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Tang MW, van Nierop FS, Koopman FA, Eggink HM, Gerlag DM, Chan MW, Zitnik R, Vaz FM, Romijn JA, Tak PP, Soeters MR. Single vagus nerve stimulation reduces early postprandial C-peptide levels but not other hormones or postprandial metabolism. Clin Rheumatol 2017; 37:505-514. [PMID: 28389989 PMCID: PMC5775981 DOI: 10.1007/s10067-017-3618-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 12/30/2022]
Abstract
A recent study in rheumatoid arthritis (RA) patients using electrical vagus nerve stimulation (VNS) to activate the inflammatory reflex has shown promising effects on disease activity. Innervation by the autonomic nerve system might be involved in the regulation of many endocrine and metabolic processes and could therefore theoretically lead to unwanted side effects. Possible effects of VNS on secretion of hormones are currently unknown. Therefore, we evaluated the effects of a single VNS on plasma levels of pituitary hormones and parameters of postprandial metabolism. Six female patients with RA were studied twice in balanced assignment (crossover design) to either VNS or no stimulation. The patients selected for this substudy had been on VNS therapy daily for at least 3 months and at maximum of 24 months. We compared 10-, 20-, and 30-min poststimulus levels to baseline levels, and a 4-h mixed meal test was performed 30 min after VNS. We also determined energy expenditure (EE) by indirect calorimetry before and after VNS. VNS did not affect pituitary hormones (growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone), postprandial metabolism, or EE. Of note, VNS reduced early postprandial insulin secretion, but not AUC of postprandial plasma insulin levels. Cortisol and catecholamine levels in serum did not change significantly. Short stimulation of vagal activity by VNS reduces early postprandial insulin secretion, but not other hormone levels and postprandial response. This suggests VNS as a safe treatment for RA patients.
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Affiliation(s)
- M W Tang
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Centre, Academic Medical Centre, University of Amsterdam, Room F4-105, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
- Department of Experimental Immunology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - F S van Nierop
- Department of Endocrinology and Metabolism, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - F A Koopman
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Centre, Academic Medical Centre, University of Amsterdam, Room F4-105, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - H M Eggink
- Department of Endocrinology and Metabolism, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - D M Gerlag
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Centre, Academic Medical Centre, University of Amsterdam, Room F4-105, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
- Currently also Clinical Unit Cambridge, GlaxoSmithKline, Cambridge, UK
| | - M W Chan
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Centre, Academic Medical Centre, University of Amsterdam, Room F4-105, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - R Zitnik
- SetPoint Medical Corporation, Valencia, CA, USA
| | - F M Vaz
- Laboratory of Genetic Metabolic Disease, Department of clinical chemistry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J A Romijn
- Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - P P Tak
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Centre, Academic Medical Centre, University of Amsterdam, Room F4-105, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
- Currently also GlaxoSmithKline, Stevenage, UK.
- University of Cambridge, Cambridge, UK.
- Ghent University, Ghent, Belgium.
| | - M R Soeters
- Department of Endocrinology and Metabolism, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Nair SC, Welsing PMJ, Choi IYK, Roth J, Holzinger D, Bijlsma JWJ, van Laar JM, Gerlag DM, Lafeber FPJG, Tak PP. A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients. PLoS One 2016; 11:e0152362. [PMID: 27029006 PMCID: PMC4814133 DOI: 10.1371/journal.pone.0152362] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/13/2016] [Indexed: 02/02/2023] Open
Abstract
Objectives Measurement of MRP8/14 serum levels has shown potential in predicting clinical response to different biological agents in rheumatoid arthritis (RA). We aimed to develop a treatment algorithm based on a prediction score using MRP8/14 measurements and clinical parameters predictive for response to different biological agents. Methods Baseline serum levels of MRP8/14 were measured in 170 patients starting treatment with infliximab, adalimumab or rituximab. We used logistic regression analysis to develop a predictive score for clinical response at 16 weeks. MRP8/14 levels along with clinical variables at baseline were investigated. We also investigated how the predictive effect of MRP8/14 was modified by drug type. A treatment algorithm was developed based on categorizing the expected response per drug type as high, intermediate or low for each patient and optimal treatment was defined. Finally, we present the utility of using this treatment algorithm in clinical practice. Results The probability of response increased with higher baseline MRP8/14 complex levels (OR = 1.39), differentially between the TNF-blockers and rituximab (OR of interaction term = 0.78), and also increased with higher DAS28 at baseline (OR = 1.28). Rheumatoid factor positivity, functional disability (a higher HAQ), and previous use of a TNF-inhibitor decreased the probability of response. Based on the treatment algorithm 80 patients would have been recommended for anti-TNF treatment, 8 for rituximab, 13 for another biological treatment (other than TNFi or rituximab) and for 69 no recommendation was made. The predicted response rates matched the observed response in the cohort well. On group level the predicted response based on the algorithm resulted in a modest 10% higher response rate in our cohort with much higher differences in response probability in individual patients treated contrary to treatment recommendation. Conclusions Prediction of response using MRP8/14 levels along with clinical predictors has potential in personalizing treatment for RA patients starting biological anti-rheumatic treatment, and might increase cost-effectiveness.
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Affiliation(s)
- S. C. Nair
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
- * E-mail:
| | - P. M. J. Welsing
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - I. Y. K. Choi
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - J. Roth
- Institute of Immunology, University Hospital Muenster, Muenster, Germany
| | - D. Holzinger
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - J. W. J. Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - J. M. van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - D. M. Gerlag
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - F. P. J. G. Lafeber
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - P. P. Tak
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
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Koopman FA, Tang MW, Vermeij J, de Hair MJ, Choi IY, Vervoordeldonk MJ, Gerlag DM, Karemaker JM, Tak PP. Autonomic Dysfunction Precedes Development of Rheumatoid Arthritis: A Prospective Cohort Study. EBioMedicine 2016; 6:231-237. [PMID: 27211565 PMCID: PMC4856742 DOI: 10.1016/j.ebiom.2016.02.029] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022] Open
Abstract
Background Heart rate variability (HRV) is a validated method to establish autonomic nervous system (ANS) activity. Rheumatoid arthritis (RA) is accompanied by ANS imbalance. We hypothesized that ANS dysfunction may precede the development of RA, which would suggest that it plays a role in its etiopathogenesis. Methods First, we assessed HRV parameters in supine (resting) and upright (active) position in healthy subjects (HS, n = 20), individuals at risk of developing arthritis (AR subjects, n = 50) and RA patients (RA, n = 20). Next, we measured resting heart rate (RHR), a parasympathetic HRV parameter, in an independent prospective cohort of AR subjects (n = 45). We also evaluated expression levels of the parasympathetic nicotinic acetylcholine receptor type 7 (α7nAChR) on circulating monocytes. Findings Both AR subjects (68 beats per minute (bpm), interquartile range (IQR) 68–73) and RA patients (68 bpm, IQR 62–76) had a significantly higher RHR compared to HS (60 bpm, IQR 56–63). RHR was significantly higher at baseline in individuals who subsequently developed arthritis. Expression levels of α7nAChR were lower in AR subjects with RHR ≥ 70 bpm compared to those with RHR < 70 bpm, consistent with reduced activity of the parasympathetic cholinergic anti-inflammatory pathway. Interpretation These data support the notion that autonomic dysfunction precedes the development of RA. Individuals at risk of developing RA show autonomic dysfunction similar to established RA patients. Autonomic dysfunction is a predictor of development of arthritis in subjects at risk of RA, suggesting a role in its etiopathogenesis.
The autonomous nervous system is a neurological control system that acts largely unconsciously and regulates a variety of bodily functions. We found that dysfunction of this system may precede and predict the development of rheumatoid arthritis (RA), a chronic inflammatory disease with great unmet need. These findings provide important insights into the changes in the nervous system contributing to the development of this condition. They also open up the perspective of potential measures aimed at prevention of RA by restoring the balance in the nervous system before arthritis develops, which would have major implications for patients as well as society.
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Affiliation(s)
- F A Koopman
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M W Tang
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J Vermeij
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M J de Hair
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, The Netherlands
| | - I Y Choi
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M J Vervoordeldonk
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - D M Gerlag
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J M Karemaker
- Department of Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P P Tak
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Hähnlein JS, Rodriguez-Carrio J, Ramwadhdoebe TH, Semmelink JF, Choi IY, van Lienden KP, Maas M, Gerlag DM, Tak PP, Geijtenbeek TBH, van Baarsen LGM. A1.19 Altered distribution of innate lymphoid cell populations in human LYMPH node biopsies obtained during the earliest phases of systemic autoimmunity. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.19] [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: 11/04/2022]
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Hähnlein J, Ramwadhdoebe TH, Semmelink JF, Safy M, van Lienden KP, Maas M, Gerlag DM, Tak PP, Geijtenbeek TBH, van Baarsen LGM. A3.06 Distinct expression pattern of peripheral tissue-restricted antigens in human LYMPH node stromal cells during the earliest phases of rheumatoid arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.83] [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: 11/04/2022]
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van Baarsen LGM, de Hair MJH, Semmelink JF, Choi IY, Gerlag DM, Tak PP. A7.7 Synovial tissue profiling in autoantibody positive individuals without arthritis reveals gene signatures associated with subsequent development of rheumatoid arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.177] [Citation(s) in RCA: 2] [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] [Indexed: 11/03/2022]
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Koopman FA, Tang MW, Vermeij J, de Hair MJ, Choi IY, Vervoordeldonk MJ, Gerlag DM, Karemaker JM, Tak PP. A7.8 Autonomic dysfunction in the preclinical phase of rheumatoid arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.178] [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: 11/04/2022]
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Maijer KI, Noort AR, de Hair MJH, van der Leij C, van Zoest KPM, Choi IY, Gerlag DM, Maas M, Tak PP, Tas SW. A6.21 NF-κB-inducing kinase (NIK) is expressed in synovial endothelial cells in early arthritis patients and correlates with markers of inflammation. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.147] [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: 11/03/2022]
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Ramwadhdoebe TH, Hähnlein J, Maijer KI, Gerlag DM, Tak PP, van Baarsen LGM. A1.8 CD4 +T-helper cell subsets in lymph node biopsies and peripheral blood during the earliest phases of rheumatoid arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.8] [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: 11/04/2022]
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Hähnlein J, Ramwadhdoebe TH, Semmelink JF, Choi IY, Smits NAM, Berger FH, Maas M, Gerlag DM, Geijtenbeek TBH, Tak PP, van Baarsen LBM. A6.9 Distinct expression of T-cell homing molecules in human autoimmune lymph node stromal cells upon TLR-3 triggering. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.135] [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: 11/03/2022]
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Van der Horst A, Choi YK, van Schaardenburg DJ, Gerlag DM, Hamann D, Tak PP, Thurlings RM. A7.3 The mucosal anti-citrullinated protein antibody response in pre-clinical rheumatoid arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.173] [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: 11/03/2022]
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Ramwadhdoebe TH, Hähnlein J, van Kuijk BJ, Choi IY, Gerlag DM, Tak PP, van Baarsen LGM. A1.20 Lymphoid tissue analyses in autoantibody positive individuals at risk for developing rheumatoid arthritis reveals an important role for CD8 +T cells during the earliest phases of autoimmunity. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.20] [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: 11/04/2022]
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Ramwadhdoebe TH, Boumans MJH, Bruijnen STG, Safy M, Berger FH, van Baarsen LGM, van der Laken CJ, Gerlag DM, Thurlings RM, Tak PP. A8.10 The effect of rituximab treatment on B and T cell subsets in lymphoid tissues of patients with rheumatoid arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Greven DEA, Cohen ES, Gerlag DM, Campbell J, Woods J, Davis N, van Nieuwenhuijze A, Lewis A, Heasmen S, McCourt M, Corkill D, Dodd A, Elvin J, Statache G, Wicks IP, Anderson IK, Nash A, Sleeman MA, Tak PP. Preclinical characterisation of the GM-CSF receptor as a therapeutic target in rheumatoid arthritis. Ann Rheum Dis 2014; 74:1924-30. [PMID: 24936585 PMCID: PMC4602263 DOI: 10.1136/annrheumdis-2014-205234] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/01/2014] [Indexed: 01/19/2023]
Abstract
Objective Previous work has suggested that the granulocyte macrophage colony stimulating factor (GM-CSF)–GM-CSF receptor α axis (GM-CSFRα) may provide a new therapeutic target for the treatment of rheumatoid arthritis (RA). Therefore, we investigated the cellular expression of GM-CSFRα in RA synovial tissue and investigated the effects of anti-GM-CSFRα antibody treatment in vitro and in vivo in a preclinical model of RA. Methods We compared GM-CSFRα expression on macrophages positive for CD68 or CD163 on synovial biopsy samples from patients with RA or psoriatic arthritis (PsA) to disease controls. In addition, we studied the effects of CAM-3003, an anti-GM-CSFR antibody in a collagen induced arthritis model of RA in DBA/1 mice. The pharmacokinetic profile of CAM-3003 was studied in naïve CD1(ICR) mice (see online supplement) and used to interpret the results of the pharmacodynamic studies in BALB/c mice. Results GM-CSFRα was expressed by CD68 positive and CD163 positive macrophages in the synovium, and there was a significant increase in GM-CSFRα positive cells in patients in patients with RA as well as patients with PsA compared with patients with osteoarthritis and healthy controls. In the collagen induced arthritis model there was a dose dependent reduction of clinical arthritis scores and the number of F4/80 positive macrophages in the inflamed synovium after CAM-3003 treatment. In BALB/c mice CAM-3003 inhibited recombinant GM-CSF mediated margination of peripheral blood monocytes and neutrophils. Conclusions The findings support the ongoing development of therapies aimed at interfering with GM-CSF or its receptor in various forms of arthritis, such as RA and PsA.
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Affiliation(s)
- D E A Greven
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/ University of Amsterdam, Amsterdam, The Netherlands
| | - E S Cohen
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - D M Gerlag
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/ University of Amsterdam, Amsterdam, The Netherlands GlaxoSmithKline, Cambridge, UK
| | - J Campbell
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - J Woods
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - N Davis
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - A van Nieuwenhuijze
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - A Lewis
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - S Heasmen
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - M McCourt
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - D Corkill
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - A Dodd
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - J Elvin
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - G Statache
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/ University of Amsterdam, Amsterdam, The Netherlands
| | - I P Wicks
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - I K Anderson
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - A Nash
- Department of Research and Development, CSL Limited, Parkville, Victoria, Australia
| | - M A Sleeman
- Department of Respiratory, Inflammation and AutoImmunity Research, MedImmune Limited, Cambridge, UK
| | - P P Tak
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/ University of Amsterdam, Amsterdam, The Netherlands GlaxoSmithKline, Stevenage, UK University of Cambridge, Cambridge, UK
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Hähnlein J, Ramwadhdoebe TH, Semmelink JF, Maijer KI, Choi IY, Smits NAM, Berger FH, Maas M, Gerlag DM, Geijtenbeek TB, Tak PP, van Baarsen LGM. A8.17 Expression of the autoimmune regulator aire in human lymph node stromal cells. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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de Hair MJH, van de Sande MGH, Ramwadhdoebe TH, van der Leij C, Maas M, Hansson M, Klareskog L, Landewé R, Serre G, van Schaardenburg D, Gerlag DM, van Baarsen LGM, Tak PP. Reply: To PMID 24574210. Arthritis Rheumatol 2014; 66:1683-4. [PMID: 24577836 DOI: 10.1002/art.38411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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de Hair MJH, van de Sande MGH, Ramwadhdoebe TH, Hansson M, Landewé R, van der Leij C, Maas M, Serre G, van Schaardenburg D, Klareskog L, Gerlag DM, van Baarsen LGM, Tak PP. Features of the synovium of individuals at risk of developing rheumatoid arthritis: implications for understanding preclinical rheumatoid arthritis. Arthritis Rheumatol 2014; 66:513-22. [PMID: 24574210 PMCID: PMC4034588 DOI: 10.1002/art.38273] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/05/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Findings from previous studies have suggested that subclinical inflammation of the synovium does not coincide with the appearance of rheumatoid arthritis (RA)-specific autoantibodies. This study was undertaken to examine the relationship between the presence of autoantibodies, changes in the synovium, and development of arthritis over time in a markedly larger, prospective study. METHODS Fifty-five individuals who were IgM rheumatoid factor positive and/or anti-citrullinated protein antibody (ACPA) positive (detected by the anti-cyclic citrullinated peptide antibody test) and who were without any evidence of arthritis upon physical examination were included in the study. ACPAs were subsequently also detected using a multiplex chip-based assay. All individuals underwent magnetic resonance imaging and mini-arthroscopic synovial biopsy sampling of a knee joint at inclusion and were prospectively followed up. Proportional hazards regression analysis was performed to investigate whether changes in the synovium were associated with the onset of arthritis. RESULTS Fifteen individuals (27%) developed arthritis after a median followup time of 13 months (interquartile range 6-27 months; range 1-47 months). No overt synovial inflammation was observed, but CD3+ T cell numbers in the biopsy tissue showed a borderline association with subsequent development of clinically manifest arthritis (hazard ratio 2.8, 95% confidence interval [95% CI] 0.9-9.1; P = 0.088). In addition, the presence of CD8+ T cells was associated with ACPA positivity (odds ratio [OR] 16.0, 95% CI 1.7-151.1) and with the total number of ACPAs present (OR 1.4, 95% CI 1.0-1.8). CONCLUSION These findings confirm and extend previous results showing the absence of clearcut synovial inflammation in individuals having systemic autoimmunity associated with RA. However, subtle infiltration by synovial T cells may precede the signs and symptoms of arthritis in preclinical RA.
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Affiliation(s)
- MJH de Hair
- Academic Medical Center and University of AmsterdamAmsterdam, The Netherlands
| | - MGH van de Sande
- Academic Medical Center and University of AmsterdamAmsterdam, The Netherlands
| | - TH Ramwadhdoebe
- Academic Medical Center and University of AmsterdamAmsterdam, The Netherlands
| | - M Hansson
- Karolinska Institute and Karolinska University HospitalSolna, Stockholm, Sweden
| | - R Landewé
- Academic Medical Center and University of Amsterdam, Amsterdam, The Netherlands, and Atrium Medical CenterHeerlen, The Netherlands
| | - C van der Leij
- Academic Medical Center and University of AmsterdamAmsterdam, The Netherlands
| | - M Maas
- Academic Medical Center and University of AmsterdamAmsterdam, The Netherlands
| | - G Serre
- Toulouse III UniversityToulouse, France
| | | | - L Klareskog
- Karolinska Institute and Karolinska University HospitalSolna, Stockholm, Sweden
| | - DM Gerlag
- Academic Medical Center and University of Amsterdam, Amsterdam, The Netherlands, GlaxoSmithKline, Stevenage, UK, and University of CambridgeCambridge, UK
| | - LGM van Baarsen
- Academic Medical Center and University of AmsterdamAmsterdam, The Netherlands
| | - PP Tak
- Academic Medical Center and University of Amsterdam, Amsterdam, The Netherlands, GlaxoSmithKline, Stevenage, UK, and University of CambridgeCambridge, UK
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Ramwadhdoebe TH, van Baarsen LGM, Berger FH, Maas M, Gerlag DM, Tak PP, Lebre MC. A8.34 CD1C + dendritic cells are overrepresented in lymph nodes of early arthritis patients and related to B cell responses. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.208] [Citation(s) in RCA: 2] [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] [Indexed: 11/03/2022]
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Ramwadhdoebe TH, Hähnlein J, Maijer KI, Choi IY, Safy M, van Boven LJ, de Hair MJ, Maas M, Gerlag DM, Tak PP, van Baarsen LGM. A1.32 An imbalance between inflammatory and regulatory T-cell subsets in LYMPH node biopsies during the earliest phases of rheumatoid arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.31] [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: 11/03/2022]
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Tang MW, Reedquist KA, Garcia S, Gerlag DM, Tak PP. 1.57 Prolactin is locally produced in the synovium of patients with inflammatory arthritic diseases and promotes macrophage activation. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.56] [Citation(s) in RCA: 5] [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] [Indexed: 11/03/2022]
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Choi IYK, Herenius MJ, Wijbrandts CA, Thurlings RM, Roth J, Föll D, Gerlag DM, Tak PP, Holzinger D. THU0167 MRP8/14 Serum Complexes as Predictor of Response to Biological Treatments in Rheumatoid Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maijer KI, Noort AR, de Hair MJH, van der Leij C, van Zoest KPM, Gerlag DM, Maas M, Tak PP, Tas SW. THU0083 NF-KB-Inducing Kinase (NIK) Expression in Synovial Blood Vessels Correlates with Systemic Markers of Inflammation and Local Disease Activity in Early Arthritis Patients, but is not Disease Specific. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.611] [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: 11/04/2022]
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Ramwadhdoebe TH, Hähnlein J, Maijer KI, Boorsma J, van Boven LJ, Gerlag DM, Tak PP, van Baarsen LGM. THU0111 T-Cell Subsets in Lymph Node Biopsies of Autoantibody Positive Subjects at Risk of Rheumatoid Arthritis (RA) and Early RA Patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.639] [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: 11/04/2022]
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Maijer KI, de Hair MJH, Li W, Defranoux NA, Sasso EH, Gerlag DM, Tak PP. FRI0062 Evaluation of a multi-biomarker disease activity (vectra ™ da algorithm) in early rheumatoid arthritis and unclassified arthritis patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1189] [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: 11/04/2022]
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Tang MW, Reedquist KA, Goffin V, Gerlag DM, Tak PP. AB0033 Systemic secreted prolactin in ra leads to proinflammatory cytokine production in macrophages. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2356] [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: 11/03/2022]
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van Baarsen LGM, de Hair MJH, Ramwadhdoebe TH, Zijlstra IJAJ, Maas M, Gerlag DM, Tak PP. The cellular composition of lymph nodes in the earliest phase of inflammatory arthritis. Ann Rheum Dis 2013; 72:1420-4. [PMID: 23661491 PMCID: PMC3711496 DOI: 10.1136/annrheumdis-2012-202990] [Citation(s) in RCA: 44] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease of unknown aetiology. Recent work has shown that systemic autoimmunity precedes synovial inflammation, and animal models have suggested that changes in the lymph nodes may precede those in the synovial tissue. Therefore, we investigated the cellular composition of the lymph node in the earliest phases of inflammatory arthritis. Methods Thirteen individuals positive for immunoglobulin M (IgM) rheumatoid factor and/or anticitrullinated protein antibodies without arthritis were included. Additionally, we studied 14 early arthritis patients (arthritis duration ≤6 months, naïve for disease-modifying antirheumatic drugs), and eight healthy controls. All subjects underwent ultrasound-guided inguinal lymph node biopsy. Different T- and B-lymphocyte subsets were analysed by multicolour flow cytometry. Results There was an increase in activated CD69 CD8 T cells and CD19 B cells in early arthritis patients compared with healthy controls. We also observed a trend towards increased CD19 B cells in autoantibody-positive individuals without arthritis compared with healthy controls. Conclusions This exploratory study suggests that there is increased immune cell activation within lymph nodes of early arthritis patients as well as in autoantibody-positive individuals at risk of developing RA. This method provides a unique tool to investigate immunological changes in the lymph node compartment in the earliest phases of inflammatory arthritis.
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Affiliation(s)
- L G M van Baarsen
- Division of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Doorenspleet ME, Klarenbeek PL, de Hair MJH, van Schaik BDC, Esveldt REE, van Kampen AHC, Gerlag DM, Musters A, Baas F, Tak PP, de Vries N. Rheumatoid arthritis synovial tissue harbours dominant B-cell and plasma-cell clones associated with autoreactivity. Ann Rheum Dis 2013; 73:756-62. [PMID: 23606709 DOI: 10.1136/annrheumdis-2012-202861] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify potential autoreactive B-cell and plasma-cell clones by quantitatively analysing the complete human B-cell receptor (BCR) repertoire in synovium and peripheral blood in early and established rheumatoid arthritis (RA). METHODS The BCR repertoire was screened in synovium and blood of six patients with early RA (ERA) (<6 months) and six with established RA (ESRA) (>20 months). In two patients, the repertoires in different joints were compared. Repertoires were analysed by next-generation sequencing from mRNA, generating >10 000 BCR heavy-chain sequence reads per sample. For each clone, the degree of expansion was calculated as the percentage of the total number of reads encoding the specific clonal sequence. Clones with a frequency ≥ 0.5% were considered dominant. RESULTS Multiple dominant clones were found in inflamed synovium but hardly any in blood. Within an individual patient, the same dominant clones were detected in different joints. The majority of the synovial clones were class-switched; however, the fraction of clones that expressed IgM was higher in ESRA than ERA patients. Dominant synovial clones showed autoreactive features: in ERA in particular the clones were enriched for immunoglobulin heavy chain gene segment V4-34 (IGHV4-34) and showed longer CDR3 lengths. Dominant synovial clones that did not encode IGHV4-34 also had longer CDR3s than peripheral blood. CONCLUSIONS In RA, the synovium forms a niche where expanded--potentially autoreactive--B cells and plasma cells reside. The inflamed target tissue, especially in the earliest phase of disease, seems to be the most promising compartment for studying autoreactive cells.
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Affiliation(s)
- M E Doorenspleet
- Department of Clinical Immunology & Rheumatology, Academic Medical Center of the University of Amsterdam, , Amsterdam, The Netherlands
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Ramwadhdoebe TH, Hähnlein J, Maijer KI, Boorsma J, Boven LJV, Gerlag DM, Tak PP, Baarsen LGMV. A3.13 Investigating T-Cell Subsets in Lymph Node Biopsies of Autoantibody Positive Individuals and Early Arthritis Patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-203216.13] [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: 11/03/2022]
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Hähnlein J, Ramwadhdoebe TH, Maijer KI, Choi YK, Smits NAM, Maas M, Gerlag DM, Tak PP, Baarsen LGMV. A1.5 Exploring the Role of the Lymph Node Microenvironment in Health and Disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-203214.5] [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: 11/04/2022]
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31
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Klaasen R, Herenius MMJ, Wijbrandts CA, de Jager W, van Tuyl LH, Nurmohamed MT, Prakken BJ, Gerlag DM, Tak PP. Treatment-specific changes in circulating adipocytokines: a comparison between tumour necrosis factor blockade and glucocorticoid treatment for rheumatoid arthritis. Ann Rheum Dis 2012; 71:1510-6. [PMID: 22440821 PMCID: PMC3414229 DOI: 10.1136/annrheumdis-2011-200646] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective There is increasing evidence that adipocytokines may exert proinflammatory and destructive effects in rheumatoid arthritis (RA). Hence, the authors investigated the relationship between adipocytokines and several features associated with RA (inflammation, joint destruction and cardiovascular disease), as well as the effect of treatment with a tumour necrosis factor inhibitor or glucocorticoids (GCs) hereupon. Methods Serum levels of adiponectin, leptin, resistin, visfatin, vaspin and lipids were determined in a well-defined cohort of patients with RA before and after 16 weeks of adalimumab treatment (adalimumab cohort). The same parameters were analysed in two other cohorts of patients with RA before and after 2 weeks of high-dose prednisolone (high GC cohort) and before and after 22 weeks of treatment with a combination regimen with tapered high-dose prednisolone (COBRA -GC cohort). Radiographs of hands and feet (adalimumab and COBRA-GC cohorts) were assessed at baseline and after treatment. Results Treatment with adalimumab or GC showed opposing effects on vaspin and visfatin levels. Lipid levels improved after several months of adalimumab or GC treatment; in the adalimumab cohort, this was related to reduced visfatin levels, independent of C reactive protein levels. After long-term adalimumab or GC treatment, resistin levels declined, which was associated with a decrease in inflammation markers. In the adalimumab cohort, baseline resistin levels were predictive of baseline radiological damage, independent of anticitrullinated peptide antibodies status or C reactive protein levels. Conclusion Changes in serum adipocytokine levels were treatment specific, further strengthening the role of visfatin and resistin in several disease manifestations of RA.
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Affiliation(s)
- R Klaasen
- Division of Clinical Immunology and Rheumatology, Room F4-105, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Klaasen R, Wijbrandts CA, van Kuijk AW, Pots D, Gerlag DM, Tak PP. Synovial synoviolin in relation to response to TNF blockade in patients with rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis 2012; 71:1260-1. [PMID: 22345123 DOI: 10.1136/annrheumdis-2011-200741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Doorenspleet ME, Klarenbeek PL, Boumans MJ, Thurlings RM, Esveldt RE, van Schaik BD, van Kampen AH, Gerlag DM, Baas F, Tak PP, Plenge RM, de Vries N. Disruption of dominant B cell/plasma cell clones in rheumatoid arthritis synovium by rituximab correlates with treatment response. Ann Rheum Dis 2012. [DOI: 10.1136/annrheumdis-2011-201234.14] [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: 11/03/2022]
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Lebre MC, Jonckheere CL, Kraan MC, van Kuijk AWR, Bos JD, de Rie M, Gerlag DM, Tak PP. Expression of IL-20 in lesional skin and synovium of patients with psoriatic arthritis compared to rheumatoid arthritis and its response to ALEFACEPT treatment. Ann Rheum Dis 2012. [DOI: 10.1136/annrheumdis-2011-201230.32] [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: 11/04/2022]
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van Baarsen LGM, de Hair MJH, Ramwadhdoebe TH, van de Sande M, Zijlstra IJAJ, Maas M, Gerlag DM, Tak PP. Investigating the cellular composition of lymph nodes in preclinical and early inflammatory arthritis: a feasibility study. Ann Rheum Dis 2012. [DOI: 10.1136/annrheumdis-2011-201231.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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36
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Tang MW, Gerlag DM, Codullo V, de Sousa ECV, Reuwer AQ, Twickler M, Tak PP. The role of prolactin, as sex hormone, and its receptor involved in rheumatoid arthritis. Ann Rheum Dis 2012. [DOI: 10.1136/annrheumdis-2011-201238.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van Baarsen LGM, Lebre MC, van der Coelen D, Gerlag DM, Tak PP. Expression levels of interleukin-17a, interleukin-17f and their receptors in synovium of patients with rheumatoid arthritis, psoriatic arthritis and osteoarthritis: a target validation study. Ann Rheum Dis 2012. [DOI: 10.1136/annrheumdis-2011-201230.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Klarenbeek PL, de Hair MJH, Doorenspleet ME, van Schaik BDC, Esveldt REE, van de Sande MGH, Cantaert T, Gerlag DM, Baeten D, van Kampen AHC, Baas F, Tak PP, de Vries N. Inflamed target tissue provides a specific niche for highly expanded T-cell clones in early human autoimmune disease. Ann Rheum Dis 2012; 71:1088-93. [PMID: 22294635 DOI: 10.1136/annrheumdis-2011-200612] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To profile quantitatively the T-cell repertoire in multiple joints and peripheral blood of patients with recent onset (early) or established rheumatoid arthritis (RA) using a novel next-generation sequencing protocol to identify potential autoreactive clones. METHODS Synovium of patients with recent onset (early) RA (<6 months) (n=6) or established RA (>18 months) (n=6) was screened for T-cell clones by sequencing over 10 000 T-cell receptors (TCR) per sample. T cells from paired blood samples were analysed for comparison. From two patients synovial T cells were obtained from multiple inflamed joints. The degree of expansion of each individual clone was based on its unique CDR3 sequence frequency within a sample. Clones with a frequency of over 0.5% were considered to be highly expanded clones (HEC). RESULTS In early RA synovium, the T-cell repertoire was dominated by 35 HEC (median, range 2-70) accounting for 56% of the TCR sequenced. The clonal dominance in the synovium was patient specific and significantly greater than in established RA (median of 11 HEC (range 5-24) in established RA synovium accounting for 9.8% of T cells; p<0.01). 34% (range 28-40%) of the most expanded T-cell clones were shared between different joints in the same patients, compared with only 4% (range 0-8%) between synovium and blood (p=0.01). CONCLUSIONS In RA, a systemic autoimmune disease, the inflamed synovium forms a niche for specific expanded T-cell clones, especially in early disease. This suggests that, at least in RA, autoreactive T cells should be addressed specifically in the inflamed tissue, preferably in the early phase of the disease.
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Affiliation(s)
- P L Klarenbeek
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/ University of Amsterdam, Amsterdam, The Netherlands
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de Hair MJH, Lehmann KA, van de Sande MGH, Maijer KI, Gerlag DM, Tak PP. The clinical picture of rheumatoid arthritis according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria: Is this still the same disease? ACTA ACUST UNITED AC 2012; 64:389-93. [DOI: 10.1002/art.33348] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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40
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Boumans MJH, Houbiers JGA, Verschueren P, Ishikura H, Westhovens R, Brouwer E, Rojkovich B, Kelly S, den Adel M, Isaacs J, Jacobs H, Gomez-Reino J, Holtkamp GM, Hastings A, Gerlag DM, Tak PP. Safety, tolerability, pharmacokinetics, pharmacodynamics and efficacy of the monoclonal antibody ASK8007 blocking osteopontin in patients with rheumatoid arthritis: a randomised, placebo controlled, proof-of-concept study. Ann Rheum Dis 2011; 71:180-5. [PMID: 21917822 DOI: 10.1136/annrheumdis-2011-200298] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Osteopontin is an extracellular matrix protein with diverse immunomodulatory functions. The authors assessed the safety, tolerability, pharmacokinetics, pharmacodynamics and initial efficacy of the humanised monoclonal antibody ASK8007, which blocks osteopontin. METHODS In this double-blind, multicentre, combined first-in-man, single-dose escalation (phase I, part A) and proof-of-concept, multiple-dose (phase IIA, part B) study, rheumatoid arthritis (RA) patients with active disease were randomly assigned to receive ASK8007 or placebo intravenously. Safety monitoring, pharmacokinetic and pharmacodynamic analyses and clinical assessments were performed throughout the study. The expression of phenotypic cell markers was evaluated in synovial tissue biopsy samples obtained at baseline and 43 days after initiation of treatment (part B) by immunohistochemistry and digital image analysis. Two co-primary efficacy endpoints were the change from baseline in the disease activity score evaluated in 28 joints (DAS28) and the change from baseline in the number of CD68 synovial sublining macrophages, both assessed on day 43 (part B). RESULTS ASK8007 was overall safe and well tolerated up to the highest studied dose (20 mg/kg). Quantifiable concentrations of ASK8007 were detected in synovial fluid. No differences were observed for changes from baseline in DAS28 and CD68 sublining macrophages between ASK8007 and placebo-treated patients. Within the ASK8007 treatment group, there were also no apparent clinical responses or changes in sublining macrophages. In addition, ASK8007 treatment did not change other assessed biomarkers. CONCLUSIONS Osteopontin blockade is well tolerated and not related to safety concerns. These results consistently show that osteopontin blockade is unlikely to induce robust clinical improvement in RA patients.
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Affiliation(s)
- M J H Boumans
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, The Netherlands
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Boumans MJH, Vos K, Gerlag DM, Tak PP. Biological treatment of rheumatoid arthritis: towards a more cost-effective re-treatment regimen using rituximab? Ann Rheum Dis 2011; 71:472-3. [DOI: 10.1136/annrheumdis-2011-200370] [Citation(s) in RCA: 2] [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] [Indexed: 11/04/2022]
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Doorenspleet ME, de Hair MJ, Herenius MM, Klarenbeek PL, Wijbrandts CA, van de Sande MG, van Schaik BD, Esveldt RE, Singh JK, van Kampen AH, Gerlag DM, Baas F, Tak PP, de Vries N. In rheumatoid arthritis highly expanded B cell clones can be found in the early synovitis stage. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149005.15] [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: 11/04/2022]
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Boumans MJH, Roelse AJK, Geerdink M, Gerlag DM, Tak PP. Retreatment of rheumatoid arthritis patients with 1x1000 mg rituximab results in sustained clinical response in clinical responders initially treated with 2x1000 mg rituximab. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149013.33] [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: 11/04/2022]
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de Hair MJ, van de Sande MG, Bos W, van der Leij C, Smith MD, Maas M, van Schaardenburg D, Dijkmans BA, Gerlag DM, Tak PP. Rheumatoid arthritis: involvement of the synovium in the preclinical phase? Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149096.12] [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: 11/04/2022]
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Frleta M, van Baarsen LGM, de Launay D, Garrelfs M, Gerlag DM, Tak PP, Reedquist KA. Tangiopoietins-1 and -2 are differentially regulated and make distinct contributions to synovial Tie2 activation in patients with rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.148965.17] [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: 11/04/2022]
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Klarenbeek PL, de Hair MJ, Doorenspleet ME, Alivernini S, van Schaik BDC, van de Sande MG, Berger FH, van Kampen AHC, Gerlag DM, Baas F, Tak PP, de Vries N. T- and B cell clones circulate between synovial tissue and lymph node in early stages of rheumatoid arthritis (RA): elucidating the role of lymph nodes in RA. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.148999.8] [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: 11/04/2022]
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van Baarsen LGM, Lebre MC, van der Coelen D, Snoek BC, Gerlag DM, Tak PP. IL-17 levels in synovium of patients with rheumatoid arthritis, psoriatic arthritis and osteoarthritis: Target validation in various forms of arthritis. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149013.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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48
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Herenius MMJ, Thurlings RM, Wijbrandts CA, Bennink RJ, Dohmen SE, Voermans C, Wouters D, Izmailova ES, Gerlag DM, van Eck-Smit BLF, Tak PP. Monocyte migration to the synovium in rheumatoid arthritis patients treated with adalimumab. Ann Rheum Dis 2011; 70:1160-2. [PMID: 21345816 PMCID: PMC3086080 DOI: 10.1136/ard.2010.141549] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives The mechanism of action of treatment with tumour necrosis factor (TNF) blockers in rheumatoid arthritis (RA) is still not completely understood. The aim of this study was to test if adalimumab treatment could affect the influx of monocytes into the synovium. Methods A novel technique was used to analyse the migration of labelled autologous monocytes before and 14 days after initiation of adalimumab treatment using scintigraphy. CD14 monocytes were isolated from patients with RA, using a positive selection procedure with magnetic-activated cell sorting, and labelled with technetium-99m-hexamethylpropylene-amino-oxime. Scintigraphic scans were made 1, 2 and 3 h after re-infusion. Results As early as 14 days after the start of treatment with adalimumab a significant decrease in disease activity score evaluated in 28 joints was shown. There was no significant decrease in the influx of monocytes into the joint at this time. Conclusions This study indicates that adalimumab treatment does not reduce the influx of monocytes into the synovium early after initiation of treatment. As previous studies showed a rapid decrease in macrophage infiltration after TNF-antibody therapy, which could not be explained by increased cell death, this points to an important role for enhanced efflux of inflammatory cells from the synovium.
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Affiliation(s)
- M M J Herenius
- D ivision of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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van de Sande MGH, de Hair MJH, van der Leij C, Klarenbeek PL, Bos WH, Smith MD, Maas M, de Vries N, van Schaardenburg D, Dijkmans BAC, Gerlag DM, Tak PP. Different stages of rheumatoid arthritis: features of the synovium in the preclinical phase. Ann Rheum Dis 2010; 70:772-7. [PMID: 21177292 DOI: 10.1136/ard.2010.139527] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aetiology of rheumatoid arthritis (RA), a prototype immune-mediated inflammatory disorder, is poorly understood. It is currently unknown whether the disease process starts in the synovium, the primary target of RA, or at other sites in the body. OBJECTIVE To examine, in a prospective study, the presence of synovitis in people with an increased risk of developing RA. METHODS Thirteen people without evidence of arthritis, who were positive for IgM rheumatoid factor and/or anticitrullinated protein antibodies, were included in the study. To evaluate synovial inflammatory changes, all participants underwent dynamic contrast-enhanced MRI and arthroscopic synovial biopsy sampling of a knee joint at inclusion. Results were compared with knee MRI data and synovial biopsy data of 6 and 10 healthy controls, respectively. RESULTS MRI findings evaluated by measurement of maximal enhancement, rate of enhancement, synovial volume and enhancement shape curve distribution were similar between the autoantibody-positive subjects and the healthy controls. Consistent with these findings, all but one autoantibody-positive subject showed very low scores for phenotypic markers, adhesion molecules and vascularity, all in the same range as those in normal controls. The one person with higher scores had patellofemoral joint space narrowing. CONCLUSION Subclinical inflammation of the synovium does not coincide with the appearance of serum autoantibodies during the pre-RA stage. Thus, systemic autoimmunity precedes the development of synovitis, suggesting that a 'second hit' is involved. This study supports the rationale for exploring preventive strategies aimed at interfering with the humoral immune response before synovial inflammation develops.
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Affiliation(s)
- M G H van de Sande
- Division of Clinical Immunology and Rheumatology, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
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Thurlings RM, Boumans M, Tekstra J, Vos K, van Westing DM, van Baarsen LG, Bos C, Kirou KA, Gerlag DM, Crow MK, Verweij CL, Tak PP. The relationship between the type I interferon signature and the response to rituximab in rheumatoid arthritis. Ann Rheum Dis 2010. [DOI: 10.1136/ard.2010.129585k] [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: 11/04/2022]
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