1
|
Abheiden CNH, Blomjous BS, Slaager C, Landman AJEMC, Ket JCF, Salmon JE, Buyon JP, Heymans MW, DE Vries JIP, Bultink IEM, DE Boer MA. Systemic Lupus Erythematosus is Associated With an Increased Frequency of Spontaneous Preterm Births: Systematic Review and Meta-analysis. Am J Obstet Gynecol 2024:S0002-9378(24)00439-3. [PMID: 38492714 DOI: 10.1016/j.ajog.2024.03.010] [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: 10/24/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Preterm birth (PTB) is one of the most frequent complications of pregnancies in women with systemic lupus erythematosus (SLE). The high indicated PTB proportion due to hypertensive disorders of pregnancy and/or fetal growth restriction is well known, and preventive measures as well as screening for early detection are performed. The risk of spontaneous PTB is less well recognized. The purpose of this study is to determine the proportions of spontaneous and indicated PTB in pregnancies of women with SLE DATA SOURCES: A systematic literature search using Pubmed, Embase, Web of Science and Google Scholar was performed in June 2021 STUDY ELIGIBILITY CRITERIA: Studies in pregnant women with SLE reporting spontaneous and indicated PTB rates were selected. Original research articles published from 1995 to June 2021 were included STUDY APPRAISAL AND SYNTHESIS METHODS: Quality and risk of bias of the included studies were assessed using the Newcastle-Ottawa Quality Assessment Scale. To estimate the pooled event rates and 95% confidence intervals, meta-analysis of single proportions with a random-effects model was performed. RESULTS We included 21 articles, containing data of 8157 pregnancies in women with SLE. On average 31% (95% prediction interval [0.14; 0.50]) of the pregnancies resulted in PTB, including 14% (95% prediction interval [0.04; 0.27]) spontaneous, and 16% (95% prediction interval [0.03; 0.35])indicated PTB CONCLUSIONS: In pregnant women with SLE, spontaneous as well as indicated PTB proportions are high. This information should be applied in (pre-pregnancy) counselling and management in pregnancy. The knowledge obtained by this meta-analysis, paves the way for further research of associated risk factors and development of interventions to reduce spontaneous PTB in SLE pregnancies.
Collapse
Affiliation(s)
- Carolien N H Abheiden
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, the Netherlands. Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands.
| | - Birgit S Blomjous
- Department of Rheumatology & Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Center, the Netherlands. Amsterdam institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Ciska Slaager
- Department of Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anadeijda J E M C Landman
- Amsterdam UMC, Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, the Netherlands. Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jane E Salmon
- Hospital for Special Surgery and Weill Cornell Medical College, New York, United States of America
| | - Jill P Buyon
- New York University Grossman School of Medicine, New York, United States of America
| | - Martijn W Heymans
- Department of Epidemiology & Data Science, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Johanna I P DE Vries
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, the Netherlands. Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands
| | - Irene E M Bultink
- Department of Rheumatology & Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Center, the Netherlands. Amsterdam institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marjon A DE Boer
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, the Netherlands. Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Denvir B, Carlucci PM, Corbitt K, Buyon JP, Belmont HM, Gold HT, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Barbour KE, Helmick CG, Parton H, Izmirly PM. Prevalence of concomitant rheumatologic diseases and autoantibody specificities among racial and ethnic groups in SLE patients. Front Epidemiol 2024; 4:1334859. [PMID: 38516120 PMCID: PMC10956350 DOI: 10.3389/fepid.2024.1334859] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
Objective Leveraging the Manhattan Lupus Surveillance Program (MLSP), a population-based registry of cases of systemic lupus erythematosus (SLE) and related diseases, we investigated the proportion of SLE with concomitant rheumatic diseases, including Sjögren's disease (SjD), antiphospholipid syndrome (APLS), and fibromyalgia (FM), as well as the prevalence of autoantibodies in SLE by sex and race/ethnicity. Methods Prevalent SLE cases fulfilled one of three sets of classification criteria. Additional rheumatic diseases were defined using modified criteria based on data available in the MLSP: SjD (anti-SSA/Ro positive and evidence of keratoconjunctivitis sicca and/or xerostomia), APLS (antiphospholipid antibody positive and evidence of a blood clot), and FM (diagnosis in the chart). Results 1,342 patients fulfilled SLE classification criteria. Of these, SjD was identified in 147 (11.0%, 95% CI 9.2-12.7%) patients with women and non-Latino Asian patients being the most highly represented. APLS was diagnosed in 119 (8.9%, 95% CI 7.3-10.5%) patients with the highest frequency in Latino patients. FM was present in 120 (8.9%, 95% CI 7.3-10.5) patients with non-Latino White and Latino patients having the highest frequency. Anti-dsDNA antibodies were most prevalent in non-Latino Asian, Black, and Latino patients while anti-Sm antibodies showed the highest proportion in non-Latino Black and Asian patients. Anti-SSA/Ro and anti-SSB/La antibodies were most prevalent in non-Latino Asian patients and least prevalent in non-Latino White patients. Men were more likely to be anti-Sm positive. Conclusion Data from the MLSP revealed differences among patients classified as SLE in the prevalence of concomitant rheumatic diseases and autoantibody profiles by sex and race/ethnicity underscoring comorbidities associated with SLE.
Collapse
Affiliation(s)
- Brendan Denvir
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Philip M. Carlucci
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Kelly Corbitt
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Heather T. Gold
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Jane E. Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Joan M. Bathon
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Yousaf Ali
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ellen M. Ginzler
- Division of Rheumatology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | | | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kamil E. Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Charles G. Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hilary Parton
- Division of Disease Control, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| |
Collapse
|
3
|
Yelnik CM, Xie X, Guerra MM, Costedoat-Chalumeau N, Khosroshahi A, Kamen DL, Schwartz N, Katz P, Minett M, Amoss RT, Fu A, Guettrot-Imbert G, Lazaro E, Le Guern V, Oates J, Dall'Era M, Yazdany J, Molto A, Kim MY, Salmon JE. Prevalence of clinically meaningful antiphospholipid antibodies in patients with systemic lupus erythematosus varies by race and ethnicity. Ann Rheum Dis 2024; 83:404-406. [PMID: 37875285 PMCID: PMC10922457 DOI: 10.1136/ard-2023-224952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Cécile M Yelnik
- Département de Médecine Interne et d'Immunologie Clinique, Universite de Lille, Lille, France
| | - Xianhong Xie
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marta M Guerra
- Department of Medicine/Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Cochin Hospital, Paris, France
- ECAMO Team (INSERM U-1153), CRESS - Université Paris Cité, Paris, France
| | - Arezou Khosroshahi
- Lowance Center for Human Immunology, Emory University, Atlanta, Georgia, USA
| | - Diane L Kamen
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Noa Schwartz
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Patricia Katz
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Margaret Minett
- Department of Medicine/Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - R Toby Amoss
- Lowance Center for Human Immunology, Emory University, Atlanta, Georgia, USA
| | - April Fu
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Estibaliz Lazaro
- Department of Internal Medicine, Haut Lévêque Hospital, Bordeaux, France
- ImmunoconcEpT Lab, Bordeaux University, Bordeaux, France
| | | | - Jim Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maria Dall'Era
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Jinoos Yazdany
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Anna Molto
- ECAMO Team (INSERM U-1153), CRESS - Université Paris Cité, Paris, France
- Department of Rheumatology, Cochin Hospital, Paris, France
| | - Mimi Y Kim
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jane E Salmon
- Department of Medicine/Rheumatology, Hospital for Special Surgery, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
4
|
Lokki AI, Ren Z, Triebwasser M, Daly E, Perola M, Auro K, Burwick R, Salmon JE, Daly M, Laivuori H, Atkinson JP, Java A, Meri S. Identification of complement factor H variants that predispose to pre-eclampsia: A genetic and functional study. BJOG 2023; 130:1473-1482. [PMID: 37156755 PMCID: PMC10592561 DOI: 10.1111/1471-0528.17529] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The objective of the study was to investigate the role of genetic variants in complement proteins in pre-eclampsia. DESIGN In a case-control study involving 609 cases and 2092 controls, five rare variants in complement factor H (CFH) were identified in women with severe and complicated pre-eclampsia. No variants were identified in controls. SETTING Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality. Immune maladaptation, in particular, complement activation that disrupts maternal-fetal tolerance leading to placental dysfunction and endothelial injury, has been proposed as a pathogenetic mechanism, but this remains unproven. POPULATION We genotyped 609 pre-eclampsia cases and 2092 controls from FINNPEC and the national FINRISK cohorts. METHODS Complement-based functional and structural assays were conducted in vitro to define the significance of these five missense variants and each compared with wild type. MAIN OUTCOME MEASURES Secretion, expression and ability to regulate complement activation were assessed for factor H proteins harbouring the mutations. RESULTS We identified five heterozygous rare variants in complement factor H (L3V, R127H, R166Q, C1077S and N1176K) in seven women with severe pre-eclampsia. These variants were not identified in controls. Variants C1077S and N1176K were novel. Antigenic, functional and structural analyses established that four (R127H, R166Q, C1077S and N1176K) were deleterious. Variants R127H and C1077S were synthesised, but not secreted. Variants R166Q and N1176K were secreted normally but showed reduced binding to C3b and consequently defective complement regulatory activity. No defect was identified for L3V. CONCLUSIONS These results suggest that complement dysregulation due to mutations in complement factor H is among the pathophysiological mechanisms underlying severe pre-eclampsia.
Collapse
Affiliation(s)
- A Inkeri Lokki
- Immunobiology Research Program, Bacteriology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Zhen Ren
- Division of Clinical Immunology and Allergy, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael Triebwasser
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Emma Daly
- Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Markus Perola
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Kirsi Auro
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Richard Burwick
- Maternal Fetal Medicine, San Gabriel Valley Perinatal Medical Group, Pomona Valley Hospital Medical Center, Pomona, California, USA
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jane E Salmon
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA
| | - Mark Daly
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere University, Tampere, Finland
- Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - John P Atkinson
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anuja Java
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Seppo Meri
- Immunobiology Research Program, Bacteriology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- HUSLAB Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
5
|
Hasan G, Ferucci ED, Buyon JP, Belmont HM, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H, Izmirly PM. Population-based prevalence and incidence estimates of mixed connective tissue disease from the Manhattan Lupus Surveillance Program. Rheumatology (Oxford) 2023; 62:2845-2849. [PMID: 36538873 DOI: 10.1093/rheumatology/keac703] [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: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE Epidemiological data for MCTD are limited. Leveraging data from the Manhattan Lupus Surveillance Program (MLSP), a racially/ethnically diverse population-based registry of cases with SLE and related diseases including MCTD, we provide estimates of the prevalence and incidence of MCTD. METHODS MLSP cases were identified from rheumatologists, hospitals and population databases using a variety of International Classification of Diseases, Ninth Revision codes. MCTD was defined as one of the following: fulfilment of our modified Alarcon-Segovia and Kahn criteria, which required a positive RNP antibody and the presence of synovitis, myositis and RP; a diagnosis of MCTD and no other diagnosis of another CTD; and a diagnosis of MCTD regardless of another CTD diagnosis. RESULTS Overall, 258 (7.7%) cases met a definition of MCTD. Using our modified Alarcon-Segovia and Kahn criteria for MCTD, the age-adjusted prevalence was 1.28 (95% CI 0.72, 2.09) per 100 000. Using our definition of a diagnosis of MCTD and no other diagnosis of another CTD yielded an age-adjusted prevalence and incidence of MCTD of 2.98 (95% CI 2.10, 4.11) per 100 000 and 0.39 (95% CI 0.22, 0.64) per 100 000, respectively. The age-adjusted prevalence and incidence were highest using a diagnosis of MCTD regardless of other CTD diagnoses and were 16.22 (95% CI 14.00, 18.43) per 100 000 and 1.90 (95% CI 1.49, 2.39) per 100 000, respectively. CONCLUSIONS The MLSP provided estimates for the prevalence and incidence of MCTD in a diverse population. The variation in estimates using different case definitions is reflective of the challenge of defining MCTD in epidemiologic studies.
Collapse
Affiliation(s)
- Ghadeer Hasan
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Elizabeth D Ferucci
- Division of Community Health Services, Department of Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Jane E Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Joan M Bathon
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yousaf Ali
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ellen M Ginzler
- Division of Rheumatology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Chaim Putterman
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hilary Parton
- Division of Disease Control, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, USA
| | - Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
6
|
Graversgaard C, Salmon JE, Schreiber K. First prospective observational data on pregnancies in patients with primary Sjögren's syndrome. Lancet Rheumatol 2023; 5:e306-e307. [PMID: 38251594 DOI: 10.1016/s2665-9913(23)00123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Christine Graversgaard
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Jane E Salmon
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Karen Schreiber
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark; Institute for Regional Health Research, Odense University Hospital, Odense, Denmark; Thrombosis and Haemostasis, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| |
Collapse
|
7
|
Mehta B, Jannat-Khah D, Glaser KK, Luo Y, Sammaritano LR, Branch DW, Goodman SM, Lockshin M, Wang F, Ibrahim S, Salmon JE. Fetal and maternal morbidity in pregnant patients with Lupus: a 10-year US nationwide analysis. RMD Open 2023; 9:rmdopen-2022-002752. [PMID: 37185223 DOI: 10.1136/rmdopen-2022-002752] [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: 09/26/2022] [Accepted: 12/12/2022] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To evaluate and quantify the indicators of fetal and maternal morbidity in deliveries for patients with systemic lupus erythematosus (SLE) compared with deliveries in patients without SLE. METHODS We used retrospective data from the National Inpatient Sample (NIS) to identify all delivery related hospital admissions of patients with and without SLE from 2008 to 2017 using ICD-9/10 codes. Fetal morbidity indicators included pre-term delivery and intrauterine growth restriction (IUGR). 21 indicators of severe maternal morbidity were identified using standard Centers for Disease Control and Prevention (CDC) definitions. Descriptive statistics, including 95% confidence intervals, were calculated using sample weights from the NIS dataset. RESULTS Among the 40 million delivery-related admissions, 51 161 patients were reported to have SLE. Patients with SLE had a higher risk of fetal morbidity, including IUGR (8.0% vs 2.7%) and pre-term delivery (14.5% vs 7.3%), than patients without SLE. During delivery, mothers with SLE were nearly four times as likely to require a blood transfusion or develop a cerebrovascular disorder, and 15 times as likely to develop acute renal failure than those without SLE. CONCLUSION Our study demonstrates that fetal morbidity and severe maternal morbidity occur at a higher rate in patients with SLE compared with those without. This quantitative work can help inform and counsel patients with SLE during pregnancy and planning.
Collapse
Affiliation(s)
- Bella Mehta
- Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Deanna Jannat-Khah
- Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | | | - Yiming Luo
- Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa R Sammaritano
- Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - D Ware Branch
- University of Utah Health, Salt Lake City, Utah, USA
| | - Susan M Goodman
- Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Michael Lockshin
- Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Fei Wang
- Weill Cornell Medicine, New York, New York, USA
| | | | - Jane E Salmon
- Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
8
|
Moyle K, Peterson LK, Guerra MM, Kim M, Allshouse AA, Benson AE, Salmon JE, Branch D. Anti-β2 glycoprotein-I domain 1 antiphospholipid antibodies as a marker for adverse pregnancy outcomes. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.318] [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: 01/09/2023]
|
9
|
Guttmann A, Denvir B, Aringer M, Buyon JP, Belmont HM, Sahl S, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H, Izmirly PM. Evaluation of the EULAR/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus in a Population-Based Registry. Arthritis Care Res (Hoboken) 2022; 75:1007-1016. [PMID: 35638708 DOI: 10.1002/acr.24960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/04/2022] [Accepted: 05/24/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Using the Manhattan Lupus Surveillance Program, a multiracial/ethnic population-based registry, we aimed to compare 3 commonly used classification criteria for systemic lupus erythematosus (SLE) to identify unique cases and determine the incidence and prevalence of SLE using the EULAR/American College of Rheumatology (ACR) criteria. METHODS SLE cases were defined as fulfilling the 1997 ACR, the Systemic Lupus International Collaborating Clinics (SLICC), or the EULAR/ACR classification criteria. We quantified the number of cases uniquely associated with each and the number fulfilling all 3 criteria. Prevalence and incidence using the EULAR/ACR classification criteria and associated 95% confidence intervals (95% CIs) were calculated. RESULTS A total of 1,497 cases fulfilled at least 1 of the 3 classification criteria, with 1,008 (67.3%) meeting all 3 classifications, 138 (9.2%) fulfilling only the SLICC criteria, 35 (2.3%) fulfilling only the 1997 ACR criteria, and 34 (2.3%) uniquely fulfilling the EULAR/ACR criteria. Patients solely satisfying the EULAR/ACR criteria had <4 manifestations. The majority classified only by the 1997 ACR criteria did not meet any of the defined immunologic criteria. Patients fulfilling only the SLICC criteria did so based on the presence of features unique to this system. Using the EULAR/ACR classification criteria, age-adjusted overall prevalence and incidence rates of SLE in Manhattan were 59.6 (95% CI 55.9-63.4) and 4.9 (95% CI 4.3-5.5) per 100,000 population, with age-adjusted prevalence and incidence rates highest among non-Hispanic Black female patients. CONCLUSION Applying the 3 commonly used classification criteria to a population-based registry identified patients with SLE fulfilling only 1 validated definition. The most recently developed EULAR/ACR classification criteria revealed prevalence and incidence estimates similar to those previously established for the ACR and SLICC classification schemes.
Collapse
Affiliation(s)
| | - Brendan Denvir
- New York University School of Medicine, New York, New York
| | - Martin Aringer
- University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jill P Buyon
- New York University School of Medicine, New York, New York
| | | | - Sara Sahl
- Harbor-University of California Medical Center, Los Angeles
| | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Anca Askanase
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Joan M Bathon
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Yousaf Ali
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ellen M Ginzler
- State University of New York Downstate Health Sciences University, Brooklyn
| | | | | | | | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | | |
Collapse
|
10
|
Tong M, Kayani T, Jones DM, Salmon JE, Whirledge S, Chamley LW, Abrahams VM. Antiphospholipid antibodies increase endometrial stromal cell decidualization, senescence and inflammation via TLR4, ROS and p38 MAP kinase signaling. Arthritis Rheumatol 2022; 74:1001-1012. [PMID: 35044724 DOI: 10.1002/art.42068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/23/2021] [Accepted: 01/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Miscarriage affects one in seven pregnancies and antiphospholipid autoantibodies (aPL) are one of the biggest risk factors for recurrent pregnancy loss. While aPL target the endometrial stroma, little is known about their impact. Endometrial stromal cells (EnSCs) undergo decidualization each menstrual cycle, priming the uterus to receive implanting embryos. Thus, appropriate decidualization and EnSC function is key for establishment of a successful pregnancy. METHODS EnSCs under decidualizing conditions were exposed to aPL or control IgG alone or in the presence of either a Toll-like receptor 4 (TLR4) antagonist, a p38 MAPK inhibitor, a reactive oxygen species (ROS) inhibitor, low-molecular weight heparin (LMWH), or acetyl salicylic acid (ASA). Secretion of decidualization markers and inflammatory interleukin (IL)-8 were quantified by ELISA, and senescence-associated β-galactosidase activity was evaluated. In a mouse model of decidualization, aPL or control IgG was administered and uterine expression of decidualization and inflammatory markers quantified by RT-qPCR. RESULTS aPL increased human EnSC decidualization, senescence and inflammation. This phenotype was recapitulated in the mouse model. The decidualization and inflammatory responses were partially mediated by TLR4 and p38 MAP kinase, while the decidualization and senescence responses were ROS-dependent. LMWH, commonly used to treat aPL-positive women at risk for obstetric complications, reduced the ability of aPL to increase EnSC decidualization and inflammation. CONCLUSION These findings shed new light on the pathogenesis of pregnancy complications in women with aPL and underscore the benefit of heparin for preventing pregnancy loss in this high-risk population.
Collapse
Affiliation(s)
- Mancy Tong
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Teimur Kayani
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Deidre M Jones
- Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Jane E Salmon
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Shannon Whirledge
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
11
|
Chu H, Sacharidou A, Nguyen A, Li C, Chambliss KL, Salmon JE, Shen YM, Lo J, Leone GW, Herz J, Hui DY, Marciano DK, Abrahams VM, Natale BV, Montalbano AP, Xiao X, Xu L, Natale DR, Shaul PW, Mineo C. Protein Phosphatase 2A Activation Via ApoER2 in Trophoblasts Drives Preeclampsia in a Mouse Model of the Antiphospholipid Syndrome. Circ Res 2021; 129:735-750. [PMID: 34404233 DOI: 10.1161/circresaha.120.318941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Haiyan Chu
- Center for Pulmonary and Vascular Biology, Pediatrics (H.C., A.S., A.N., C.L., K.L.C., P.W.S., C.M.)
| | - Anastasia Sacharidou
- Center for Pulmonary and Vascular Biology, Pediatrics (H.C., A.S., A.N., C.L., K.L.C., P.W.S., C.M.)
| | - An Nguyen
- Center for Pulmonary and Vascular Biology, Pediatrics (H.C., A.S., A.N., C.L., K.L.C., P.W.S., C.M.)
| | - Chun Li
- Center for Pulmonary and Vascular Biology, Pediatrics (H.C., A.S., A.N., C.L., K.L.C., P.W.S., C.M.)
| | - Ken L Chambliss
- Center for Pulmonary and Vascular Biology, Pediatrics (H.C., A.S., A.N., C.L., K.L.C., P.W.S., C.M.)
| | - Jane E Salmon
- Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York (J.E.S.)
| | - Yu-Min Shen
- Internal Medicine (Y.-M.S., D.K.M.), University of Texas Southwestern Medical Center, Dallas
| | - Julie Lo
- Obstetrics and Gynecology (J.L.), University of Texas Southwestern Medical Center, Dallas
| | - Gustavo W Leone
- Froedtert-Medical College of Wisconsin Cancer Center, Medical College of Wisconsin, Milwaukee (G.W.L.)
| | - Joachim Herz
- Molecular Genetics (J.H.), University of Texas Southwestern Medical Center, Dallas
| | - David Y Hui
- Pathology, University of Cincinnati College of Medicine (D.Y.H.)
| | - Denise K Marciano
- Internal Medicine (Y.-M.S., D.K.M.), University of Texas Southwestern Medical Center, Dallas.,Cell Biology (D.K.M., C.M.), University of Texas Southwestern Medical Center, Dallas
| | - Vikki M Abrahams
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT (V.M.A.)
| | - Bryony V Natale
- Obstetrics, Gynecology & Reproductive Science, University of California San Diego, La Jolla (B.V.N., D.R.N.).,Obstetrics and Gynaecology, School of Medicine, Queen's University, Ontario, Canada (B.V.N., D.R.N.)
| | - Alina P Montalbano
- Biochemistry and Obstetrics and Gynecology (A.P.M.), University of Texas Southwestern Medical Center, Dallas
| | - Xue Xiao
- Population and Data Sciences and Pediatrics (X.X., L.X.), University of Texas Southwestern Medical Center, Dallas
| | - Lin Xu
- Population and Data Sciences and Pediatrics (X.X., L.X.), University of Texas Southwestern Medical Center, Dallas
| | - David R Natale
- Obstetrics, Gynecology & Reproductive Science, University of California San Diego, La Jolla (B.V.N., D.R.N.).,Obstetrics and Gynaecology, School of Medicine, Queen's University, Ontario, Canada (B.V.N., D.R.N.)
| | - Philip W Shaul
- Center for Pulmonary and Vascular Biology, Pediatrics (H.C., A.S., A.N., C.L., K.L.C., P.W.S., C.M.)
| | - Chieko Mineo
- Center for Pulmonary and Vascular Biology, Pediatrics (H.C., A.S., A.N., C.L., K.L.C., P.W.S., C.M.).,Cell Biology (D.K.M., C.M.), University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
12
|
Kasturi S, Price LL, Paushkin V, Salmon JE, McAlindon TE, Mandl LA. Impact of the first wave of the COVID-19 pandemic on systemic lupus erythematosus patients: Results from a multi-center prospective cohort. Lupus 2021; 30:1747-1755. [PMID: 34284676 DOI: 10.1177/09612033211033981] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the initial impact of the COVID-19 pandemic on individuals with systemic lupus erythematosus (SLE). METHODS Patients with SLE participating in a multi-center longitudinal cohort study in New York and Boston were invited to complete a supplemental web-based questionnaire in the summer of 2020. Participants completed standardized patient-reported outcome (PRO) measures and a combination of Likert scale and open-ended questions exploring the impact of the COVID-19 pandemic on their health and access to health care. Changes in PROs were evaluated with paired t-tests and frequencies of worsened symptoms were calculated. A thematic qualitative analysis was conducted on free text responses. RESULTS Of 97 patients invited, 63 (65%) completed a supplemental questionnaire. Nearly 50% of respondents exhibited increases in anxiety (47.5%) and depression (48.3%) and over 40% scored worse in measures of pain interference, fatigue, and cognitive abilities. Respondents with pre-existing diagnoses of anxiety did not differ from other participants in PRO scores, but were more than three times as likely to report worsened health status. Patients denied difficulties accessing medications (85%) or medical care (84%) and over 50% participated in telehealth visits. Anxiety and increased health risks due to immunosuppression were recurring themes in free text responses. CONCLUSIONS SLE patients experienced a significant physical and emotional toll in the initial months of the COVID-19 pandemic. Comprehensive patient-centered care, including monitoring and addressing anxiety and health-related quality of life, is critical to improving health outcomes in this population during the ongoing health crisis.
Collapse
Affiliation(s)
- Shanthini Kasturi
- Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, USA
| | - Lori Lyn Price
- Institute of Clinical Research and Health Policy Studies, 1867Tufts Medical Center, Tufts Medical Center, Boston, USA.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, USA
| | - Vasilissa Paushkin
- Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, USA
| | - Jane E Salmon
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, USA
| | - Lisa A Mandl
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, USA
| |
Collapse
|
13
|
Barbhaiya M, Stamm B, Vitone G, Frey MB, Jannat-Khah D, Levine J, Vega J, Feldman CH, Salmon JE, Crow MK, Bykerk V, Lockshin MD, Sammaritano L, Mandl LA. Pregnancy and Rheumatic Disease: Experience at a Single Center in New York City During the COVID-19 Pandemic. Arthritis Care Res (Hoboken) 2021; 73:1004-1012. [PMID: 33342085 DOI: 10.1002/acr.24547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/17/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The present study was undertaken to evaluate the pregnancy experiences of women receiving care in the division of rheumatology at a major academic center in New York City during the COVID-19 pandemic. METHODS A web-based COVID-19 survey was emailed to 26,045 patients who were followed in the division of rheumatology at a single center in New York City. Women ages 18-50 years were asked about their pregnancy. We compared the COVID-19 experience between pregnant and nonpregnant women and also explored the impact of the pandemic on prenatal care and perinatal outcomes. RESULTS Among 7,094 of the 26,045 respondents, 1,547 were women ages 18-50 years, with 61 (4%) reporting being pregnant during the pandemic. The prevalence of self-reported COVID-19 was similar in pregnant and nonpregnant women (8% versus 9%, respectively; P = 0.76). Among women with COVID-19, pregnant women had a shorter duration of symptoms (P < 0.01) and were more likely to experience loss of smell or taste (P = 0.02) than nonpregnant women. Approximately three-fourths of women had a systemic rheumatic disease, with no differences when stratified by pregnancy or COVID-19 status. In all, 67% of pregnant women noted changes to prenatal care during the pandemic, and 23% of postpartum women stated that the pandemic affected delivery. CONCLUSION Among women followed in the division of rheumatology at a major center in New York City, pregnancy was not associated with increased self-reported COVID-19. Pregnancy was associated with a shorter duration of COVID-19 symptoms and a higher prevalence of loss of smell or taste. The COVID-19 pandemic impacted prenatal care for the majority of pregnant patients.
Collapse
Affiliation(s)
- Medha Barbhaiya
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Bessie Stamm
- Hospital for Special Surgery, New York, New York
| | | | | | - Deanna Jannat-Khah
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Jonah Levine
- Hospital for Special Surgery, New York, New York
| | - JoAnn Vega
- Hospital for Special Surgery, New York, New York
| | - Candace H Feldman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jane E Salmon
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Mary K Crow
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Vivian Bykerk
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael D Lockshin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Lisa Sammaritano
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Lisa A Mandl
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| |
Collapse
|
14
|
Simard JF, Rossides M, Arkema EV, Svenungsson E, Wikström AK, Mittleman MA, Salmon JE. Maternal Hypertensive Disorders in Pregnant Women With Systemic Lupus Erythematosus and Future Cardiovascular Outcomes. Arthritis Care Res (Hoboken) 2021; 73:574-579. [PMID: 32004410 PMCID: PMC9071180 DOI: 10.1002/acr.24160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy (HDPs) increase cardiovascular disease (CVD) risk. Pregnancy morbidities, including preeclampsia and CVD, are common in systemic lupus erythematosus (SLE). Possible connections are important to explore. In a population-based cohort, we investigated whether HDPs are associated with a higher risk of cardiovascular outcomes separately in women with SLE and those without SLE to examine the role of SLE. METHODS We identified first singleton births in the Medical Birth Register (1987-2012) among mothers with SLE and a large general population comparison group. Discharge diagnoses for HDPs, cardiovascular outcomes, and hypertension in the National Patient Register were identified using International Classification of Diseases codes. We estimated adjusted hazard ratios and 95% confidence intervals of the association between HDPs and outcomes in separate models in women with and without SLE. We then evaluated additive and multiplicative effect modification using relative excess risk due to interaction and Cox models jointly accounting for SLE and HDPs, respectively. Mediation analysis estimated the proportion of the association between SLE and outcome explained by HDPs. RESULTS HDPs were more common in pregnant women with SLE (20% versus 7%). In SLE, HDPs were associated with a 2-fold higher rate of cardiovascular outcomes and a 3-fold higher rate of incident hypertension. HDPs mediated 20% of the latter association. In women without SLE, HDPs were associated with higher incidence of hypertension later in life. CONCLUSION In women with SLE and those without SLE, HDPs were associated with a 3-fold higher rate of hypertension. In SLE, women with HDPs developed cardiovascular outcomes twice as often as women without HDPs.
Collapse
Affiliation(s)
- Julia F Simard
- Stanford School of Medicine, Stanford, California, and Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| |
Collapse
|
15
|
Lokki AI, Teirilä L, Triebwasser M, Daly E, Bhattacharjee A, Uotila L, Llort Asens M, Kurki MI, Perola M, Auro K, Salmon JE, Daly M, Atkinson JP, Laivuori H, Fagerholm S, Meri S. Dysfunction of complement receptors CR3 (CD11b/18) and CR4 (CD11c/18) in pre-eclampsia: a genetic and functional study. BJOG 2021; 128:1282-1291. [PMID: 33539617 DOI: 10.1111/1471-0528.16660] [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] [Accepted: 12/01/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To study genetic variants and their function within genes coding for complement receptors in pre-eclampsia. DESIGN A case-control study. SETTING Pre-eclampsia is a common vascular disease of pregnancy. The clearance of placenta-derived material is one of the functions of the complement system in pregnancy. POPULATION We genotyped 500 women with pre-eclamptic pregnancies and 190 pregnant women without pre-eclampsia, as controls, from the FINNPEC cohort, and 122 women with pre-eclamptic pregnancies and 1905 controls from the national FINRISK cohort. METHODS The functional consequences of genotypes discovered by targeted exomic sequencing were explored by analysing the binding of the main ligand iC3b to mutated CR3 or CR4, which were transiently expressed on the surface of COS-1 cells. MAIN OUTCOME MEASURES Allele frequencies were compared between pre-eclamptic pregnancies and controls in genetic studies. The functional consequences of selected variants were measured by binding assays. RESULTS The most significantly pre-eclampsia-linked CR3 variant M441K (P = 4.27E-4, OR = 1.401, 95% CI = 1.167-1.682) displayed a trend of increased adhesion to iC3b (P = 0.051). The CR4 variant A251T was found to enhance the adhesion of CR4 to iC3b, whereas W48R resulted in a decrease of the binding of CR4 to iC3b. CONCLUSIONS Results suggest that changes in complement-facilitated phagocytosis are associated with pre-eclampsia. Further studies are needed to ascertain whether aberrant CR3 and CR4 activity leads to altered pro- and anti-inflammatory cytokine responses in individuals carrying the associated variants, and the role of these receptors in pre-eclampsia pathogenesis. TWEETABLE ABSTRACT Genetic variants of complement receptors CR3 and CR4 have functional consequences that are associated with pre-eclampsia.
Collapse
Affiliation(s)
- A I Lokki
- Translational Immunology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
| | - L Teirilä
- Translational Immunology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Bacteriology and immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Triebwasser
- Department of Medicine, Division of Rheumatology, Washington University School of Medicine, Saint Louis, MO, USA
| | - E Daly
- Hospital and Harvard Medical School, Boston, MA, USA
| | - A Bhattacharjee
- Herantis Pharma Plc, Espoo, Finland.,Neuroscience Center, HiLife, University of Helsinki, Helsinki, Finland
| | - L Uotila
- Research Services, University of Helsinki, Helsinki, Finland
| | - M Llort Asens
- Molecular and Integrative Biosciences Research Program, Faculty of Bio- and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - M I Kurki
- Neurosurgery of Neuro Center, Kuopio University Hospital, Finland.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - M Perola
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - K Auro
- Department of Government Services, National Institute for Health and Welfare, Helsinki, Finland
| | - J E Salmon
- Hospital for Special Surgery-Weill Cornell Medicine, Department of Medicine, New York, NY, USA
| | - M Daly
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.,Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - J P Atkinson
- Department of Medicine, Division of Rheumatology, Washington University School of Medicine, Saint Louis, MO, USA
| | - H Laivuori
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland.,Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Fagerholm
- Molecular and Integrative Biosciences Research Program, Faculty of Bio- and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - S Meri
- Translational Immunology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Bacteriology and immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | -
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
16
|
Cohen H, Cuadrado MJ, Erkan D, Duarte-Garcia A, Isenberg DA, Knight JS, Ortel TL, Rahman A, Salmon JE, Tektonidou MG, Williams DJ, Willis R, Woller SC, Andrade D. 16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends. Lupus 2020; 29:1571-1593. [PMID: 33100166 PMCID: PMC7658424 DOI: 10.1177/0961203320950461] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [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: 07/18/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Abstract
Antiphospholipid syndrome (APS), an acquired autoimmune thrombophilia, is characterised by thrombosis and/or pregnancy morbidity in association with persistent antiphospholipid antibodies. The 16th International Congress on Antiphospholipid Antibodies Task Force on APS Treatment Trends reviewed the current status with regard to existing and novel treatment trends for APS, which is the focus of this Task Force report. The report addresses current treatments and developments since the last report, on the use of direct oral anticoagulants in patients with APS, antiplatelet agents, adjunctive therapies (hydroxychloroquine, statins and vitamin D), targeted treatment including rituximab, belimumab, and anti-TNF agents, complement inhibition and drugs based on peptides of beta-2-glycoprotein I. In addition, the report summarises potential new players, including coenzyme Q10, adenosine receptor agonists and adenosine potentiation. In each case, the report provides recommendations for clinicians, based on the current state of the art, and suggests a clinical research agenda. The initiation and development of appropriate clinical studies requires a focus on devising suitable outcome measures, including a disease activity index, an optimal damage index, and a specific quality of life index.
Collapse
Affiliation(s)
- Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University
College London, London, UK
- University College London Hospitals NHS Foundation Trust,
London, UK
| | - Maria J Cuadrado
- Rheumatology Department, Clinica Universidad de Navarra, Madrid,
Spain
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital
for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Ali Duarte-Garcia
- Division of Rheumatology, Department of Internal Medicine, Mayo
Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health
Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - David A Isenberg
- University College London Hospitals NHS Foundation Trust,
London, UK
- Centre for Rheumatology, Division of Medicine, University
College London, London, UK
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor,
Michigan, USA
| | - Thomas L Ortel
- Division of Hematology, Department of Medicine, and Department
of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Anisur Rahman
- Centre for Rheumatology, Division of Medicine, University
College London, London, UK
| | - Jane E Salmon
- Division of Rheumatology, Hospital for Special surgery, Weill
Cornell Medicine, New York, NY, USA
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, National
and Kapodistrian University of Athens, Athens, Greece
| | - David J Williams
- University College London Hospitals NHS Foundation Trust,
London, UK
- UCL EGA Institute for Women’s Health, University College
London, London, UK
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of
Texas Medical Branch, Galveston, TX, USA
| | - Scott C Woller
- Department of Medicine, Intermountain Medical Center, Murray
UT; Division of General Internal Medicine, University of Utah School of
Medicine, Salt Lake City, UT, USA
| | | |
Collapse
|
17
|
Fernandez-Ruiz R, Bornkamp N, Kim MY, Askanase A, Zezon A, Tseng CE, Belmont HM, Saxena A, Salmon JE, Lockshin M, Buyon JP, Izmirly PM. Discontinuation of hydroxychloroquine in older patients with systemic lupus erythematosus: a multicenter retrospective study. Arthritis Res Ther 2020; 22:191. [PMID: 32807233 PMCID: PMC7430013 DOI: 10.1186/s13075-020-02282-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background Although hydroxychloroquine (HCQ) is a mainstay of treatment for patients with systemic lupus erythematosus (SLE), ocular toxicity can result from accumulated exposure. As the longevity of patients with SLE improves, data are needed to balance the risk of ocular toxicity and the risk of disease flare, especially in older patients with quiescent disease. Accordingly, this study was initiated to examine the safety of HCQ withdrawal in older SLE patients. Methods Data were obtained by retrospective chart review at three major lupus centers in New York City. Twenty-six patients who discontinued HCQ and thirty-two patients on HCQ matched for gender, race/ethnicity, and age were included in this study. The primary outcome was the occurrence of a lupus flare classified by the revised version of the Safety of Estrogens in Lupus Erythematosus: National Assessment version of the Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) Flare composite index, within 1 year of HCQ withdrawal or matched time of continuation. Results Five patients (19.2%) in the HCQ withdrawal group compared to five (15.6%) in the HCQ continuation group experienced a flare of any severity (odds ratio [OR] = 1.28; 95% CI 0.31, 5.30; p = 0.73). There were no severe flares in either group. The results were similar after adjusting for length of SLE, number of American College of Rheumatology criteria, low complement levels, and SELENA-SLEDAI score, and in a propensity score analysis (OR = 1.18; 95% CI 0.23, 6.16; p = 0.84). The analysis of time to any flare revealed a non-significant earlier time to flare in the HCQ withdrawal group (log-rank p = 0.67). Most flares were in the cutaneous and musculoskeletal systems, but one patient in the continuation group developed pericarditis. The most common reason for HCQ withdrawal was retinal toxicity (42.3%), followed by patient’s preference (34.6%), other confirmed or suspected adverse effects (15.4%), ophthalmologist recommendation for macular degeneration (3.8%), and rheumatologist recommendation for quiescent SLE (3.8%). Conclusions In this retrospective study of older stable patients with SLE on long-term HCQ, withdrawal did not significantly increase the risk of flares.
Collapse
Affiliation(s)
- Ruth Fernandez-Ruiz
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
| | - Nicole Bornkamp
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Mimi Y Kim
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Anna Zezon
- Division of Rheumatology, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Chung-E Tseng
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Amit Saxena
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Jane E Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Michael Lockshin
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
| |
Collapse
|
18
|
Lockshin MD, Guerra M, Salmon JE. Elective Termination of Pregnancy in Autoimmune Rheumatic Diseases: Experience From Two Databases. Arthritis Rheumatol 2020; 72:1325-1329. [PMID: 32162838 DOI: 10.1002/art.41249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/03/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To provide reference data regarding the frequency and safety of elective termination of pregnancy in women with autoimmune rheumatic diseases followed up in 2 referral databases. METHODS Two large databases, one from an autoimmune rheumatic disease referral clinical practice with a known interest in pregnancy (the Barbara Volcker Center for Women and Rheumatic Disease [BVC]), and one from an observational study of systemic lupus erythematosus- and antiphospholipid antibody-associated pregnancies (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus [PROMISSE]), were interrogated for histories of prior elective termination of pregnancy and complications related to incident pregnancy termination. RESULTS Of women who had had prior pregnancies, 21.7% of 1,307 in the BVC database and 25.3% of 297 in the PROMISSE database gave histories of 1-5 prior elective terminations of pregnancy; BVC patients reported no flares or hospitalizable complications due to pregnancy termination. Of 674 incident pregnancies, termination for fetal or maternal reasons was recommended for 15 (2%); of these, 2 fetuses died before the procedure was carried out and 1 woman declined termination and, though gravely ill, successfully delivered. She died of cardiomyopathy 3 years later. CONCLUSION Many patients with autoimmune rheumatic disease undergo elective termination of pregnancy; few report complications. In medically indicated termination of pregnancy, there are no adverse signals of unusual complications or disease flare.
Collapse
Affiliation(s)
- Michael D Lockshin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Marta Guerra
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Jane E Salmon
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| |
Collapse
|
19
|
Weskamp G, Tüshaus J, Li D, Feederle R, Maretzky T, Swendemann S, Falck-Pedersen E, McIlwain DR, Mak TW, Salmon JE, Lichtenthaler SF, Blobel CP. ADAM17 stabilizes its interacting partner inactive Rhomboid 2 (iRhom2) but not inactive Rhomboid 1 (iRhom1). J Biol Chem 2020; 295:4350-4358. [PMID: 32060096 PMCID: PMC7105298 DOI: 10.1074/jbc.ra119.011136] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/04/2020] [Indexed: 11/06/2022] Open
Abstract
The metalloprotease ADAM17 (a disintegrin and metalloprotease 17) is a key regulator of tumor necrosis factor α (TNFα), interleukin 6 receptor (IL-6R), and epidermal growth factor receptor (EGFR) signaling. ADAM17 maturation and function depend on the seven-membrane-spanning inactive rhomboid-like proteins 1 and 2 (iRhom1/2 or Rhbdf1/2). Most studies to date have focused on overexpressed iRhom1 and -2, so only little is known about the properties of the endogenous proteins. Here, we show that endogenous iRhom1 and -2 can be cell surface-biotinylated on mouse embryonic fibroblasts (mEFs), revealing that endogenous iRhom1 and -2 proteins are present on the cell surface and that iRhom2 also is present on the surface of lipopolysaccharide-stimulated primary bone marrow-derived macrophages. Interestingly, very little, if any, iRhom2 was detectable in mEFs or bone marrow-derived macrophages lacking ADAM17, suggesting that iRhom2 is stabilized by ADAM17. By contrast, the levels of iRhom1 were slightly increased in the absence of ADAM17 in mEFs, indicating that its stability does not depend on ADAM17. These findings support a model in which iRhom2 and ADAM17 are obligate binding partners and indicate that iRhom2 stability requires the presence of ADAM17, whereas iRhom1 is stable in the absence of ADAM17.
Collapse
Affiliation(s)
- Gisela Weskamp
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, New York 10021
| | - Johanna Tüshaus
- Institute for Advanced Study, Technical University Munich, 85748 Garching, Germany; Neuroproteomics, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany
| | - Daniel Li
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, New York 10021
| | - Regina Feederle
- German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Institute for Diabetes and Obesity, Monoclonal Antibody Core Facility, Helmholtz Zentrum Munich, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Thorsten Maretzky
- Inflammation Program and Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Steven Swendemann
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, New York 10021
| | - Erik Falck-Pedersen
- Department of Biochemistry, Cellular and Molecular Biology, Weill Cornell Medicine, New York, New York 10021
| | - David R McIlwain
- Baxter Laboratory in Stem Cell Biology, Department of Microbiology and Immunology, Stanford University, Stanford, California 94305
| | - Tak W Mak
- Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, University Health Network, Toronto, Ontario M5G 2M9, Canada
| | - Jane E Salmon
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, New York 10021; Department of Medicine, Weill Cornell Medicine, New York, New York 10021
| | - Stefan F Lichtenthaler
- Institute for Advanced Study, Technical University Munich, 85748 Garching, Germany; Neuroproteomics, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Carl P Blobel
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, New York 10021; Institute for Advanced Study, Technical University Munich, 85748 Garching, Germany; Department of Medicine, Weill Cornell Medicine, New York, New York 10021; Department of Physiology, Biophysics and Systems Biology, Weill Cornell Medicine, New York, New York 10021.
| |
Collapse
|
20
|
Davis-Porada J, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, Sammaritano LR, Branch DW, Sawitzke A, Merrill JT, Buyon JP, Salmon JE. Low frequency of flares during pregnancy and post-partum in stable lupus patients. Arthritis Res Ther 2020; 22:52. [PMID: 32188491 PMCID: PMC7081564 DOI: 10.1186/s13075-020-2139-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Lupus patients are at risk for pregnancy loss, and it has been generally accepted that women with SLE should have low disease activity prior to conception. However, there are conflicting results regarding the effect of pregnancy on SLE flares. This study aims to identify predictors of flares during and after pregnancy in SLE patients with inactive or stable disease activity during the first trimester and to characterize and estimate the frequency of post-partum flares in these patients. Methods SLE patients in the multicenter, prospective PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study were evaluated for flares during and after pregnancy using the SELENA-SLEDAI Flare Index. Flares during pregnancy were assessed in all 384 patients and post-partum flares in 234 patients with study visits 2–6 months post-partum. Logistic regression models were fit to the data to identify independent risk factors for flare. Results During pregnancy, 20.8% of patients had mild/moderate flares and 6.25% had severe. Post-partum, 27.7% of patients had mild/moderate flares and 1.7% had severe. The mild flares rarely required treatment. Younger age, low C4 and higher PGA at baseline were independently associated with higher risk of having at least one mild/moderate or severe flare during pregnancy. Older patients were at decreased risk of flare, as well as those with quiescent disease at baseline. No variables evaluated at baseline or the visit most proximal to delivery was significantly associated with risk of flare post-partum. Medications were not associated with flare during or after pregnancy. Conclusion In patients with inactive or stable mild disease activity at the time of conception, lupus disease flares during and after pregnancy are typically mild and occur at similar rates. Flares during pregnancy are predicted by the patients’ age and clinical and serological activity at baseline.
Collapse
Affiliation(s)
- Julia Davis-Porada
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Mimi Y Kim
- Albert Einstein College of Medicine, New York, NY, USA
| | - Marta M Guerra
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Carl A Laskin
- Mount Sinai Hospital Toronto, Toronto, Ontario, Canada.,Trio Fertility, Toronto, Ontario, Canada
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael D Lockshin
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.,Weill Cornell Medicine, New York, NY, USA
| | - Lisa R Sammaritano
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.,Weill Cornell Medicine, New York, NY, USA
| | - D Ware Branch
- Intermountain Healthcare, Salt Lake City, UT, USA.,University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Allen Sawitzke
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Joan T Merrill
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Jill P Buyon
- New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
| | - Jane E Salmon
- Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA. .,Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
21
|
Affiliation(s)
- Jane E Salmon
- From the Hospital for Special Surgery and Weill Cornell Medicine (J.E.S.) and the Colton Center for Autoimmunity, NYU School of Medicine (T.B.N.) - both in New York
| | - Timothy B Niewold
- From the Hospital for Special Surgery and Weill Cornell Medicine (J.E.S.) and the Colton Center for Autoimmunity, NYU School of Medicine (T.B.N.) - both in New York
| |
Collapse
|
22
|
Craft JE, Crow MK, Lockshin MD, Salmon JE, Diamond B, Elkon KB, Flood J, Fox DA, Gabriel SE, Gilkeson GS, Hahn BH, Hardin J, Koopman WJ, Seaman WE, Wofsy D, Sergent JS, Uknis AB, Weinblatt ME. Georgia Abortion Law and Our Commitment to Patients. Arthritis Rheumatol 2019; 72:377-378. [PMID: 31637878 DOI: 10.1002/art.41143] [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]
Affiliation(s)
| | | | | | | | | | | | - Joseph Flood
- Ohio State University Medical Center, Columbus, OH
| | | | | | | | - Bevra H Hahn
- University of California Los Angeles Medical Center
| | - John Hardin
- Montefiore Hospital and Medical Center, Bronx, NY
| | | | | | | | | | | | | |
Collapse
|
23
|
Shipman WD, Chyou S, Ramanathan A, Izmirly PM, Sharma S, Pannellini T, Dasoveanu DC, Qing X, Magro CM, Granstein RD, Lowes MA, Pamer EG, Kaplan DH, Salmon JE, Mehrara BJ, Young JW, Clancy RM, Blobel CP, Lu TT. A protective Langerhans cell-keratinocyte axis that is dysfunctional in photosensitivity. Sci Transl Med 2019; 10:10/454/eaap9527. [PMID: 30111646 DOI: 10.1126/scitranslmed.aap9527] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 07/13/2018] [Indexed: 12/14/2022]
Abstract
Photosensitivity, or skin sensitivity to ultraviolet radiation (UVR), is a feature of lupus erythematosus and other autoimmune and dermatologic conditions, but the mechanistic underpinnings are poorly understood. We identify a Langerhans cell (LC)-keratinocyte axis that limits UVR-induced keratinocyte apoptosis and skin injury via keratinocyte epidermal growth factor receptor (EGFR) stimulation. We show that the absence of LCs in Langerin-diphtheria toxin subunit A (DTA) mice leads to photosensitivity and that, in vitro, mouse and human LCs can directly protect keratinocytes from UVR-induced apoptosis. LCs express EGFR ligands and a disintegrin and metalloprotease 17 (ADAM17), the metalloprotease that activates EGFR ligands. Deletion of ADAM17 from LCs leads to photosensitivity, and UVR induces LC ADAM17 activation and generation of soluble active EGFR ligands, suggesting that LCs protect by providing activated EGFR ligands to keratinocytes. Photosensitive systemic lupus erythematosus (SLE) models and human SLE skin show reduced epidermal EGFR phosphorylation and LC defects, and a topical EGFR ligand reduces photosensitivity. Together, our data establish a direct tissue-protective function for LCs, reveal a mechanistic basis for photosensitivity, and suggest EGFR stimulation as a treatment for photosensitivity in lupus erythematosus and potentially other autoimmune and dermatologic conditions.
Collapse
Affiliation(s)
- William D Shipman
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, NY 10065, USA.,Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY 10065, USA.,Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Susan Chyou
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Anusha Ramanathan
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Peter M Izmirly
- Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Sneh Sharma
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Tania Pannellini
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Dragos C Dasoveanu
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021, USA.,Department of Physiology, Biophysics and Systems Biology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Xiaoping Qing
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | | | | | - Eric G Pamer
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Daniel H Kaplan
- Department of Dermatology, University of Pittsburgh, PA 15260, USA.,Department of Immunology, University of Pittsburgh, PA 15260, USA
| | - Jane E Salmon
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY 10065, USA.,Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.,Division of Rheumatology and Pediatric Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA
| | - Babak J Mehrara
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - James W Young
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Rockefeller University, New York, NY 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.,Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Robert M Clancy
- Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Carl P Blobel
- Department of Physiology, Biophysics and Systems Biology, Weill Cornell Medicine, New York, NY 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.,Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, NY 10021, USA.,Institute for Advanced Studies, Technical University Munich, Munich, Germany
| | - Theresa T Lu
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY 10065, USA. .,Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021, USA.,Division of Rheumatology and Pediatric Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA.,Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10065, USA
| |
Collapse
|
24
|
Burg N, Swendeman S, Worgall S, Hla T, Salmon JE. Sphingosine 1-Phosphate Receptor 1 Signaling Maintains Endothelial Cell Barrier Function and Protects Against Immune Complex-Induced Vascular Injury. Arthritis Rheumatol 2019; 70:1879-1889. [PMID: 29781582 DOI: 10.1002/art.40558] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Immune complex (IC) deposition activates polymorphonuclear neutrophils (PMNs), increases vascular permeability, and leads to organ damage in systemic lupus erythematosus and rheumatoid arthritis. The bioactive lipid sphingosine 1-phosphate (S1P), acting via S1P receptor 1 (S1P1 ), is a key regulator of endothelial cell (EC) barrier function. This study was undertaken to investigate whether augmenting EC integrity via S1P1 signaling attenuates inflammatory injury mediated by ICs. METHODS In vitro barrier function was assessed in human umbilical vein endothelial cells (HUVECs) by electrical cell-substrate impedance sensing. Phosphorylation of myosin light chain 2 (p-MLC-2) and VE-cadherin staining in HUVECs were assessed by immunofluorescence. A reverse Arthus reaction (RAR) was induced in the skin and lungs of mice with S1P1 deleted from ECs (S1P1 EC-knockout [ECKO] mice) and mice treated with S1P1 agonists and antagonists. RESULTS S1P1 agonists prevented loss of barrier function in HUVECs treated with IC-activated PMNs. S1P1 ECKO and wild-type (WT) mice treated with S1P1 antagonists had amplified RAR, whereas specific S1P1 agonists attenuated skin and lung RAR in WT mice. ApoM-Fc, a novel S1P chaperone, mitigated EC cell barrier dysfunction induced by activated PMNs in vitro and attenuated lung RAR. Expression levels of p-MLC-2 and disruption of VE-cadherin, each representing manifestations of cell contraction and destabilization of adherens junctions, respectively, that were induced by activated PMNs, were markedly reduced by treatment with S1P1 agonists and ApoM-Fc. CONCLUSION Our findings indicate that S1P1 signaling in ECs modulates vascular responses to IC deposition. S1P1 agonists and ApoM-Fc enhance the EC barrier, limit leukocyte escape from capillaries, and provide protection against inflammatory injury. The S1P/S1P1 axis is a newly identified target to attenuate tissue responses to IC deposition and mitigate end-organ damage.
Collapse
Affiliation(s)
- Nathalie Burg
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | - Timothy Hla
- Boston Children's Hospital, Boston, Massachusetts
| | - Jane E Salmon
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| |
Collapse
|
25
|
Izmirly PM, Buyon JP, Wan I, Belmont HM, Sahl S, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H. The Incidence and Prevalence of Adult Primary Sjögren's Syndrome in New York County. Arthritis Care Res (Hoboken) 2019; 71:949-960. [PMID: 30044541 DOI: 10.1002/acr.23707] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/17/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Extant epidemiologic data of primary Sjögren's syndrome (SS) remains limited, particularly for racial/ethnic populations in the US. The Manhattan Lupus Surveillance Program (MLSP) is a population-based retrospective registry of cases of systemic lupus erythematosus and related diseases, including primary SS in Manhattan, New York. The MLSP was used to provide estimates of the incidence and prevalence of primary SS across major racial/ethnic populations. METHODS MLSP cases were identified from hospitals, rheumatologists, and population databases. Three case definitions were used for primary SS, including physician diagnosis, rheumatologist diagnosis, and modified primary SS criteria. Rates among Manhattan residents were age-adjusted, and capture-recapture analyses were conducted to assess underascertainment of cases. RESULTS By physician diagnosis, age-adjusted overall incidence and prevalence rates of primary SS among adult Manhattan residents were 3.5 and 13.1 per 100,000 person-years, respectively. Capture-recapture adjustment increased incidence and prevalence rates (4.1 and 14.2 per 100,000 person-years, respectively). Based on physician diagnosis, incidence and prevalence rates were approximately 6 times higher among women than men (P < 0.001). Incidence of primary SS was statistically higher among non-Latina Asian women (10.5) and non-Latina white women (6.2) compared with Latina women (3.2). Incidence was also higher among non-Latina Asian women compared with non-Latina black women (3.3). Prevalence of primary SS did not differ by race/ethnicity. Similar trends were observed when more restrictive case definitions were applied. CONCLUSION Data from the MLSP revealed disparities among Manhattan residents in primary SS incidence and prevalence by sex and differences in primary SS incidence by race/ethnicity among women. These data also provided epidemiologic estimates for the major racial/ethnic populations in the US.
Collapse
Affiliation(s)
| | - Jill P Buyon
- New York University School of Medicine, New York, New York
| | - Isabella Wan
- New York University School of Medicine, New York, New York
| | | | - Sara Sahl
- Harbor-University of California Medical Center, Los Angeles
| | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Anca Askanase
- Columbia University College of Physicians & Surgeons, New York, New York
| | - Joan M Bathon
- Columbia University College of Physicians & Surgeons, New York, New York
| | | | - Yousaf Ali
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ellen M Ginzler
- State University of New York Downstate College of Medicine, Brooklyn
| | | | | | | | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| |
Collapse
|
26
|
Hanscombe KB, Morris DL, Noble JA, Dilthey AT, Tombleson P, Kaufman KM, Comeau M, Langefeld CD, Alarcon-Riquelme ME, Gaffney PM, Jacob CO, Sivils KL, Tsao BP, Alarcon GS, Brown EE, Croker J, Edberg J, Gilkeson G, James JA, Kamen DL, Kelly JA, McCune J, Merrill JT, Petri M, Ramsey-Goldman R, Reveille JD, Salmon JE, Scofield H, Utset T, Wallace DJ, Weisman MH, Kimberly RP, Harley JB, Lewis CM, Criswell LA, Vyse TJ. Genetic fine mapping of systemic lupus erythematosus MHC associations in Europeans and African Americans. Hum Mol Genet 2019; 27:3813-3824. [PMID: 30085094 PMCID: PMC6196648 DOI: 10.1093/hmg/ddy280] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/24/2018] [Indexed: 11/14/2022] Open
Abstract
Genetic variation within the major histocompatibility complex (MHC) contributes substantial risk for systemic lupus erythematosus, but high gene density, extreme polymorphism and extensive linkage disequilibrium (LD) have made fine mapping challenging. To address the problem, we compared two association techniques in two ancestrally diverse populations, African Americans (AAs) and Europeans (EURs). We observed a greater number of Human Leucocyte Antigen (HLA) alleles in AA consistent with the elevated level of recombination in this population. In EUR we observed 50 different A-C-B-DRB1-DQA-DQB multilocus haplotype sequences per hundred individuals; in the AA sample, these multilocus haplotypes were twice as common compared to Europeans. We also observed a strong narrow class II signal in AA as opposed to the long-range LD observed in EUR that includes class I alleles. We performed a Bayesian model choice of the classical HLA alleles and a frequentist analysis that combined both single nucleotide polymorphisms (SNPs) and classical HLA alleles. Both analyses converged on a similar subset of risk HLA alleles: in EUR HLA- B*08:01 + B*18:01 + (DRB1*15:01 frequentist only) + DQA*01:02 + DQB*02:01 + DRB3*02 and in AA HLA-C*17:01 + B*08:01 + DRB1*15:03 + (DQA*01:02 frequentist only) + DQA*02:01 + DQA*05:01+ DQA*05:05 + DQB*03:19 + DQB*02:02. We observed two additional independent SNP associations in both populations: EUR rs146903072 and rs501480; AA rs389883 and rs114118665. The DR2 serotype was best explained by DRB1*15:03 + DQA*01:02 in AA and by DRB1*15:01 + DQA*01:02 in EUR. The DR3 serotype was best explained by DQA*05:01 in AA and by DQB*02:01 in EUR. Despite some differences in underlying HLA allele risk models in EUR and AA, SNP signals across the extended MHC showed remarkable similarity and significant concordance in direction of effect for risk-associated variants.
Collapse
Affiliation(s)
- Ken B Hanscombe
- Department of Medical and Molecular Genetics, King's College London, London, UK
| | - David L Morris
- Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Janelle A Noble
- CHORI, Children's Hospital Oakland Research Institute, Oakland, California, USA
| | | | - Philip Tombleson
- Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Kenneth M Kaufman
- Center for Autoimmune Genomics and Etiology (CAGE), Department of Pediatrics, Cincinnati Children's Medical Center & University of Cincinnati and the US Department of Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Mary Comeau
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carl D Langefeld
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Marta E Alarcon-Riquelme
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research (GENYO), Granada, Spain.,Unit of Chronic Inflammation, Institute of Environmental Medicine, Karolinska Institute, Sweden
| | - Patrick M Gaffney
- Arthritis & Clinical Immunology Research Program, Division of Genomics and Data Sciences, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Chaim O Jacob
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Kathy L Sivils
- Arthritis & Clinical Immunology Research Program, Division of Genomics and Data Sciences, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Betty P Tsao
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Graciela S Alarcon
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth E Brown
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Croker
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff Edberg
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary Gilkeson
- Division of Rheumatology, Medical University of South Carolina, Charleston, SC, USA
| | - Judith A James
- Arthritis & Clinical Immunology Research Program, Division of Genomics and Data Sciences, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Diane L Kamen
- Division of Rheumatology, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer A Kelly
- Arthritis & Clinical Immunology Research Program, Division of Genomics and Data Sciences, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Joseph McCune
- Michigan Medicine Rheumatology Clinic,Taubman Center Floor 3 Reception A, 1500 E Medical Center Dr SPC 5358, Ann Arbor, MI, USA
| | - Joan T Merrill
- Oklahoma Medical Research Foundation,825 N.E. 13th Street, Oklahoma City, OK, USA
| | - Michelle Petri
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - John D Reveille
- Department of Internal Medicine, The University of Texas, Fannin, MSB, Houston, TX, USA
| | - Jane E Salmon
- Division of Rheumatology, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY, USA
| | - Hal Scofield
- Arthritis & Clinical Immunology Research Program, Division of Genomics and Data Sciences, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Oklahoma Clinical and Translational Science Institute,University of Oklahoma Health Sciences Center, 920 NE Stanton L. Young, Oklahoma City, OK, USA
| | - Tammy Utset
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Daniel J Wallace
- Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Robert P Kimberly
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John B Harley
- Center for Autoimmune Genomics and Etiology (CAGE), Department of Pediatrics, Cincinnati Children's Medical Center & University of Cincinnati and the US Department of Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Cathryn M Lewis
- Department of Medical and Molecular Genetics, King's College London, London, UK.,MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lindsey A Criswell
- Rosalind Russell / Ephraim P Engleman Rheumatology Research Center, Division of Rheumatology, UCSF School of Medicine, San Francisco, CA, USA
| | - Timothy J Vyse
- Department of Medical and Molecular Genetics, King's College London, London, UK
| |
Collapse
|
27
|
Hong S, Banchereau R, Maslow BSL, Guerra MM, Cardenas J, Baisch J, Branch DW, Porter TF, Sawitzke A, Laskin CA, Buyon JP, Merrill J, Sammaritano LR, Petri M, Gatewood E, Cepika AM, Ohouo M, Obermoser G, Anguiano E, Kim TW, Nulsen J, Nehar-Belaid D, Blankenship D, Turner J, Banchereau J, Salmon JE, Pascual V. Longitudinal profiling of human blood transcriptome in healthy and lupus pregnancy. J Exp Med 2019; 216:1154-1169. [PMID: 30962246 PMCID: PMC6504211 DOI: 10.1084/jem.20190185] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/22/2022] Open
Abstract
Healthy and uncomplicated lupus pregnancies exhibit early and sustained transcriptional modulation of lupus-related pathways. This might contribute to fetal tolerance while predisposing pregnant women to certain infections. Failure to modulate these pathways is associated with lupus pregnancy complications. Systemic lupus erythematosus carries an increased risk of pregnancy complications, including preeclampsia and fetal adverse outcomes. To identify the underlying molecular mechanisms, we longitudinally profiled the blood transcriptome of 92 lupus patients and 43 healthy women during pregnancy and postpartum and performed multicolor flow cytometry in a subset of them. We also profiled 25 healthy women undergoing assisted reproductive technology to monitor transcriptional changes around embryo implantation. Sustained down-regulation of multiple immune signatures, including interferon and plasma cells, was observed during healthy pregnancy. These changes appeared early after embryo implantation and were mirrored in uncomplicated lupus pregnancies. Patients with preeclampsia displayed early up-regulation of neutrophil signatures that correlated with expansion of immature neutrophils. Lupus pregnancies with fetal complications carried the highest interferon and plasma cell signatures as well as activated CD4+ T cell counts. Thus, blood immunomonitoring reveals that both healthy and uncomplicated lupus pregnancies exhibit early and sustained transcriptional modulation of lupus-related signatures, and a lack thereof associates with adverse outcomes.
Collapse
Affiliation(s)
- Seunghee Hong
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY.,Department of Pediatrics, Weill Cornell Medicine, New York, NY.,Baylor Institute for Immunology Research, Dallas, TX
| | - Romain Banchereau
- Baylor Institute for Immunology Research, Dallas, TX.,Oncology Biomarker Development, Genentech, South San Francisco, CA
| | | | - Marta M Guerra
- Department of Medicine and Program in Inflammation and Autoimmunity, Hospital for Special Surgery, New York, NY
| | | | - Jeanine Baisch
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY.,Department of Pediatrics, Weill Cornell Medicine, New York, NY.,Baylor Institute for Immunology Research, Dallas, TX
| | - D Ware Branch
- University of Utah Health Sciences Center, Salt Lake City, UT.,Intermountain Healthcare, Salt Lake City, UT
| | - T Flint Porter
- University of Utah Health Sciences Center, Salt Lake City, UT.,Intermountain Healthcare, Salt Lake City, UT
| | - Allen Sawitzke
- University of Utah Health Sciences Center, Salt Lake City, UT
| | - Carl A Laskin
- Mount Sinai Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Jill P Buyon
- New York University School of Medicine, New York, NY
| | - Joan Merrill
- Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Lisa R Sammaritano
- Department of Medicine and Program in Inflammation and Autoimmunity, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Marina Ohouo
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY.,Department of Pediatrics, Weill Cornell Medicine, New York, NY.,Baylor Institute for Immunology Research, Dallas, TX
| | | | | | - Tae Whan Kim
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY.,Department of Pediatrics, Weill Cornell Medicine, New York, NY.,Baylor Institute for Immunology Research, Dallas, TX
| | - John Nulsen
- University of Connecticut School of Medicine, Farmington, CT
| | | | | | - Jacob Turner
- Baylor Institute for Immunology Research, Dallas, TX
| | | | - Jane E Salmon
- Department of Medicine and Program in Inflammation and Autoimmunity, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Virginia Pascual
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY.,Department of Pediatrics, Weill Cornell Medicine, New York, NY.,Baylor Institute for Immunology Research, Dallas, TX
| |
Collapse
|
28
|
Mulla MJ, Pasternak MC, Salmon JE, Chamley LW, Abrahams VM. Role of NOD2 in antiphospholipid antibody-induced and bacterial MDP amplification of trophoblast inflammation. J Autoimmun 2018; 98:103-112. [PMID: 30594350 DOI: 10.1016/j.jaut.2018.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/22/2018] [Revised: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
Women with antiphospholipid antibodies (aPL) are at high risk for pregnancy complications, such as preeclampsia. We previously demonstrated that aPL recognizing β2GPI promote an extravillous trophoblast pro-inflammatory, anti-migratory and anti-angiogenic profile similar to that seen in preeclampsia. Since preeclampsia in the absence of aPL may have an underlying infectious element, women with aPL may be at increased risk for preeclampsia or other adverse outcomes if an infection is present. Our objective was to determine the impact the common bacterial component, muramyl dipeptide (MDP), has on trophoblast responses to aPL. Herein, we report that bacterial MDP amplifies trophoblast IL-1β expression, processing, and secretion in the presence of aPL through activation of NOD2. In the absence of MDP, NOD2 also mediates anti- β2GPI antibody-induced trophoblast IL-1β and VEGF secretion. Additionally, we report a role for extravillous trophoblast vimentin as a novel danger signal that contributes to the aPL-induced trophoblast IL-1β production. Together our data indicate that NOD2 mediates trophoblast inflammatory and angiogenic responses to aPL alone, and mediates trophoblast inflammation in the presence of bacterial MDP. These findings suggest that a bacterial infection at the maternal-fetal interface may exacerbate the impact aPL have on trophoblast inflammation and, thus, on pregnancy outcome.
Collapse
Affiliation(s)
- Melissa J Mulla
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Monica C Pasternak
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Jane E Salmon
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence W Chamley
- Department of Obstetrics & Gynecology, University of Auckland, Auckland, New Zealand
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA.
| |
Collapse
|
29
|
Yelnik CM, Lambert M, Drumez E, Le Guern V, Bacri JL, Guerra MM, Laskin CA, Branch DW, Sammaritano LR, Morel N, Guettrot-Imbert G, Launay D, Hachulla E, Hatron PY, Salmon JE, Costedoat-Chalumeau N. Bleeding complications and antithrombotic treatment in 264 pregnancies in antiphospholipid syndrome. Lupus 2018; 27:1679-1686. [PMID: 30016929 DOI: 10.1177/0961203318787032] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to evaluate the safety of antithrombotic treatments prescribed during pregnancy in patients with antiphospholipid syndrome (APS). Methods This international, multicenter study included two cohorts of patients: a retrospective French cohort and a prospective US cohort (PROMISSE study). Inclusion criteria were (1) APS (Sydney criteria), (2) live pregnancy at 12 weeks of gestation (WG) with (3) follow-up data until six weeks post-partum. According to APS standard of care, patients were treated with aspirin and/or low-molecular weight heparin (LMWH) at prophylactic (pure obstetric APS) or therapeutic doses (history of thrombosis). Major bleeding was defined as abnormal blood loss during the pregnancy and/or post-partum period requiring intervention for hemostasis or transfusion, or during the peripartum period greater than 500 mL and/or requiring surgery or transfusion. Other bleeding events were classified as minor. Results Two hundred and sixty-four pregnancies (87 prospectively collected) in 204 patients were included (46% with history of thrombosis, 23% with associated systemic lupus). During pregnancy, treatment included LMWH ( n = 253; 96%) or low-dose aspirin ( n = 223; 84%), and 215 (81%) patients received both therapies. The live birth rate was 89% and 82% in the retrospective and prospective cohorts, respectively. Adverse pregnancy outcomes occurred in 28% of the retrospective cohort and in 40% of the prospective cohort. No maternal death was observed in either cohort. A combined total of 45 hemorrhagic events (25%) occurred in the retrospective cohort, but major bleeding was reported in only six pregnancies (3%). Neither heparin nor aspirin alone nor combined therapy increased the risk of hemorrhage. We also did not observe an increased rate of bleeding in the case of a short interval between last LMWH (less than 24 hours) or aspirin (less than five days) doses and delivery. Only emergency Caesarean section was significantly associated with an increased risk of bleeding (odds ratio (OR) 5.03 (1.41-17.96); p=.016). In the prospective cohort, only one minor bleeding event was reported (vaginal bleeding). Conclusion Our findings support the safety of antithrombotic therapy with aspirin and/or LMWH during pregnancy in high-risk women with APS, and highlight the need for better treatments to improve pregnancy outcomes in APS. PROMISSE Study ClinicalTrials.gov identifier: NCT00198068.
Collapse
Affiliation(s)
- C M Yelnik
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - M Lambert
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - E Drumez
- 2 CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Département de Biostatistique, University of Lille, France
| | - V Le Guern
- 3 Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, Paris, France
| | - J-L Bacri
- 4 Service de Médecine Interne, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - M M Guerra
- 5 Rheumatology, Hospital for Special Surgery, New York, USA
| | - C A Laskin
- 6 University of Toronto and Trio Fertility, Toronto, Canada
| | - D W Branch
- 7 University of Utah and Intermountain Healthcare, Salt Lake City, USA
| | | | - N Morel
- 3 Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, Paris, France
| | - G Guettrot-Imbert
- 3 Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, Paris, France
| | - D Launay
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - E Hachulla
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - P-Y Hatron
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - J E Salmon
- 5 Rheumatology, Hospital for Special Surgery, New York, USA
| | - N Costedoat-Chalumeau
- 3 Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, Paris, France.,8 Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,9 INSERM U 1153, Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Paris, France
| |
Collapse
|
30
|
Mulla MJ, Weel IC, Potter JA, Gysler SM, Salmon JE, Peraçoli MTS, Rothlin CV, Chamley LW, Abrahams VM. Antiphospholipid Antibodies Inhibit Trophoblast Toll-Like Receptor and Inflammasome Negative Regulators. Arthritis Rheumatol 2018; 70:891-902. [PMID: 29342502 DOI: 10.1002/art.40416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Women with antiphospholipid antibodies (aPL) are at risk for pregnancy complications associated with poor placentation and placental inflammation. Although these antibodies are heterogeneous, some anti-β2 -glycoprotein I (anti-β2 GPI) antibodies can activate Toll-like receptor 4 (TLR-4) and NLRP3 in human first-trimester trophoblasts. The objective of this study was to determine the role of negative regulators of TLR and inflammasome function in aPL-induced trophoblast inflammation. METHODS Human trophoblasts were not treated or were treated with anti-β2 GPI aPL or control IgG in the presence or absence of the common TAM (TYRO3, AXL, and Mer tyrosine kinase [MERTK]) receptor ligand growth arrest-specific protein 6 (GAS6) or the autophagy-inducer rapamycin. The expression and function of the TAM receptor pathway and autophagy were measured by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), Western blotting, and enzyme-linked immunosorbent assay (ELISA). Antiphospholipid antibody-induced trophoblast inflammation was measured by qRT-PCR, activity assays, and ELISA. RESULTS Anti-β2 GPI aPL inhibited trophoblast TAM receptor function by reducing cellular expression of the receptor tyrosine kinases AXL and MERTK and the ligand GAS6. The addition of GAS6 blocked the effects of aPL on the TLR-4-mediated interleukin-8 (IL-8) response. However, the NLRP3 inflammasome-mediated IL-1β response was not affected by GAS6, suggesting that another regulatory pathway was involved. Indeed, anti-β2 GPI aPL inhibited basal trophoblast autophagy, and reversing this with rapamycin inhibited aPL-induced inflammasome function and IL-1β secretion. CONCLUSION Basal TAM receptor function and autophagy may serve to inhibit trophoblast TLR and inflammasome function, respectively. Impairment of TAM receptor signaling and autophagy by anti-β2 GPI aPL may allow subsequent TLR and inflammasome activity, leading to a robust inflammatory response.
Collapse
Affiliation(s)
| | - Ingrid C Weel
- Yale University, New Haven, Connecticut, and São Paulo State University, São Paulo, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Castanon A, Pierre G, Willis R, Harris EN, Papalardo E, Romay-Penabad Z, Schleh A, Jajoria P, Smikle M, DeCeulaer K, Tebo A, Jaskowski T, Guerra MM, Branch DW, Salmon JE, Petri M, Gonzalez EB. Performance Evaluation and Clinical Associations of Immunoassays That Detect Antibodies to Negatively Charged Phospholipids Other Than Cardiolipin. Am J Clin Pathol 2018; 149:401-411. [PMID: 29547897 DOI: 10.1093/ajcp/aqy003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES We evaluate the performance characteristics of antiphosphatidylserine (anti-PS), antiphosphatidylinositol (anti-PI), and antiphospholipid mixture (APhL) enzyme-linked immunosorbent assays (ELISAs) compared with anticardiolipin (aCL) and anti-β2 glycoprotein I (anti-β2GPI) in a large group of patients with antiphospholipid (aPL)-related diseases. METHODS Serum samples from 548 patients from the Hopkins and Jamaican systemic lupus erythematosus cohorts, the PROMISSE cohort, and the Antiphospholipid Standardization Laboratory were examined for immunoglobulin G (IgG)/immunoglobulin M (IgM) positivity in aCL, anti-β2GPI, anti-PS, anti-PI, and APhL ELISA assays. RESULTS All IgG assays were associated with one or more thrombotic and/or obstetric manifestations, with an increased risk associated with higher antibody titers. Analytical performance was similar among assays, but IgG assays performed better than IgM counterparts. CONCLUSIONS Increasing titers of APhL, anti-PS, and anti-PI antibodies could indicate an increased risk of thrombotic and/or obstetric aPL-related manifestations. These assays may be promising biomarkers for particular APS manifestations.
Collapse
Affiliation(s)
- Amaris Castanon
- Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| | - Grant Pierre
- Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| | - Rohan Willis
- Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| | - E Nigel Harris
- University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Elizabeth Papalardo
- Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| | | | - Alvaro Schleh
- Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| | | | - Monica Smikle
- University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Karel DeCeulaer
- University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Anne Tebo
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT
- Department of Pathology, University of Utah, Salt Lake City
| | - Troy Jaskowski
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT
| | | | - D Ware Branch
- Maternal Fetal Medicine, University of Utah and Intermountain Healthcare, Salt Lake City
| | - Jane E Salmon
- Rheumatology, Hospital for Special Surgery, New York
| | | | - Emilio B Gonzalez
- Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| |
Collapse
|
32
|
Qing X, Chinenov Y, Redecha P, Madaio M, Roelofs JJ, Farber G, Issuree PD, Donlin L, Mcllwain DR, Mak TW, Blobel CP, Salmon JE. iRhom2 promotes lupus nephritis through TNF-α and EGFR signaling. J Clin Invest 2018; 128:1397-1412. [PMID: 29369823 DOI: 10.1172/jci97650] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/23/2018] [Indexed: 12/14/2022] Open
Abstract
Lupus nephritis (LN) often results in progressive renal dysfunction. The inactive rhomboid 2 (iRhom2) is a newly identified key regulator of A disintegrin and metalloprotease 17 (ADAM17), whose substrates, such as TNF-α and heparin-binding EGF (HB-EGF), have been implicated in the pathogenesis of chronic kidney diseases. Here, we demonstrate that deficiency of iRhom2 protects the lupus-prone Fcgr2b-/- mice from developing severe kidney damage without altering anti-double-stranded DNA (anti-dsDNA) Ab production by simultaneously blocking HB-EGF/EGFR and TNF-α signaling in the kidney tissues. Unbiased transcriptome profiling of kidneys and kidney macrophages revealed that TNF-α and HB-EGF/EGFR signaling pathways are highly upregulated in Fcgr2b-/- mice, alterations that were diminished in the absence of iRhom2. Pharmacological blockade of either TNF-α or EGFR signaling protected Fcgr2b-/- mice from severe renal damage. Finally, kidneys from LN patients showed increased iRhom2 and HB-EGF expression, with interstitial HB-EGF expression significantly associated with chronicity indices. Our data suggest that activation of iRhom2/ADAM17-dependent TNF-α and EGFR signaling plays a crucial role in mediating irreversible kidney damage in LN, thereby uncovering a target for selective and simultaneous dual inhibition of 2 major pathological pathways in the effector arm of the disease.
Collapse
Affiliation(s)
| | - Yurii Chinenov
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, New York, USA
| | | | - Michael Madaio
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Joris Jth Roelofs
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Gregory Farber
- Department of Physiology, Biophysics and Systems Biology, Weill Cornell Medicine, New York, New York, USA
| | - Priya D Issuree
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, New York, USA
| | - Laura Donlin
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, New York, USA
| | - David R Mcllwain
- Baxter Laboratory in Stem Cell Biology, Department of Microbiology and Immunology, Stanford University, Stanford, California, USA
| | - Tak W Mak
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Carl P Blobel
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, New York, USA.,Department of Physiology, Biophysics and Systems Biology, Weill Cornell Medicine, New York, New York, USA.,Institute for Advanced Study, Technical University Munich, Munich, Germany.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jane E Salmon
- Program in Inflammation and Autoimmunity, and.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
33
|
Kim MY, Guerra MM, Kaplowitz E, Laskin CA, Petri M, Branch DW, Lockshin MD, Sammaritano LR, Merrill JT, Porter TF, Sawitzke A, Lynch AM, Buyon JP, Salmon JE. Complement activation predicts adverse pregnancy outcome in patients with systemic lupus erythematosus and/or antiphospholipid antibodies. Ann Rheum Dis 2018; 77:549-555. [PMID: 29371202 DOI: 10.1136/annrheumdis-2017-212224] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Studies in mouse models implicate complement activation as a causative factor in adverse pregnancy outcomes (APOs). We investigated whether activation of complement early in pregnancy predicts APOs in women with systemic lupus erythematosus (SLE) and/or antiphospholipid (aPL) antibodies. METHODS The PROMISSE Study enrolled pregnant women with SLE and/or aPL antibodies (n=487) and pregnant healthy controls (n=204) at <12 weeks gestation and evaluated them monthly. APOs were: fetal/neonatal death, preterm delivery <36 weeks because of placental insufficiency or preeclampsia and/or growth restriction <5th percentile. Complement activation products were measured on serial blood samples obtained at each monthly visit. RESULTS APO occurred in 20.5% of SLE and/or aPL pregnancies. As early as 12-15 weeks, levels of Bb and sC5b-9 were significantly higher in patients with APOs and remained elevated through 31 weeks compared with those with normal outcomes. Moreover, Bb and sC5b-9 were significantly higher in patients with SLE and/or aPL without APOs compared with healthy controls. In logistic regression analyses, Bb and sC5b-9 at 12-15 weeks remained significantly associated with APO (ORadj=1.41 per SD increase; 95% CI 1.06 to 1.89; P=0.019 and ORadj=1.37 per SD increase; 95% CI 1.05 to 1.80; P=0.022, respectively) after controlling for demographic and clinical risk factors for APOs in PROMISSE. When analyses were restricted to patients with aPL (n=161), associations between Bb at 12-15 weeks and APOs became stronger (ORadj=2.01 per SD increase; 95% CI 1.16 to 3.49; P=0.013). CONCLUSION In pregnant patients with SLE and/or aPL, increased Bb and sC5b-9 detectable early in pregnancy are strongly predictive of APOs and support activation of complement, particularly the alternative pathway, as a contributor to APOs.
Collapse
Affiliation(s)
- Mimi Y Kim
- Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marta M Guerra
- Medicine, Hospital for Special Surgery, New York, New York, USA
| | | | - Carl A Laskin
- Medicine, Mount Sinai Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Michelle Petri
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - D Ware Branch
- Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Michael D Lockshin
- Medicine, Hospital for Special Surgery, New York, New York, USA.,Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lisa R Sammaritano
- Medicine, Hospital for Special Surgery, New York, New York, USA.,Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Joan T Merrill
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - T Flint Porter
- Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Allen Sawitzke
- Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Anne M Lynch
- Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jill P Buyon
- Medicine, New York University School of Medicine, New York, New York, USA
| | - Jane E Salmon
- Medicine, Hospital for Special Surgery, New York, New York, USA.,Medicine, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
34
|
Kaplowitz ET, Ferguson S, Guerra M, Laskin CA, Buyon JP, Petri M, Lockshin MD, Sammaritano LR, Branch DW, Merrill JT, Katz P, Salmon JE. Contribution of Socioeconomic Status to Racial/Ethnic Disparities in Adverse Pregnancy Outcomes Among Women With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 70:230-235. [PMID: 28480528 DOI: 10.1002/acr.23263] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/18/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We examined rates of adverse pregnancy outcomes (APO) by race/ethnicity among women with systemic lupus erythematosus (SLE), with and without antiphospholipid antibodies (aPL), and whether socioeconomic status (SES) accounted for differences. METHODS Data were from the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study, a multicenter study that enrolled 346 patients with SLE and 62 patients with SLE and aPL (50% white, 20% African American, 17% Hispanic, 12% Asian/Pacific Islander). Measures of SES were educational attainment, median community income, and community education. Logistic regression analyses were conducted to determine odds of APO for each racial/ethnic group, controlling first for age and clinical variables, and then for SES. RESULTS The frequency of APO in white women with SLE, with and without aPL, was 29% and 11%, respectively. For African American and Hispanic women it was approximately 2-fold greater. In African American women with SLE alone, adjustment for clinical variables attenuated the odds ratio (OR) from 2.7 (95% confidence interval [95% CI] 1.3-5.5) to 2.3 (95% CI 1.1-5.1), and after additional adjustment for SES, there were no longer significant differences in APO compared to whites. In contrast, in SLE patients with aPL, whites, African Americans, and Hispanics had markedly higher risks of APO compared to white SLE patients without aPL (OR 3.5 [95% CI 1.4-7.7], OR 12.4 [95% CI 1.9-79.8], and OR 10.4 [95% CI 2.5-42.4], respectively), which were not accounted for by clinical or SES covariates. CONCLUSION This finding suggests that for African American women with SLE without aPL, SES factors are key contributors to disparities in APO, despite monthly care from experts, whereas other factors contribute to disparities in SLE with aPL.
Collapse
Affiliation(s)
| | | | - Marta Guerra
- Hospital for Special Surgery, New York, New York
| | - Carl A Laskin
- University of Toronto and TRIO Fertility, Toronto, Canada
| | - Jill P Buyon
- New York University School of Medicine, New York
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael D Lockshin
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Lisa R Sammaritano
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, Utah
| | | | - Patricia Katz
- University of California School of Medicine, San Francisco
| | - Jane E Salmon
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| |
Collapse
|
35
|
Izmirly PM, Wan I, Sahl S, Buyon JP, Belmont HM, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H. The Incidence and Prevalence of Systemic Lupus Erythematosus in New York County (Manhattan), New York: The Manhattan Lupus Surveillance Program. Arthritis Rheumatol 2017; 69:2006-2017. [PMID: 28891252 DOI: 10.1002/art.40192] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/22/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The Manhattan Lupus Surveillance Program (MLSP) is a population-based registry designed to determine the prevalence of systemic lupus erythematosus (SLE) in 2007 and the incidence from 2007 to 2009 among residents of New York County (Manhattan), New York, and to characterize cases by race/ethnicity, including Asians and Hispanics, for whom data are lacking. METHODS We identified possible SLE cases from hospital records, rheumatologist records, and administrative databases. Cases were defined according to the American College of Rheumatology (ACR) classification criteria, the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria, or the treating rheumatologist's diagnosis. Rates among Manhattan residents were age-standardized, and capture-recapture analyses were conducted to assess case underascertainment. RESULTS By the ACR definition, the age-standardized prevalence and incidence rates of SLE were 62.2 and 4.6 per 100,000 person-years, respectively. Rates were ∼9 times higher in women than in men for prevalence (107.4 versus 12.5) and incidence (7.9 versus 1.0). Compared with non-Hispanic white women (64.3), prevalence was higher among non-Hispanic black (210.9), Hispanic (138.3), and non-Hispanic Asian (91.2) women. Incidence rates were higher among non-Hispanic black women (15.7) compared with non-Hispanic Asian (6.6), Hispanic (6.5), and non-Hispanic white (6.5) women. Capture-recapture adjustment increased the prevalence and incidence rates (75.9 and 6.0, respectively). Alternate SLE definitions without capture-recapture adjustment revealed higher age-standardized prevalence and incidence rates (73.8 and 6.2, respectively, by the SLICC definition and 72.6 and 5.0 by the rheumatologist definition) than the ACR definition, with similar patterns by sex and race/ethnicity. CONCLUSION The MLSP confirms findings from other registries on disparities by sex and race/ethnicity, provides new estimates among Asians and Hispanics, and provides estimates using the SLICC criteria.
Collapse
Affiliation(s)
| | - Isabella Wan
- New York University School of Medicine, New York, New York
| | - Sara Sahl
- New York University School of Medicine, New York, New York
| | - Jill P Buyon
- New York University School of Medicine, New York, New York
| | | | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Anca Askanase
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Joan M Bathon
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Yousaf Ali
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ellen M Ginzler
- State University of New York Downstate College of Medicine, Brooklyn
| | | | | | | | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| |
Collapse
|
36
|
Swendeman SL, Xiong Y, Cantalupo A, Yuan H, Burg N, Hisano Y, Cartier A, Liu CH, Engelbrecht E, Blaho V, Zhang Y, Yanagida K, Galvani S, Obinata H, Salmon JE, Sanchez T, Di Lorenzo A, Hla T. An engineered S1P chaperone attenuates hypertension and ischemic injury. Sci Signal 2017; 10:10/492/eaal2722. [PMID: 28811382 DOI: 10.1126/scisignal.aal2722] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Endothelial dysfunction, a hallmark of vascular disease, is restored by plasma high-density lipoprotein (HDL). However, a generalized increase in HDL abundance is not beneficial, suggesting that specific HDL species mediate protective effects. Apolipoprotein M-containing HDL (ApoM+HDL), which carries the bioactive lipid sphingosine 1-phosphate (S1P), promotes endothelial function by activating G protein-coupled S1P receptors. Moreover, HDL-bound S1P is limiting in several inflammatory, metabolic, and vascular diseases. We report the development of a soluble carrier for S1P, ApoM-Fc, which activated S1P receptors in a sustained manner and promoted endothelial function. In contrast, ApoM-Fc did not modulate circulating lymphocyte numbers, suggesting that it specifically activated endothelial S1P receptors. ApoM-Fc administration reduced blood pressure in hypertensive mice, attenuated myocardial damage after ischemia/reperfusion injury, and reduced brain infarct volume in the middle cerebral artery occlusion model of stroke. Our proof-of-concept study suggests that selective and sustained targeting of endothelial S1P receptors by ApoM-Fc could be a viable therapeutic strategy in vascular diseases.
Collapse
Affiliation(s)
- Steven L Swendeman
- Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Yuquan Xiong
- Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Anna Cantalupo
- Center for Vascular Biology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Hui Yuan
- Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Nathalie Burg
- Center for Vascular Biology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA.,Hospital for Special Surgery, New York, NY 10021, USA
| | - Yu Hisano
- Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Andreane Cartier
- Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Catherine H Liu
- Center for Vascular Biology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Eric Engelbrecht
- Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Victoria Blaho
- Center for Vascular Biology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Yi Zhang
- Center for Vascular Biology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Keisuke Yanagida
- Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Sylvain Galvani
- Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Hideru Obinata
- Gunma University Initiative for Advanced Research, Gunma 371-8511, Japan
| | - Jane E Salmon
- Hospital for Special Surgery, New York, NY 10021, USA
| | - Teresa Sanchez
- Center for Vascular Biology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Annarita Di Lorenzo
- Center for Vascular Biology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Timothy Hla
- Vascular Biology Program, Boston Children's Hospital, Boston, MA 02115, USA. .,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA.,Center for Vascular Biology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| |
Collapse
|
37
|
Arkema EV, Palmsten K, Sjöwall C, Svenungsson E, Salmon JE, Simard JF. What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A Population-Based Study of Maternal and Fetal Outcomes in SLE and Pre-SLE. Arthritis Care Res (Hoboken) 2017; 68:988-94. [PMID: 27338103 PMCID: PMC5094783 DOI: 10.1002/acr.22791] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/16/2015] [Accepted: 11/17/2015] [Indexed: 11/13/2022]
Abstract
Objective To assess maternal and fetal outcomes associated with subclinical (pre‐systemic lupus erythematosus [SLE] and SLE presenting up to 5 years postpartum) and prevalent maternal SLE during pregnancy compared with the general population. Methods This prospective cohort study used population‐based Swedish registers to identify 13,598 women with first singleton pregnancies registered in the Medical Birth Register (551 prevalent SLE, 65 pre‐SLE within 0–2 years, 133 pre‐SLE within 2–5 years, and 12,847 general population). SLE was defined as ≥2 SLE‐coded discharge diagnoses in the patient register with ≥1 diagnosis from a specialist. Unadjusted risks of adverse pregnancy or birth outcomes were calculated by SLE status, and Cochran‐Armitage tests evaluated trend across exposure groups. Results Maternal outcomes such as preeclampsia, hypothyroidism, stroke, and infection were more common among women with SLE. Sixteen percent of prevalent‐SLE pregnancies were diagnosed with preeclampsia compared with 5% of those from the general population. Among the pre‐SLE women, preeclampsia was found in 26% of those with SLE within 2 years postpartum and 13% in those with SLE within 2–5 years postpartum. Similarly, infant outcomes, such as preterm birth, infection, and mortality, were worse among those born to mothers with prevalent SLE and pre‐SLE during pregnancy. The test for trend was significant for most outcomes. Conclusion Our data demonstrate that adverse maternal and fetal outcomes are more common in SLE pregnancies. Furthermore, these unfavorable outcomes are observed in pregnancies occurring prior to the diagnosis of SLE. Thus, the underlying immunologic profile of SLE and alterations preceding clinical SLE may contribute to these pregnancy complications.
Collapse
Affiliation(s)
| | | | | | | | | | - Julia F Simard
- Stanford School of Medicine, Stanford, California, and Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
38
|
Abrahams VM, Chamley LW, Salmon JE. Emerging Treatment Models in Rheumatology: Antiphospholipid Syndrome and Pregnancy: Pathogenesis to Translation. Arthritis Rheumatol 2017; 69:1710-1721. [PMID: 28445926 DOI: 10.1002/art.40136] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/20/2017] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| |
Collapse
|
39
|
Liu K, Kurien BT, Zimmerman SL, Kaufman KM, Taft DH, Kottyan LC, Lazaro S, Weaver CA, Ice JA, Adler AJ, Chodosh J, Radfar L, Rasmussen A, Stone DU, Lewis DM, Li S, Koelsch KA, Igoe A, Talsania M, Kumar J, Maier-Moore JS, Harris VM, Gopalakrishnan R, Jonsson R, Lessard JA, Lu X, Gottenberg JE, Anaya JM, Cunninghame-Graham DS, Huang AJW, Brennan MT, Hughes P, Illei GG, Miceli-Richard C, Keystone EC, Bykerk VP, Hirschfield G, Xie G, Ng WF, Nordmark G, Eriksson P, Omdal R, Rhodus NL, Rischmueller M, Rohrer M, Segal BM, Vyse TJ, Wahren-Herlenius M, Witte T, Pons-Estel B, Alarcon-Riquelme ME, Guthridge JM, James JA, Lessard CJ, Kelly JA, Thompson SD, Gaffney PM, Montgomery CG, Edberg JC, Kimberly RP, Alarcón GS, Langefeld CL, Gilkeson GS, Kamen DL, Tsao BP, McCune WJ, Salmon JE, Merrill JT, Weisman MH, Wallace DJ, Utset TO, Bottinger EP, Amos CI, Siminovitch KA, Mariette X, Sivils KL, Harley JB, Scofield RH. X Chromosome Dose and Sex Bias in Autoimmune Diseases: Increased Prevalence of 47,XXX in Systemic Lupus Erythematosus and Sjögren's Syndrome. Arthritis Rheumatol 2017; 68:1290-1300. [PMID: 26713507 DOI: 10.1002/art.39560] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 12/15/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE More than 80% of autoimmune disease predominantly affects females, but the mechanism for this female bias is poorly understood. We suspected that an X chromosome dose effect accounts for this, and we undertook this study to test our hypothesis that trisomy X (47,XXX; occurring in ∼1 in 1,000 live female births) would be increased in patients with female-predominant diseases (systemic lupus erythematosus [SLE], primary Sjögren's syndrome [SS], primary biliary cirrhosis, and rheumatoid arthritis [RA]) compared to patients with diseases without female predominance (sarcoidosis) and compared to controls. METHODS All subjects in this study were female. We identified subjects with 47,XXX using aggregate data from single-nucleotide polymorphism arrays, and, when possible, we confirmed the presence of 47,XXX using fluorescence in situ hybridization or quantitative polymerase chain reaction. RESULTS We found 47,XXX in 7 of 2,826 SLE patients and in 3 of 1,033 SS patients, but in only 2 of 7,074 controls (odds ratio in the SLE and primary SS groups 8.78 [95% confidence interval 1.67-86.79], P = 0.003 and odds ratio 10.29 [95% confidence interval 1.18-123.47], P = 0.02, respectively). One in 404 women with SLE and 1 in 344 women with SS had 47,XXX. There was an excess of 47,XXX among SLE and SS patients. CONCLUSION The estimated prevalence of SLE and SS in women with 47,XXX was ∼2.5 and ∼2.9 times higher, respectively, than that in women with 46,XX and ∼25 and ∼41 times higher, respectively, than that in men with 46,XY. No statistically significant increase of 47,XXX was observed in other female-biased diseases (primary biliary cirrhosis or RA), supporting the idea of multiple pathways to sex bias in autoimmunity.
Collapse
Affiliation(s)
- Ke Liu
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Biji T Kurien
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA.,U.S. Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA
| | - Sarah L Zimmerman
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kenneth M Kaufman
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,U.S. Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Diana H Taft
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Leah C Kottyan
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara Lazaro
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carrie A Weaver
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John A Ice
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Adam J Adler
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA.,U.S. Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA
| | - James Chodosh
- Department of Ophthalmology, Howe Laboratory, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Lida Radfar
- Department of Oral Diagnosis and Radiology, College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Astrid Rasmussen
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Donald U Stone
- Dean McGee Eye Institute and Department of Ophthalmology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - David M Lewis
- Department of Oral Diagnosis and Radiology, College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Shibo Li
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Kristi A Koelsch
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Ann Igoe
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Mitali Talsania
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Jay Kumar
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Jacen S Maier-Moore
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA.,U.S. Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA.,Department of Clinical Laboratory Sciences, University of Texas at El Paso, El Paso, TX 79968
| | - Valerie M Harris
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Rajaram Gopalakrishnan
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen 5021, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen 5021, Norway
| | - James A Lessard
- Valley Bone & Joint Clinic, 3035 DeMers Avenue, Grand Forks, ND 58201, USA
| | - Xianglan Lu
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | | | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Deborah S Cunninghame-Graham
- Division of Genetics and Molecular Medicine and Division of Immunology, Infection and Inflammatory Disease, King's College London, London
| | - Andrew J W Huang
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC 28232, USA
| | - Pamela Hughes
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Gabor G Illei
- Sjögren's Syndrome Clinic, National Institute of Dental and Craniofacial Research, Molecular Physiology and Therapeutics Branch, National Institutes of Health, Bethesda, MD 20892, USA
| | - Corinne Miceli-Richard
- Department of Rheumatology, Université Paris-Sud, AP-HP, INSERM U1012, Le Kremlin-Bicêtre, France
| | - Edward C Keystone
- Department of Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario
| | | | | | - Gang Xie
- Lunenfeld Tanenbaum and Toronto General Research Institutes, Departments of Medicine, Immunology and Molecular Genetics, University of Toronto, Toronto Ontario
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine & NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gunnel Nordmark
- Section of Rheumatology, Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Per Eriksson
- Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Roald Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Nelson L Rhodus
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - Maureen Rischmueller
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
| | - Michael Rohrer
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Barbara M Segal
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Timothy J Vyse
- Division of Genetics and Molecular Medicine and Division of Immunology, Infection and Inflammatory Disease, King's College London, London
| | | | - Torsten Witte
- Clinic for Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany
| | | | - Marta E Alarcon-Riquelme
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA.,Center Pfizer, University of Granada, Andalusian Government for Genomics and Oncological Research, PTS Granada, 18016, Spain
| | - Joel M Guthridge
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Judith A James
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Christopher J Lessard
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Jennifer A Kelly
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Susan D Thompson
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Patrick M Gaffney
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Courtney G Montgomery
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Jeffrey C Edberg
- Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, AL
| | - Robert P Kimberly
- Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, AL
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, AL
| | - Carl L Langefeld
- Center for Public Health Genomics and Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC
| | - Gary S Gilkeson
- Division of Rheumatology & Immunology, Medical University of South Carolina, Charleston, SC.,Ralph H. Johnson VA Medical Center, Charleston, SC
| | - Diane L Kamen
- Division of Rheumatology & Immunology, Medical University of South Carolina, Charleston, SC
| | - Betty P Tsao
- Division of Rheumatology, Department of Medicine, UCLA School of Medicine
| | - W Joseph McCune
- Division of Rheumatology, Department of Medicine, University of Michigan College of Medicine, Ann Arbor, Michigan
| | - Jane E Salmon
- Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY
| | - Joan T Merrill
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel J Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tammy O Utset
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Erwin P Bottinger
- Charles R. Bronfman Institute for personalized medicine, Mount Sinai Hospital, 1468 Madison Avenue, New York, NY 10029
| | - Christopher I Amos
- Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Katherine A Siminovitch
- Lunenfeld Tanenbaum and Toronto General Research Institutes, Departments of Medicine, Immunology and Molecular Genetics, University of Toronto, Toronto Ontario
| | - Xavier Mariette
- Rhumatologie, Responsable de l'Unité de Recherche Clinique Hôpitaux Universitaire Paris-Sud Université Paris-Sud, INSERM U1184 Head of Autoimmunity team, IMVA : Immunology of viral Infections and Autoimmune Diseases
| | - Kathy L Sivils
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - John B Harley
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,U.S. Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - R Hal Scofield
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.,Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA.,U.S. Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA
| |
Collapse
|
40
|
Yelnik CM, Porter TF, Branch DW, Laskin CA, Merrill JT, Guerra MM, Lockshin MD, Buyon JP, Petri M, Sammaritano LR, Stephenson MD, Kim MY, Salmon JE. Brief Report: Changes in Antiphospholipid Antibody Titers During Pregnancy: Effects on Pregnancy Outcomes. Arthritis Rheumatol 2017; 68:1964-9. [PMID: 26990620 DOI: 10.1002/art.39668] [Citation(s) in RCA: 28] [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: 10/29/2015] [Accepted: 02/25/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To measure variance in antiphospholipid antibody (aPL) levels during pregnancy and to determine if variation affects pregnancy outcomes. METHODS We used data from the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study, a multicenter prospective study of pregnant women with aPL and/or systemic lupus erythematosus (SLE). Antiphospholipid antibodies were considered present if any of the following were positive: anticardiolipin (aCL), anti-β2 -glycoprotein I (anti-β2 GPI) titers ≥40 IgG phospholipid (GPL) or IgM phospholipid (MPL) units, and/or lupus anticoagulant (LAC). Antiphospholipid antibodies were measured every trimester and postpartum. Adverse pregnancy outcomes were defined as fetal/neonatal death, preterm delivery (<36 weeks) due to preeclampsia or placental insufficiency, or growth restriction. RESULTS One hundred fifty-two aPL-positive patients were studied. Fifty-seven percent had clinical antiphospholipid syndrome (APS) and 36% had SLE. IgG aPL levels were significantly lower during the second and third trimesters compared to initial screening, but IgG aCL and anti-β2 GPI remained high-positive through pregnancy in 93% of patients during the second trimester, and in 85% of patients during the third trimester. IgM aPL titers were negative in the majority of patients and decreased modestly during pregnancy among patients who were positive. LAC frequency also decreased, but 75% of patients remained positive through the second trimester. Only 4% of patients with aPL at baseline did not have aPL in either the second or third trimesters. Changes in aPL levels or aPL status were not associated with adverse pregnancy outcomes. LAC was the only aPL associated with adverse pregnancy outcomes. CONCLUSION The aPL in the cohort decreased marginally during pregnancy, and changes were not associated with pregnancy outcomes. Our results suggest that, among women with aPL and/or SLE, measuring aPL early in pregnancy is sufficient to assess risk. Repeat aPL testing through pregnancy is unnecessary.
Collapse
Affiliation(s)
| | - T Flint Porter
- University of Utah and Intermountain Healthcare, Salt Lake City, Utah
| | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, Utah
| | - Carl A Laskin
- Carl A. Laskin, MD, University of Toronto and LifeQuest Centre for Reproductive Medicine, Toronto, Ontario, Canada
| | | | | | | | - Jill P Buyon
- New York University School of Medicine, New York, New York
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Mimi Y Kim
- Albert Einstein College of Medicine, Bronx, New York
| | | |
Collapse
|
41
|
Lokki AI, Daly E, Triebwasser M, Kurki MI, Roberson EDO, Häppölä P, Auro K, Perola M, Heinonen S, Kajantie E, Kere J, Kivinen K, Pouta A, Salmon JE, Meri S, Daly M, Atkinson JP, Laivuori H. Protective Low-Frequency Variants for Preeclampsia in the Fms Related Tyrosine Kinase 1 Gene in the Finnish Population. Hypertension 2017; 70:365-371. [PMID: 28652462 DOI: 10.1161/hypertensionaha.117.09406] [Citation(s) in RCA: 17] [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] [Received: 03/17/2017] [Revised: 04/04/2017] [Accepted: 05/28/2017] [Indexed: 12/11/2022]
Abstract
Preeclampsia is a common pregnancy-specific vascular disorder characterized by new-onset hypertension and proteinuria during the second half of pregnancy. Predisposition to preeclampsia is in part heritable. It is associated with an increased risk of cardiovascular disease later in life. We have sequenced 124 candidate genes implicated in preeclampsia to pinpoint genetic variants contributing to predisposition to or protection from preeclampsia. First, targeted exomic sequencing was performed in 500 preeclamptic women and 190 controls from the FINNPEC cohort (Finnish Genetics of Preeclampsia Consortium). Then 122 women with a history of preeclampsia and 1905 parous women with no such history from the National FINRISK Study (a large Finnish population survey on risk factors of chronic, noncommunicable diseases) were included in the analyses. We tested 146 rare and low-frequency variants and found an excess (observed 13 versus expected 7.3) nominally associated with preeclampsia (P<0.05). The most significantly associated sequence variants were protective variants rs35832528 (E982A; P=2.49E-4; odds ratio=0.387) and rs141440705 (R54S; P=0.003; odds ratio=0.442) in Fms related tyrosine kinase 1. These variants are enriched in the Finnish population with minor allele frequencies 0.026 and 0.017, respectively. They may also be associated with a lower risk of heart failure in 11 257 FINRISK women. This study provides the first evidence of maternal protective genetic variants in preeclampsia.
Collapse
Affiliation(s)
- A Inkeri Lokki
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.).
| | - Emma Daly
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Michael Triebwasser
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Mitja I Kurki
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Elisha D O Roberson
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Paavo Häppölä
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Kirsi Auro
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Markus Perola
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Seppo Heinonen
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Eero Kajantie
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Juha Kere
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Katja Kivinen
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Anneli Pouta
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Jane E Salmon
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Seppo Meri
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Mark Daly
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - John P Atkinson
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.)
| | - Hannele Laivuori
- From the Immunobiology, Research Programs Unit (A.I.L., S.M.), Molecular Neurology, Research Programs Unit (J.K.), and Institute for Molecular Medicine Finland/HiLIFE Unit (P.H., K.A., M.P., H.L.), University of Helsinki, Finland; Medical and Clinical Genetics (A.I.L., H.L.), Bacteriology and Immunology (A.I.L., S.M.), Obstetrics and Gynaecology (K.A., S.H., H.L.), and Children's Hospital (E.K), University of Helsinki and Helsinki University Hospital, Finland; Folkhälsan Institute of Genetics (J.K.), University of Helsinki, Finland; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA (E.D., M.I.K., M.D.); Department of Medicine, Division of Rheumatology (M.T., E.D.O.R., J.P.A.) and Department of Genetics (E.D.O.R.), Washington University School of Medicine, St. Louis, MO; Neurosurgery of Neuro Center, Kuopio University Hospital, Finland (M.I.K.); Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston (M.I.K.); Unit of Genetics and Biomarkers (K.A.), Department of Health (M.P., E.K.), Chronic Disease Prevention Unit, Department of Health (E.K.), and Department of Government Services (A.P.), National Institute for Health and Welfare, Helsinki, Finland; The Estonian Genome Center, University of Tartu, Estonia (M.P.); PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Finland (E.K., A.P.); Department of Biosciences and Nutrition, Karolinska Institutet, Solna, Sweden (J.K.); Department of Medical and Molecular Genetics, King's College, London, United Kingdom (J.K.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (K.K.); Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY (J.E.S.); and Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (M.D.).
| |
Collapse
|
42
|
Buyon JP, Kim MY, Guerra MM, Lu S, Reeves E, Petri M, Laskin CA, Lockshin MD, Sammaritano LR, Branch DW, Porter TF, Sawitzke A, Merrill JT, Stephenson MD, Cohn E, Salmon JE. Kidney Outcomes and Risk Factors for Nephritis (Flare/ De Novo) in a Multiethnic Cohort of Pregnant Patients with Lupus. Clin J Am Soc Nephrol 2017; 12:940-946. [PMID: 28400421 PMCID: PMC5460714 DOI: 10.2215/cjn.11431116] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/16/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Kidney disease is a critical concern in counseling patients with lupus considering pregnancy. This study sought to assess the risk of renal flares during pregnancy in women with previous lupus nephritis in partial or complete remission, particularly in those with antidouble-stranded DNA antibodies and low complement levels, and the risk of new-onset nephritis in patients with stable/mildly active SLE. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We assessed active nephritis (renal flares and de novo kidney disease) and associated predictors during pregnancy in patients with lupus with urine protein ≤1000 mg and serum creatinine <1.2 mg/dl at baseline; 373 patients (52% ethnic/racial minorities) enrolled between 2003 and 2012 were prospectively followed in the Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus Study. Active nephritis was defined by proteinuria increase of >500 mg and/or red blood cell casts. RESULTS Of 118 patients with previous kidney disease, 13 renal flares (11%) occurred (seven of 89 in complete remission and six of 29 in partial remission) compared with four with de novo kidney involvement (2%) in 255 patients without past kidney disease (P<0.001). Active nephritis was not associated with ethnicity, race, age, creatinine, BP, or antihypertensive and other medications. In multivariable logistic regression analyses, patients with past kidney disease in complete or partial remission more often experienced active nephritis (adjusted odds ratio, 6.88; 95% confidence interval, 1.84 to 25.71; P=0.004 and adjusted odds ratio, 20.98; 95% confidence interval, 4.69 to 93.98; P<0.001, respectively) than those without past kidney disease. Low C4 was associated with renal flares/de novo disease (adjusted odds ratio, 5.59; 95% confidence interval, 1.64 to 19.13; P<0.01) but not low C3 or positive anti-dsDNA alone. CONCLUSIONS De novo kidney involvement in SLE, even in ethnic/racial minorities, is uncommon during pregnancy. Past kidney disease and low C4 at baseline independently associate with higher risk of developing active nephritis. Antibodies to dsDNA alone should not raise concern, even in patients with past kidney disease, if in remission.
Collapse
Affiliation(s)
- Jill P Buyon
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Antiphospholipid syndrome (APS) is characterized by thrombosis (arterial, venous, small vessel) and/or pregnancy morbidity occurring in patients with persistently positive antiphospholipid antibodies (aPL). Catastrophic APS is the most severe form of the disease, characterized by multiple organ thromboses occurring in a short period and commonly associated with thrombotic microangiopathy (TMA). Similar to patients with complement regulatory gene mutations developing TMA, increased complement activation on endothelial cells plays a role in hypercoagulability in aPL-positive patients. In mouse models of APS, activation of the complement is required and interaction of complement (C) 5a with its receptor C5aR leads to aPL-induced inflammation, placental insufficiency, and thrombosis. Anti-C5 antibody and C5aR antagonist peptides prevent aPL-mediated pregnancy loss and thrombosis in these experimental models. Clinical studies of anti-C5 monoclonal antibody in aPL-positive patients are limited to a small number of case reports. Ongoing and future clinical studies of complement inhibitors will help determine the role of complement inhibition in the management of aPL-positive patients.
Collapse
Affiliation(s)
- Doruk Erkan
- Hospital for Special Surgery, Weill Cornell Medicine, New York, United States. Phone : +90 212 774 22 91 E-mail :
| | | |
Collapse
|
44
|
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that occurs during childbearing years and has been associated with preeclampsia. However, little is known about preeclampsia of early onset, which is associated with severe adverse maternal and perinatal outcomes. METHODS Using national population-based Swedish registers we identified women with SLE (≥2 visits with corresponding ICD codes) and a sample without SLE who gave birth to singleton infants 2001-12. Risk ratios (RR) and 95% confidence intervals (CI) for early-onset preeclampsia (defined by ICD codes corresponding to preeclampsia registered at <34 weeks) in SLE women were calculated based on adjusted modified Poisson models for first, subsequent, and all pregnancies. RESULT Among 742 births to women with SLE and 10 484 births to non-SLE women, there were 32 (4.3%) and 55 (0.5%) diagnoses of early-onset preeclampsia respectively. SLE was associated with an increased risk of early-onset preeclampsia (RR 7.8, 95% CI 4.8, 12.9, all pregnancies). The association remained similar upon restriction to women without pregestational hypertension. Adjustment for antiphospholipid syndrome (APS)-proxy attenuated the association. RRs for early-onset preeclampsia were smaller for subsequent pregnancies (RR 4.7, 95% CI 2.0, 11.2) compared to first and all (see above). CONCLUSION Women with SLE are at increased risk of early-onset preeclampsia and this increased risk may be independent of the traditional risk factors such as pregestational hypertension, APS, BMI, or smoking. Women with SLE during pregnancy should be closely monitored for early-onset preeclampsia and future research needs to identify the non-traditional preeclampsia factors that might cause this serious outcome.
Collapse
Affiliation(s)
- Julia F Simard
- Division of Epidemiology, Department of Health Research and Policy, Stanford School of Medicine, Stanford, CA,Division of Immunology and Rheumatology, Department of Medicine, Stanford School of Medicine, Stanford, CA,Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Elizabeth V Arkema
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Cathina Nguyen
- Division of Epidemiology, Department of Health Research and Policy, Stanford School of Medicine, Stanford, CA
| | - Elisabet Svenungsson
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Anna-Karin Wikstrom
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden,Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Kristin Palmsten
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Jane E Salmon
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| |
Collapse
|
45
|
Arkema EV, Askling J, Salmon JE, Simard JF. Brief Report: Sex Ratio of Offspring Born to Women With Systemic Lupus Erythematosus or Rheumatoid Arthritis. Arthritis Rheumatol 2016; 69:143-147. [PMID: 27564656 DOI: 10.1002/art.39843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/09/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether the sex ratio among offspring born to women with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) is different from that in the general population. METHODS Women with a singleton delivery were identified from the Swedish Medical Birth Register (1973-2012) and linked to the National Patient Register (1964-2012) to identify those with prevalent SLE or RA. A sample of general population comparators was identified from the Swedish Total Population Register. We calculated the percentages of males born to women with SLE, women with RA, and women in the general population, as well as the risk ratio (RR) for having a male child among first births and all births. We also examined a history of antiphospholipid syndrome in the SLE population, using International Classification of Disease codes before or at delivery. RESULTS We identified 661 women with SLE and 1,136 women with RA before their first delivery. There were a total of 1,401 deliveries to women with SLE and a total of 2,674 deliveries to women with RA. Compared with women in the general population, women with SLE and those with RA had a lower risk of having a first-born male (RR 0.92 [95% confidence interval 0.85-1.00] and RR 0.93 [95% confidence interval 0.87-0.99], respectively). Among all births, the percentage of male offspring remained lower than that in the general population, but the difference was not statistically significant for RA. CONCLUSION The proportion of male offspring born to women with prevalent SLE or RA at delivery was lower than that in the general population, although the difference was small. Chronic inflammation may affect the sex ratio through fetal loss in early gestation.
Collapse
Affiliation(s)
| | | | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Julia F Simard
- Karolinska Institutet, Stockholm, Sweden, and Stanford School of Medicine, Stanford, California
| |
Collapse
|
46
|
Rozo C, Chinenov Y, Maharaj RK, Gupta S, Leuenberger L, Kirou KA, Bykerk VP, Goodman SM, Salmon JE, Pernis AB. Targeting the RhoA-ROCK pathway to reverse T-cell dysfunction in SLE. Ann Rheum Dis 2016; 76:740-747. [PMID: 28283529 DOI: 10.1136/annrheumdis-2016-209850] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/04/2016] [Accepted: 10/09/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Deregulated production of interleukin (IL)-17 and IL-21 contributes to the pathogenesis of autoimmune disorders such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Production of IL-17 and IL-21 can be regulated by ROCK2, one of the two Rho kinases. Increased ROCK activation was previously observed in an SLE cohort. Here, we evaluated ROCK activity in a new SLE cohort, and an RA cohort, and assessed the ability of distinct inhibitors of the ROCK pathway to suppress production of IL-17 and IL-21 by SLE T cells or human Th17 cells. METHODS ROCK activity in peripheral blood mononuclear cells (PBMCs) from 29 patients with SLE, 31 patients with RA and 28 healthy controls was determined by ELISA. SLE T cells or in vitro-differentiated Th17 cells were treated with Y27632 (a pan-ROCK inhibitor), KD025 (a selective ROCK2 inhibitor) or simvastatin (which inhibits RhoA, a major ROCK activator). ROCK activity and IL-17 and IL-21 production were assessed. The transcriptional profile altered by ROCK inhibitors was evaluated by NanoString technology. RESULTS ROCK activity levels were significantly higher in patients with SLE and RA than healthy controls. Th17 cells exhibited high ROCK activity that was inhibited by Y27632, KD025 or simvastatin; each also decreased IL-17 and IL-21 production by purified SLE T cells or Th17 cells. Immune profiling revealed both overlapping and distinct effects of the different ROCK inhibitors. CONCLUSIONS ROCK activity is elevated in PBMCs from patients with SLE and RA. Production of IL-17 and IL-21 by SLE T cells or Th17 cells can furthermore be inhibited by targeting the RhoA-ROCK pathway via both non-selective and selective approaches.
Collapse
Affiliation(s)
- Cristina Rozo
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, New York, USA
| | - Yurii Chinenov
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, New York, USA.,David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
| | - Reena Khianey Maharaj
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, New York, USA
| | - Sanjay Gupta
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, New York, USA
| | - Laura Leuenberger
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, New York, USA
| | - Kyriakos A Kirou
- Department of Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Vivian P Bykerk
- Department of Rheumatology, Hospital for Special Surgery, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Susan M Goodman
- Department of Rheumatology, Hospital for Special Surgery, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Jane E Salmon
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, New York, USA.,Department of Rheumatology, Hospital for Special Surgery, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Alessandra B Pernis
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, New York, USA.,David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| |
Collapse
|
47
|
Qing X, Rogers L, Mortha A, Lavin Y, Redecha P, Issuree PD, Maretzky T, Merad M, McIlwain D, Mak TW, Overall CM, Blobel CP, Salmon JE. iRhom2 regulates CSF1R cell surface expression and non-steady state myelopoiesis in mice. Eur J Immunol 2016; 46:2737-2748. [PMID: 27601030 DOI: 10.1002/eji.201646482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/28/2016] [Accepted: 09/02/2016] [Indexed: 12/30/2022]
Abstract
CSF1R (colony stimulating factor 1 receptor) is the main receptor for CSF1 and has crucial roles in regulating myelopoeisis. CSF1R can be proteolytically released from the cell surface by ADAM17 (A disintegrin and metalloprotease 17). Here, we identified CSF1R as a major substrate of ADAM17 in an unbiased degradomics screen. We explored the impact of CSF1R shedding by ADAM17 and its upstream regulator, inactive rhomboid protein 2 (iRhom2, gene name Rhbdf2), on homeostatic development of mouse myeloid cells. In iRhom2-/- mice, we found constitutive accumulation of membrane-bound CSF1R on myeloid cells at steady state, although cell numbers of these populations were not altered. However, in the context of mixed bone marrow (BM) chimera, under competitive pressure, iRhom2-/- BM progenitor-derived monocytes, tissue macrophages and lung DCs showed a repopulation advantage over those derived from wild-type (WT) BM progenitors, suggesting enhanced CSF1R signaling in the absence of iRhom2. In vitro experiments indicate that iRhom2-/- Lin- SCA-1+ c-Kit+ (LSKs) cells, but not granulocyte-macrophage progenitors (GMPs), had faster growth rates than WT cells in response to CSF1. Our results shed light on an important role of iRhom2/ADAM17 pathway in regulation of CSF1R shedding and repopulation of monocytes, macrophages and DCs.
Collapse
Affiliation(s)
- Xiaoping Qing
- Program in Inflammation and Autoimmunity, Hospital for Special Surgery, 535 East 71 St., New York, NY 10021, USA
| | - Lindsay Rogers
- Centre for Blood Research, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Arthur Mortha
- Department of Oncological Sciences, Tisch Cancer Institute and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York City, New York 10029, USA
| | - Yonit Lavin
- Department of Oncological Sciences, Tisch Cancer Institute and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York City, New York 10029, USA
| | - Patricia Redecha
- Program in Inflammation and Autoimmunity, Hospital for Special Surgery, 535 East 71 St., New York, NY 10021, USA
| | - Priya D Issuree
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Thorsten Maretzky
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery, New York, NY 10021, USA
| | - Miriam Merad
- Department of Oncological Sciences, Tisch Cancer Institute and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York City, New York 10029, USA
| | - David McIlwain
- Baxter Laboratory in Stem Cell Biology, Department of Microbiology and Immunology, Stanford University, Stanford, CA 94305
| | - Tak W Mak
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Center, University Health Network, Toronto, ON, M5G 2M9, Canada
| | - Christopher M Overall
- Centre for Blood Research, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Carl P Blobel
- Department of Medicine, Weill Medical College of Cornell University, New York, New York 10021, USA.,Department of Physiology, Systems Biology and Biophysics, Weill Medical College of Cornell University, New York, New York 10021, USA
| | - Jane E Salmon
- Program in Inflammation and Autoimmunity, Hospital for Special Surgery, 535 East 71 St., New York, NY 10021, USA.,Department of Medicine, Weill Medical College of Cornell University, New York, New York 10021, USA
| |
Collapse
|
48
|
Mineo C, Lanier L, Jung E, Sengupta S, Ulrich V, Sacharidou A, Tarango C, Osunbunmi O, Shen YM, Salmon JE, Brekken RA, Huang X, Thorpe PE, Shaul PW. Identification of a Monoclonal Antibody That Attenuates Antiphospholipid Syndrome-Related Pregnancy Complications and Thrombosis. PLoS One 2016; 11:e0158757. [PMID: 27463336 PMCID: PMC4963039 DOI: 10.1371/journal.pone.0158757] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/21/2016] [Indexed: 11/18/2022] Open
Abstract
In the antiphospholipid syndrome (APS), patients produce antiphospholipid antibodies (aPL) that promote thrombosis and adverse pregnancy outcomes. Current therapy with anticoagulation is only partially effective and associated with multiple complications. We previously discovered that aPL recognition of cell surface β2-glycoprotein I (β2-GPI) initiates apolipoprotein E receptor 2 (apoER2)-dependent signaling in endothelial cells and in placental trophoblasts that ultimately promotes thrombosis and fetal loss, respectively. Here we sought to identify a monoclonal antibody (mAb) to β2-GPI that negates aPL-induced processes in cell culture and APS disease endpoints in mice. In a screen measuring endothelial NO synthase (eNOS) activity in cultured endothelial cells, we found that whereas aPL inhibit eNOS, the mAb 1N11 does not, and instead 1N11 prevents aPL action. Coimmunoprecipitation studies revealed that 1N11 decreases pathogenic antibody binding to β2-GPI, and it blocks aPL-induced complex formation between β2-GPI and apoER2. 1N11 also prevents aPL antagonism of endothelial cell migration, and in mice it reverses the impairment in reendothelialization caused by aPL, which underlies the non-thrombotic vascular occlusion provoked by disease-causing antibodies. In addition, aPL inhibition of trophoblast proliferation and migration is negated by 1N11, and the more than 6-fold increase in fetal resorption caused by aPL in pregnant mice is prevented by 1N11. Furthermore, the promotion of thrombosis by aPL is negated by 1N11. Thus, 1N11 has been identified as an mAb that attenuates APS-related pregnancy complications and thrombosis in mice. 1N11 may provide an efficacious, mechanism-based therapy to combat the often devastating conditions suffered by APS patients.
Collapse
Affiliation(s)
- Chieko Mineo
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail: (CM); (PWS)
| | - Lane Lanier
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Eunjeong Jung
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Samarpita Sengupta
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Victoria Ulrich
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Anastasia Sacharidou
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Cristina Tarango
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Olutoye Osunbunmi
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Yu-Min Shen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Jane E. Salmon
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States of America
| | - Rolf A. Brekken
- Department of Pharmacology and the Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Xianming Huang
- Department of Pharmacology and the Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Philip E. Thorpe
- Department of Pharmacology and the Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Philip W. Shaul
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail: (CM); (PWS)
| |
Collapse
|
49
|
Ulrich V, Gelber SE, Vukelic M, Sacharidou A, Herz J, Urbanus RT, de Groot PG, Natale DR, Harihara A, Redecha P, Abrahams VM, Shaul PW, Salmon JE, Mineo C. ApoE Receptor 2 Mediation of Trophoblast Dysfunction and Pregnancy Complications Induced by Antiphospholipid Antibodies in Mice. Arthritis Rheumatol 2016; 68:730-739. [PMID: 26474194 DOI: 10.1002/art.39453] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/24/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Pregnancies in women with the antiphospholipid syndrome (APS) are frequently complicated by fetal loss and intrauterine growth restriction (IUGR). How circulating antiphospholipid antibodies (aPL) cause pregnancy complications in APS is poorly understood. We sought to determine whether the low-density lipoprotein receptor family member apolipoprotein E receptor 2 (ApoER2) mediates trophoblast dysfunction and pregnancy complications induced by aPL. METHODS Placental and trophoblast ApoER2 expression was evaluated by immunohistochemistry and immunoblotting. Normal human IgG and aPL were purified from healthy individuals and APS patients, respectively. The role of ApoER2 in aPL-induced changes in trophoblast proliferation and migration and in kinase activation was assessed using RNA interference in HTR-8/SVneo cells. The participation of ApoER2 in aPL-induced pregnancy loss and IUGR was evaluated in pregnant ApoER2(+/+) and ApoER2(-/-) mice injected with aPL or normal human IgG. RESULTS We found that ApoER2 is abundant in human and mouse placental trophoblasts and in multiple trophoblast-derived cell lines, including HTR-8/SVneo cells. ApoER2 and its interaction with the cell surface protein β2 -glycoprotein I were required for aPL-induced inhibition of cultured trophoblast proliferation and migration. In parallel, aPL antagonism of Akt kinase activation by epidermal growth factor in trophoblasts was mediated by ApoER2. Furthermore, in a murine passive-transfer model of pregnancy complications of APS, ApoER2(-/-) mice were protected from both aPL-induced fetal loss and aPL-induced IUGR. CONCLUSION ApoER2 plays a major role in the attenuation of trophoblast function by aPL, and the receptor mediates aPL-induced pregnancy complications in vivo in mice. ApoER2-directed interventions can now potentially be developed to combat the pregnancy complications associated with APS.
Collapse
Affiliation(s)
- Victoria Ulrich
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shari E Gelber
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Milena Vukelic
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Anastasia Sacharidou
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joachim Herz
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rolf T Urbanus
- Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Philip G de Groot
- Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David R Natale
- Department of Reproductive Medicine, University of California-San Diego, San Diego, California
| | - Anirudha Harihara
- Department of Reproductive Medicine, University of California-San Diego, San Diego, California
| | - Patricia Redecha
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology & Reproductive Sciences, Divisions of Reproductive Sciences and Maternal-Fetal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Philip W Shaul
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jane E Salmon
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - Chieko Mineo
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
50
|
Willis R, Pierangeli SS, Jaskowski TD, Malmberg E, Guerra M, Salmon JE, Petri M, Branch DW, Tebo AE. Performance Characteristics of Commercial Immunoassays for the Detection of IgG and IgM Antibodies to β2 Glycoprotein I and an Initial Assessment of Newly Developed Reference Materials for Assay Calibration. Am J Clin Pathol 2016; 145:796-805. [PMID: 27267373 DOI: 10.1093/ajcp/aqw065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the performance characteristics and impact of newly developed reference calibrators on the commutability between anti-β2 glycoprotein I (anti-β2 GPI) immunoassays in antiphospholipid syndrome (APS) and/or systemic lupus erythematosus (SLE). METHODS Immunoglobulin G (IgG) and immunoglobulin M (IgM) anti-β2 GPI immunoassays from four manufacturers were evaluated. Serum samples from 269 patients (APS only, n = 31; SLE and APS, n = 83; SLE only, n = 129; pregnancy-related clinical manifestations without APS, n = 26) and 162 women with histories of successful pregnancies were tested. Results were expressed in kit-specific arbitrary units and in the calibrator reference units (RUs) based on 99th percentile cutoff values. Diagnostic accuracies, correlation between kits, and specific clinical manifestations in APS were investigated. RESULTS The sensitivities of the assays ranged from 15.8% to 27.2% (IgG) and 12.3% to 15.8% (IgM) while specificities ranged from 79.4% to 86.5% (IgG) and 80.6% to 84.5% (IgM). There was moderate to almost perfect interassay reliability (Cohen κ, 0.69-0.98), and Spearman correlation coefficients were generally improved when results of the IgG determinations were expressed in RUs. CONCLUSIONS Although qualitative agreements between immunoassays for both antibody isotypes are acceptable, correlations with APS clinical manifestations were kit dependent. Only the use of IgG reference material improved quantitative correlations between assays.
Collapse
Affiliation(s)
- Rohan Willis
- From Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| | - Silvia S Pierangeli
- From Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston
| | - Troy D Jaskowski
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT
| | - Elisabeth Malmberg
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT
| | - Marta Guerra
- Rheumatology, Hospital for Special Surgery, New York, NY
| | - Jane E Salmon
- Rheumatology, Hospital for Special Surgery, New York, NY
| | - Michelle Petri
- Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D Ware Branch
- Maternal Fetal Medicine, University of Utah and Intermountain Healthcare, Salt Lake City
| | - Anne E Tebo
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT Department of Pathology, University of Utah, Salt Lake City.
| |
Collapse
|