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Malakooti SK, Siddiqui H, Wilson B, Bej T, O’Mara M, Desotelle A, Lange A, Shive CL, Singer NG, McComsey GA, Kostadinova L, Mattar M, Zidar DA, Anthony DD. Higher Vitamin D Levels before Methotrexate Therapy Initiation Are Associated with Lower Subsequent Mortality in Patients with Rheumatoid Arthritis. Nutrients 2024; 16:401. [PMID: 38337687 PMCID: PMC10857393 DOI: 10.3390/nu16030401] [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: 01/08/2024] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Vitamin D deficiency is associated with mortality in the general population and has been observed in one rheumatoid arthritis (RA) cohort. Here, we investigate the relationship between 25-hydroxyvitamin D (25(OH)D) levels before methotrexate (MTX) therapy initiation in patients with RA and the subsequent all-cause mortality in a national Veterans Affairs (VA) cohort. (2) This is a retrospective study on RA patients time-oriented around the initial MTX prescription and 25(OH)D levels before starting MTX. We examined survival in patients with 25(OH)D levels > 50 nmol/L and ≤50 nmol/L using the Cox Proportional Hazard Model and fully adjusted for risk factors. (3) In total, 15,109 RA patients were included in the nationwide cohort. RA patients with 25(OH)D levels > 50 nmol/L before starting MTX had a 28% reduced risk of mortality when compared to those with levels ≤ 50 nmol/L (HR: 0.72, CI: 0.64-0.80, p < 0.001) after adjusting for traditional risk factors. (4) In this national RA cohort receiving standard-of-care MTX, patients with 25(OH)D levels > 50 nmol/L have a lower subsequent mortality when compared to those with 25(OH)D levels ≤ 50 nmol/L. It remains to be determined whether increasing Vitamin D levels in RA patients initially found to be Vitamin D deficient impacts their all-cause mortality.
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Affiliation(s)
- Shahdi K. Malakooti
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Hinnah Siddiqui
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Brigid Wilson
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Taissa Bej
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Megan O’Mara
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Alexandra Desotelle
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Alyssa Lange
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Carey L. Shive
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Nora G. Singer
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA
| | - Grace A. McComsey
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Lenche Kostadinova
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Maya Mattar
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - David A. Zidar
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
| | - Donald D. Anthony
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA; (H.S.); (B.W.)
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Kostadinova L, Lange A, Damjanovska S, Gad I, Syed S, Siddiqui H, Yousif P, Kowal CM, Shive C, Burant C, Singer N, Bej T, Al-Kindi S, Wilson B, Mattar M, Zidar DA, Anthony DD. Dr. Kostadinova et al reply. J Rheumatol 2023; 50:1356. [PMID: 37399468 DOI: 10.3899/jrheum.2023-0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- Lenche Kostadinova
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Alyssa Lange
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sofi Damjanovska
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Ibtissam Gad
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sameena Syed
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Husna Siddiqui
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Patrick Yousif
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Corinne M Kowal
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Carey Shive
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
- Department of Pathology, Case Western Reserve University
| | - Christopher Burant
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Nora Singer
- Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Taissa Bej
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sadeer Al-Kindi
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Brigid Wilson
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Maya Mattar
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - David A Zidar
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Donald D Anthony
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University;
- Department of Pathology, Case Western Reserve University
- Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Dudley HM, O'Mara M, Auma A, Gong J, Ross Y, Gurevich N, Carbone S, Reihs A, Nguyen Y, McComsey GA, Cao Y, Balazs AB, Gordesky L, Payne M, Singer N, Kostadinova L, Wilson B, Zidar DA, King CL, Canaday DH, Shive CL, Mattar MM, Anthony DD. Rheumatoid arthritis and older age are associated with lower humoral and cellular immune response to primary series COVID-19 mRNA vaccine. Vaccine 2023; 41:6112-6119. [PMID: 37659895 DOI: 10.1016/j.vaccine.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE People with autoimmune disease have worse COVID-19 infection-related outcomes, lower antibody responses to COVID-19 vaccine, and higher rates of breakthrough infection. Immunosuppressive medications used to treat rheumatoid arthritis (RA) are associated with lower COVID-19 vaccine responses, though independent contributions of comorbidities, T-cell immunity, and age are less clear. We sought to test the hypothesis that RA, immunosuppressive medications used to treat RA, and older age, contribute to reduced B and T cell response to COVID-19 vaccine. METHODS We evaluated serum samples, taken the day of 1st vaccine dose, the day of 2nd dose, 2-6 weeks after 2nd dose, 7-12 weeks after 2nd dose, 13-24 weeks after 2nd dose, and 2-6 weeks after the 3rd dose, for anti-spike IgG and neutralizing antibody levels to Wuhan and Omicron BA.1 and peripheral blood mononuclear cells (PBMC) for spike-specific IFN-γ and IL-2 production by ELISPOT assay in 46 RA and 101 non-autoimmune control participants before and after the primary series COVID-19 mRNA vaccination. RESULTS RA participants had lower spike-specific IgG and Wuhan-strain neutralizing antibody levels 2-6 weeks compared to controls after the second dose of primary vaccine series. Neutralizing antibody levels against Omicron BA.1 were low in both groups. IFN-γ production correlated with Wuhan neutralizing antibody levels, while older age negatively correlated with spike-specific IL-2, IFN-γ and IgG. Lower antibody levels were associated with older age, RA status, and medication usage, while lower T cell responses were associated primarily with older age. CONCLUSIONS These data indicate lower COVID-19 mRNA vaccine-induced antibody levels in persons with RA compared to individuals without RA, likely partially attributable to immune suppressive medications. At the same time, older age is associated with lower antibody and cellular immune response to COVID-19 vaccines.
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Affiliation(s)
- Holly M Dudley
- Department of Molecular Biology, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Megan O'Mara
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Ann Auma
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Jenny Gong
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Yael Ross
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Natalie Gurevich
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Sarah Carbone
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Alex Reihs
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Ynez Nguyen
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Grace A McComsey
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Yi Cao
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, United States
| | | | - Larraine Gordesky
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Michael Payne
- Department of Global Health, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Nora Singer
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Lenche Kostadinova
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Brigid Wilson
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - David A Zidar
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Global Health, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Christopher L King
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Global Health, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - David H Canaday
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Carey L Shive
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Maya M Mattar
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Donald D Anthony
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
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Shive CL, Kowal CM, Desotelle AF, Nguyen Y, Carbone S, Kostadinova L, Davitkov P, O’Mara M, Reihs A, Siddiqui H, Wilson BM, Anthony DD. Endotoxemia Associated with Liver Disease Correlates with Systemic Inflammation and T Cell Exhaustion in Hepatitis C Virus Infection. Cells 2023; 12:2034. [PMID: 37626844 PMCID: PMC10453378 DOI: 10.3390/cells12162034] [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: 06/16/2023] [Revised: 07/29/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Both acute and chronic hepatitis C virus (HCV) infections are characterized by inflammation. HCV and reduced liver blood filtration contribute to inflammation; however, the mechanisms of systemic immune activation and dysfunction as a result of HCV infection are not clear. We measured circulating inflammatory mediators (IL-6, IP10, sCD163, sCD14), indices of endotoxemia (EndoCab, LBP, FABP), and T cell markers of exhaustion and senescence (PD-1, TIGIT, CD57, KLRG-1) in HCV-infected participants, and followed a small cohort after direct-acting anti-viral therapy. IL-6, IP10, Endocab, LBP, and FABP were elevated in HCV participants, as were T cell co-expression of exhaustion and senescence markers. We found positive associations between IL-6, IP10, EndoCab, LBP, and co-expression of T cell markers of exhaustion and senescence. We also found numerous associations between reduced liver function, as measured by plasma albumin levels, and T cell exhaustion/senescence, inflammation, and endotoxemia. We found positive associations between liver stiffness (TE score) and plasma levels of IL-6, IP10, and LBP. Lastly, plasma IP10 and the proportion of CD8 T cells co-expressing PD-1 and CD57 decreased after initiation of direct-acting anti-viral therapy. Although associations do not prove causality, our results support the model that translocation of microbial products, resulting from decreased liver blood filtration, during HCV infection drives chronic inflammation that results in T cell exhaustion/senescence and contributes to systemic immune dysfunction.
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Affiliation(s)
- Carey L. Shive
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
- Pathology Department, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Corinne M. Kowal
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
| | - Alexandra F. Desotelle
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
| | - Ynez Nguyen
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
| | - Sarah Carbone
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
| | - Lenche Kostadinova
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
| | - Perica Davitkov
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
| | - Megan O’Mara
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
| | - Alexandra Reihs
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
| | - Hinnah Siddiqui
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
| | - Brigid M. Wilson
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Donald D. Anthony
- Cleveland VA Medical Center, Cleveland, OH 44106, USA; (C.M.K.); (A.F.D.); (Y.N.); (S.C.); (L.K.); (P.D.); (M.O.); (A.R.); (H.S.); (B.M.W.); (D.D.A.)
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
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5
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Lange A, Kostadinova L, Damjanovska S, Gad I, Syed S, Siddiqui H, Yousif P, Kowal CM, Shive C, Burant C, Singer N, Bej T, Al-Kindi S, Wilson B, Mattar M, Zidar DA, Anthony DD. Red Cell Distribution Width and Absolute Lymphocyte Count Associate With Biomarkers of Inflammation and Subsequent Mortality in Rheumatoid Arthritis. J Rheumatol 2023; 50:166-174. [PMID: 36319020 PMCID: PMC9898085 DOI: 10.3899/jrheum.211411] [Citation(s) in RCA: 1] [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] [Accepted: 08/09/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Morbidity and mortality in rheumatoid arthritis (RA) is partly mitigated by maintaining immune and hematologic homeostasis. Identification of those at risk is challenging. Red cell distribution width (RDW) and absolute lymphocyte count (ALC) associate with cardiovascular disease (CVD) and mortality in the general population, and with disease activity in RA. How these variables relate to inflammation and mortality in RA was investigated. METHODS In a retrospective single Veterans Affairs (VA) Rheumatology Clinic cohort of 327 patients with RA treated with methotrexate (MTX)+/- a tumor necrosis factor (TNF) inhibitor (TNFi), we evaluated RDW and ALC before and during therapy and in relation to subsequent mortality. Findings were validated in a national VA cohort (n = 13,914). In a subset of patients and controls, we evaluated inflammatory markers. RESULTS In the local cohort, high RDW and low ALC prior to MTX treatment was associated with subsequent mortality over 10 years (both P < 0.001). The highest mortality was observed in those with both high RDW and low ALC. This remained after adjusting for age and comorbidities and was validated in the national RA cohort. In the immunology cohort, soluble and cellular inflammatory markers were higher in patients with RA than in controls. ALC correlated with age, plasma TNF receptor II, natural killer HLA-DR mean fluorescence intensity, and CD4CM/CD8CM HLA-DR/CD38%, whereas RDW associated with age and ALC. MTX initiation was followed by an increase in RDW and a decrease in ALC. TNFi therapy added to MTX resulted in an increase in ALC. CONCLUSION RDW and ALC before disease-modifying antirheumatic drug therapy are associated with biomarkers of monocyte/macrophage inflammation and subsequent mortality. The mechanistic linkage between TNF signaling and lymphopenia found here warrants further investigation.
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Affiliation(s)
- Alyssa Lange
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Lenche Kostadinova
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sofi Damjanovska
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Ibtissam Gad
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sameena Syed
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Husna Siddiqui
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Patrick Yousif
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Corinne M Kowal
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Carey Shive
- C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University
| | - Christopher Burant
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Nora Singer
- N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University
| | - Taissa Bej
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sadeer Al-Kindi
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Brigid Wilson
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Maya Mattar
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - David A Zidar
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Donald D Anthony
- D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
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6
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Damjanovska S, Davitkov P, Gopal S, Kostadinova L, Kowal C, Lange A, Moreland A, Shive CL, Wilson B, Bej T, Al-Kindi S, Falck-Ytter Y, Zidar DA, Anthony DD. High Red Cell Distribution Width and Low Absolute Lymphocyte Count Associate With Subsequent Mortality in HCV Infection. Pathog Immun 2022; 6:90-104. [PMID: 34988340 PMCID: PMC8714176 DOI: 10.20411/pai.v6i2.467] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Hepatitis-C virus (HCV) chronic infection can lead to cirrhosis, hepatocellular carcinoma (HCC), end-stage liver disease, cardiovascular disease (CVD), and mortality. Transient Elastography (TE) is used to non-invasively assess fibrosis. Whether immune monitoring provides additive prognostic value is not established. Increased red-cell distribution width (RDW) and decreased absolute lymphocyte count (ALC) predict mortality in those without liver disease. Whether these relationships remain during HCV infection is unknown. Materials and Methods: A retrospective cohort of 1,715 single-site VA Liver Clinic patients receiving Transient Elastography (TE) 2014-2019 to evaluate HCV-associated liver damage were evaluated for RDW and ALC in relation to traditional parameters of cardiovascular risk, liver health, development of HCC, and mortality. Results: The cohort was 97% male, 55% African American, 26% with diabetes mellitus, 67% with hypertension, and 66% with tobacco use. After TE, 3% were subsequently diagnosed with HCC, and 12% (n=208) died. Most deaths (n=189) were due to non-liver causes. The TE score associated with prevalent CVD, positively correlated with atherosclerotic cardiovascular disease (ASCVD) 10-Year Risk Score, age, RDW, and negatively correlated with ALC. Patients with anisocytosis (RDW above 14%) or lymphopenia (ALC level under 1.2×109/L) had greater subsequent all-cause mortality, even after adjusting for age, TE score, and comorbidities. TE score, and to a modest degree RDW, were associated with subsequent liver-associated mortality, while TE score, RDW, and ALC were each independently associated with non-liver cause of death. Conclusion: Widely available mortality calculators generally require multiple pieces of clinical information. RDW and ALC, parameters collected on a single laboratory test that is commonly performed, prior to HCV therapy may be pragmatic markers of long-term risk of mortality.
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Affiliation(s)
- Sofi Damjanovska
- Department of Medicine, Cleveland VA Medical Center, Case Western Reserve University.,Department of Medicine, University Hospitals Cleveland Medical Center
| | - Perica Davitkov
- Division of Gastroenterology, Cleveland VA Medical Center, Case Western Reserve University
| | - Surya Gopal
- Department of Medicine, Cleveland VA Medical Center, Case Western Reserve University
| | - Lenche Kostadinova
- Department of Medicine, Cleveland VA Medical Center, Case Western Reserve University.,Department of Medicine, University Hospitals Cleveland Medical Center
| | - Corrine Kowal
- Department of Medicine, Cleveland VA Medical Center, Case Western Reserve University
| | - Alyssa Lange
- Department of Medicine, Cleveland VA Medical Center, Case Western Reserve University
| | - Anita Moreland
- Division of Gastroenterology, Cleveland VA Medical Center, Case Western Reserve University
| | - Carey L Shive
- Department of Medicine, Cleveland VA Medical Center, Case Western Reserve University.,Department of Pathology, Case Western Reserve University, Cleveland, OH
| | - Brigid Wilson
- Research and Education Foundation for Cleveland VA, Cleveland, OH
| | - Taissa Bej
- Research and Education Foundation for Cleveland VA, Cleveland, OH
| | - Sadeer Al-Kindi
- University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Cleveland VA Medical Center, Case Western Reserve University
| | - David A Zidar
- Department of Medicine, Cleveland VA Medical Center, Case Western Reserve University
| | - Donald D Anthony
- Department of Medicine, Cleveland VA Medical Center, Case Western Reserve University.,Department of Pathology, Case Western Reserve University, Cleveland, OH.,Department of Medicine, MetroHealth Medical Center, Cleveland, OH
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7
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Auma AWN, Shive CL, Kostadinova L, Anthony DD. Variable Normalization of Naïve CD4+ Lymphopenia and Markers of Monocyte and T Cell Activation over the Course of Direct-Acting Anti-Viral Treatment of Chronic Hepatitis C Virus Infection. Viruses 2021; 14:50. [PMID: 35062255 PMCID: PMC8780994 DOI: 10.3390/v14010050] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic hepatitis C virus (HCV) infection is associated with naïve CD4+ T cell lymphopenia and long-standing/persistent elevation of cellular and soluble immune activation parameters, the latter heightened in the setting of HIV co-infection. The underlying mechanisms are not completely understood. However, we recently reported that accelerated peripheral cell death may contribute to naïve CD4+ T cell loss and that mechanistic relationships between monocyte activation, T cell activation, and soluble inflammatory mediators may also contribute. Chronic HCV infection can be cured by direct-acting anti-viral (DAA) therapy, and success is defined as sustained virological response (SVR, undetectable HCV RNA (ribonucleic acid) at 12 weeks after DAA treatment completion). However, there is no general consensus on the short-term and long-term immunological outcomes of DAA therapy. Here, we consolidate previous reports on the partial normalization of naïve CD4+ lymphopenia and T cell immune activation and the apparent irreversibility of monocyte activation following DAA therapy in HCV infected and HCV/HIV co-infected individuals. Further, advanced age and cirrhosis are associated with delayed or abrogation of immune reconstitution after DAA therapy, an indication that non-viral factors also likely contribute to host immune dysregulation in HCV infection.
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Affiliation(s)
- Ann W. N. Auma
- Department of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA; (A.W.N.A.); (C.L.S.)
| | - Carey L. Shive
- Department of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA; (A.W.N.A.); (C.L.S.)
- Cleveland VA Medical Center, Cleveland, OH 44106, USA;
| | | | - Donald D. Anthony
- Department of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA; (A.W.N.A.); (C.L.S.)
- Cleveland VA Medical Center, Cleveland, OH 44106, USA;
- Metro Health Medical Center, Division of Rheumatology, Cleveland, OH 44106, USA
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8
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Kostadinova L, Selim G, Chakalaroski P, Smickoska S, Stoleska M, Nonkuloski D. Radiation-induced Mucositis in Patients with Oropharyngeal Cancer Treated with Moderate Acceleration of Intensity-modulated Radiation Therapy and Simultaneous Integrated Boost Concomitant with Weekly Cisplatin. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Radiation-induced mucositis is one of the limiting factors during radiotherapy, disturbing the quality of life and in some cases leading to discontinuation of therapy. Intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) represents advanced form of radiotherapy technique in treatment of oropharyngeal carcinoma enabling precision cancer targeting with reducing dose to healthy normal tissues.
AIM: The aim of this study was to present maximum grade and duration of a maximum grade of radiation-induced acute mucositis, influence of total volume of oral mucosa, and volumes of oral mucosa which are encompassed by radiation volume of 54 Gy and 66 Gy on the expression of grade of acute mucositis and influence of primary origin of tumor on encompassing with radiation volumes in patients treated with moderate acceleration of IMRT-SIB concomitant weekly cycle of chemotherapy with cisplatin.
MATERIALS AND METHODS: Planned research included 30 patients with oropharyngeal cancer who received their treatment at the University Clinic of Radiotherapy and Oncology in Skopje with moderate acceleration of IMRT-SIB and weekly concomitant cisplatin. Assessment of radiation-induced acute mucositis was performed according to the acute radiation morbidity scoring criteria of the Radiation Therapy Oncology Group.
RESULTS: Maximum grade of acute reaction was confluent mucositis with strong pain and was manifested in 27 patients (90%) with maximum time of duration of 28 days (range 7–28) and median duration of 18 days (range 7–28). Patients, in whom the primary origin of tumor was base of the tongue, a statistically significant difference (p = 0.04) was found for volume of oral mucosa encompassed with PTV66, compared to other localizations of primary oropharyngeal origin. Statistically non-significant difference was found between volume of total oral mucosa and volumes of oral mucosa which are encompassed with radiation volume of 54 Gy and 66 Gy and expression of grade of acute mucositis in the 5th and 6th weeks of radiotherapy.
CONCLUSION: According to these results, recommendations are delineation of oral mucosa as critical structure and implementation of IMRT-SIB to achieve reduction of grade of acute mucositis.
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9
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Kostadinova L, Shive CL, Zebrowski E, Fuller B, Rife K, Hirsch A, Compan A, Moreland A, Falck-Ytter Y, Popkin DL, Anthony DD. Soluble Markers of Immune Activation Differentially Normalize and Selectively Associate with Improvement in AST, ALT, Albumin, and Transient Elastography During IFN-Free HCV Therapy. Pathog Immun 2018; 3:149-163. [PMID: 30370392 PMCID: PMC6201254 DOI: 10.20411/pai.v3i1.242] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background During chronic hepatitis C virus (HCV) infection, Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels mark active liver inflammation and tissue damage, while albumin reflects synthetic liver function and nutritional status. Transient Elastography (TE) is a clinical measure of liver stiffness that facilitates evaluation of liver damage stage. While a portion of the TE score is attributable to liver fibrosis and relatively irreversible damage, another component of the TE score is attributable to liver inflammation or edema. Markers of inflammation during chronic HCV infection include soluble markers of immune activation, which are also associated with morbid outcome (including cardiovascular disease and liver-disease progression). Whether soluble markers of immune activation or changes in their level during HCV therapy relate to normalization of AST, ALT, Albumin, or TE score, is not clear. Methods We evaluated soluble markers of immune activation (plasma sCD14, IL-6, sCD163, autotaxin [ATX], and Mac2BP) and TE score, and their relationship in 20 HCV-infected patients before, during, and after HCV-directed IFN-free direct-acting antiviral (DAA) therapy. We evaluated normalization of parameters and the relationship between each over a 6-month window. Results Before therapy, serum AST levels positively correlated with plasma levels of sCD14, sCD163, and Mac2BP, while ALT levels positively correlated with Mac2BP. Serum albumin level negatively correlated with plasma IL-6 and ATX levels. IFN-free therapy uniformly resulted in sustained virological response at 12 and 24 weeks after therapy completion. After initiation of therapy AST and ALT normalized, while levels of ATX, Mac2BP, sCD163, and TE score partially normalized over 6 months. Additionally, change in AST level and APRI score correlated with change in sCD163, IL-6, and Mac2BP levels, and change in ALT correlated with change in IL-6 and Mac2BP levels. Improvement in TE score correlated with a decrease in the level of sCD14 at week 4, and almost statistically significant with decrease in sCD14 at weeks 20-24 after initiation of IFN-free HCV therapy. Conclusions Soluble markers of immune activation normalize or partially normalize at different rates after initiation of curative HCV DAA therapy, and TE scores improve, with wide variability in the degree of absolute improvement in liver stiffness from patient to patient. Decline magnitude of sCD14 was associated with improvement in TE score, while magnitude of improvement in AST correlated with reduction in sCD163 levels. These data provide support for a model where monocyte/Kupffer cell activation may account for a portion of the liver inflammation and edema, which is at least partially reversible following initiation of HCV DAA therapy.
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Affiliation(s)
- Lenche Kostadinova
- The Louis Stokes VA Medical Center, Cleveland, Ohio.,Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, Ohio
| | - Carey L Shive
- The Louis Stokes VA Medical Center, Cleveland, Ohio.,Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, Ohio
| | - Elizabeth Zebrowski
- The Louis Stokes VA Medical Center, Cleveland, Ohio.,Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, Ohio
| | - Brianna Fuller
- The Louis Stokes VA Medical Center, Cleveland, Ohio.,Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, Ohio
| | - Kelsey Rife
- The Louis Stokes VA Medical Center, Cleveland, Ohio
| | - Amy Hirsch
- The Louis Stokes VA Medical Center, Cleveland, Ohio
| | - Anita Compan
- The Louis Stokes VA Medical Center, Cleveland, Ohio
| | | | - Yngve Falck-Ytter
- The Louis Stokes VA Medical Center, Cleveland, Ohio.,Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, Ohio
| | - Daniel L Popkin
- The Louis Stokes VA Medical Center, Cleveland, Ohio.,Department of Dermatology, University Hospitals Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Donald D Anthony
- The Louis Stokes VA Medical Center, Cleveland, Ohio.,Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, Ohio
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10
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Judge CJ, Kostadinova L, Sherman KE, Butt AA, Falck-Ytter Y, Funderburg NT, Landay AL, Lederman MM, Sieg SF, Sandberg JK, Anthony DD. CD56 bright NK IL-7Rα expression negatively associates with HCV level, and IL-7-induced NK function is impaired during HCV and HIV infections. J Leukoc Biol 2017; 102:171-184. [PMID: 28400540 DOI: 10.1189/jlb.5a1116-456r] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/12/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
Several lines of evidence support the concept that NK cells play an important role in control of hepatitis C virus (HCV) infection via cytokine secretion and cytotoxicity. IL-7 is a homeostatic cytokine with a role in T cell development, activation, proliferation, and cytokine secretion. The IL-7Rα chain [cluster of differentiation (CD)127] is expressed on NK cells, with greatest abundance on the CD56brightCD16dim/- (CD56bright) subset. Here, we measured CD127 expression on CD56bright, CD56dimCD16+ (CD56dim), or CD56negCD16+ (CD56neg) NK cell subsets of 25 uninfected donors (UD); 34 chronic HCV-infected, treatment-naïve; 25 HIV-infected, virally suppressed on antiretroviral therapy (ART); and 42 HCV-HIV-coinfected subjects on ART. Interestingly, CD127 expression on CD56bright NK cells negatively correlated with HCV plasma levels in HCV monoinfection and HCV-HIV coinfection. IL-7 induced CD69 expression, as well as IFN-γ production, in CD56bright NK cells and also enhanced the IFN-α-induced CD69 expression on these cells. The latter was impaired in HIV infection. Furthermore, IL-7 induced B cell lymphoma 2 (BCL-2) expression and cell cycling of CD56bright NK cells, and this effect was impaired in HCV- and HIV-infected subjects. Whereas IL-7-stimulated CD56bright NK cell degranulation appeared intact in all cohorts, we observed impaired IL-7-activated NK cell cytolytic function in HCV- and HIV-infected subjects. Finally, IL-7-induced phosphorylation of STAT-5 (pSTAT-5) signaling was impaired in NK cells of subjects with chronic viral infection, and this was reversible upon 6 mo of viral suppression with IFN-free HCV therapy. These results implicate that IL-7-dependent NK cell activation and effector function may be other host immune surveillance mechanisms that are impaired in viral infections.
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Affiliation(s)
- Chelsey J Judge
- Department of Pathology, Cleveland VA Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Medicine, University Hospitals Case Medical Center and Center for AIDS Research (CFAR), Case Western Reserve University, Cleveland, Ohio, USA
| | - Lenche Kostadinova
- Department of Medicine, University Hospitals Case Medical Center and Center for AIDS Research (CFAR), Case Western Reserve University, Cleveland, Ohio, USA
| | - Kenneth E Sherman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Adeel A Butt
- Weill Cornell Medical College, New York, New York, USA.,Hamad Healthcare Quality Institute and Hamad Medical Corporation, Doha, Qatar
| | - Yngve Falck-Ytter
- Department of Pathology, Cleveland VA Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Medicine, University Hospitals Case Medical Center and Center for AIDS Research (CFAR), Case Western Reserve University, Cleveland, Ohio, USA
| | - Nicholas T Funderburg
- School of Health and Rehabilitation, Division of Medical Laboratory Science, The Ohio State University, Columbus, Ohio, USA
| | - Alan L Landay
- Rush University Medical Center, Chicago, Illinois, USA: and
| | - Michael M Lederman
- Department of Medicine, University Hospitals Case Medical Center and Center for AIDS Research (CFAR), Case Western Reserve University, Cleveland, Ohio, USA
| | - Scott F Sieg
- Department of Medicine, University Hospitals Case Medical Center and Center for AIDS Research (CFAR), Case Western Reserve University, Cleveland, Ohio, USA
| | - Johan K Sandberg
- Center for Infection Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Donald D Anthony
- Department of Pathology, Cleveland VA Medical Center, Case Western Reserve University, Cleveland, Ohio, USA; .,Department of Medicine, University Hospitals Case Medical Center and Center for AIDS Research (CFAR), Case Western Reserve University, Cleveland, Ohio, USA
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11
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Kostadinova L, Shive CL, Judge C, Zebrowski E, Compan A, Rife K, Hirsch A, Falck-Ytter Y, Schlatzer DM, Li X, Chance MR, Rodriguez B, Popkin DL, Anthony DD. During Hepatitis C Virus (HCV) Infection and HCV-HIV Coinfection, an Elevated Plasma Level of Autotaxin Is Associated With Lysophosphatidic Acid and Markers of Immune Activation That Normalize During Interferon-Free HCV Therapy. J Infect Dis 2016; 214:1438-1448. [PMID: 27540113 DOI: 10.1093/infdis/jiw372] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 02/05/2016] [Accepted: 08/09/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Immune activation predicts morbidity during hepatitis C virus (HCV) infection and human immunodeficiency virus (HIV) infection, although mechanisms underlying immune activation are unclear. Plasma levels of autotaxin and its enzymatic product, lysophosphatidic acid (LPA), are elevated during HCV infection, and LPA activates immunocytes, but whether this contributes to immune activation is unknown. METHODS We evaluated plasma levels of autotaxin, interleukin 6 (IL-6), soluble CD14 (sCD14), soluble CD163 (sCD163), and Mac2 binding protein (Mac2BP) during HCV infection, HIV infection, and HCV-HIV coinfection, as well as in uninfected controls, before and after HIV antiretroviral therapy (ART) initiation and during interferon-free HCV therapy. RESULTS We observed greater plasma autotaxin levels in HCV-infected and HCV-HIV-coinfected participants, compared with uninfected participants, primarily those with a higher ratio of aspartate aminotransferase level to platelet count. Autotaxin levels correlated with IL-6, sCD14, sCD163, Mac2BP, and LPA levels in HCV-infected participants and with Mac2BP levels in HCV-HIV-coinfected participants, while in HIV-infected individuals, sCD14 levels correlated with Mac2BP levels. Autotaxin, LPA, and sCD14 levels normalized, while sCD163 and Mac2BP levels partially normalized within 6 months of starting interferon-free HCV therapy. sCD163 and IL-6 levels normalized within 6 months of starting ART for HIV infection. In vitro, LPA activated monocytes. CONCLUSIONS These data indicate that elevated levels of autotaxin and soluble markers of immune activation during HCV infection are partially reversible within 6 months of initiating interferon-free HCV treatment and that autotaxin may be causally linked to immune activation during HCV infection and HCV-HIV coinfection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Daniel L Popkin
- Department of Dermatology, Cleveland VA Medical Center, University Hospitals Case Medical Center, Case Center for AIDS Research, Case Western Reserve University, Ohio
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12
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Kambara H, Gunawardane L, Zebrowski E, Kostadinova L, Jobava R, Krokowski D, Hatzoglou M, Anthony DD, Valadkhan S. Regulation of Interferon-Stimulated Gene BST2 by a lncRNA Transcribed from a Shared Bidirectional Promoter. Front Immunol 2015; 5:676. [PMID: 25688240 PMCID: PMC4311693 DOI: 10.3389/fimmu.2014.00676] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/15/2014] [Indexed: 01/30/2023] Open
Abstract
Recent genome-wide studies have revealed the presence of thousands of long non-protein-coding RNAs (lncRNAs), some of which may play critical roles in the cell. We have previously shown that a large number of lncRNAs show differential expression in response to interferon (IFN)α stimulation in primary human cells. Here, we show that a subset of IFN-induced lncRNAs are positioned in proximity of protein-coding IFN-stimulated genes (ISGs). The majority of gene pairs originated from bidirectional promoters and showed positively correlated expression. We focused our analysis on a pair consisting of the known protein-coding ISG, BST2, and an un-studied putative lncRNA originating from the promoter region of BST2 in a divergent orientation. We showed that this transcript was a multi-exonic, polyadenylated long RNA that lacked protein-coding capacity. BST2 and the lncRNA were both induced in response to IFNα in diverse cell types. The induction of both genes was mediated through the JAK-STAT pathway, suggesting that IFN-stimulated response elements within the shared promoter activated the transcription of both genes. RNAi-mediated knock-down of the lncRNA resulted in down-regulation of BST2, and we could show that this down-regulation occurred at the level of transcription. Forced overexpression of this lncRNA, which we named BST2 IFN-Stimulated Positive Regulator (BISPR), resulted in up-regulation of BST2, indicating that the regulation of expression of BST2 by BISPR is mediated through interactions involving BISPR RNA itself, rather than the impact of its transcription from an adjacent locus. Importantly, upon IFN stimulation, transcriptional activation of BISPR preceded the induction of BST2, suggesting that expression of BISPR facilitated the initiation of transcription in its paired protein-coding gene. The lncRNA-mediated transcriptional regulation described in this study may help govern the expression of additional protein-coding RNAs involved in IFN response and other cellular processes.
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Affiliation(s)
- Hiroto Kambara
- Department of Biochemistry, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Lalith Gunawardane
- Department of Biochemistry, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Elizabeth Zebrowski
- Divisions of Infectious and Rheumatic Diseases, Department of Medicine, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Lenche Kostadinova
- Divisions of Infectious and Rheumatic Diseases, Department of Medicine, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Raul Jobava
- Department of Nutrition, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Dawid Krokowski
- Department of Nutrition, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Maria Hatzoglou
- Department of Nutrition, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Donald D Anthony
- Divisions of Infectious and Rheumatic Diseases, Department of Medicine, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Saba Valadkhan
- Department of Biochemistry, Case Western Reserve University School of Medicine , Cleveland, OH , USA
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13
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Kambara H, Niazi F, Kostadinova L, Moonka DK, Siegel CT, Post AB, Carnero E, Barriocanal M, Fortes P, Anthony DD, Valadkhan S. Negative regulation of the interferon response by an interferon-induced long non-coding RNA. Nucleic Acids Res 2014; 42:10668-80. [PMID: 25122750 PMCID: PMC4176326 DOI: 10.1093/nar/gku713] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) play critical roles in diverse cellular processes; however, their involvement in many critical aspects of the immune response including the interferon (IFN) response remains poorly understood. To address this gap, we compared the global gene expression pattern of primary human hepatocytes before and at three time points after treatment with IFN-α. Among ∼200 IFN-induced lncRNAs, one transcript showed ∼100-fold induction. This RNA, which we named lncRNA-CMPK2, was a spliced, polyadenylated nuclear transcript that was induced by IFN in diverse cell types from human and mouse. Similar to protein-coding IFN-stimulated genes (ISGs), its induction was dependent on JAK-STAT signaling. Intriguingly, knockdown of lncRNA-CMPK2 resulted in a marked reduction in HCV replication in IFN-stimulated hepatocytes, suggesting that it could affect the antiviral role of IFN. We could show that lncRNA-CMPK2 knockdown resulted in upregulation of several protein-coding antiviral ISGs. The observed upregulation was caused by an increase in both basal and IFN-stimulated transcription, consistent with loss of transcriptional inhibition in knockdown cells. These results indicate that the IFN response involves a lncRNA-mediated negative regulatory mechanism. lncRNA-CMPK2 was strongly upregulated in a subset of HCV-infected human livers, suggesting a role in modulation of the IFN response in vivo.
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Affiliation(s)
- Hiroto Kambara
- Department of Biochemistry, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Farshad Niazi
- Department of Biochemistry, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Lenche Kostadinova
- Divisions of Infectious and Rheumatic Diseases, Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Dilip K Moonka
- Division of Gastroenterology, Henry Ford Health System, Detroit, MI 48202, USA
| | - Christopher T Siegel
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106, USA
| | - Anthony B Post
- Department of Gastroenterology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA
| | - Elena Carnero
- Department of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Marina Barriocanal
- Department of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Puri Fortes
- Department of Hepatology and Gene Therapy, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Donald D Anthony
- Divisions of Infectious and Rheumatic Diseases, Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Saba Valadkhan
- Department of Biochemistry, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
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