| | - Daniel Aili
- Laboratory of Molecular Materials Division of Biophysics and Bioengineering Department of Physics, Chemistry and Biology Linköping University Linköping 581 83 Sweden
| |
Collapse
|
13
|
Greigert H, Genet C, Ramon A, Bonnotte B, Samson M. New Insights into the Pathogenesis of Giant Cell Arteritis: Mechanisms Involved in Maintaining Vascular Inflammation. J Clin Med 2022; 11:2905. [PMID: 35629030 PMCID: PMC9143803 DOI: 10.3390/jcm11102905] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
The giant cell arteritis (GCA) pathophysiology is complex and multifactorial, involving a predisposing genetic background, the role of immune aging and the activation of vascular dendritic cells by an unknown trigger. Once activated, dendritic cells recruit CD4 T cells and induce their activation, proliferation and polarization into Th1 and Th17, which produce interferon-gamma (IFN-γ) and interleukin-17 (IL-17), respectively. IFN-γ triggers the production of chemokines by vascular smooth muscle cells, which leads to the recruitment of additional CD4 and CD8 T cells and also monocytes that differentiate into macrophages. Recent data have shown that IL-17, IFN-γ and GM-CSF induce the differentiation of macrophage subpopulations, which play a role in the destruction of the arterial wall, in neoangiogenesis or intimal hyperplasia. Under the influence of different mediators, mainly endothelin-1 and PDGF, vascular smooth muscle cells migrate to the intima, proliferate and change their phenotype to become myofibroblasts that further proliferate and produce extracellular matrix proteins, increasing the vascular stenosis. In addition, several defects in the immune regulatory mechanisms probably contribute to chronic vascular inflammation in GCA: a defect in the PD-1/PD-L1 pathway, a quantitative and qualitative Treg deficiency, the implication of resident cells, the role of GM-CSF and IL-6, the implication of the NOTCH pathway and the role of mucosal‑associated invariant T cells and tissue‑resident memory T cells.
Collapse
|
14
|
Corbera-Bellalta M, Alba-Rovira R, Muralidharan S, Espígol-Frigolé G, Ríos-Garcés R, Marco-Hernández J, Denuc A, Kamberovic F, Pérez-Galán P, Joseph A, D'Andrea A, Bondensgaard K, Cid MC, Paolini JF. Blocking GM-CSF receptor α with mavrilimumab reduces infiltrating cells, pro-inflammatory markers and neoangiogenesis in ex vivo cultured arteries from patients with giant cell arteritis. Ann Rheum Dis 2022; 81:524-536. [PMID: 35045965 PMCID: PMC8921590 DOI: 10.1136/annrheumdis-2021-220873] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/08/2021] [Indexed: 12/26/2022]
Abstract
Background Effective and safe therapies are needed for the treatment of patients with giant cell arteritis (GCA). Emerging as a key cytokine in inflammation, granulocyte-macrophage colony stimulating factor (GM-CSF) may play a role in promoting inflammation in GCA. Objectives To investigate expression of GM-CSF and its receptor in arterial lesions from patients with GCA. To analyse activation of GM-CSF receptor-associated signalling pathways and expression of target genes. To evaluate the effects of blocking GM-CSF receptor α with mavrilimumab in ex vivo cultured arteries from patients with GCA. Methods Quantitative real time PCR, in situ RNA hybridisation, immunohistochemistry, immunofluorescence and confocal microscopy, immunoassay, western blot and ex vivo temporal artery culture. Results GM-CSF and GM-CSF receptor α mRNA and protein were increased in GCA lesions; enhanced JAK2/STAT5A expression/phosphorylation as well as increased expression of target genes CD83 and Spi1/PU.1 were observed. Treatment of ex vivo cultured GCA arteries with mavrilimumab resulted in decreased transcripts of CD3ε, CD20, CD14 and CD16 cell markers, and reduction of infiltrating CD16 and CD3ε cells was observed by immunofluorescence. Mavrilimumab reduced expression of molecules relevant to T cell activation (human leukocyte antigen-DR [HLA-DR]) and Th1 differentiation (interferon-γ), the pro-inflammatory cytokines: interleukin 6 (IL-6), tumour necrosis factor α (TNFα) and IL-1β, as well as molecules related to vascular injury (matrix metalloprotease 9, lipid peroxidation products and inducible nitric oxide synthase [iNOS]). Mavrilimumab reduced CD34 + cells and neoangiogenesis in GCA lesions. Conclusion The inhibitory effects of mavrilimumab on multiple steps in the GCA pathogenesis cascade in vitro are consistent with the clinical observation of reduced GCA flares in a phase 2 trial and support its development as a therapeutic option for patients with GCA.
Collapse
Affiliation(s)
- Marc Corbera-Bellalta
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roser Alba-Rovira
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Georgina Espígol-Frigolé
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roberto Ríos-Garcés
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier Marco-Hernández
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Farah Kamberovic
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | | | | | - Maria C Cid
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - John F Paolini
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, USA
| |
Collapse
|
15
|
Stojanovic M, Raskovic S, Milivojevic V, Miskovic R, Soldatovic I, Stankovic S, Rankovic I, Stankovic Stanojevic M, Dragasevic S, Krstic M, Diamantopoulos AP. Enhanced Liver Fibrosis Score as a Biomarker for Vascular Damage Assessment in Patients with Takayasu Arteritis-A Pilot Study. J Cardiovasc Dev Dis 2021; 8:187. [PMID: 34940542 DOI: 10.3390/jcdd8120187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/05/2021] [Accepted: 12/10/2021] [Indexed: 01/26/2023] Open
Abstract
Takayasu Arteritis (TA) is characterized by granulomatous panarteritis, vessel wall fibrosis, and irreversible vascular impairment. The aim of this study is to explore the usefulness of the Enhanced Liver Fibrosis score (ELF), procollagen-III aminoterminal propeptide (PIIINP), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), and hyaluronic acid (HA) in assessing vascular damage in TA patients. ELF, PIIINP, TIMP-1, and HA were measured in 24 TA patients, and the results were correlated with the clinical damage indexes (VDI and TADS), an imaging damage score (CARDS), and disease activity scores (NIH and ITAS2010). A mean ELF score 8.42 (±1.12) and values higher than 7.7 (cut-off for liver fibrosis) in 21/24 (87.5%) of patients were detected. The VDI and TADS correlated significantly to ELF (p < 0.01). Additionally, a strong association across ELF and CARDS (p < 0.0001), PIIINP and CARDS (p < 0.001), and HA and CARDS (p < 0.001) was observed. No correlations of the tested biomarkers with inflammatory parameters, NIH, and ITAS2010 scores were found. To our knowledge, this is the first study that suggests the association of the serum biomarkers PIIINP, HA, and ELF score with damage but not with disease activity in TA patients. The ELF score and PIIINP may be useful biomarkers reflecting an ongoing fibrotic process and quantifying vascular damage.
Collapse
|
16
|
Solimando AG, Vacca A, Dammacco F. Highlights in clinical medicine-Giant cell arteritis, polymyalgia rheumatica and Takayasu's arteritis: pathogenic links and therapeutic implications. Clin Exp Med 2021; 22:509-518. [PMID: 34741677 DOI: 10.1007/s10238-021-00770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
Giant cell arteritis (GCA), frequently associated with polymyalgia rheumatica (PMR), and Takayasu's arteritis (TAK) are characterized by extensive vascular remodeling that results in occlusion and stenosis. The pathophysiological mechanisms underlying the onset of GCA/PMR and TAK are still hypothetical. However, similarities and differences in the immunopathology and clinical phenotypes of these diseases point toward a possible link between them. The loss of tolerance in the periphery, a breakdown of tissue barriers, and the development of granulomatous vasculitis define a disease continuum. However, statistically powered studies are needed to confirm these correlations. In addition to glucocorticoids, inhibition of the interleukin-6 axis has been proposed as a cornerstone in the treatment of GCA/PMR and TAK. Novel biologic agents targeting the pathogenic pathway at various levels hold promise to achieve glucocorticoid-free sustained remission.
Collapse
Affiliation(s)
- Antonio Giovanni Solimando
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Polyclinic, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Polyclinic, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Polyclinic, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| |
Collapse
|
17
|
Samson M, Greigert H, Ciudad M, Gerard C, Ghesquière T, Trad M, Corbera-Bellalta M, Genet C, Ouandji S, Cladière C, Thebault M, Ly KH, Liozon E, Maurier F, Bienvenu B, Terrier B, Guillevin L, Charles P, Quipourt V, Devilliers H, Gabrielle PH, Creuzot-Garcher C, Tarris G, Martin L, Saas P, Audia S, Cid MC, Bonnotte B. Improvement of Treg immune response after treatment with tocilizumab in giant cell arteritis. Clin Transl Immunology 2021; 10:e1332. [PMID: 34532040 PMCID: PMC8435365 DOI: 10.1002/cti2.1332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/20/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives To study the percentage, suppressive function and plasticity of Treg in giant cell arteritis (GCA), and the effects of glucocorticoids and tocilizumab. Methods Blood samples were obtained from 40 controls and 43 GCA patients at baseline and after treatment with glucocorticoids + IV tocilizumab (n = 20) or glucocorticoids (n = 23). Treg percentage and phenotype were assessed by flow cytometry. Suppressive function of Treg was assessed by measuring their ability to inhibit effector T‐cell (Teff) proliferation and polarisation into Th1 and Th17 cells. Results Treg (CD4+CD25highFoxP3+) frequency in total CD4+ T cells was decreased in active GCA patients when compared to controls (2.5% vs. 4.7%, P < 0.001) and increased after treatment with tocilizumab but worsened after treatment with glucocorticoids alone. Treg lacking exon 2 of FoxP3 were increased in GCA patients when compared to controls (23% vs. 10% of total Treg, P = 0.0096) and normalised after treatment with tocilizumab + glucocorticoids but not glucocorticoids alone. In GCA patients, Treg were unable to control Teff proliferation and induced ˜50% increase in the amount of IL‐17+ Teff, which was improved after in vitro blockade of the IL‐6 pathway by tocilizumab. Conclusion This study reports quantitative and functional disruptions in the regulatory immune response of GCA patients and demonstrates that, unlike glucocorticoids, tocilizumab improves Treg immune response.
Collapse
Affiliation(s)
- Maxime Samson
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marion Ciudad
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Claire Gerard
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Thibault Ghesquière
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Malika Trad
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marc Corbera-Bellalta
- Vasculitis Research Unit Department of Autoimmune Diseases Hospital Clinic University of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) CRB-CELLEX Barcelona Spain
| | - Coraline Genet
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Sethi Ouandji
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Claudie Cladière
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marine Thebault
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Kim Heang Ly
- Department of Internal Medicine CHU de Limoges Limoges France
| | - Eric Liozon
- Department of Internal Medicine CHU de Limoges Limoges France
| | - François Maurier
- Department of Internal Medicine HP-Metz Site Belle Isle Metz France
| | - Boris Bienvenu
- Department of Internal Medicine Hôpital Saint-Joseph Marseille France
| | - Benjamin Terrier
- Department of Internal Medicine National Referral Center for Systemic and Rare Autoimmune Diseases Hôpital Cochin APHP Paris France
| | - Loïc Guillevin
- Department of Internal Medicine National Referral Center for Systemic and Rare Autoimmune Diseases Hôpital Cochin APHP Paris France
| | - Pierre Charles
- Department of Internal Medicine Institut Mutualiste Montsouris Paris France
| | - Valérie Quipourt
- Department of Geriatric Internal Medicine Dijon University Hospital Dijon France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases Dijon University Hospital Dijon France.,INSERM CIC 1432 Clinical Epidemiology Unit Dijon France
| | | | | | - Georges Tarris
- Department of Pathology Dijon University Hospital Dijon France
| | - Laurent Martin
- Department of Pathology Dijon University Hospital Dijon France
| | - Philippe Saas
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France.,CIC-1431 INSERM Besançon University Hospital EFS Besançon France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Maria Cinta Cid
- Vasculitis Research Unit Department of Autoimmune Diseases Hospital Clinic University of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) CRB-CELLEX Barcelona Spain
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| |
Collapse
|
18
|
Ghesquière T, Ciudad M, Ramon A, Greigert H, Gerard C, Cladière C, Thébault M, Genet C, Devilliers H, Maurier F, Ornetti P, Quipourt V, Gabrielle PH, Creuzot-Garcher C, Tarris G, Martin L, Soudry-Faure A, Saas P, Audia S, Bonnotte B, Samson M. Mucosal-associated invariant T cells in Giant Cell Arteritis. J Autoimmun 2021; 121:102652. [PMID: 34000675 DOI: 10.1016/j.jaut.2021.102652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to assess the implication of mucosal-associated invariant T (MAIT) cells in GCA. Blood samples were obtained from 34 GCA patients (before and after 3 months of treatment with glucocorticoids (GC) alone) and compared with 20 controls aged >50 years. MAIT cells, defined by a CD3+CD4-TCRγδ-TCRVα7.2+CD161+ phenotype, were analyzed by flow cytometry. After sorting, we assessed the ability of MAIT cells to proliferate and produce cytokines after stimulation with anti CD3/CD28 microbeads or IL-12 and IL-18. MAIT were stained in temporal artery biopsies (TAB) by confocal microscopy. MAIT cells were found in the arterial wall of positive TABs but was absent in negative TAB. MAIT frequency among total αβ-T cells was similar in the blood of patients and controls (0.52 vs. 0.57%; P = 0.43) and not modified after GC treatment (P = 0.82). Expression of IFN-γ was increased in MAIT cells from GCA patients compared to controls (44.49 vs. 32.9%; P = 0.029), and not modified after 3 months of GC therapy (P = 0.82). When they were stimulated with IL-12 and IL-18, MAIT from GCA patients produced very high levels of IFN-γ and displayed a stronger proliferation compared with MAIT from controls (proliferation index 3.39 vs. 1.4; P = 0.032). In GCA, the functional characteristics of MAIT cells are modified toward a pro-inflammatory phenotype and a stronger proliferation capability in response to IL-12 and IL-18, suggesting that MAIT might play a role in GCA pathogenesis. Our results support the use of treatments targeting IL-12/IL-18 to inhibit the IFN-γ pathway in GCA.
Collapse
Affiliation(s)
- Thibault Ghesquière
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Marion Ciudad
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - André Ramon
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France; Department of Rheumatology, Dijon University Hospital, Dijon, France
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Claire Gerard
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Claudie Cladière
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Marine Thébault
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Coraline Genet
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, Dijon, France
| | - François Maurier
- Department of Internal Medicine, Hospital Belle Isle, Metz, France
| | - Paul Ornetti
- Department of Rheumatology, Dijon University Hospital, Dijon, France; CIC-1432 Plateforme d'investigation Technologique Dijon University Hospital, INSERM UMR1093-CAPS, Université Bourgogne, Dijon, France
| | - Valérie Quipourt
- Department of Internal Medicine and Geriatrics, Dijon University Hospital, Dijon, France
| | | | | | - Georges Tarris
- Department of Pathology, CHU François Mitterrand, Dijon, France
| | - Laurent Martin
- Department of Pathology, CHU François Mitterrand, Dijon, France
| | - Agnès Soudry-Faure
- Unité de Soutien Méthodologique, DRCI, Dijon Bourgogne University Hospital, 21000, Dijon, France
| | - Philippe Saas
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France; CIC-1431, INSERM, Besançon University Hospital, EFS Bourgogne Franche-Comté, LabEx LipSTIC, F-25000, Besançon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000, Dijon, France.
| |
Collapse
|
19
|
Abstract
Giant cell arteritis (GCA) is a granulomatous systemic vasculitis of large- and medium-sized arteries that affects the elderly. In recent years, advances in diagnostic imaging have revealed a greater degree of large vessel involvement than previously recognized, distinguishing classical cranial- from large vessel (LV)- GCA. GCA often co-occurs with the poorly understood inflammatory arthritis/bursitis condition polymyalgia rheumatica (PMR) and has overlapping features with other non-infectious granulomatous vasculitides that affect the aorta, namely Takayasu Arteritis (TAK) and the more recently described clinically isolated aortitis (CIA). Here, we review the literature focused on the immunopathology of GCA on the background of the three settings in which comparisons are informative: LV and cranial variants of GCA; PMR and GCA; the three granulomatous vasculitides (GCA, TAK, and CIA). We discuss overlapping and unique features between these conditions across clinical presentation, epidemiology, imaging, and conventional histology. We propose a model of GCA where abnormally activated circulating cells, especially monocytes and CD4+ T cells, enter arteries after an unknown stimulus and cooperate to destroy it and review the evidence for how this mechanistically occurs in active disease and improves with treatment.
Collapse
Affiliation(s)
- Michelle L Robinette
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Paul A Monach
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.,Rheumatology Section, VA Boston Healthcare System, Boston, MA, United States
| |
Collapse
|
20
|
Greigert H, Gerard C, Ciudad M, Ghesquiere T, Devilliers H, Bielefeld P, Ramon A, Arnould L, Creuzot-Garcher C, Tarris G, Martin L, Audia S, Bonnotte B, Samson M. Interaction entre les cellules résidentes de la paroi vasculaire et les lymphocytes T au cours de l’artérite à cellules géantes. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Wang L, Ai Z, Khoyratty T, Zec K, Eames HL, van Grinsven E, Hudak A, Morris S, Ahern D, Monaco C, Eruslanov EB, Luqmani R, Udalova IA. ROS-producing immature neutrophils in giant cell arteritis are linked to vascular pathologies. JCI Insight 2020; 5:139163. [PMID: 32960815 PMCID: PMC7605529 DOI: 10.1172/jci.insight.139163] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022] Open
Abstract
Giant cell arteritis (GCA) is a common form of primary systemic vasculitis in adults, with no reliable indicators of prognosis or treatment responses. We used single cell technologies to comprehensively map immune cell populations in the blood of patients with GCA and identified the CD66b+CD15+CD10lo/–CD64– band neutrophils and CD66bhiCD15+CD10lo/–CD64+/bright myelocytes/metamyelocytes to be unequivocally associated with both the clinical phenotype and response to treatment. Immature neutrophils were resistant to apoptosis, remained in the vasculature for a prolonged period of time, interacted with platelets, and extravasated into the tissue surrounding the temporal arteries of patients with GCA. We discovered that immature neutrophils generated high levels of extracellular reactive oxygen species, leading to enhanced protein oxidation and permeability of endothelial barrier in an in vitro coculture system. The same populations were also detected in other systemic vasculitides. These findings link functions of immature neutrophils to disease pathogenesis, establishing a clinical cellular signature of GCA and suggesting different therapeutic approaches in systemic vascular inflammation. Bona fide immature neutrophil subsets produce unchecked extracellular ROS that contributes to vascular pathologies.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Alison Hudak
- Botnar Research Centre, Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Headington, Oxford, United Kingdom
| | - Susan Morris
- Botnar Research Centre, Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Headington, Oxford, United Kingdom
| | | | | | - Evgeniy B Eruslanov
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raashid Luqmani
- Botnar Research Centre, Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Headington, Oxford, United Kingdom
| | | |
Collapse
|
22
|
Deshayes S, de Boysson H, Dumont A, Vivien D, Manrique A, Aouba A. An overview of the perspectives on experimental models and new therapeutic targets in giant cell arteritis. Autoimmun Rev 2020; 19:102636. [DOI: 10.1016/j.autrev.2020.102636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022]
|
23
|
Cid MC, Ríos-Garcés R, Terrades-García N, Espígol-Frigolé G. Treatment of giant-cell arteritis: from broad spectrum immunosuppressive agents to targeted therapies. Rheumatology (Oxford) 2020; 59:iii17-iii27. [DOI: 10.1093/rheumatology/kez645] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
Abstract
For decades, the treatment of GCA has relied on glucocorticoids. Work over the past two decades has supported a modest efficacy of MTX but no clear benefit from anti-TNF-based therapies. More recently, the therapeutic armamentarium for GCA has expanded. The availability of agents targeting specific cytokines, cytokine receptors or signalling pathways, along with a better, although still limited, understanding of the immunopathology of GCA, are opening further therapeutic possibilities. Blocking IL-6 receptor with tocilizumab has been effective in maintaining remission and reducing glucocorticoid exposure and tocilizumab has been approved for the treatment of GCA. However, nearly half of the patients do not benefit from tocilizumab and additional options need to be investigated. This review focuses on standard therapeutic approaches and on targeted therapies that have been or are currently under investigation.
Collapse
Affiliation(s)
- Maria C Cid
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Roberto Ríos-Garcés
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Nekane Terrades-García
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
24
|
Régent A, Ly KH, Mouthon L. [Physiopathology of giant cell arteritis: From inflammation to vascular remodeling]. Presse Med 2019; 48:919-30. [PMID: 31543394 DOI: 10.1016/j.lpm.2019.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/10/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Giant cell arteritis (GCA) is a large-vessel vasculitis involving the aorta and its main branches, especially supra aortic branches. Although much progress has been made, the pathophysiology remains incompletely understood. An initial trigger, suspected of infectious origin, lead to the maturation and recruitment of dendritic cells (DC). The lack of migration of these DC allows the local recruitment of T-lymphocytes (LT). These LT- CD4+ polarize in Type 1 helper (Th1), Th17 but also Th9. A qualitative and quantitative deficit in regulatory T cells (Treg) is observed under the influence of IL-21 overproduction. In addition, an imbalance in the Th17/Treg balance is favored by IL-6. The secretion of IFN-γ, IL-17, IL-6, IL-33 is responsible for a sustained local inflammatory reaction that is organized around tertiary lymphoid follicles. Locally recruited macrophages secrete reactive forms of oxygen together with VEGF and PDGF. These growth factors, together with neurotrophins and endothelin contribute to increase the proliferation of vascular smooth muscle cells (VSMCs). The imbalance between matrix metalloproteases (MMP)-2, MMP-9 and MMP-14 and tissue inhibitors of metalloproteases (TIMP)-1 and TIMP-2 also contribute to the remodeling process occurring in the vessel wall. Finally, arterial neovascularization contribute to the perpetuation of lymphocyte recruitment. This persistent remodeling is sometimes complicated by ischemic events responsible for the initial severity of the disease.
Collapse
|
25
|
Rodriguez-Pla A, Warner RL, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Sreih AG, Ytterberg SR, Johnson KJ, Merkel PA, Monach PA. Evaluation of Potential Serum Biomarkers of Disease Activity in Diverse Forms of Vasculitis. J Rheumatol 2019; 47:1001-1010. [PMID: 31474593 PMCID: PMC7050393 DOI: 10.3899/jrheum.190093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We evaluated potential circulating biomarkers of disease activity in giant cell arteritis (GCA), Takayasu arteritis (TA), polyarteritis nodosa (PAN), and eosinophilic granulomatosis with polyangiitis (EGPA). METHODS A panel of 22 serum proteins was tested in patients enrolled in the Vasculitis Clinical Research Consortium Longitudinal Studies of GCA, TA, PAN, or EGPA. Mixed models were used for most analyses. A J48 classification tree method was used to find the most relevant markers to differentiate between active and inactive GCA. RESULTS Tests were done on 418 samples from 152 patients (60 GCA, 29 TA, 26 PAN, 37 EGPA), during both active vasculitis and remission. In GCA, these showed significant (p < 0.05) differences between disease states: B cell-attracting chemokine 1 (BCA)-1/CXC motif ligand 13 (CXCL13), erythrocyte sedimentation rate (ESR), interferon-γ-induced protein 10/CXC motif chemokine 10, soluble interleukin 2 receptor α (sIL-2Rα), and tissue inhibitor of metalloproteinase-1 (TIMP-1). In EGPA, these showed significant increases during active disease: granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage-CSF, interleukin (IL)-6, IL-15, and sIL-2Rα. BCA-1/CXCL13 also showed such increases, but only after adjustment for treatment. In PAN, ESR and matrix metalloprotease (MMP)-3 showed significant differences between disease states. Differences in biomarker levels between diseases were significant for 11 markers and were more striking (all p < 0.01) than differences related to disease activity. A combination of lower values of TIMP-1, IL-6, interferon-γ, and MMP-3 correctly classified 87% of samples with inactive GCA. CONCLUSION We identified novel biomarkers of disease activity in GCA and EGPA. Differences of biomarker levels between diseases, independent of disease activity, were more apparent than differences related to disease activity. Further studies are needed to determine whether these serum proteins have potential for clinical use in distinguishing active disease from remission or in predicting longer-term outcomes.
Collapse
Affiliation(s)
- Alicia Rodriguez-Pla
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Roscoe L Warner
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - David Cuthbertson
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Simon Carette
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Nader A Khalidi
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Curry L Koening
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Carol A Langford
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Carol A McAlear
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Larry W Moreland
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Christian Pagnoux
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Philip Seo
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Ulrich Specks
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Antoine G Sreih
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Steven R Ytterberg
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Kent J Johnson
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | - Peter A Merkel
- From Boston University, Boston, Massachusetts; University of Arizona, Tucson, Arizona; University of Michigan, Ann Arbor, Michigan; University of South Florida, Tampa, Florida, USA; Mount Sinai Hospital, Toronto; McMaster University, Hamilton, Ontario, Canada; University of Utah, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; University of Pennsylvania, Philadelphia; University of Pittsburgh, Pittsburgh, Pennsylvania; Johns Hopkins University, Baltimore, Maryland; Mayo Clinic, Rochester, Minnesota; VA Boston Healthcare System, Boston, Massachusetts, USA.,A. Rodriguez-Pla, MD, PhD, MPH, Boston University, and the University of Arizona; R.L. Warner, PhD, University of Michigan; D. Cuthbertson, MS, University of South Florida; S. Carette, MD, Mount Sinai Hospital; N.A. Khalidi, MD, McMaster University; C.L. Koening, MD, MS, University of Utah; C.A. Langford, MD, MHS, Cleveland Clinic; C.A. McAlear, MD, University of Pennsylvania; L.W. Moreland, MD, University of Pittsburgh; C. Pagnoux, MD, MPH, Mount Sinai Hospital; P. Seo, MD, MHS, Johns Hopkins University; U. Specks, MD, Mayo Clinic; A.G. Sreih, MD, University of Pennsylvania; S.R. Ytterberg, MD, Mayo Clinic; K.J. Johnson, MD, University of Arizona; P.A. Merkel, MD, MPH, University of Pennsylvania; P.A. Monach, MD, PhD, Boston University, and the VA Boston Healthcare System
| | | | | |
Collapse
|
26
|
Strehl C, Ehlers L, Gaber T, Buttgereit F. Glucocorticoids-All-Rounders Tackling the Versatile Players of the Immune System. Front Immunol 2019; 10:1744. [PMID: 31396235 PMCID: PMC6667663 DOI: 10.3389/fimmu.2019.01744] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/10/2019] [Indexed: 12/13/2022] Open
Abstract
Glucocorticoids regulate fundamental processes of the human body and control cellular functions such as cell metabolism, growth, differentiation, and apoptosis. Moreover, endogenous glucocorticoids link the endocrine and immune system and ensure the correct function of inflammatory events during tissue repair, regeneration, and pathogen elimination via genomic and rapid non-genomic pathways. Due to their strong immunosuppressive, anti-inflammatory and anti-allergic effects on immune cells, tissues and organs, glucocorticoids significantly improve the quality of life of many patients suffering from diseases caused by a dysregulated immune system. Despite the multitude and seriousness of glucocorticoid-related adverse events including diabetes mellitus, osteoporosis and infections, these agents remain indispensable, representing the most powerful, and cost-effective drugs in the treatment of a wide range of rheumatic diseases. These include rheumatoid arthritis, vasculitis, and connective tissue diseases, as well as many other pathological conditions of the immune system. Depending on the therapeutically affected cell type, glucocorticoid actions strongly vary among different diseases. While immune responses always represent complex reactions involving different cells and cellular processes, specific immune cell populations with key responsibilities driving the pathological mechanisms can be identified for certain autoimmune diseases. In this review, we will focus on the mechanisms of action of glucocorticoids on various leukocyte populations, exemplarily portraying different autoimmune diseases as heterogeneous targets of glucocorticoid actions: (i) Abnormalities in the innate immune response play a crucial role in the initiation and perpetuation of giant cell arteritis (GCA). (ii) Specific types of CD4+ T helper (Th) lymphocytes, namely Th1 and Th17 cells, represent important players in the establishment and course of rheumatoid arthritis (RA), whereas (iii) B cells have emerged as central players in systemic lupus erythematosus (SLE). (iv) Allergic reactions are mainly triggered by several different cytokines released by activated Th2 lymphocytes. Using these examples, we aim to illustrate the versatile modulating effects of glucocorticoids on the immune system. In contrast, in the treatment of lymphoproliferative disorders the pro-apoptotic action of glucocorticoids prevails, but their mechanisms differ depending on the type of cancer. Therefore, we will also give a brief insight into the current knowledge of the mode of glucocorticoid action in oncological treatment focusing on leukemia.
Collapse
Affiliation(s)
- Cindy Strehl
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany
| | - Lisa Ehlers
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany
| | - Timo Gaber
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany
| |
Collapse
|
27
|
Abstract
Glucocorticoids (GC) remain the gold standard of the treatment of giant cell arteritis provided objectives of GC-tapering are accurately followed: 15 to 20mg/day at 3 months, 10mg/day at 6 months, 5mg/day at 9-12 months and withdrawal between 12 and 18 months. In case of corticodependance at ≥7.5 mg/day of prednisone or intolerance to GC, a GCsparing therapy has to be introduced, mainly methotrexate or tocilizumab. Individual characteristics of each patient, data about the efficacy of the treatment, its cost and how easy the follow-up under this treatment is are important factors to consider for choosing the right GC-sparing therapy. For all these reasons, except particular situations, we prefer using methotrexate before tocilizumab. Prevention of cardiovascular events is an important aspect of the treatment of GCA. We recommend using aspirin (75-100mg/day) during the first month of treatment or longer in case of occurrence of an ischemic complication. Each patient treated for GCA should receive a prevention of osteoporosis with respect of usual recommendations.
Collapse
|
28
|
Prieto-gonzález S, Villarreal-compagny M, Cid MC. Utilidad de las técnicas de imagen en la valoración de la arteritis de células gigantes. Med Clin (Barc) 2019; 152:495-501. [DOI: 10.1016/j.medcli.2018.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/23/2022]
|
29
|
Abstract
PURPOSE OF REVIEW This review aims to discuss the use of fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) for diagnosis and management of patients with large-vessel vasculitis (LVV). RECENT FINDINGS Incidence of LVV is likely underestimated, in part due to its non-specific symptoms. Nevertheless, early diagnosis of LVV is essential to initiate timely therapy in order to prevent vascular complications, such as stenoses and aneurysms. FDG PET/CT imaging has the ability to detect LVV during the acute phase, prior to edema and other vascular structural changes, with its high sensitivity for inflammatory activity. FDG PET/CT was shown to be a powerful prognostic marker by allowing identification of patients at risk of vascular complications. Additionally, preliminary data support the use of FDG PET/CT to follow therapy efficacy. FDG PET/CT allows early detection of inflammation, before morphological and irreversible vascular changes can be observed, allowing prompt diagnosis and treatment of LVV.
Collapse
Affiliation(s)
- Matthieu Pelletier-Galarneau
- Department of Medical Imaging, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.,Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Terrence D Ruddy
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| |
Collapse
|
30
|
Croci S, Bonacini M, Muratore F, Caruso A, Fontana A, Boiardi L, Soriano A, Cavazza A, Cimino L, Belloni L, Perry O, Fridkin M, Parmeggiani M, Blank M, Shoenfeld Y, Salvarani C. The therapeutic potential of tuftsin-phosphorylcholine in giant cell arteritis. J Autoimmun 2019; 98:113-121. [PMID: 30638709 DOI: 10.1016/j.jaut.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/09/2018] [Accepted: 01/02/2019] [Indexed: 01/13/2023]
Abstract
Tuftsin-PhosphorylCholine (TPC) is a novel bi-specific molecule which links tuftsin and phosphorylcholine. TPC has shown immunomodulatory activities in experimental mouse models of autoimmune diseases. We studied herein the effects of TPC ex vivo on both peripheral blood mononuclear cells (PBMCs) and temporal artery biopsies (TABs) obtained from patients with giant cell arteritis (GCA) and age-matched disease controls. GCA is an immune-mediated disease affecting large vessels. Levels of 18 cytokines in supernatants, PBMC viability, T helper (Th) cell differentiation of PBMCs and gene expression in TABs were analyzed. Treatment ex vivo with TPC decreased the production of IL-1β, IL-2, IL-5, IL-6, IL-9, IL-12(p70), IL-13, IL-17A, IL-18, IL-21, IL-22, IL-23, IFNγ, TNFα, GM-CSF by CD3/CD28 activated PBMCs whereas it negligibly affected cell viability. It reduced Th1 and Th17 differentiation while did not impact Th22 differentiation in PBMCs stimulated by phorbol 12-myristate 13-acetate plus ionomycin. In inflamed TABs, treatment with TPC down-regulated the production of IL-1β, IL-6, IL-13, IL-17A and CD68 gene expression. The effects of TPC were comparable to the effects of dexamethasone, included as the standard of care, with the exception of a greater reduction of IL-2, IL-18, IFNγ in CD3/CD28 activated PBMCs and CD68 gene in inflamed TABs. In conclusion our results warrant further investigations regarding TPC as an immunotherapeutic agent in GCA and potentially other autoimmune and inflammatory diseases.
Collapse
Affiliation(s)
- Stefania Croci
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Martina Bonacini
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Muratore
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Caruso
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Fontana
- Unit of Vascular Surgery, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Boiardi
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Soriano
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Campus Bio-Medico, University of Rome, Rome, Italy
| | - Alberto Cavazza
- Unit of Pathology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Unit of Ocular Immunology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Belloni
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ori Perry
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mati Fridkin
- Department of Organic Chemistry, The Weizmann Institute of Sciences, Rehovot, Israel
| | - Maria Parmeggiani
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Miri Blank
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
31
|
Roth I, Casas R, Ribó-Coll M, Doménech M, Lamuela-Raventós RM, Estruch R. Acute consumption of Andalusian aged wine and gin decreases the expression of genes related to atherosclerosis in men with high cardiovascular risk: Randomized intervention trial. Clin Nutr 2018; 38:1599-1606. [PMID: 30471795 DOI: 10.1016/j.clnu.2018.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/29/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Atherosclerosis is an inflammatory disease. Previous studies have suggested the beneficial effects of moderate consumption of alcoholic beverages on reducing cardiovascular risk (CVR). The aim of this study was to evaluate the effects of acute consumption of Andalusian aged wine (AAW) and gin by analyzing the expression of genes related to the appearance and progression of atherosclerosis in men with high CVR. METHODS We performed an open, randomized, controlled, crossover trial including 41 men with high CVR between 55 and 80 years age, who received a single dose of AAW or gin (0.5 g ethanol/kg). The expression of 10 genes related to atherosclerosis was determined by RT-PCR at baseline and 4 h after the intervention. RESULTS Gene expression analysis 4 h after consumption of each alcoholic beverage showed a significant decrease in Toll-like receptors 4 and 6 (TLR4, TLR6) and Caspase-1 (p < 0.05 all). Additionally, TLR2, Interleukin-1 receptor, chemokine receptor 3 and inflammasome expression decreased after AAW intake (p < 0.05, all) while only chemokine receptor 5 decreased after gin consumption (p = 0.039). CONCLUSION The decrease in the expression of several genes related to the appearance and progression of atherosclerosis was greater after AAW than gin intake, suggesting that the phenolic content of AAW may play a protective role against atherosclerosis.
Collapse
Affiliation(s)
- Irene Roth
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Universitat de Barcelona, Spain
| | - Rosa Casas
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Universitat de Barcelona, Spain; CIBER CB06/03 Fisiopatología de la Obesidad y la Nutrición, (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain
| | - Margarita Ribó-Coll
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Universitat de Barcelona, Spain
| | - Mónica Doménech
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Universitat de Barcelona, Spain
| | - Rosa M Lamuela-Raventós
- CIBER CB06/03 Fisiopatología de la Obesidad y la Nutrición, (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain; Nutrition and Food Science Department-XaRTA, INSA, Pharmacy School, University of Barcelona, Spain
| | - Ramón Estruch
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Universitat de Barcelona, Spain; CIBER CB06/03 Fisiopatología de la Obesidad y la Nutrición, (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.
| |
Collapse
|
32
|
Kong X, Zhang X, Lv P, Cui X, Ma L, Chen H, Liu H, Lin J, Jiang L. Treatment of Takayasu arteritis with the IL-6R antibody tocilizumab vs. cyclophosphamide. Int J Cardiol 2018; 266:222-228. [DOI: 10.1016/j.ijcard.2017.12.066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/20/2017] [Accepted: 12/19/2017] [Indexed: 11/27/2022]
|
33
|
Conway R, O'Neill L, McCarthy GM, Murphy CC, Fabre A, Kennedy S, Veale DJ, Wade SM, Fearon U, Molloy ES. Interleukin 12 and interleukin 23 play key pathogenic roles in inflammatory and proliferative pathways in giant cell arteritis. Ann Rheum Dis 2018; 77:1815-1824. [PMID: 30097452 DOI: 10.1136/annrheumdis-2018-213488] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The pathogenesis of giant cell arteritis (GCA) remains unclear. TH1 and TH17 pathways are implicated, but the proximal initiators and effector cytokines are unknown. Our aim was to assess the role of interleukin 12 (IL-12) and interleukin 23 (IL-23) in GCA pathogenesis. METHODS IL-12 and IL-23 expression were quantified by immunohistochemistry in temporal artery biopsies (TABs). Temporal artery (TA) explant, peripheral blood mononuclear cell (PBMC) and myofibroblast outgrowth culture models were established. PBMCs and TA explants were cultured for 24 hours in the presence or absence of IL-12 (50 ng/mL) or IL-23 (10 ng/mL). Gene expression in TA was quantified by real-time PCR and cytokine secretion by ELISA. Myofibroblast outgrowths were quantified following 28-day culture. RESULTS Immunohistochemistry demonstrated increased expression of interleukin 12p35 (IL-12p35) and interleukin 23p19 (IL-23p19) in biopsy-positive TAs, localised to inflammatory cells. IL-12p35 TA expression was significantly increased in those with cranial ischaemic complications (p=0.026) and large vessel vasculitis (p=0.006). IL-23p19 TA expression was increased in those with two or more relapses (p=0.007). In PBMC cultures, exogenous IL-12 significantly increased interleukin 6 (IL-6) (p=0.009), interleukin 22 (IL-22) (p=0.003) and interferon γ (IFN-γ) (p=0.0001) and decreased interleukin 8 (IL-8) (p=0.0006) secretion, while exogenous IL-23 significantly increased IL-6 (p=0.029), IL-22 (p=0.001), interleukin 17A (IL-17A) (p=0.0003) and interleukin 17F (IL-17F) (p=0.012) secretion. In ex vivo TA explants, IL-23 significantly increased gene expression of IL-8 (p=0.0001) and CCL-20 (p=0.027) and protein expression of IL-6 (p=0.002) and IL-8 (p=0.004). IL-12 (p=0.0005) and IL-23 (p<0.0001) stimulation increased the quantity of myofibroblast outgrowths from TABs. CONCLUSION IL-12 and IL-23 play central and distinct roles in stimulating inflammatory and proliferative pathways relevant to GCA pathogenesis.
Collapse
Affiliation(s)
- Richard Conway
- Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital Dublin, Academic Medical Centre, Dublin 4, Ireland.,CARD Newman Research Fellow, University College Dublin, Dublin, Ireland
| | - Lorraine O'Neill
- Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital Dublin, Academic Medical Centre, Dublin 4, Ireland
| | - Geraldine M McCarthy
- Mater Misericordiae University Hospital, Dublin Academic Medical Centre, Dublin, Ireland
| | - Conor C Murphy
- RCSI Department of Ophthalmology, Royal College of Surgeons of Ireland, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Aurelie Fabre
- Department of Pathology, St Vincent's University Hospital, Dublin, Ireland
| | - Susan Kennedy
- Department of Pathology, St Vincent's University Hospital, Dublin, Ireland
| | - Douglas J Veale
- Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital Dublin, Academic Medical Centre, Dublin 4, Ireland
| | - Sarah M Wade
- Department of Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Ursula Fearon
- Department of Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Eamonn S Molloy
- Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital Dublin, Academic Medical Centre, Dublin 4, Ireland
| |
Collapse
|
34
|
Kuret T, Burja B, Feichtinger J, Thallinger GG, Frank-Bertoncelj M, Lakota K, Žigon P, Sodin-Semrl S, Čučnik S, Tomšič M, Hočevar A. Gene and miRNA expression in giant cell arteritis-a concise systematic review of significantly modified studies. Clin Rheumatol 2019; 38:307-16. [PMID: 30069799 DOI: 10.1007/s10067-018-4231-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/06/2018] [Accepted: 07/23/2018] [Indexed: 12/14/2022]
Abstract
Giant cell arteritis (GCA) is a systemic vasculitis in individuals older than 50 years, characterized by headaches, visual disturbances, painful scalp, jaw claudication, impairment of limb arteries, and systemic inflammation, among other symptoms. GCA diagnosis is confirmed by a positive temporal artery biopsy (TAB) or by imaging modalities. A prominent acute phase response with inflammation is the hallmark of the disease, predominantly targeting large- and medium-sized arteries leading to stenosis or occlusion of arterial lumen. To date, there are no reliable tissue markers specific for GCA. Scarce reports have indicated the importance of epigenetics in GCA. The current systematic review reports significantly changed candidate biomarkers in TABs of GCA patients compared to non-GCA patients using qPCR.
Collapse
|
35
|
Terrades-Garcia N, Cid MC. Pathogenesis of giant-cell arteritis: how targeted therapies are influencing our understanding of the mechanisms involved. Rheumatology (Oxford) 2018; 57:ii51-ii62. [PMID: 29982777 DOI: 10.1093/rheumatology/kex423] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 12/13/2022] Open
Abstract
GCA is a chronic granulomatous vasculitis that affects large- and medium-sized vessels. Both the innate and the adaptive immune system are thought to play an important role in the initial events of the pathogenesis of GCA. Amplification cascades are involved in the subsequent development and progression of the disease, resulting in vascular inflammation, remodelling and occlusion. The development of large-vessel vasculitis in genetically modified mice has provided some evidence regarding potential mechanisms that lead to vascular inflammation. However, the participation of specific mechanistic pathways in GCA has not been fully established because of the paucity and limitations of functional models. Treatment of GCA is evolving, and novel therapies are being incorporated into the GCA treatment landscape. In addition, to improve the management of GCA, targeted therapies are providing functional proof of concept of the relevance of particular pathogenic mechanisms in the development of GCA and in sustaining vascular inflammation.
Collapse
Affiliation(s)
- Nekane Terrades-Garcia
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| |
Collapse
|
36
|
Espígol-Frigolé G, Planas-Rigol E, Lozano E, Corbera-Bellalta M, Terrades-García N, Prieto-González S, García-Martínez A, Hernández-Rodríguez J, Grau JM, Cid MC. Expression and Function of IL12/23 Related Cytokine Subunits (p35, p40, and p19) in Giant-Cell Arteritis Lesions: Contribution of p40 to Th1- and Th17-Mediated Inflammatory Pathways. Front Immunol 2018; 9:809. [PMID: 29731755 PMCID: PMC5920281 DOI: 10.3389/fimmu.2018.00809] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/03/2018] [Indexed: 12/17/2022] Open
Abstract
Background Giant-cell arteritis (GCA) is considered a T helper (Th)1- and Th17-mediated disease. Interleukin (IL)-12 is a heterodimeric cytokine (p35/p40) involved in Th1 differentiation. When combining with p19 subunit, p40 compose IL-23, a powerful pro-inflammatory cytokine that maintains Th17 response. Objectives The aims of this study were to investigate p40, p35, and p19 subunit expression in GCA lesions and their combinations to conform different cytokines, to assess the effect of glucocorticoid treatment on subunit expression, and to explore functional roles of p40 by culturing temporal artery sections with a neutralizing anti-human IL-12/IL-23p40 antibody. Methods and results p40 and p19 mRNA concentrations measured by real-time RT-PCR were significantly higher in temporal arteries from 50 patients compared to 20 controls (4.35 ± 4.06 vs 0.51 ± 0.75; p < 0.0001 and 20.32 ± 21.78 vs 4.17 ± 4.43 relative units; p < 0.0001, respectively). No differences were found in constitutively expressed p35 mRNA. Contrarily, p40 and p19 mRNAs were decreased in temporal arteries from 16 treated GCA patients vs those from 34 treatment-naïve GCA patients. Accordingly, dexamethasone reduced p40 and p19 expression in cultured arteries. Subunit associations to conform IL-12 and IL-23 were confirmed by proximity-ligation assay in GCA lesions. Immunofluorescence revealed widespread p19 and p35 expression by inflammatory cells, independent from p40. Blocking IL-12/IL-23p40 tended to reduce IFNγ and IL-17 mRNA production by cultured GCA arteries and tended to increase Th17 inducers IL-1β and IL-6. Conclusion IL-12 and IL-23 heterodimers are increased in GCA lesions and decrease with glucocorticoid treatment. p19 and p35 subunits are much more abundant than p40, indicating an independent role for these subunits or their potential association with alternative subunits. The modest effect of IL-12/IL-23p40 neutralization may indicate compensation by redundant cytokines or cytokines resulting from alternative combinations.
Collapse
Affiliation(s)
- Georgina Espígol-Frigolé
- Vasculitis Research Unit, Department of Autoimmune Diseases, Clinical Institute of Medicine and Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-CRB CELLEX), Barcelona, Spain
| | - Ester Planas-Rigol
- Vasculitis Research Unit, Department of Autoimmune Diseases, Clinical Institute of Medicine and Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-CRB CELLEX), Barcelona, Spain
| | - Ester Lozano
- Vasculitis Research Unit, Department of Autoimmune Diseases, Clinical Institute of Medicine and Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-CRB CELLEX), Barcelona, Spain
| | - Marc Corbera-Bellalta
- Vasculitis Research Unit, Department of Autoimmune Diseases, Clinical Institute of Medicine and Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-CRB CELLEX), Barcelona, Spain
| | - Nekane Terrades-García
- Vasculitis Research Unit, Department of Autoimmune Diseases, Clinical Institute of Medicine and Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-CRB CELLEX), Barcelona, Spain
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Clinical Institute of Medicine and Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-CRB CELLEX), Barcelona, Spain
| | - Ana García-Martínez
- Vasculitis Research Unit, Department of Emergency Medicine, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Jose Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Clinical Institute of Medicine and Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-CRB CELLEX), Barcelona, Spain
| | - Josep M Grau
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Maria C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Clinical Institute of Medicine and Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS-CRB CELLEX), Barcelona, Spain
| |
Collapse
|
37
|
Slart RHJA; Writing group., Reviewer group., Members of EANM Cardiovascular., Members of EANM Infection & Inflammation., Members of Committees, SNMMI Cardiovascular., Members of Council, PET Interest Group., Members of ASNC., EANM Committee Coordinator. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging 2018; 45:1250-69. [PMID: 29637252 DOI: 10.1007/s00259-018-3973-8] [Citation(s) in RCA: 267] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 02/07/2023]
Abstract
Large vessel vasculitis (LVV) is defined as a disease mainly affecting the large arteries, with two major variants, Takayasu arteritis (TA) and giant cell arteritis (GCA). GCA often coexists with polymyalgia rheumatica (PMR) in the same patient, since both belong to the same disease spectrum. FDG-PET/CT is a functional imaging technique which is an established tool in oncology, and has also demonstrated a role in the field of inflammatory diseases. Functional FDG-PET combined with anatomical CT angiography, FDG-PET/CT(A), may be of synergistic value for optimal diagnosis, monitoring of disease activity, and evaluating damage progression in LVV. There are currently no guidelines regarding PET imaging acquisition for LVV and PMR, even though standardization is of the utmost importance in order to facilitate clinical studies and for daily clinical practice. This work constitutes a joint procedural recommendation on FDG-PET/CT(A) imaging in large vessel vasculitis (LVV) and PMR from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine (EANM), the Cardiovascular Council of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and the PET Interest Group (PIG), and endorsed by the American Society of Nuclear Cardiology (ASNC). The aim of this joint paper is to provide recommendations and statements, based on the available evidence in the literature and consensus of experts in the field, for patient preparation, and FDG-PET/CT(A) acquisition and interpretation for the diagnosis and follow-up of patients with suspected or diagnosed LVV and/or PMR. This position paper aims to set an internationally accepted standard for FDG-PET/CT(A) imaging and reporting of LVV and PMR.
Collapse
|
38
|
Burja B, Kuret T, Sodin-semrl S, Lakota K, Rotar Ž, Ješe R, Mrak-poljšak K, Žigon P, Thallinger G, Feichtinger J, Čučnik S, Tomšič M, Praprotnik S, Hočevar A. A concise review of significantly modified serological biomarkers in giant cell arteritis, as detected by different methods. Autoimmun Rev 2018; 17:188-94. [DOI: 10.1016/j.autrev.2017.11.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
39
|
Ishida M, Kuroiwa Y, Yoshida E, Sato M, Krupa D, Henry N, Ikeda K, Kaneko Y. Residual symptoms and disease burden among patients with rheumatoid arthritis in remission or low disease activity: a systematic literature review. Mod Rheumatol 2018; 28:789-799. [PMID: 29251034 DOI: 10.1080/14397595.2017.1416940] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To identify, describe and summarize evidence on residual symptoms and disease burdens in rheumatoid arthritis (RA) patients qualified as being in remission or low disease activity (LDA). METHODS A systematic literature review (SLR) was conducted according to Cochrane collaboration guidelines. The population of interest was adult patients with RA in remission or LDA. The reported outcomes of interest were any symptoms or burdens. RESULTS Fifty-one publications were identified through an eDatabase search. Together with 17 articles found through other sources, 68 were included for full text review. The most commonly reported residual symptoms were pain (number of studies = 25), fatigue (n = 21) and morning stiffness (n = 5). Reported disease burdens included mental health (n = 15), sleep disturbances (n = 7) and work productivity (n = 5), impairment in quality of life (n = 21), and functional disability (n = 34). Substantial residual symptoms and disease burdens were found to be present in patients in remission or LDA. CONCLUSION This is the first SLR to investigate residual symptoms and disease burdens in RA patients in remission or LDA. The results indicate that despite achieving conventional clinical targets, the disease continues to affect patients, suggesting the existence of unmet need under the current treatment paradigm.
Collapse
Affiliation(s)
- Masato Ishida
- a Medical Development Unit Japan , Eli Lilly Japan K.K. , Kobe , Japan
| | - Yuki Kuroiwa
- a Medical Development Unit Japan , Eli Lilly Japan K.K. , Kobe , Japan
| | - Emiko Yoshida
- a Medical Development Unit Japan , Eli Lilly Japan K.K. , Kobe , Japan
| | - Masayo Sato
- a Medical Development Unit Japan , Eli Lilly Japan K.K. , Kobe , Japan
| | | | | | - Kei Ikeda
- c Department of Allergy and Clinical Immunology , Chiba University Hospital , Chiba , Japan
| | - Yuko Kaneko
- d Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan
| |
Collapse
|
40
|
Prieto-González S, Terrades-García N, Corbera-Bellalta M, Planas-Rigol E, Miyabe C, Alba MA, Ponce A, Tavera-Bahillo I, Murgia G, Espígol-Frigolé G, Marco-Hernández J, Hernández-Rodríguez J, García-Martínez A, Unizony SH, Cid MC. Serum osteopontin: a biomarker of disease activity and predictor of relapsing course in patients with giant cell arteritis. Potential clinical usefulness in tocilizumab-treated patients. RMD Open 2017; 3:e000570. [PMID: 29299342 PMCID: PMC5743901 DOI: 10.1136/rmdopen-2017-000570] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/23/2017] [Accepted: 11/24/2017] [Indexed: 11/03/2022] Open
Abstract
Background Osteopontin (OPN) is a glycoprotein involved in Th1 and Th17 differentiation, tissue inflammation and remodelling. We explored the role of serum OPN (sOPN) as a biomarker in patients with giant cell arteritis (GCA). Methods sOPN was measured by immunoassay in 76 treatment-naïve patients with GCA and 25 age-matched and sex-matched controls. In 36 patients, a second measurement was performed after 1 year of glucocorticoid treatment. Baseline clinical and laboratory findings, as well as relapses and glucocorticoid requirements during follow-up, were prospectively recorded. sOPN and C reactive protein (CRP) were measured in 32 additional patients in remission treated with glucocorticoids or tocilizumab (interleukin 6 (IL-6) receptor antagonist). In cultured temporal arteries exposed and unexposed to tocilizumab, OPN mRNA expression and protein production were measured by reverse transcription polymerase chain reaction (RT-PCR) and immunoassay, respectively. Results sOPN concentration (ng/mL; mean±SD) was significantly elevated in patients with active disease (116.75±65.61) compared with controls (41.10±22.65; p<0.001). A significant decline in sOPN was observed in paired samples as patients entered disease remission (active disease 102.45±57.72, remission 46.47±23.49; p<0.001). sOPN correlated with serum IL-6 (r=0.55; p<0.001). Baseline sOPN concentrations were significantly higher in relapsing versus non-relapsing patients (relapsers 129.08±74.24, non-relapsers 90.63±41.02; p=0.03). OPN mRNA expression and protein production in cultured arteries were not significantly modified by tocilizumab. In tocilizumab-treated patients, CRP became undetectable, whereas sOPN was similar in patients in tocilizumab-maintained (51.91±36.25) or glucocorticoid-maintained remission (50.65±23.59; p=0.49). Conclusions sOPN is a marker of disease activity and a predictor of relapse in GCA. Since OPN is not exclusively IL-6-dependent, sOPN might be a suitable disease activity biomarker in tocilizumab-treated patients.
Collapse
Affiliation(s)
- Sergio Prieto-González
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Nekane Terrades-García
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Marc Corbera-Bellalta
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Ester Planas-Rigol
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Chie Miyabe
- Division of Rheumatology, Allergy and Immunology, Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco A Alba
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Ariel Ponce
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Itziar Tavera-Bahillo
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Giuseppe Murgia
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Javier Marco-Hernández
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Ana García-Martínez
- Department of Emergency Medicine, Hospital Clínic, University of Barcelona, IDIBAPS, CRB-CELLEX, Barcelona, Spain
| | - Sebastian H Unizony
- Division of Rheumatology, Allergy and Immunology, Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria C Cid
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| |
Collapse
|
41
|
Samson M, Bonnotte B. De la physiopathologie de l’artérite à cellules géantes aux nouvelles cibles thérapeutiques. Rev Med Interne 2017; 38:670-678. [DOI: 10.1016/j.revmed.2017.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022]
|
42
|
Samson M, Corbera-Bellalta M, Audia S, Planas-Rigol E, Martin L, Cid MC, Bonnotte B. Recent advances in our understanding of giant cell arteritis pathogenesis. Autoimmun Rev 2017; 16:833-844. [DOI: 10.1016/j.autrev.2017.05.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/13/2017] [Indexed: 12/12/2022]
|
43
|
Planas-Rigol E, Terrades-Garcia N, Corbera-Bellalta M, Lozano E, Alba MA, Segarra M, Espígol-Frigolé G, Prieto-González S, Hernández-Rodríguez J, Preciado S, Lavilla R, Cid MC. Endothelin-1 promotes vascular smooth muscle cell migration across the artery wall: a mechanism contributing to vascular remodelling and intimal hyperplasia in giant-cell arteritis. Ann Rheum Dis 2017; 76:1624-1634. [DOI: 10.1136/annrheumdis-2016-210792] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 01/01/2023]
Abstract
BackgroundGiant-cell arteritis (GCA) is an inflammatory disease of large/medium-sized arteries, frequently involving the temporal arteries (TA). Inflammation-induced vascular remodelling leads to vaso-occlusive events. Circulating endothelin-1 (ET-1) is increased in patients with GCA with ischaemic complications suggesting a role for ET-1 in vascular occlusion beyond its vasoactive function.ObjectiveTo investigate whether ET-1 induces a migratory myofibroblastic phenotype in human TA-derived vascular smooth muscle cells (VSMC) leading to intimal hyperplasia and vascular occlusion in GCA.Methods and resultsImmunofluorescence/confocal microscopy showed increased ET-1 expression in GCA lesions compared with control arteries. In inflamed arteries, ET-1 was predominantly expressed by infiltrating mononuclear cells whereas ET receptors, particularly ET-1 receptor B (ETBR), were expressed by both mononuclear cells and VSMC. ET-1 increased TA-derived VSMC migration in vitro and α-smooth muscle actin (αSMA) expression and migration from the media to the intima in cultured TA explants. ET-1 promoted VSMC motility by increasing activation of focal adhesion kinase (FAK), a crucial molecule in the turnover of focal adhesions during cell migration. FAK activation resulted in Y397 autophosphorylation creating binding sites for Src kinases and the p85 subunit of PI3kinases which, upon ET-1 exposure, colocalised with FAK at the focal adhesions of migrating VSMC. Accordingly, FAK or PI3K inhibition abrogated ET-1-induced migration in vitro. Consistently, ET-1 receptor A and ETBR antagonists reduced αSMA expression and delayed VSMC outgrowth from cultured GCA-involved artery explants.ConclusionsET-1 is upregulated in GCA lesions and, by promoting VSMC migration towards the intimal layer, may contribute to intimal hyperplasia and vascular occlusion in GCA.
Collapse
|
44
|
Prieto-González S, Espígol-Frigolé G, García-Martínez A, Alba MA, Tavera-Bahillo I, Hernández-Rodríguez J, Renú A, Gilabert R, Lomeña F, Cid MC. The Expanding Role of Imaging in Systemic Vasculitis. Rheum Dis Clin North Am 2016; 42:733-51. [PMID: 27742024 DOI: 10.1016/j.rdc.2016.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Various imaging modalities, including color duplex ultrasonography, CT angiography, magnetic resonance angiography, and PET, are emerging as important aids to the diagnosis, staging, evaluation of disease activity and response to treatment in systemic vasculitis. Although large-vessel vasculitis is the main target of imaging, refinement and increasing accuracy of imaging modalities are also providing useful information in the evaluation of medium-vessel and small-vessel vasculitis.
Collapse
|
45
|
Wang JH, Zhao L, Pan X, Chen NN, Chen J, Gong QL, Su F, Yan J, Zhang Y, Zhang SH. Hypoxia-stimulated cardiac fibroblast production of IL-6 promotes myocardial fibrosis via the TGF-β1 signaling pathway. J Transl Med 2016; 96:839-52. [PMID: 27348628 DOI: 10.1038/labinvest.2016.65] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/16/2016] [Accepted: 05/01/2016] [Indexed: 12/15/2022] Open
Abstract
Interlukin-6 (IL-6) is a multifunctional cytokine produced by several cell types that has a role in fibrosis. Fibroblasts (FBs) maintain this underlying pathogenic change through regulation of IL-6 production; however, its potential functional role in regulating surrounding cellular structural changes during ischemic myocardial remodeling remains unexplored. Here, we generated FBs, cardiomyocytes (CMs), and blood vascular endothelial cells (ECs) from the ventricles of neonatal rats. IL-6 was then overexpressed in FBs and the cells were treated with IL-6 receptor inhibitor (IL6RI), TGF-β1 receptor inhibitor (TβRI), or MMP2/MMP9 inhibitor (MMPI) using monoculture or coculture models under hypoxic conditions. The results indicate that overexpression of IL-6 is sufficient to induce myofibroblastic proliferation, differentiation, and fibrosis, probably via increased TGF-β1-mediated MMP2/MMP3 signaling. The use of IL6RI, TβRI, or MMPI diminished these effects. In addition, IL-6 activated the apoptosis-associated factors Caspase3 and Smad3, and decreased the expression of anti-apoptotic factor Bcl2, resulting in apoptosis of CMs under hypoxic coculture: IL6RI or TβRI inhibited these effects. Unexpectedly, IL-6-overexpressing FBs significantly increased the angiogenesis of ECs, which involved significant increases in the expression of proangiogenic growth factors. Treatment of FBs with IL6RI or TβRI in coculture with ECs reduced the levels of secreted proangiogenic growth factors, and the angiogenesis of ECs was significantly downregulated. Thus, IL-6 functions in ischemic myocardial remodeling through multifunctional reprogramming of hypoxia-associated FBs towards fibrosis via upregulation of the TGF-β1 signaling pathway.
Collapse
|
46
|
Corbera-Bellalta M, Planas-Rigol E, Lozano E, Terrades-García N, Alba MA, Prieto-González S, García-Martínez A, Albero R, Enjuanes A, Espígol-Frigolé G, Hernández-Rodríguez J, Roux-Lombard P, Ferlin WG, Dayer JM, Kosco-Vilbois MH, Cid MC. Blocking interferon γ reduces expression of chemokines CXCL9, CXCL10 and CXCL11 and decreases macrophage infiltration in ex vivo cultured arteries from patients with giant cell arteritis. Ann Rheum Dis 2015; 75:1177-86. [DOI: 10.1136/annrheumdis-2015-208371] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/06/2015] [Indexed: 01/21/2023]
Abstract
BackgroundInterferon γ (IFNγ) is considered a seminal cytokine in the pathogenesis of giant cell arteritis (GCA), but its functional role has not been investigated. We explored changes in infiltrating cells and biomarkers elicited by blocking IFNγ with a neutralising monoclonal antibody, A6, in temporal arteries from patients with GCA.MethodsTemporal arteries from 34 patients with GCA (positive histology) and 21 controls were cultured on 3D matrix (Matrigel) and exposed to A6 or recombinant IFNγ. Changes in gene/protein expression were measured by qRT-PCR/western blot or immunoassay. Changes in infiltrating cells were assessed by immunohistochemistry/immunofluorescence. Chemotaxis/adhesion assays were performed with temporal artery-derived vascular smooth muscle cells (VSMCs) and peripheral blood mononuclear cells (PBMCs).ResultsBlocking endogenous IFNγ with A6 abrogated STAT-1 phosphorylation in cultured GCA arteries. Furthermore, selective reduction in CXCL9, CXCL10 and CXCL11 chemokine expression was observed along with reduction in infiltrating CD68 macrophages. Adding IFNγ elicited consistent opposite effects. IFNγ induced CXCL9, CXCL10, CXCL11, CCL2 and intracellular adhesion molecule-1 expression by cultured VSMC, resulting in increased PBMC chemotaxis/adhesion. Spontaneous expression of chemokines was higher in VSMC isolated from GCA-involved arteries than in those obtained from controls. Incubation of IFNγ-treated control arteries with PBMC resulted in adhesion/infiltration by CD68 macrophages, which did not occur in untreated arteries.ConclusionsOur ex vivo system suggests that IFNγ may play an important role in the recruitment of macrophages in GCA by inducing production of specific chemokines and adhesion molecules. Vascular wall components (ie, VSMC) are mediators of these functions and may facilitate progression of inflammatory infiltrates through the vessel wall.
Collapse
|
47
|
O'Neill L, Rooney P, Molloy D, Connolly M, McCormick J, McCarthy G, Veale DJ, Murphy CC, Fearon U, Molloy E. Regulation of Inflammation and Angiogenesis in Giant Cell Arteritis by Acute-Phase Serum Amyloid A. Arthritis Rheumatol 2015; 67:2447-56. [DOI: 10.1002/art.39217] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/21/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Lorraine O'Neill
- St. Vincent's University Hospital and Dublin Academic Medical Centre; Dublin Ireland
| | - Peadar Rooney
- St. Vincent's University Hospital and Dublin Academic Medical Centre; Dublin Ireland
| | - Danielle Molloy
- St. Vincent's University Hospital and Dublin Academic Medical Centre; Dublin Ireland
| | - Mary Connolly
- St. Vincent's University Hospital and Dublin Academic Medical Centre; Dublin Ireland
| | - Jennifer McCormick
- St. Vincent's University Hospital and Dublin Academic Medical Centre; Dublin Ireland
| | - Geraldine McCarthy
- Mater Misericordiae University Hospital and Dublin Academic Medical Centre; Dublin Ireland
| | - Douglas J. Veale
- St. Vincent's University Hospital and Dublin Academic Medical Centre; Dublin Ireland
| | - Conor C. Murphy
- Royal College of Surgeons of Ireland and Royal Victoria Eye and Ear Hospital; Dublin Ireland
| | - Ursula Fearon
- St. Vincent's University Hospital and Dublin Academic Medical Centre; Dublin Ireland
| | - Eamonn Molloy
- St. Vincent's University Hospital and Dublin Academic Medical Centre; Dublin Ireland
| |
Collapse
|
48
|
Abstract
Giant cell arteritis (GCA) is a large-vessel vasculitis predominantly affecting older people, with a peak incidence between 70 and 79 years of age. If untreated, ischaemic complications can be catastrophic for the patient, including blindness. We review the current treatment paradigms for this condition, the mainstay of which is immediate high-dose glucocorticoid therapy with a gradual dose tapering. Adverse events of glucocorticoid therapy are often observed after 12-24 months and corticosteroid-sparing adjuvant therapies are used in severe disease, multiple flares or patients at high risk of prolonged therapy. The current understanding of the pathogenesis of GCA is explored. This has informed the identification of new potential targets and approaches to treatment. Blockade of interleukin (IL)-6 (tocilizumab) and IL-1 (gevokizumab) are being evaluated in phase III clinical trials. It is hoped that improved risk stratification of organ damage and relapses will be developed using imaging and biomarkers, allowing for individualised treatment for patients; however, there remains further work to be done before this becomes a reality.
Collapse
Affiliation(s)
- Lauren Steel
- Rheumatology, Southend University Hospital, Prittlewell Chase, Westcliff-on-sea, Essex, SS0 0RY, UK
| | | | | |
Collapse
|
49
|
van der Geest KSM, Abdulahad WH, Rutgers A, Horst G, Bijzet J, Arends S, Roffel MP, Boots AMH, Brouwer E. Serum markers associated with disease activity in giant cell arteritis and polymyalgia rheumatica. Rheumatology (Oxford) 2015; 54:1397-402. [DOI: 10.1093/rheumatology/keu526] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Indexed: 11/13/2022] Open
|
50
|
Abstract
PURPOSE OF REVIEW Better biomarkers are needed for guiding management of patients with vasculitis. Large cohorts and technological advances had led to an increase in preclinical studies of potential biomarkers. RECENT FINDINGS The most interesting markers described recently include a gene expression signature in CD8+ T cells that predicts tendency to relapse or remain relapse-free in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, and a pair of urinary proteins that are elevated in Kawasaki disease but not other febrile illnesses. Both of these studies used 'omics' technologies to generate and then test hypotheses. More conventional hypothesis-based studies have indicated that the following circulating proteins have potential to improve upon clinically available tests: pentraxin-3 in giant cell arteritis and Takayasu's arteritis; von Willebrand factor antigen in childhood central nervous system vasculitis; eotaxin-3 and other markers related to eosinophils or Th2 immune responses in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome); and matrix metalloproteinase-3, tissue inhibitor of metalloproteinase-1, and CXCL13 in ANCA-associated vasculitis. SUMMARY New markers testable in blood and urine have the potential to assist with diagnosis, staging, assessment of current disease activity, and prognosis. However, the standards for clinical usefulness, in particular, the demonstration of either very high sensitivity or very high specificity have yet to be met for clinically relevant outcomes.
Collapse
|