1
|
Ellis JM, Estevez Burns RA, Blue Star JA, Patience MA, Brown LN, Ruggieri J, Joiner AV, Little MA, Talcott WG. A social-ecological examination of sleep among Airmen in technical training. Mil Psychol 2024; 36:311-322. [PMID: 38661470 DOI: 10.1080/08995605.2023.2177470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Inadequate sleep is an on-going risk to the health and mission readiness of U.S. Armed Forces, with estimates of sleep problems high above U.S. civilian populations. Intervening early in the career of active duty Air Force personnel (or "Airmen") with education and the establishment of healthy behaviors may prevent short and long term-detriments of sleep problems. This paper describes the results of a qualitative study seeking to understand the facilitators and barriers to achieving good sleep in a technical training school during the first year of entry into the United States Air Force. Using the social ecological framework and content analysis, three focus groups with Airmen were conducted to explore themes at the individual, social, environmental, and organizational/policy level. Overall, results indicated a cohort motivated to achieve good sleep, and also struggling with a number of barriers across each level. This paper highlights opportunities for population health interventions during technical training aimed at supporting Airmen in developing healthy sleep behaviors early in the course of their career.
Collapse
Affiliation(s)
- J M Ellis
- Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio- Lackland, United States Air Force, Arlington, Virginia
| | - R A Estevez Burns
- Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio- Lackland, United States Air Force, Arlington, Virginia
| | - J A Blue Star
- Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio- Lackland, United States Air Force, Arlington, Virginia
| | - M A Patience
- Malcolm Grow Medical Clinics and Surgery Center, 316th Medical Group, Joint Base Andrews, United States Air Force, Arlington, Virginia
| | - L N Brown
- 412th Medical Group, Edwards Air Force Base, United States Air Force, Arlington, Virginia
| | - J Ruggieri
- 5th Medical Group, Minot Air Force Base, United States Air Force, Arlington, Virginia
| | - A V Joiner
- 71st Medical Group, Vance Air Force Base, United States Air Force, Arlington, Virginia
| | - M A Little
- School of Medicine, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - W G Talcott
- Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio- Lackland, United States Air Force, Arlington, Virginia
- School of Medicine, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
2
|
Ridge K, Moran B, Alvarado-Vazquez PA, Hallgren J, Little MA, Irvine AD, O'Farrelly C, Dunne J, Finlay CM, Conlon N. Lin -CD117 +CD34 +FcεRI + progenitor cells are increased in chronic spontaneous urticaria and predict clinical responsiveness to anti-IgE therapy. Allergy 2024. [PMID: 38634175 DOI: 10.1111/all.16127] [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: 12/23/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a common, debilitating skin disorder characterized by recurring episodes of raised, itchy and sometimes painful wheals lasting longer than 6 weeks. CSU is mediated by mast cells which are absent from peripheral blood. However, lineage-CD34hiCD117int/hiFcεRI+ cells in blood have previously been shown to represent a mast cell precursor. METHODS We enumerated FcεRI-, FcεRI+ and FcεRIhi lineage-CD34+CD117+ cells using flow cytometry in blood of patients with CSU (n = 55), including 12 patients receiving omalizumab and 43 not receiving omalizumab (n = 43). Twenty-two control samples were studied. Disease control and patient response to omalizumab was evaluated using the urticaria control test. We performed single-cell RNA sequencing (scRNA-Seq) on lineage-CD34hiCD117hi blood cells from a subset of patients with CSU (n = 8) and healthy controls (n = 4). RESULTS CSU patients had more lineage-CD34+CD117+FcεRI+ blood cells than controls. Lineage-CD34+CD117+FcεRI+ cells were significantly higher in patients with CSU who had an objective clinical response to omalizumab when compared to patients who had poor disease control 90 days after initiation of omalizumab. scRNA-Seq revealed that lineage-CD34+CD117+FcεRI+ cells contained both lymphoid and myeloid progenitor lineages, with omalizumab responsive patients having proportionally more myeloid progenitors. The myeloid progenitor lineage contained small numbers of true mast cell precursors along with more immature FcεRI- and FcεRI+ myeloid progenitors. CONCLUSION Increased blood CD34+CD117+FcεRI+ cells may reflect enhanced bone marrow egress in the setting of CSU. High expression of these cells strongly predicts better clinical responses to the anti-IgE therapy, omalizumab.
Collapse
Affiliation(s)
- Katie Ridge
- UCARE Centre, Clinical and Diagnostic Immunology, St. James's Hospital, Dublin, Ireland
- Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Barry Moran
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Jenny Hallgren
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Mark A Little
- Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Trinity Kidney Centre, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Alan D Irvine
- Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Cliona O'Farrelly
- Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Jean Dunne
- UCARE Centre, Clinical and Diagnostic Immunology, St. James's Hospital, Dublin, Ireland
| | - Conor M Finlay
- Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Trinity Kidney Centre, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Niall Conlon
- UCARE Centre, Clinical and Diagnostic Immunology, St. James's Hospital, Dublin, Ireland
- Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
3
|
Bate S, McGovern D, Costigliolo F, Tan PG, Kratky V, Scott J, Chapman GB, Brown N, Floyd L, Brilland B, Martín-Nares E, Aydın MF, Ilyas D, Butt A, Nic an Riogh E, Kollar M, Lees JS, Yildiz A, Hinojosa-Azaola A, Dhaygude A, Roberts SA, Rosenberg A, Wiech T, Pusey CD, Jones RB, Jayne DR, Bajema I, Jennette JC, Stevens KI, Augusto JF, Mejía-Vilet JM, Dhaun N, McAdoo SP, Tesar V, Little MA, Geetha D, Brix SR. The Improved Kidney Risk Score in ANCA-Associated Vasculitis for Clinical Practice and Trials. J Am Soc Nephrol 2024; 35:335-346. [PMID: 38082490 PMCID: PMC10914211 DOI: 10.1681/asn.0000000000000274] [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: 08/04/2023] [Accepted: 11/03/2023] [Indexed: 01/27/2024] Open
Abstract
SIGNIFICANCE STATEMENT Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. More than 1500 patients were collated in an international longitudinal study to revise the ANCA kidney risk score. The score showed satisfactory performance, mimicking the original study (Harrell's C=0.779). In the development cohort of 959 patients, no additional parameters aiding the tool were detected, but replacing the GFR with creatinine identified an additional cutoff. The parameter interstitial fibrosis and tubular atrophy was modified to allow wider access, risk points were reweighted, and a fourth risk group was created, improving predictive ability (C=0.831). In the validation, the new model performed similarly well with excellent calibration and discrimination ( n =480, C=0.821). The revised score optimizes prognostication for clinical practice and trials. BACKGROUND Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. A retrospective international longitudinal cohort was collated to revise the ANCA renal risk score. METHODS The primary end point was ESKD with patients censored at last follow-up. Cox proportional hazards were used to reweight risk factors. Kaplan-Meier curves, Harrell's C statistic, receiver operating characteristics, and calibration plots were used to assess model performance. RESULTS Of 1591 patients, 1439 were included in the final analyses, 2:1 randomly allocated per center to development and validation cohorts (52% male, median age 64 years). In the development cohort ( n =959), the ANCA renal risk score was validated and calibrated, and parameters were reinvestigated modifying interstitial fibrosis and tubular atrophy allowing semiquantitative reporting. An additional cutoff for kidney function (K) was identified, and serum creatinine replaced GFR (K0: <250 µ mol/L=0, K1: 250-450 µ mol/L=4, K2: >450 µ mol/L=11 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were reweighted (N0: >25%=0, N1: 10%-25%=4, N2: <10%=7, T0: none/mild or <25%=0, T1: ≥ mild-moderate or ≥25%=3 points), and four risk groups created: low (0-4 points), moderate (5-11), high (12-18), and very high (21). Discrimination was C=0.831, and the 3-year kidney survival was 96%, 79%, 54%, and 19%, respectively. The revised score performed similarly well in the validation cohort with excellent calibration and discrimination ( n =480, C=0.821). CONCLUSIONS The updated score optimizes clinicopathologic prognostication for clinical practice and trials.
Collapse
Affiliation(s)
- Sebastian Bate
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Dominic McGovern
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Francesca Costigliolo
- Division of Nephrology, Dialysis and Transplantation, University of Genova, Genova, Italy
- Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pek Ghe Tan
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Renal Unit, Northern Health, Victoria, Australia
| | - Vojtech Kratky
- 1st Faculty of Medicine, Charles University, Prague, Czechia
- Department of Nephrology, General University Hospital, Prague, Czechia
| | - Jennifer Scott
- Trinity Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Gavin B. Chapman
- University/BHF Centre for Cardiovascular Science, University of Edinburgh and Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nina Brown
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Lauren Floyd
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, CHU d’Angers, Angers, France
| | - Eduardo Martín-Nares
- Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Duha Ilyas
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal, Transplantation and Urology Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Arslan Butt
- Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | | | - Marek Kollar
- Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Jennifer S. Lees
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Abdülmecit Yildiz
- Division of Nephrology, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Andrea Hinojosa-Azaola
- Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ajay Dhaygude
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Stephen A. Roberts
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thorsten Wiech
- University Medical Center Hamburg-Eppendorf, Institute of Pathology, Hamburg, Germany
| | - Charles D. Pusey
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Rachel B. Jones
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - David R.W. Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ingeborg Bajema
- Department of Pathology, Groningen University Medical Center, Groningen, The Netherlands
| | - J. Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kate I. Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | | | - Juan Manuel Mejía-Vilet
- Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, University of Edinburgh and Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Stephen P. McAdoo
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Vladimir Tesar
- 1st Faculty of Medicine, Charles University, Prague, Czechia
- Department of Nephrology, General University Hospital, Prague, Czechia
| | - Mark A. Little
- Trinity Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Duruvu Geetha
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Silke R. Brix
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Renal, Transplantation and Urology Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
4
|
Hellmich B, Sanchez-Alamo B, Schirmer JH, Berti A, Blockmans D, Cid MC, Holle JU, Hollinger N, Karadag O, Kronbichler A, Little MA, Luqmani RA, Mahr A, Merkel PA, Mohammad AJ, Monti S, Mukhtyar CB, Musial J, Price-Kuehne F, Segelmark M, Teng YKO, Terrier B, Tomasson G, Vaglio A, Vassilopoulos D, Verhoeven P, Jayne D. EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update. Ann Rheum Dis 2024; 83:30-47. [PMID: 36927642 DOI: 10.1136/ard-2022-223764] [Citation(s) in RCA: 78] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Since the publication of the EULAR recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in 2016, several randomised clinical trials have been published that have the potential to change clinical care and support the need for an update. METHODS Using EULAR standardised operating procedures, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 16 countries. We modified existing recommendations and created new recommendations. RESULTS Four overarching principles and 17 recommendations were formulated. We recommend biopsies and ANCA testing to assist in establishing a diagnosis of AAV. For remission induction in life-threatening or organ-threatening AAV, we recommend a combination of high-dose glucocorticoids (GCs) in combination with either rituximab or cyclophosphamide. We recommend tapering of the GC dose to a target of 5 mg prednisolone equivalent/day within 4-5 months. Avacopan may be considered as part of a strategy to reduce exposure to GC in granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). Plasma exchange may be considered in patients with rapidly progressive glomerulonephritis. For remission maintenance of GPA/MPA, we recommend rituximab. In patients with relapsing or refractory eosinophilic GPA, we recommend the use of mepolizumab. Azathioprine and methotrexate are alternatives to biologics for remission maintenance in AAV. CONCLUSIONS In the light of recent advancements, these recommendations provide updated guidance on AAV management. As substantial data gaps still exist, informed decision-making between physicians and patients remains of key relevance.
Collapse
Affiliation(s)
- Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken, Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim unter Teck, Germany
| | | | - Jan H Schirmer
- Rheumatology & Clinical Immunology and Cluster of Excellence Precision Medicine in Chronic Inflammation, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Alvise Berti
- CIBIO, Universita degli Studi di Trento, Trento, Italy
- Rheumatology, Santa Chiara Hospital, Trento, Italy
| | - Daniel Blockmans
- Department of Internal Medicine, University Hospital of Leuven, Leuven, Belgium
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumuenster, Germany
| | - Nicole Hollinger
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken, Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim unter Teck, Germany
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Vasculitis Research Center, Hacettepe University School of Medicine, Anakra, Turkey
| | - Andreas Kronbichler
- Department of Internal Medicine IV, Medical University, Innsbruck, Austria
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK
| | - Alfred Mahr
- Klinik für Rheumatologie, Kantonspital St Gallen, St Gallen, Switzerland
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aladdin J Mohammad
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Clinical Sciences, Lund University & Department of Rheumatology, Skåne Hospital, Lund, Sweden
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Jacek Musial
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis-, and Complement-Mediated Systemic Autoimmune Diseases (LuVaCs), Department of Internal Medicine, Section Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Gunnar Tomasson
- Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Rheumatology and Centre for Rheumatology Research, University Hospital Reykjavik, Reykjavik, Iceland
| | - Augusto Vaglio
- Nephrology Unit, Meyer Children's Hospital, and Department of Biomedical, Experimental and Clinical Science, University of Florence, Florence, Italy
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Peter Verhoeven
- Dutch Patient Vasculitis Organization, Haarlem, The Netherlands
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
5
|
Gisslander K, Rutherford M, Aslett L, Basu N, Dradin F, Hederman L, Hruskova Z, Kardaoui H, Lamprecht P, Lichołai S, Musial J, O'Sullivan D, Puechal X, Scott J, Segelmark M, Straka R, Terrier B, Tesar V, Tesi M, Vaglio A, Wandrei D, White A, Wójcik K, Yaman B, Little MA, Mohammad AJ. Data quality and patient characteristics in European ANCA-associated vasculitis registries: data retrieval by federated querying. Ann Rheum Dis 2024; 83:112-120. [PMID: 37907255 PMCID: PMC10804071 DOI: 10.1136/ard-2023-224571] [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] [Received: 06/13/2023] [Accepted: 09/16/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES This study aims to describe the data structure and harmonisation process, explore data quality and define characteristics, treatment, and outcomes of patients across six federated antineutrophil cytoplasmic antibody-associated vasculitis (AAV) registries. METHODS Through creation of the vasculitis-specific Findable, Accessible, Interoperable, Reusable, VASCulitis ontology, we harmonised the registries and enabled semantic interoperability. We assessed data quality across the domains of uniqueness, consistency, completeness and correctness. Aggregated data were retrieved using the semantic query language SPARQL Protocol and Resource Description Framework Query Language (SPARQL) and outcome rates were assessed through random effects meta-analysis. RESULTS A total of 5282 cases of AAV were identified. Uniqueness and data-type consistency were 100% across all assessed variables. Completeness and correctness varied from 49%-100% to 60%-100%, respectively. There were 2754 (52.1%) cases classified as granulomatosis with polyangiitis (GPA), 1580 (29.9%) as microscopic polyangiitis and 937 (17.7%) as eosinophilic GPA. The pattern of organ involvement included: lung in 3281 (65.1%), ear-nose-throat in 2860 (56.7%) and kidney in 2534 (50.2%). Intravenous cyclophosphamide was used as remission induction therapy in 982 (50.7%), rituximab in 505 (17.7%) and pulsed intravenous glucocorticoid use was highly variable (11%-91%). Overall mortality and incidence rates of end-stage kidney disease were 28.8 (95% CI 19.7 to 42.2) and 24.8 (95% CI 19.7 to 31.1) per 1000 patient-years, respectively. CONCLUSIONS In the largest reported AAV cohort-study, we federated patient registries using semantic web technologies and highlighted concerns about data quality. The comparison of patient characteristics, treatment and outcomes was hampered by heterogeneous recruitment settings.
Collapse
Affiliation(s)
- Karl Gisslander
- Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
| | | | - Louis Aslett
- Department of Mathematical Science, University of Durham, Durham, UK
| | - Neil Basu
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | | | - Lucy Hederman
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Zdenka Hruskova
- Department of Nephrology, General University Hospital, Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hicham Kardaoui
- National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, Universitat zu Lubeck, Lubeck, Germany
| | - Sabina Lichołai
- Division of Molecular Biology and Clinical Genetics, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Musial
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Declan O'Sullivan
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Xavier Puechal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- French Vasculitis Study Group, Paris, France
| | - Jennifer Scott
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Mårten Segelmark
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Richard Straka
- General University Hospital in Prague, Praha, Czech Republic
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- French Vasculitis Study Group, Paris, France
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michelangelo Tesi
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Dagmar Wandrei
- Clinical Trials Unit, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Arthur White
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Krzysztof Wójcik
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Beyza Yaman
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Mark A Little
- ADAPT SFI Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Aladdin J Mohammad
- Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
6
|
Roccatello D, Padoan R, Sciascia S, Iorio L, Nic An Ríogh E, Little MA. Might maintenance therapy be discontinued once clinical remission is achieved in ANCA-associated vasculitis? Autoimmun Rev 2024; 23:103438. [PMID: 37652397 DOI: 10.1016/j.autrev.2023.103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) encompasses a group of rare, multisystem autoimmune disorders characterised by the occurrence of inflammation and damage to small blood vessels, leading to a wide range of clinical manifestations. They include granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). Outcomes for patients with MPA and GPA have been transformed over recent years. However, the establishment of effective maintenance therapy aiming to balance the risks of disease relapse with those related to prolonged immunosuppression has become a clinical priority. This review aims to explore two differing perspectives on this unsolved problem. Pros and Cons of the following approaches will be discussed: "Biomarker-guided personalised approach on top of generic maintenance strategy guidelines" or "ANCA specificity-related personalised maintenance treatment after intensive B-cell depletion"?
Collapse
Affiliation(s)
- Dario Roccatello
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnet and ERN-RITA Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, ASL Città di Torino and University of Torino, Turin, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy.
| | - Savino Sciascia
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnet and ERN-RITA Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, ASL Città di Torino and University of Torino, Turin, Italy
| | - Luca Iorio
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Eithne Nic An Ríogh
- Trinity Kidney Centre, Trinity Translational Medicine Institute, School of Medicine, Trinity College, Dublin, Ireland
| | - Mark A Little
- Trinity Kidney Centre, Trinity Translational Medicine Institute, School of Medicine, Trinity College, Dublin, Ireland
| |
Collapse
|
7
|
Fahey MC, Krukowski RA, Anderson RT, Cohn WF, Porter KJ, Reid T, Wiseman KP, You W, Wood CH, Rucker TW, Little MA. Reaching adults who smoke cigarettes in rural Appalachia: Rationale, design & analysis plan for a mixed-methods study disseminating pharmacy-delivered cessation treatment. Contemp Clin Trials 2023; 134:107335. [PMID: 37730197 PMCID: PMC10841546 DOI: 10.1016/j.cct.2023.107335] [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: 05/24/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Unlike other U.S. geographical regions, cigarette smoking prevalence remains stagnant in rural Appalachia. One avenue for reaching rural residents with evidence-based smoking cessation treatments could be utilizing community pharmacists. This paper describes the design, rationale, and analysis plan for a mixed-method study that will determine combinations of cessation treatment components that can be integrated within community pharmacies in rural Appalachia. The aim is to quantify the individual and synergistic effects of five highly disseminable and sustainable cessation components in a factorial experiment. METHODS This sequential, mixed-method research design, based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will use a randomized controlled trial with a 25 fully crossed factorial design (32 treatment combinations) to test, alone and in combination, the most effective evidence-based cessation components: (1) QuitAid (yes vs. no) (2) tobacco quit line (yes vs. no) (3) SmokefreeTXT (yes vs. no) (4) combination NRT lozenge + NRT patch (vs. NRT patch alone), and (5) eight weeks of NRT (vs. standard four weeks). RESULTS Logistic regression will model abstinence at six-months, including indicators for the five treatment factors and all two-way interactions between the treatment factors. Demographic and smoking history variables will be considered to assess potential effect modification. Poisson regression will model quit attempts and percent of adherence to treatment components as secondary outcomes. CONCLUSION This study will provide foundational evidence on how community pharmacies in medically underserved, rural regions can be leveraged to increase utilization of existing evidence-based tobacco cessation resources for treating tobacco dependence. CLINICAL TRIALS NCT05660525.
Collapse
Affiliation(s)
- M C Fahey
- Medical University of South Carolina, Charleston, SC, USA
| | - R A Krukowski
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - R T Anderson
- University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - W F Cohn
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K J Porter
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - T Reid
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K P Wiseman
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - W You
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - C H Wood
- My Pharmacy, Greensboro, NC, USA
| | - T W Rucker
- University of Virginia, Health Systems, Nellysford, VA, USA
| | - M A Little
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA.
| |
Collapse
|
8
|
Moiseev S, Bulanov N, Crnogorac M, Direskeneli H, Galesic K, Gazel U, Geetha D, Guillevin L, Hrušková Z, Little MA, O'Neill L, Makarov E, McAdoo SP, Mohammad AJ, Moran S, Novikov P, Pusey CD, Rahmattulla C, Satrapová V, Silva J, Suvorov A, Tesar V, Terrier B, Willeit P, Zhao MH, Kronbichler A, Jayne DRW. Traditional and Disease-Specific Risk Factors for Cardiovascular Events in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Multinational Retrospective Study. J Rheumatol 2023; 50:1145-1151. [PMID: 36642436 DOI: 10.3899/jrheum.220851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the occurrence of cardiovascular events (CVEs) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, China, Turkey, Russia, the United Kingdom, and the USA. METHODS Patients with a definite diagnosis of AAV who were followed for ≥ 3 months and had sufficient documentation were included. Data on myocardial infarction (MI) and stroke were collected retrospectively from tertiary vasculitis centers. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS Over a median follow-up of 62.0 months (IQR 22.6-100.0), CVEs (mostly MIs) occurred in 245 (10.7%) of 2286 patients with AAV, with a higher frequency in China and the UK. On multivariate regression analysis, older age (55-64.9 yrs, HR 2.93, 95% CI 1.99-4.31), smoking (HR 1.98, 95% CI 1.48-2.64), Chinese origin (HR 4.24, 95% CI 3.07-5.85), and pulmonary (HR 1.50, 95% CI 1.09-2.06) and kidney (HR 3.02, 95% CI 2.08-4.37) involvement were independent variables associated with a higher occurrence of CVEs. CONCLUSION We showed that geographic region and both traditional and disease-specific (kidney involvement in particular) factors were independently associated with CVEs. Proper assessment and management of modifiable cardiovascular (CV) risk factors are essential for prevention of CV morbidity in patients with AAV.
Collapse
Affiliation(s)
- Sergey Moiseev
- S. Moiseev, MD, Professor, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, and Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Nikolay Bulanov
- N. Bulanov, MD, P. Novikov, MD, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Matija Crnogorac
- M. Crnogorac, MD, K. Galesic, MD, Professor, Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Haner Direskeneli
- H. Direskeneli, MD, Professor, U. Gazel, MD, Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Kresimir Galesic
- M. Crnogorac, MD, K. Galesic, MD, Professor, Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Ummugulsum Gazel
- H. Direskeneli, MD, Professor, U. Gazel, MD, Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Duvuru Geetha
- D. Geetha, MD, Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Loic Guillevin
- L. Guillevin, MD, Professor, B. Terrier, PhD, Professor, Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Zdenka Hrušková
- Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Mark A Little
- M.A. Little, MD, Professor, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, and Irish Centre for Vascular Biology, Tallaght University Hospital, Dublin, Ireland
| | - Liam O'Neill
- L. O'Neill, MD, University Hospital Galway, Dublin, Ireland
| | - Egor Makarov
- E. Makarov, MD, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Stephen P McAdoo
- S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Aladdin J Mohammad
- A.J. Mohammad, MD, Department of Rheumatology, Clinical Sciences-Lund, Lund University, Lund, Sweden, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Sarah Moran
- S. Moran, MD, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Pavel Novikov
- N. Bulanov, MD, P. Novikov, MD, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Charles D Pusey
- S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Chinar Rahmattulla
- C. Rahmattulla, PhD, Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Veronika Satrapová
- Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Joana Silva
- S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Alexander Suvorov
- A. Suvorov, MD, Centre for Analysis of Complex Systems, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vladimír Tesar
- Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Benjamin Terrier
- L. Guillevin, MD, Professor, B. Terrier, PhD, Professor, Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Peter Willeit
- P. Willeit, PhD, Professor, Clinical Epidemiology Team, Medical University of Innsbruck, Innsbruck, Austria, and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ming-Hui Zhao
- M.H. Zhao, MD, Professor, Renal Division, Peking University First Hospital, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Andreas Kronbichler
- A. Kronbichler, PhD, D.R.W. Jayne, MD, Professor, Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, and Department of Medicine, University of Cambridge, Cambridge, UK.
| | - David R W Jayne
- A. Kronbichler, PhD, D.R.W. Jayne, MD, Professor, Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, and Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
9
|
Gisslander K, Mohammad AJ, Vaglio A, Little MA. Overcoming challenges in rare disease registry integration using the semantic web - a clinical research perspective. Orphanet J Rare Dis 2023; 18:253. [PMID: 37644439 PMCID: PMC10466902 DOI: 10.1186/s13023-023-02841-z] [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: 03/21/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023] Open
Abstract
The growing number of disease-specific patient registries for rare diseases has highlighted the need for registry interoperability and data linkage, leading to large-scale rare disease data integration projects using Semantic Web based solutions. These technologies may be difficult to grasp for rare disease experts, leading to limited involvement by domain expertise in the data integration process. Here, we propose a data integration framework starting from the perspective of the clinical researcher, allowing for purposeful rare disease registry integration driven by clinical research questions.
Collapse
Affiliation(s)
- Karl Gisslander
- Department of Clinical Sciences - Rheumatology, Lund University, Lund, SE-221 85, Sweden.
| | - Aladdin J Mohammad
- Department of Clinical Sciences - Rheumatology, Lund University, Lund, SE-221 85, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Mark A Little
- TTMI, Trinity Health Kidney Centre, Dublin, Ireland
- ADAPT, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
10
|
Moiseev S, Bulanov N, Crnogorac M, Direskeneli H, Galesic K, Gazel U, Geetha D, Guillevin L, Hrušková Z, Little MA, O'Neill L, Makarov E, McAdoo SP, Mohammad AJ, Moran S, Novikov P, Pusey CD, Rahmattulla C, Satrapová V, Silva J, Suvorov A, Tesar V, Terrier B, Willeit P, Zhao MH, Kronbichler A, Jayne DRW. Traditional and Disease Specific Risk Factors for Cardiovascular Events in ANCA-Associated Vasculitis: A Multinational Retrospective Study. J Rheumatol 2023; 50:1094. [PMID: 37527882 DOI: 10.3899/jrheum.220851.c1] [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: 08/03/2023]
|
11
|
Odler B, Bruchfeld A, Scott J, Geetha D, Little MA, Jayne DRW, Kronbichler A. Challenges of defining renal response in ANCA-associated vasculitis: call to action? Clin Kidney J 2023; 16:965-975. [PMID: 37261001 PMCID: PMC10229283 DOI: 10.1093/ckj/sfad009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Indexed: 12/06/2023] Open
Abstract
Avoiding end-stage kidney disease in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) has a high therapeutic priority. Although renal response is a crucial measure to capture clinically relevant changes, clinal trials have used various definitions and no well-studied key surrogate markers to predict renal outcome in AAV exist. Differences in clinical features and histopathologic and therapeutic approaches will influence the course of kidney function. Its assessment through traditional surrogates (i.e. serum creatinine, glomerular filtration rate, proteinuria, hematuria and disease activity scores) has limitations. Refinement of these markers and the incorporation of novel approaches such as the assessment of histopathological changes using cutting-edge molecular and machine learning mechanisms or new biomarkers could significantly improve prognostication. The timing is favourable since large datasets of trials conducted in AAV are available and provide a valuable resource to establish renal surrogate markers and, likely, aim to investigate optimized and tailored treatment approaches according to a renal response score. In this review we discuss important points missed in the assessment of kidney function in patients with AAV and point towards the importance of defining renal response and clinically important short- and long-term predictors of renal outcome.
Collapse
Affiliation(s)
- Balazs Odler
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Annette Bruchfeld
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine Karolinska Institutet, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Linköpings Universitet, Linköping, Sweden
| | - Jennifer Scott
- Trinity Health Kidney Center, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mark A Little
- Trinity Health Kidney Center, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - David R W Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | |
Collapse
|
12
|
Phelan T, Lawler C, Pichlmair A, Little MA, Bowie AG, Brady G. Molluscum Contagiosum Virus Protein MC008 Targets NF-κB Activation by Inhibiting Ubiquitination of NEMO. J Virol 2023; 97:e0010823. [PMID: 36916940 PMCID: PMC10062130 DOI: 10.1128/jvi.00108-23] [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: 01/20/2023] [Accepted: 02/17/2023] [Indexed: 03/16/2023] Open
Abstract
Molluscum contagiosum virus (MCV) is a human-adapted poxvirus that causes a common and persistent yet mild infection characterized by distinct, contagious, papular skin lesions. These lesions are notable for having little or no inflammation associated with them and can persist for long periods without an effective clearance response from the host. Like all poxviruses, MCV encodes potent immunosuppressive proteins that perturb innate immune pathways involved in virus sensing, the interferon response, and inflammation, which collectively orchestrate antiviral immunity and clearance, with several of these pathways converging at common signaling nodes. One such node is the regulator of canonical nuclear factor kappa B (NF-κB) activation, NF-κB essential modulator (NEMO). Here, we report that the MCV protein MC008 specifically inhibits NF-κB through its interaction with NEMO, disrupting its early ubiquitin-mediated activation and subsequent downstream signaling. MC008 is the third NEMO-targeting inhibitor to be described in MCV to date, with each inhibiting NEMO activation in distinct ways, highlighting strong selective pressure to evolve multiple ways of disabling this key signaling protein. IMPORTANCE Inflammation lies at the heart of most human diseases. Understanding the pathways that drive this response is the key to new anti-inflammatory therapies. Viruses evolve to target inflammation; thus, understanding how they do this reveals how inflammation is controlled and, potentially, how to disable it when it drives disease. Molluscum contagiosum virus (MCV) has specifically evolved to infect humans and displays an unprecedented ability to suppress inflammation in our tissue. We have identified a novel inhibitor of human innate signaling from MCV, MC008, which targets NEMO, a core regulator of proinflammatory signaling. Furthermore, MC008 appears to inhibit early ubiquitination, thus interrupting later events in NEMO activation, thereby validating current models of IκB kinase (IKK) complex regulation.
Collapse
Affiliation(s)
- Thomas Phelan
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, St. James’ Hospital Campus, Dublin, Ireland
| | - Clara Lawler
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, St. James’ Hospital Campus, Dublin, Ireland
| | | | - Mark A. Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, St. James’ Hospital Campus, Dublin, Ireland
| | - Andrew G. Bowie
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Gareth Brady
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, St. James’ Hospital Campus, Dublin, Ireland
| |
Collapse
|
13
|
Hawerkamp HC, Dyer AH, Patil ND, McElheron M, O’Dowd N, O’Doherty L, Mhaonaigh AU, George AM, O’Halloran AM, Reddy C, Kenny RA, Little MA, Martin-Loeches I, Bergin C, Kennelly SP, Donnelly SC, Bourke NM, Long A, Sui J, Doherty DG, Conlon N, Cheallaigh CN, Fallon PG. Characterisation of the pro-inflammatory cytokine signature in severe COVID-19. Front Immunol 2023; 14:1170012. [PMID: 37063871 PMCID: PMC10101230 DOI: 10.3389/fimmu.2023.1170012] [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: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Clinical outcomes from infection with SARS-CoV-2, the cause of the COVID-19 pandemic, are remarkably variable ranging from asymptomatic infection to severe pneumonia and death. One of the key drivers of this variability is differing trajectories in the immune response to SARS-CoV-2 infection. Many studies have noted markedly elevated cytokine levels in severe COVID-19, although results vary by cohort, cytokine studied and sensitivity of assay used. We assessed the immune response in acute COVID-19 by measuring 20 inflammatory markers in 118 unvaccinated patients with acute COVID-19 (median age: 70, IQR: 58-79 years; 48.3% female) recruited during the first year of the pandemic and 44 SARS-CoV-2 naïve healthy controls. Acute COVID-19 was associated with marked elevations in nearly all pro-inflammatory markers, whilst eleven markers (namely IL-1β, IL-2, IL-6, IL-10, IL-18, IL-23, IL-33, TNF-α, IP-10, G-CSF and YKL-40) were associated with disease severity. We observed significant correlations between nearly all markers elevated in those infected with SARS-CoV-2 consistent with widespread immune dysregulation. Principal component analysis highlighted a pro-inflammatory cytokine signature (with strongest contributions from IL-1β, IL-2, IL-6, IL-10, IL-33, G-CSF, TNF-α and IP-10) which was independently associated with severe COVID-19 (aOR: 1.40, 1.11-1.76, p=0.005), invasive mechanical ventilation (aOR: 1.61, 1.19-2.20, p=0.001) and mortality (aOR 1.57, 1.06-2.32, p = 0.02). Our findings demonstrate elevated cytokines and widespread immune dysregulation in severe COVID-19, adding further evidence for the role of a pro-inflammatory cytokine signature in severe and critical COVID-19.
Collapse
Affiliation(s)
- Heike C. Hawerkamp
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Adam H. Dyer
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- *Correspondence: Adam H. Dyer, ; Padraic G. Fallon,
| | - Neha D. Patil
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Matt McElheron
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Niamh O’Dowd
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Laura O’Doherty
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
| | - Aisling Ui Mhaonaigh
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland
| | - Angel M. George
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland
| | - Aisling M. O’Halloran
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Conor Reddy
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Mark A. Little
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland
| | | | - Colm Bergin
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Sean P. Kennelly
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Seamas C. Donnelly
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Clinical Medicine, Tallaght University Hospital, Dublin, Ireland
| | - Nollaig M. Bourke
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aideen Long
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Jacklyn Sui
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Derek G. Doherty
- Department of Immunology, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Cliona Ni Cheallaigh
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Padraic G. Fallon
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
- *Correspondence: Adam H. Dyer, ; Padraic G. Fallon,
| |
Collapse
|
14
|
Floyd L, Bate S, Hadi Kafagi A, Brown N, Scott J, Srikantharajah M, Myslivecek M, Reid G, Aqeel F, Frausova D, Kollar M, Kieu PL, Khurshid B, Pusey CD, Dhaygude A, Tesar V, McAdoo S, Little MA, Geetha D, Brix SR. Risk Stratification to Predict Renal Survival in Anti-Glomerular Basement Membrane Disease. J Am Soc Nephrol 2023; 34:505-514. [PMID: 36446430 PMCID: PMC10103284 DOI: 10.1681/asn.2022050581] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 12/03/2022] Open
Abstract
SIGNIFICANCE STATEMENT Most patients with anti-glomerular basement membrane (GBM) disease present with rapidly progressive glomerulonephritis, and more than half develop ESKD. Currently, no tools are available to aid in the prognostication or management of this rare disease. In one of the largest assembled cohorts of patients with anti-GBM disease (with 174 patients included in the final analysis), the authors demonstrated that the renal risk score for ANCA-associated vasculitis is transferable to anti-GBM disease and the renal histology is strongly predictive of renal survival and recovery. Stratifying patients according to the percentage of normal glomeruli in the kidney biopsy and the need for RRT at the time of diagnosis improves outcome prediction. Such stratification may assist in the management of anti-GBM disease. BACKGROUND Prospective randomized trials investigating treatments and outcomes in anti-glomerular basement membrane (anti-GBM) disease are sparse, and validated tools to aid prognostication or management are lacking. METHODS In a retrospective, multicenter, international cohort study, we investigated clinical and histologic parameters predicting kidney outcome and sought to identify patients who benefit from rescue immunosuppressive therapy. We also explored applying the concept of the renal risk score (RRS), currently used to predict renal outcomes in ANCA-associated vasculitis, to anti-GBM disease. RESULTS The final analysis included 174 patients (out of a total of 191). Using Cox and Kaplan-Meier methods, we found that the RRS was a strong predictor for ESKD. The 36-month renal survival was 100%, 62.4%, and 20.7% in the low-risk, moderate-risk, and high-risk groups, respectively. The need for renal replacement therapy (RRT) at diagnosis and the percentage of normal glomeruli in the biopsy were independent predictors of ESKD. The best predictor for renal recovery was the percentage of normal glomeruli, with a cut point of 10% normal glomeruli providing good stratification. A model with the predictors RRT and normal glomeruli ( N ) achieved superior discrimination for significant differences in renal survival. Dividing patients into four risk groups led to a 36-month renal survival of 96.4% (no RRT, N ≥10%), 74.0% (no RRT, N <10%), 42.3% (RRT, N ≥10%), and 14.1% (RRT, N <10%), respectively. CONCLUSIONS These findings demonstrate that the RRS concept is transferrable to anti-GBM disease. Stratifying patients according to the need for RRT at diagnosis and renal histology improves prediction, highlighting the importance of normal glomeruli. Such stratification may assist in the management of anti-GBM disease. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2023_02_27_JASN0000000000000060.mp3.
Collapse
Affiliation(s)
- Lauren Floyd
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Sebastian Bate
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Abdul Hadi Kafagi
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Nina Brown
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Jennifer Scott
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
- Irish Centre for Vascular Biology, Dublin, Ireland
| | | | - Marek Myslivecek
- First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Nephrology, General University Hospital, Prague, Czech Republic
| | - Graeme Reid
- Renal Pathology, Adult Histopathology Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Faten Aqeel
- Department of Medicine, John Hopkins University, Baltimore, Maryland
| | - Doubravka Frausova
- First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Nephrology, General University Hospital, Prague, Czech Republic
| | - Marek Kollar
- Centre of Clinical and Transplant Pathology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Phuong Le Kieu
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Bilal Khurshid
- Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Charles D. Pusey
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Ajay Dhaygude
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Vladimir Tesar
- First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Nephrology, General University Hospital, Prague, Czech Republic
| | - Stephen McAdoo
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Mark A. Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
- Irish Centre for Vascular Biology, Dublin, Ireland
| | - Duvuru Geetha
- Department of Medicine, John Hopkins University, Baltimore, Maryland
| | - Silke R. Brix
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
- Renal, Urology and Transplantation Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
15
|
Leacy E, Batten I, Sanelli L, McElheron M, Brady G, Little MA, Khouri H. Optimal LC-MS metabolomic profiling reveals emergent changes to monocyte metabolism in response to lipopolysaccharide. Front Immunol 2023; 14:1116760. [PMID: 37033938 PMCID: PMC10077522 DOI: 10.3389/fimmu.2023.1116760] [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: 12/05/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Immunometabolism examines the links between immune cell function and metabolism. Dysregulation of immune cell metabolism is now an established feature of innate immune cell activation. Advances in liquid chromatography mass spectrometry (LC-MS) technologies have allowed discovery of unique insights into cellular metabolomics. Here we have studied and compared different sample preparation techniques and data normalisation methods described in the literature when applied to metabolomic profiling of human monocytes. Methods Primary monocytes stimulated with lipopolysaccharide (LPS) for four hours was used as a study model. Monocytes (n=24) were freshly isolated from whole blood and stimulated for four hours with lipopolysaccharide (LPS). A methanol-based extraction protocol was developed and metabolomic profiling carried out using a Hydrophilic Interaction Liquid Chromatography (HILIC) LC-MS method. Data analysis pipelines used both targeted and untargeted approaches, and over 40 different data normalisation techniques to account for technical and biological variation were examined. Cytokine levels in supernatants were measured by ELISA. Results This method provided broad coverage of the monocyte metabolome. The most efficient and consistent normalisation method was measurement of residual protein in the metabolite fraction, which was further validated and optimised using a commercial kit. Alterations to the monocyte metabolome in response to LPS can be detected as early as four hours post stimulation. Broad and profound changes in monocyte metabolism were seen, in line with increased cytokine production. Elevated levels of amino acids and Krebs cycle metabolites were noted and decreases in aspartate and β-alanine are also reported for the first time. In the untargeted analysis, 154 metabolite entities were significantly altered compared to unstimulated cells. Pathway analysis revealed the most prominent changes occurred to (phospho-) inositol metabolism, glycolysis, and the pentose phosphate pathway. Discussion These data report the emergent changes to monocyte metabolism in response to LPS, in line with reports from later time points. A number of these metabolites are reported to alter inflammatory gene expression, which may facilitate the increases in cytokine production. Further validation is needed to confirm the link between metabolic activation and upregulation of inflammatory responses.
Collapse
Affiliation(s)
- Emma Leacy
- Trinity Translational Medicine Institute, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
- *Correspondence: Emma Leacy, ; Mark A. Little,
| | - Isabella Batten
- Trinity Translational Medicine Institute, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Laetitia Sanelli
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Matthew McElheron
- Trinity Translational Medicine Institute, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Gareth Brady
- Trinity Translational Medicine Institute, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Mark A. Little
- Trinity Translational Medicine Institute, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, Ireland
- *Correspondence: Emma Leacy, ; Mark A. Little,
| | - Hania Khouri
- Agilent Technologies, Stockpoty, England, United Kingdom
| |
Collapse
|
16
|
Collister D, Farrar M, Farrar L, Brown P, Booth M, Firth T, Mahr A, Zeng L, Little MA, Mustafa RA, Fussner LA, Meara A, Guyatt G, Jayne D, Merkel PA, Walsh M. Plasma Exchange for ANCA-Associated Vasculitis: An International Survey of Patient Preferences. Kidney Med 2022; 5:100595. [PMID: 36686273 PMCID: PMC9851885 DOI: 10.1016/j.xkme.2022.100595] [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] [Indexed: 12/26/2022] Open
Abstract
Rationale & Objective We sought to elicit patient preferences regarding the use of plasma exchange in antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and its tradeoffs of risk of kidney failure and risk of serious infection. Study Design Patient survey. Setting & Participants The online survey was circulated to adults with AAV via kidney and vasculitis networks in Canada, the United Kingdom, and the United States. Outcomes Respondents reviewed the estimated 1-year risks of kidney failure and serious infection in AAV with and without plasma exchange across 5 serum creatinine categories (150, 250, 350, 450, and 600 μmol/L). For each scenario, participants indicated whether or not they would choose plasma exchange. Analytical Approach Responses were assessed with multilevel multivariable logistic regression models to identify predictors of respondent choice regarding treatment with plasma exchange. Results The 470 respondents from the 13 countries (United States 61.7%, United Kingdom 20.0%, Canada 13.8%, and other countries 4.5%) had a mean age of 58.6 (SD 14.3) years, 70.2% women. Respondents were more likely to choose plasma exchange in scenarios at high risk of kidney failure and serious infection (creatinine level of 350 or 450 μmol/L) compared with lower risk scenarios or the highest risk scenario. However, 145 (30.9%) chose plasma exchange across all scenarios, whereas 80 (17.0%) declined plasma exchange across all scenarios. Respondents from the United Kingdom (OR, 2.61; 95% CI, 1.09-6.22) who received previous dialysis (OR, 2.70; 95% CI, 1.12-6.52) or received previous plasma exchange (OR, 5.62; 95% CI, 2.72-11.61) were more likely to choose plasma exchange, whereas older respondents (OR, 0.98; 95% CI, 0.96-0.99 per 1 year increase) were less likely. Limitations Unclear generalizability to non-English-speaking, older, and less health literate adults, possible responder bias, survivor bias, lack of individualized risk assessments for kidney failure, and serious infection. Conclusions Patients with AAV do not express a consistent choice for plasma exchange, which highlights the need for shared decision making.
Collapse
Affiliation(s)
- David Collister
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada,Population Health Research Institute, Hamilton, Ontario, Canada,Address for Correspondence: David Collister, MD, PhD, University of Alberta, 11-113H Clinical Sciences Bldg, 11350 83 Ave Edmonton, AB, Canada, T6G2P4.
| | | | | | - Paul Brown
- Vasculitis Patient-Powered Research Network, Kansas City, MO
| | - Michelle Booth
- Vasculitis Patient-Powered Research Network, Kansas City, MO
| | | | - Alfred Mahr
- Clinic for Rheumatology, Kantonnspital St Gallen, St Gallen, Switzerland
| | - Linan Zeng
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mark A. Little
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, Ireland
| | - Reem A. Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Health System, Kansas City, KS
| | - Lynn A. Fussner
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Alexa Meara
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David Jayne
- Department of Medicine, University of Cambridge, United Kingdom
| | - Peter A. Merkel
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA,Division of Clinical Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Michael Walsh
- Population Health Research Institute, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,Department of Medicine, Division of Nephrology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
17
|
Aendekerk JP, Jiemy WF, Raveling-Eelsing E, Bijnens N, Abdul-Hamid MA, Strating IM, Dekkema GJ, Sanders JSF, Stegeman CA, Damoiseaux JGMC, Little MA, Heeringa P, van Paassen P. CD163 and CD206 expression define distinct macrophage subsets involved in active ANCA-associated glomerulonephritis. J Autoimmun 2022; 133:102914. [PMID: 36183584 DOI: 10.1016/j.jaut.2022.102914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Macrophages are key players in the immunopathology of anti-neutrophil cytoplasmic antibody (ANCA) mediated-vasculitis (AAV) with glomerulonephritis (ANCA GN). Different macrophage phenotypes are expected to play distinct roles in ANCA GN. Macrophages expressing CD163 and CD206 are found in lesions associated with ANCA GN. Hence, we aimed to investigate the clinicopathological significance of CD206 and CD163 in ANCA GN in a multicenter retrospective cohort study. MATERIAL AND METHODS Patients with ANCA-associated vasculitis, with clinical data, serum and urine samples were included from three cohorts. Serum soluble CD206 (ssCD206) and urinary soluble CD163 (usCD163) levels were measured. Human kidney tissue samples (n = 53) were stained for CD206 and CD163 using immunohistochemistry and immunofluorescence, and findings were correlated with clinical and pathological data. RESULTS In total, 210 patients were included (i.e., ANCA GN, n = 134; AAV without GN, n = 24; AAV in remission n = 52). Increased levels of both ssCD206 and usCD163 were seen in ANCA GN. High levels of ssCD206 declined after reaching remission, however, ssCD206 did not improve the accuracy of usCD163 to detect ANCA GN. Soluble markers correlated with histopathological findings. CD163+CD206- macrophages were found in the glomerulus and may play pivotal roles in glomerulonephritis, whereas CD206+CD163- and CD206+CD163+ macrophages were located tubulointerstitially and likely play a more prominent role in ANCA-associated tubulointerstitial inflammation. In ANCA GN patients increasing levels of ssCD206 increased the risk for end-stage renal disease and mortality. CONCLUSIONS Our results confirm and extend the notion that CD206+ and CD163+ macrophages are prominent components of the cellular infiltrate in ANCA GN. We found distinct macrophage phenotypes that may play distinct roles in the immunopathology of ANCA GN and elaborate on a potential mechanism underlying the findings of this study. usCD163 remains an excellent marker to detect active ANCA GN, whereas ssCD206 seems a more prominent marker for risk prediction.
Collapse
Affiliation(s)
- Joop P Aendekerk
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, P. Debyelaan 25, 6229HX, Maastricht, the Netherlands
| | - William F Jiemy
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands; Department of Pathology and Medical Biology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Elisabeth Raveling-Eelsing
- Department of Pathology and Medical Biology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Nele Bijnens
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, P. Debyelaan 25, 6229HX, Maastricht, the Netherlands
| | - Myrurgia A Abdul-Hamid
- Department of Pathology, Maastricht University Medical Center, P. Debyelaan 25, 6229HX Maastricht, the Netherlands
| | - Inge M Strating
- Department of Pathology and Medical Biology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Gerjan J Dekkema
- Department of Pathology and Medical Biology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Jan-Stephan F Sanders
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Coen A Stegeman
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Jan G M C Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, P. Debyelaan 25, 6229HX, Maastricht, the Netherlands
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, St. James's Street, Dublin 8, Ireland
| | - Peter Heeringa
- Department of Pathology and Medical Biology, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Pieter van Paassen
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, P. Debyelaan 25, 6229HX, Maastricht, the Netherlands.
| |
Collapse
|
18
|
Scott J, Nic an Ríogh E, Al Nokhatha S, Cowhig C, Verrelli A, Fitzgerald T, White A, Walsh C, Aslett L, DeFreitas D, Clarkson MR, Holian J, Griffin MD, Conlon N, O’Meara Y, Casserly L, Molloy E, Power J, Moran SM, Little MA. ANCA-associated vasculitis in Ireland: a multi-centre national cohort study. HRB Open Res 2022; 5:80. [PMID: 37251362 PMCID: PMC10213823 DOI: 10.12688/hrbopenres.13651.1] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 11/02/2023] Open
Abstract
Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare multisystem autoimmune disease. There is a need for interoperable national registries to enable reporting of real-world long-term outcomes and their predictors in AAV. Methods: The Irish National Rare Kidney Disease (RKD) registry was founded in 2012. To date, 842 patients with various forms of vasculitis have been recruited across eight nephrology, rheumatology and immunology centres. We focus here on patient- and disease- characteristics, treatment and outcomes of the 397 prospectively recruited patients with AAV. Results: Median age was 64 years (IQR 55-73), 57.9% were male, 58.9% had microscopic polyangiitis and 85.9% had renal impairment. Cumulative one- and five-year patient survival was 94% and 77% respectively. Median follow-up was 33.5 months (IQR 10.7-52.7). After controlling for age, baseline renal dysfunction (p = 0.04) and the burden of adverse events (p <0.001) were independent predictors of death overall. End-stage-kidney-disease (ESKD) occurred in 73 (18.4%) patients; one- and five-year renal survival was 85% and 79% respectively. Baseline severity of renal insufficiency (p = 0.02), urine soluble CD163 (usCD163) (p = 0.002) and "sclerotic" Berden histological class (p = 0.001) were key determinants of ESKD risk. Conclusions: Long-term outcomes of Irish AAV patients are comparable to other reported series. Our results emphasise the need for personalisation of immunosuppression, to limit treatment toxicity, particularly in those with advanced age and renal insufficiency. Baseline usCD163 is a potential biomarker for ESKD prediction and should be validated in a large independent cohort.
Collapse
Affiliation(s)
- Jennifer Scott
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, D02 PN40, Ireland
| | - Eithne Nic an Ríogh
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, D02 PN40, Ireland
| | - Shamma Al Nokhatha
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, D02 PN40, Ireland
| | - Cliona Cowhig
- Department of Nephrology, Beaumont Hospital, Dublin, D09 V2N0, Ireland
| | - Alyssa Verrelli
- Department of Nephrology, Cork University Hospital, Cork, T12 DC4A, Ireland
| | - Ted Fitzgerald
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, D02 PN40, Ireland
- Department of Nephrology, Beaumont Hospital, Dublin, D09 V2N0, Ireland
| | - Arthur White
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, D02 PN40, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Louis Aslett
- Department of Mathematical Sciences, Durham University, Durham, DH1 3LE, UK
| | - Declan DeFreitas
- Department of Nephrology, Beaumont Hospital, Dublin, D09 V2N0, Ireland
| | | | - John Holian
- Department of Nephrology, St. Vincent’s University Hospital, Dublin, D04 T6F4, Ireland
| | - Matthew D. Griffin
- Department of Nephrology, University Hospital Galway, Galway, H91 YR71, Ireland
| | - Niall Conlon
- Department of Immunology, St. James’s Hospital, Dublin, D08 NHY1, Ireland
| | - Yvonne O’Meara
- Department of Nephrology, Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Liam Casserly
- Department of Nephrology, University Hospital Limerick, Limerick, V94 F858, Ireland
| | - Eamonn Molloy
- Department of Rheumatology, St. Vincent’s University Hospital, Dublin, D04 T6F4, Ireland
| | - Julie Power
- Vasculitis Ireland Awareness, Dublin, Ireland
| | - Sarah M. Moran
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, D02 PN40, Ireland
- Department of Nephrology, Cork University Hospital, Cork, T12 DC4A, Ireland
| | - Mark A. Little
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, D02 PN40, Ireland
| |
Collapse
|
19
|
Wang LY, Wang RX, Wang C, Chen SF, Sun XJ, Li ZY, Chen M, Little MA, Zhao MH. IAPs antagonist SM164 ameliorates experimental MPO-ANCA-associated vasculitis via enhancing fatty acid oxidation in neutrophils. Rheumatology (Oxford) 2022:6779969. [PMID: 36308438 DOI: 10.1093/rheumatology/keac621] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of life-threatening autoimmune diseases. Inhibitors of apoptosis proteins (IAPs) are a class of molecules engaged in cell death and inflammation, interventions of which are proven effective in a number of inflammatory diseases. Here we tested whether targeting IAPs could ameliorate AAV and explored the potential mechanism. METHODS We collected 19 kidney specimens from patients with myeloperoxidase (MPO)-AAV to investigate the expression of IAPs. The IAPs pan-inhibitor SM164 was used to treat the experimental autoimmune vasculitis (EAV) rat model of AAV. RNA sequencing of renal cortex and enrichment analysis were developed to interpret gene expression. Functional experiments were performed to investigate the role of SM164 on neutrophils and endothelial cells. RESULTS The expressions of three IAPs (cIAP1, cIAP2 and XIAP) were upregulated in kidneys of AAV patients compared with normal controls. SM164 dramatically reduced renal injury in EAV rats. Transcriptomic analysis revealed prominent alterations in fatty acid oxidation and respiratory burst following SM164 treatment. Functional studies demonstrated that SM164 inhibited neutrophil activation induced by MPO-ANCA positive IgG or serum from MPO-AAV patients, and such inhibitory effect was abolished by gene silencing or pharmacological inhibition of fatty acid oxidation. SM164 also inhibited the adhesion of neutrophils to endothelial cells with little effect on the endothelial injury induced by serum from MPO-AAV patients. CONCLUSION Inhibition of IAPs with SM164 played a protective role in AAV through enhancing intracellular fatty acid oxidation in neutrophils.
Collapse
Affiliation(s)
- Luo-Yi Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.,Department of Nephrology, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital and People's Hospital of Zhengzhou University, Henan, China
| | - Rui-Xue Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Chen Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Su-Fang Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Xiao-Jing Sun
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Zhi-Ying Li
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, St. James' Hospital Campus; Irish Centre for Vascular Biology, Trinity College Dublin, Dublin, Ireland
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Beijing, China
| |
Collapse
|
20
|
McKenna E, Wubben R, Isaza-Correa JM, Melo AM, Mhaonaigh AU, Conlon N, O'Donnell JS, Ní Cheallaigh C, Hurley T, Stevenson NJ, Little MA, Molloy EJ. Neutrophils in COVID-19: Not Innocent Bystanders. Front Immunol 2022; 13:864387. [PMID: 35720378 PMCID: PMC9199383 DOI: 10.3389/fimmu.2022.864387] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/29/2022] [Indexed: 12/18/2022] Open
Abstract
Unusually for a viral infection, the immunological phenotype of severe COVID-19 is characterised by a depleted lymphocyte and elevated neutrophil count, with the neutrophil-to-lymphocyte ratio correlating with disease severity. Neutrophils are the most abundant immune cell in the bloodstream and comprise different subpopulations with pleiotropic actions that are vital for host immunity. Unique neutrophil subpopulations vary in their capacity to mount antimicrobial responses, including NETosis (the generation of neutrophil extracellular traps), degranulation and de novo production of cytokines and chemokines. These processes play a role in antiviral immunity, but may also contribute to the local and systemic tissue damage seen in acute SARS-CoV-2 infection. Neutrophils also contribute to complications of COVID-19 such as thrombosis, acute respiratory distress syndrome and multisystem inflammatory disease in children. In this Progress review, we discuss the anti-viral and pathological roles of neutrophils in SARS-CoV-2 infection, and potential therapeutic strategies for COVID-19 that target neutrophil-mediated inflammatory responses.
Collapse
Affiliation(s)
- Ellen McKenna
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland.,Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St James' Hospital, Dublin, Ireland
| | - Richard Wubben
- Viral Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - Johana M Isaza-Correa
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland.,Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St James' Hospital, Dublin, Ireland
| | - Ashanty M Melo
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland.,Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St James' Hospital, Dublin, Ireland
| | - Aisling Ui Mhaonaigh
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St James' Hospital, Trinity College Dublin, Dublin, Ireland
| | | | - Clíona Ní Cheallaigh
- Department of Clinical Medicine, Trinity Centre for Health Science, Trinity College Dublin, Dublin, Ireland.,Department of Infectious Diseases, St James's Hospital, Dublin, Ireland
| | - Tim Hurley
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland.,Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St James' Hospital, Dublin, Ireland.,Neonatology, Coombe Women and Infant's University Hospital, Dublin, Ireland.,National Children's Research Centre, Children's Hospital Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Nigel J Stevenson
- Viral Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland.,Viral Immunology Group, Royal College of Surgeons in Ireland - Medical College of Bahrain, Al Muharraq, Bahrain
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland.,Irish Centre for Vascular Biology, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland.,Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St James' Hospital, Dublin, Ireland.,Neonatology, Coombe Women and Infant's University Hospital, Dublin, Ireland.,National Children's Research Centre, Children's Hospital Ireland (CHI) at Crumlin, Dublin, Ireland.,Neonatology, Children's Hospital Ireland (CHI) at Crumlin, Dublin, Ireland.,Paediatrics, Children's Hospital Ireland (CHI) at Tallaght, Tallaght University Hospital, Dublin, Ireland
| |
Collapse
|
21
|
Scott J, Havyarimana E, Navarro-Gallinad A, White A, Wyse J, van Geffen J, van Weele M, Buettner A, Wanigasekera T, Walsh C, Aslett L, Kelleher JD, Power J, Ng J, O'Sullivan D, Hederman L, Basu N, Little MA, Zgaga L. The association between ambient UVB dose and ANCA-associated vasculitis relapse and onset. Arthritis Res Ther 2022; 24:147. [PMID: 35717248 PMCID: PMC9206351 DOI: 10.1186/s13075-022-02834-6] [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: 09/07/2021] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background The aetiology of ANCA-associated vasculitis (AAV) and triggers of relapse are poorly understood. Vitamin D (vitD) is an important immunomodulator, potentially responsible for the observed latitudinal differences between granulomatous and non-granulomatous AAV phenotypes. A narrow ultraviolet B spectrum induces vitD synthesis (vitD-UVB) via the skin. We hypothesised that prolonged periods of low ambient UVB (and by extension vitD deficiency) are associated with the granulomatous form of the disease and an increased risk of AAV relapse. Methods Patients with AAV recruited to the Irish Rare Kidney Disease (RKD) (n = 439) and UKIVAS (n = 1961) registries were studied. Exposure variables comprised latitude and measures of ambient vitD-UVB, including cumulative weighted UVB dose (CW-D-UVB), a well-validated vitD proxy. An n-of-1 study design was used to examine the relapse risk using only the RKD dataset. Multi-level models and logistic regression were used to examine the effect of predictors on AAV relapse risk, phenotype and serotype. Results Residential latitude was positively correlated (OR 1.41, 95% CI 1.14–1.74, p = 0.002) and average vitD-UVB negatively correlated (0.82, 0.70–0.99, p = 0.04) with relapse risk, with a stronger effect when restricting to winter measurements (0.71, 0.57–0.89, p = 0.002). However, these associations were not restricted to granulomatous phenotypes. We observed no clear relationship between latitude, vitD-UVB or CW-D-UVB and AAV phenotype or serotype. Conclusion Our findings suggest that low winter ambient UVB and prolonged vitD status contribute to AAV relapse risk across all phenotypes. However, the development of a granulomatous phenotype does not appear to be directly vitD-mediated. Further research is needed to determine whether sufficient vitD status would reduce relapse propensity in AAV. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02834-6.
Collapse
Affiliation(s)
- Jennifer Scott
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland
| | - Enock Havyarimana
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Arthur White
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Jason Wyse
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Jos van Geffen
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, The Netherlands
| | - Michiel van Weele
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, The Netherlands
| | - Antonia Buettner
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland
| | - Tamara Wanigasekera
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Louis Aslett
- Department of Mathematical Science, University of Durham, Durham, UK
| | - John D Kelleher
- School of Computer Science, Technological University Dublin, Dublin, Ireland
| | - Julie Power
- Vasculitis Ireland Awareness, Galway, Ireland
| | - James Ng
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Declan O'Sullivan
- ADAPT Centre for Digital Content, Trinity College Dublin, Dublin, Ireland
| | - Lucy Hederman
- ADAPT Centre for Digital Content, Trinity College Dublin, Dublin, Ireland
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland. .,ADAPT Centre for Digital Content, Trinity College Dublin, Dublin, Ireland.
| | - Lina Zgaga
- Department of Public Health and Primary Care, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | | |
Collapse
|
22
|
McGlinn K, Rutherford MA, Gisslander K, Hederman L, Little MA, O'Sullivan D. FAIRVASC: A semantic web approach to rare disease registry integration. Comput Biol Med 2022; 145:105313. [DOI: 10.1016/j.compbiomed.2022.105313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022]
|
23
|
Egan AC, Kronbichler A, Neumann I, Bettiol A, Carlson N, Cid MC, Emmi G, Gopaluni S, Harper L, Hauser T, Little MA, Luqmani RA, Mahr A, McClure M, Mohammad AJ, Nelveg-Kristensen KE, Ohlsson S, Peh CA, Rutherford M, Sanchez Alamo B, Scott J, Segelmark M, Smith RM, Szpirt WM, Tomasson G, Trivioli G, Vaglio A, Walsh M, Wester Trejo M, Westman K, Bajema IM, Jayne DR. The Sound of Interconnectivity; The European Vasculitis Society 2022 Report. Kidney Int Rep 2022; 7:1745-1757. [PMID: 35967106 PMCID: PMC9366365 DOI: 10.1016/j.ekir.2022.05.018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022] Open
Abstract
The first European Vasculitis Society (EUVAS) meeting report was published in 2017. Herein, we report on developments in the past 5 years which were greatly influenced by the pandemic. The adaptability to engage virtually, at this critical time in society, embodies the importance of networks and underscores the role of global collaborations. We outline state-of-the-art webinar topics, updates on developments in the last 5 years, and proposals for agendas going forward. A host of newly reported clinical trials is shaping practice on steroid minimization, maintenance strategies, and the role of newer therapies. To guide longer-term strategies, a longitudinal 10-year study investigating relapse, comorbidity, malignancy, and survival rates is at an advanced stage. Disease assessment studies are refining classification criteria to differentiate forms of vasculitis more fully. A large international validation study on the histologic classification of anti-neutrophil cytoplasmic antibody (ANCA) glomerulonephritis, recruiting new multicenter sites and comparing results with the Kidney Risk Score, has been conducted. Eosinophilic granulomatosis with polyangiitis (EGPA) genomics offers potential pathogenic subset and therapeutic insights. Among biomarkers, ANCA testing is favoring immunoassay as the preferred method for diagnostic evaluation. Consolidated development of European registries is progressing with an integrated framework to analyze large clinical data sets on an unprecedented scale.
Collapse
|
24
|
Zeng L, Walsh M, Guyatt GH, Siemieniuk RAC, Collister D, Booth M, Brown P, Farrar L, Farrar M, Firth T, Fussner LA, Kilian K, Little MA, Mavrakanas TA, Mustafa RA, Piram M, Stamp LK, Xiao Y, Lytvyn L, Agoritsas T, Vandvik PO, Mahr A. Plasma exchange and glucocorticoid dosing for patients with ANCA-associated vasculitis: a clinical practice guideline. BMJ 2022; 376:e064597. [PMID: 35217581 DOI: 10.1136/bmj-2021-064597] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CLINICAL QUESTIONS What is the role of plasma exchange and what is the optimal dose of glucocorticoids in the first 6 months of therapy of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)? This guideline was triggered by the publication of a new randomised controlled trial. CURRENT PRACTICE Existing guideline recommendations vary regarding the use of plasma exchange in AAV and lack explicit recommendations regarding the tapering regimen of glucocorticoids during induction therapy. RECOMMENDATIONS The guideline panel makes a weak recommendation against plasma exchange in patients with low or low-moderate risk of developing end stage kidney disease (ESKD), and a weak recommendation in favour of plasma exchange in patients with moderate-high or high risk of developing ESKD. For patients with pulmonary haemorrhage without renal involvement, the panel suggests not using plasma exchange (weak recommendation). The panel made a strong recommendation in favour of a reduced dose rather than standard dose regimen of glucocorticoids, which involves a more rapid taper rate and lower cumulative dose during the first six months of therapy. HOW THIS GUIDELINE WAS CREATED A guideline panel including patients, a care giver, clinicians, content experts, and methodologists produced these recommendations using GRADE and in adherence with standards for trustworthy guidelines. The recommendations are based on two linked systematic reviews. The panel took an individual patient perspective in the development of recommendations. THE EVIDENCE The systematic review of plasma exchange identified nine randomised controlled trials (RCTs) that enrolled 1060 patients with AAV. Plasma exchange probably has little or no effect on mortality or disease relapse (moderate and low certainty). Plasma exchange probably reduces the one year risk of ESKD (approximately 0.1% reduction in those with low risk, 2.1% reduction in those with low-moderate risk, 4.6% reduction in those with moderate-high risk, and 16.0% reduction in those with high risk or requiring dialysis) but increases the risk of serious infections (approximately 2.7% increase in those with low risk, 4.9% increase in those with low-moderate risk, 8.5% increase in those with moderate-high risk, to 13.5% in high risk group) at 1 year (moderate to high certainty). The guideline panel agreed that most patients with low or low-moderate risk of developing ESKD would consider the harms to outweigh the benefits, while most of those with moderate-high or high risk would consider the benefits to outweigh the harms. For patients with pulmonary haemorrhage without kidney involvement, based on indirect evidence, plasma exchange may have little or no effect on death (very low certainty) but may have an important increase in serious infections at 1 year (approximately 6.8% increase, low certainty). The systematic review of different dose regimens of glucocorticoids identified two RCTs at low risk of bias with 704 and 140 patients respectively. A reduced dose regimen of glucocorticoid probably reduces the risk of serious infections by approximately 5.9% to 12.8% and probably does not increase the risk of ESKD at the follow-up of 6 months to longer than 1 year (moderate certainty for both outcomes). UNDERSTANDING THE RECOMMENDATION The recommendations were made with the understanding that patients would place a high value on reduction in ESKD and less value on avoiding serious infections. The panel concluded that most (50-90%) of fully informed patients with AAV and with low or low-moderate risk of developing ESKD with or without pulmonary haemorrhage would decline plasma exchange, whereas most patients with moderate-high or high risk or requiring dialysis with or without pulmonary haemorrhage would choose to receive plasma exchange. The panel also inferred that the majority of fully informed patients with pulmonary haemorrhage without kidney involvement would decline plasma exchange and that all or almost all (≥90%) fully informed patients with AAV would choose a reduced dose regimen of glucocorticoids during the first 6 months of therapy.
Collapse
Affiliation(s)
- Linan Zeng
- Pharmacy department/Evidence-based pharmacy centre, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michael Walsh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David Collister
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | | | | | | | | | | | - Lynn A Fussner
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Karin Kilian
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mark A Little
- Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
- Irish Centre for Vascular Biology, Tallaght University Hospital, Dublin, Ireland
| | - Thomas A Mavrakanas
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas, USA
| | - Maryam Piram
- CHU Sainte Justine Research Center, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
- CEREMAIA, Centre d'épidémiologie et de santé des populations (CESP), University Paris-Saclay, Le Kremlin Bicêtre, France
| | - Lisa K Stamp
- University of Otago Christchurch, Christchurch, New Zealand
| | - Yingqi Xiao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- West China School of Nursing/Department of Nursing, West China Hospital, Sichuan University, China
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Per O Vandvik
- Department of Medicine, Lovisenberg Hospital Trust, Oslo, Norway
| | - Alfred Mahr
- Rheumatology Clinic, Department of Internal Medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| |
Collapse
|
25
|
Boyle S, Hussain M, Kirby C, Brennan S, Clarke L, Mullan R, Halpenny D, Conlon N, Little MA, Conlon BJ, Abdulrahman S. Oro-Naso-Sino-Orbital-Cutaneous Fistula From Prolonged Cocaine Use. Ir Med J 2022; 115:544. [PMID: 35420004] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Presentation We present the case of a 48-year-old man with nasal cellulitis and subsequent oro-naso-sino-orbital-cutaneous fistula from prolonged cocaine use. Diagnosis Initial laboratory investigations reported a raised white cell count (WBC) and C-Reactive Protein (CRP) and subsequently a positive atypical anti-neutrophil cytoplasm antibodies (ANCA) and positive anti-proteinase (PR3). Perihilar lung nodularity on chest imaging raised the possibility of a systemic autoimmune response. His urinalysis was positive for cocaine. Treatment He was commenced on Augmentin, Amphotericin B and Prednisolone. An obturator was created to manage the oro-nasal fistula. A subsequent naso-cutaneous defect was re-approximated. Daily nasal saline douche and abstinence of cocaine were recommended. Discussion Cocaine use in the community is rising and poses a challenge to multiple facets of our health care system.
Collapse
Affiliation(s)
- S Boyle
- ENT Department Tallaght University Hospital, Dublin 24, Ireland
| | - M Hussain
- ENT Department Tallaght University Hospital, Dublin 24, Ireland
| | - C Kirby
- Rheumatology Department Tallaght University Hospital, Dublin 24, Ireland
| | - S Brennan
- Pathology Department, Tallaght University Hospital, Dublin 24, Ireland
| | - L Clarke
- Pathology Department, Tallaght University Hospital, Dublin 24, Ireland
| | - R Mullan
- Rheumatology Department Tallaght University Hospital, Dublin 24, Ireland
| | - D Halpenny
- Radiology Department, Tallaght University Hospital, Dublin 24, Ireland
| | - N Conlon
- Autoimmune Department, St James Hospital, Dublin 8, Ireland
| | - M A Little
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin 24, Ireland
| | - B J Conlon
- ENT Department Tallaght University Hospital, Dublin 24, Ireland
| | - S Abdulrahman
- ENT Department Tallaght University Hospital, Dublin 24, Ireland
| |
Collapse
|
26
|
Elhassan EAE, Murray SL, Connaughton DM, Kennedy C, Cormican S, Cowhig C, Stapleton C, Little MA, Kidd K, Bleyer AJ, Živná M, Kmoch S, Fennelly NK, Doyle B, Dorman A, Griffin MD, Casserly L, Harris PC, Hildebrandt F, Cavalleri GL, Benson KA, Conlon PJ. The utility of a genetic kidney disease clinic employing a broad range of genomic testing platforms: experience of the Irish Kidney Gene Project. J Nephrol 2022; 35:1655-1665. [PMID: 35099770 PMCID: PMC9300532 DOI: 10.1007/s40620-021-01236-2] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/16/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Genetic testing presents a unique opportunity for diagnosis and management of genetic kidney diseases (GKD). Here, we describe the clinical utility and valuable impact of a specialized GKD clinic, which uses a variety of genomic sequencing strategies. METHODS In this prospective cohort study, we undertook genetic testing in adults with suspected GKD according to prespecified criteria. Over 7 years, patients were referred from tertiary centres across Ireland to an academic medical centre as part of the Irish Kidney Gene Project. RESULTS Among 677 patients, the mean age was of 37.2 ± 13 years, and 73.9% of the patients had family history of chronic kidney disease (CKD). We achieved a molecular diagnostic rate of 50.9%. Four genes accounted for more than 70% of identified pathogenic variants: PKD1 and PKD2 (n = 186, 53.4%), MUC1 (8.9%), and COL4A5 (8.3%). In 162 patients with a genetic diagnosis, excluding PKD1/PKD2, the a priori diagnosis was confirmed in 58% and in 13% the diagnosis was reclassified. A genetic diagnosis was established in 22 (29.7%) patients with CKD of uncertain aetiology. Based on genetic testing, a diagnostic kidney biopsy was unnecessary in 13 (8%) patients. Presence of family history of CKD and the underlying a priori diagnosis were independent predictors (P < 0.001) of a positive genetic diagnosis. CONCLUSIONS A dedicated GKD clinic is a valuable resource, and its implementation of various genomic strategies has resulted in a direct, demonstrable clinical and therapeutic benefits to affected patients.
Collapse
Affiliation(s)
- Elhussein A E Elhassan
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland. .,Department of Medicine, Dublin, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Susan L Murray
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland.,Department of Medicine, Dublin, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dervla M Connaughton
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Claire Kennedy
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Sarah Cormican
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Cliona Cowhig
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Caragh Stapleton
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, St James' Street, Dublin 8, Ireland
| | - Kendrah Kidd
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anthony J Bleyer
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Martina Živná
- Research Unit for Rare Diseases, Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Stanislav Kmoch
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Research Unit for Rare Diseases, Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Brendan Doyle
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - Anthony Dorman
- Department of Pathology, Beaumont Hospital, Dublin, Ireland.,Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Matthew D Griffin
- Nephrology Department, Galway University Hospitals, Saolta University Healthcare Group, Galway, Ireland.,Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, National University of Ireland, Galway, Ireland
| | - Liam Casserly
- Department of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Ireland
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Friedhelm Hildebrandt
- Department of Paediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Gianpiero L Cavalleri
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Katherine A Benson
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Peter J Conlon
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland.,Department of Medicine, Dublin, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
27
|
Moran SM, Scott J, Clarkson MR, Conlon N, Dunne J, Griffin MD, Griffin TP, Groarke E, Holian J, Judge C, Wyse J, McLoughlin K, O’Hara PV, Kretzler M, Little MA. The Clinical Application of Urine Soluble CD163 in ANCA-Associated Vasculitis. J Am Soc Nephrol 2021; 32:2920-2932. [PMID: 34518279 PMCID: PMC8806104 DOI: 10.1681/asn.2021030382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Up to 70% of patients with ANCA-associated vasculitis (AAV) develop GN, with 26% progressing to ESKD. Diagnostic-grade and noninvasive tools to detect active renal inflammation are needed. Urinary soluble CD163 (usCD163) is a promising biomarker of active renal vasculitis, but a diagnostic-grade assay, assessment of its utility in prospective diagnosis of renal vasculitis flares, and evaluation of its utility in proteinuric states are needed. METHODS We assessed a diagnostic-grade usCD163 assay in (1) a real-world cohort of 405 patients with AAV and 121 healthy and 488 non-AAV disease controls; (2) a prospective multicenter study of 84 patients with potential renal vasculitis flare; (3) a longitudinal multicenter cohort of 65 patients with podocytopathy; and (4) a cohort of 29 patients with AAV (with or without proteinuria) and ten controls. RESULTS We established a diagnostic reference range, with a cutoff of 250 ng/mmol for active renal vasculitis (area under the curve [AUC], 0.978). Using this cutoff, usCD163 was elevated in renal vasculitis flare (AUC, 0.95) but remained low in flare mimics, such as nonvasculitic AKI. usCD163's specificity declined in patients with AAV who had nephrotic-range proteinuria and in those with primary podocytopathy, with 62% of patients with nephrotic syndrome displaying a "positive" usCD163. In patients with AAV and significant proteinuria, usCD163 normalization to total urine protein rather than creatinine provided the greatest clinical utility for diagnosing active renal vasculitis. CONCLUSIONS usCD163 is elevated in renal vasculitis flare and remains low in flare mimics. Nonspecific protein leakage in nephrotic syndrome elevates usCD163 in the absence of glomerular macrophage infiltration, resulting in false-positive results; this can be corrected with urine protein normalization.
Collapse
Affiliation(s)
- Sarah M. Moran
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland,Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Jennifer Scott
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | | | | | | | - Matthew D. Griffin
- REMEDI at CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, National University of Ireland, Galway, Ireland,Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Tomas P. Griffin
- REMEDI at CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, National University of Ireland, Galway, Ireland,Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | | | - John Holian
- St Vincent’s University Hospital, Dublin, Ireland
| | - Conor Judge
- Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland,Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Jason Wyse
- Discipline of Statistics and Information Systems, Trinity College Dublin, Dublin, Ireland
| | | | | | - Matthias Kretzler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Mark A. Little
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland,Beaumont Kidney Centre, Dublin, Ireland,Tallaght University Hospital, Dublin, Ireland
| | | |
Collapse
|
28
|
Rutherford MA, Scott J, Karabayas M, Antonelou M, Gopaluni S, Gray D, Barrett J, Brix SR, Dhaun N, McAdoo SP, Smith RM, Geddes C, Jayne D, Luqmani R, Salama AD, Little MA, Basu N. Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study. Arthritis Rheumatol 2021; 73:1713-1719. [PMID: 33750043 PMCID: PMC8251299 DOI: 10.1002/art.41728] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 10/29/2020] [Accepted: 03/04/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE COVID-19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and may be at risk of severe outcomes following COVID-19. We undertook this study to establish the risk factors for severe COVID-19 outcomes in these patients, including the impact of immunosuppressive therapies. METHODS A multicenter cohort was developed through the participation of centers affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes are described. Logistic regression was used to evaluate associations between potential risk factors and a severe COVID-19 outcome, defined as a requirement for advanced oxygen therapy, a requirement for invasive ventilation, or death. RESULTS The cohort included 65 patients with systemic vasculitis who developed COVID-19 (median age 70 years, 49% women), of whom 25 patients (38%) experienced a severe outcome. Most patients (55 of 65 [85%]) had antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Almost all patients required hospitalization (59 of 65 [91%]), 7 patients (11%) were admitted to intensive care, and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcomes (adjusted odds ratio [OR] 3.7 [95% confidence interval 1.1-14.9]; P = 0.047), as was comorbid respiratory disease (adjusted OR 7.5 [95% confidence interval 1.9-38.2]; P = 0.006). Vasculitis disease activity and nonglucocorticoid immunosuppressive therapy were not associated with severe outcomes. CONCLUSION In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID-19. These data can inform clinical decision-making relating to the risk of severe COVID-19 in this vulnerable patient group.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Silke R. Brix
- Manchester University NHS Foundation Trust and University of ManchesterManchesterUK
| | | | | | | | | | | | | | - Alan D. Salama
- University College London and Royal Free HospitalLondonUK
| | | | | | | |
Collapse
|
29
|
Salas A, Kant S, Floyd L, Kratky V, Brix SR, Prendecki M, Schönermarck U, Scott J, Saha M, Gauckler P, Li T, Sharma PD, Ayoub I, Morris AD, Dhaygude AP, Hruskova Z, Tesar V, McAdoo SP, Little MA, Derebail VK, Poulton CJ, Seo P, Kronbichler A, Geetha D. ANCA Vasculitis Induction Management During the COVID-19 Pandemic. Kidney Int Rep 2021; 6:2903-2907. [PMID: 34426797 PMCID: PMC8373584 DOI: 10.1016/j.ekir.2021.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Antonio Salas
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sam Kant
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lauren Floyd
- Department of Nephrology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Vojtěch Kratky
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Silke R Brix
- Renal, Urology and Transplantation Unit, Manchester University Hospitals, Manchester, UK
| | - Maria Prendecki
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Jennifer Scott
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Manish Saha
- Division of Nephrology, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Philipp Gauckler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Tingting Li
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Purva D Sharma
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Isabelle Ayoub
- Department of Medicine, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adam D Morris
- Department of Nephrology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Ajay P Dhaygude
- Department of Nephrology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Zdenka Hruskova
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Hospital, London, UK
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Vimal K Derebail
- Division of Nephrology, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Caroline J Poulton
- Division of Nephrology, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Philip Seo
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Duvuru Geetha
- Division of Nephrology and Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
30
|
Cowhig C, Scott J, Dorman AM, Little MA, de Freitas DG. Acute renal allograft failure in a patient with vasculitis. Rheumatology (Oxford) 2021; 60:iii43-iii46. [PMID: 34137875 DOI: 10.1093/rheumatology/keab045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/08/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Cliona Cowhig
- Beaumont Hospital Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Jennifer Scott
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Anthony M Dorman
- Beaumont Hospital Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Mark A Little
- Beaumont Hospital Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland.,Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Declan G de Freitas
- Beaumont Hospital Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| |
Collapse
|
31
|
Phelan T, Dunne J, Conlon N, Cheallaigh CN, Abbott WM, Faba-Rodriguez R, Amanat F, Krammer F, Little MA, Hughes G, Bergin C, Kerr C, Sundaresan S, Long A, McCormack W, Brady G. Dynamic Assay for Profiling Anti-SARS-CoV-2 Antibodies and Their ACE2/Spike RBD Neutralization Capacity. Viruses 2021; 13:v13071371. [PMID: 34372581 PMCID: PMC8309970 DOI: 10.3390/v13071371] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 12/25/2022] Open
Abstract
Serological assays have been widely employed during the coronavirus disease 2019 (COVID-19) pandemic to measure antibody responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to track seroconversion in populations. However, currently available assays do not allow determination of neutralization capacity within the assay protocol. Furthermore, commercial serology assays have a high buy-in cost that is inaccessible for many research groups. We have replicated the serological enzyme-linked immunosorbent assay for the detection of SARS-CoV-2 antibody isotypes, developed at the Icahn School of Medicine at Mount Sinai, New York. Additionally, we have modified the protocol to include a neutralization assay with only a minor modification to this protocol. We used this assay to screen local COVID-19 patient sera (n = 91) and pre-COVID-19 control sera (n = 103), and obtained approximate parity with approved commercial anti-nucleoprotein-based assays with these sera. Furthermore, data from our neutralization assay closely aligns with that generated using a spike-based pseudovirus infection model when a subset of patient sera was analyzed.
Collapse
Affiliation(s)
- Thomas Phelan
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, D08 W9RT, Ireland; (C.N.C.); (G.H.); (C.B.); (C.K.); (S.S.); (A.L.); (W.M.)
- Correspondence: (T.P.); (G.B.)
| | - Jean Dunne
- Department of Immunology, St. James’s Hospital, D08 NHY1 Dublin, Ireland; (J.D.); (N.C.)
| | - Niall Conlon
- Department of Immunology, St. James’s Hospital, D08 NHY1 Dublin, Ireland; (J.D.); (N.C.)
- Department of Immunology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Clíona Ní Cheallaigh
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, D08 W9RT, Ireland; (C.N.C.); (G.H.); (C.B.); (C.K.); (S.S.); (A.L.); (W.M.)
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland
| | - W. Mark Abbott
- Peak Proteins Ltd., Alderley Park, Mereside, Macclesfield SK10 4TG, UK; (W.M.A.); (R.F.-R.)
| | - Raquel Faba-Rodriguez
- Peak Proteins Ltd., Alderley Park, Mereside, Macclesfield SK10 4TG, UK; (W.M.A.); (R.F.-R.)
| | - Fatima Amanat
- Department of Microbiology, Icahn School of Medicine, Mount Sinai, New York, NY 10029-5674, USA; (F.A.); (F.K.)
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine, Mount Sinai, New York, NY 10029-5674, USA; (F.A.); (F.K.)
| | - Mark A. Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, St. James’ Hospital Campus, D08 W9RT Dublin, Ireland;
| | - Gerry Hughes
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, D08 W9RT, Ireland; (C.N.C.); (G.H.); (C.B.); (C.K.); (S.S.); (A.L.); (W.M.)
- Department of Pharmacy, St James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Colm Bergin
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, D08 W9RT, Ireland; (C.N.C.); (G.H.); (C.B.); (C.K.); (S.S.); (A.L.); (W.M.)
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Colm Kerr
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, D08 W9RT, Ireland; (C.N.C.); (G.H.); (C.B.); (C.K.); (S.S.); (A.L.); (W.M.)
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Sudharshana Sundaresan
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, D08 W9RT, Ireland; (C.N.C.); (G.H.); (C.B.); (C.K.); (S.S.); (A.L.); (W.M.)
| | - Aideen Long
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, D08 W9RT, Ireland; (C.N.C.); (G.H.); (C.B.); (C.K.); (S.S.); (A.L.); (W.M.)
| | - William McCormack
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, D08 W9RT, Ireland; (C.N.C.); (G.H.); (C.B.); (C.K.); (S.S.); (A.L.); (W.M.)
| | - Gareth Brady
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, D08 W9RT, Ireland; (C.N.C.); (G.H.); (C.B.); (C.K.); (S.S.); (A.L.); (W.M.)
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, St. James’ Hospital Campus, D08 W9RT Dublin, Ireland;
- Correspondence: (T.P.); (G.B.)
| |
Collapse
|
32
|
Scott J, Canepa C, Buettner A, Ryan L, Moloney B, Cormican S, Walsh C, White A, Salama AD, Little MA. A cohort study to investigate sex-specific differences in ANCA-associated glomerulonephritis outcomes. Sci Rep 2021; 11:13080. [PMID: 34158593 PMCID: PMC8219762 DOI: 10.1038/s41598-021-92629-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/07/2021] [Accepted: 05/17/2021] [Indexed: 12/14/2022] Open
Abstract
Data surrounding sex-specific differences in ANCA-associated vasculitis glomerulonephritis (ANCA-GN) outcomes is sparse. We hypothesised that the previously observed increased risk of end-stage kidney disease (ESKD) in males is driven by sex-specific variation in immunosuppression dosing. Patients were recruited to the Irish Rare Kidney Disease Registry or followed by the Royal Free Hospital vasculitis team (2012–2020). Inclusion criteria: prior diagnosis of ANCA-GN (biopsy proven pauci-immune glomerulonephritis) and positive serology for anti-MPO or -PR3 antibodies. Renal and patient survival, stratified by sex and Berden histological class, was analysed. The cumulative- and starting dose/kilogram of induction agents and prednisolone, respectively, was compared between sexes. 332 patients were included. Median follow-up was time 40.2 months (IQR 17.3–69.2). 73 (22%) reached ESKD and 47 (14.2%) died. Overall 1- and 5-year renal survival was 82.2% and 76.7% in males and 87.1% and 82.0% in females, respectively (p 0.13). The hazard ratio for ESKD in males versus females, after adjustment for age, ANCA serology, baseline creatinine and histological class was 1.07 (95% CI 0.59–1.93). There was no difference between sexes in the dose/kilogram of any induction agent. We did not observe a strong impact of sex on renal outcome in ANCA-GN. Treatment intensity does not vary by sex.
Collapse
Affiliation(s)
- Jennifer Scott
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Carolina Canepa
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Antonia Buettner
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Louise Ryan
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Bróna Moloney
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Sarah Cormican
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Regenerative Medical Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Arthur White
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Alan D Salama
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Dublin, Ireland. .,Irish Centre for Vascular Biology, Tallaght University Hospital, Tallaght, Dublin, Ireland.
| |
Collapse
|
33
|
Batten I, Robinson MW, White A, Walsh C, Fazekas B, Wyse J, Buettner A, D'Arcy S, Greenan E, Murphy CC, Wigston Z, Gabhann-Dromgoole JN, Vital EM, Little MA, Bourke NM. Investigation of type I interferon responses in ANCA-associated vasculitis. Sci Rep 2021; 11:8272. [PMID: 33859290 PMCID: PMC8050071 DOI: 10.1038/s41598-021-87760-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/13/2021] [Indexed: 12/23/2022] Open
Abstract
Type I interferon (IFN) dysregulation is a major contributory factor in the development of several autoimmune diseases, termed type I interferonopathies, and is thought to be the pathogenic link with chronic inflammation in these conditions. Anti-neutrophil cytoplasmic antibody (ANCA)-Associated Vasculitis (AAV) is an autoimmune disease characterised by necrotising inflammation of small blood vessels. The underlying biology of AAV is not well understood, however several studies have noted abnormalities in type I IFN responses. We hypothesised that type I IFN responses are systemically dysregulated in AAV, consistent with features of a type I interferonopathy. To investigate this, we measured the expression of seven interferon regulated genes (IRGs) (ISG15, SIGLEC1, STAT1, RSAD2, IFI27, IFI44L and IFIT1) in peripheral blood samples, as well as three type I IFN regulated proteins (CXCL10, MCP-1 and CCL19) in serum samples from AAV patients, healthy controls and disease controls. We found no difference in type I IFN regulated gene or protein expression between AAV patients and healthy controls. Furthermore, IRG and IFN regulated protein expression did not correlate with clinical measurements of disease activity in AAV patients. Thus, we conclude that systemic type I IFN responses are not key drivers of AAV pathogenesis and AAV should not be considered a type I interferonopathy.
Collapse
Affiliation(s)
- Isabella Batten
- Department of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Mark W Robinson
- Department of Biology, Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Kildare, Ireland
| | - Arthur White
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Barbara Fazekas
- Regenerative Medicine Institute (REMEDI), School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Jason Wyse
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Antonia Buettner
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Suzanne D'Arcy
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Emily Greenan
- Department of Ophthalmology, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin 2, Ireland
| | - Conor C Murphy
- Department of Ophthalmology, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin 2, Ireland
| | - Zoe Wigston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Joan Ní Gabhann-Dromgoole
- Department of Ophthalmology, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,School of Pharmacy and Biomolecular Sciences (PBS) and RSCI Research Institute, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Nollaig M Bourke
- Department of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
34
|
McKenna E, Mhaonaigh AU, Wubben R, Dwivedi A, Hurley T, Kelly LA, Stevenson NJ, Little MA, Molloy EJ. Neutrophils: Need for Standardized Nomenclature. Front Immunol 2021; 12:602963. [PMID: 33936029 PMCID: PMC8081893 DOI: 10.3389/fimmu.2021.602963] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
Neutrophils are the most abundant innate immune cell with critical anti-microbial functions. Since the discovery of granulocytes at the end of the nineteenth century, the cells have been given many names including phagocytes, polymorphonuclear neutrophils (PMN), granulocytic myeloid derived suppressor cells (G-MDSC), low density neutrophils (LDN) and tumor associated neutrophils (TANS). This lack of standardized nomenclature for neutrophils suggest that biologically distinct populations of neutrophils exist, particularly in disease, when in fact these may simply be a manifestation of the plasticity of the neutrophil as opposed to unique populations. In this review, we profile the surface markers and granule expression of each stage of granulopoiesis to offer insight into how each stage of maturity may be identified. We also highlight the remarkable surface marker expression profiles between the supposed neutrophil populations.
Collapse
Affiliation(s)
- Ellen McKenna
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St James' Hospital, Dublin, Ireland
| | | | - Richard Wubben
- Viral Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - Amrita Dwivedi
- Trinity Health Kidney Centre, TTMI, Trinity College, Dublin, Ireland
| | - Tim Hurley
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St James' Hospital, Dublin, Ireland.,Neonatology, Coombe Women and Infant's University Hospital, Dublin, Ireland
| | - Lynne A Kelly
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St James' Hospital, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - Nigel J Stevenson
- Viral Immunology Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland.,Viral Immunology Group, Royal College of Surgeons in Ireland-Medical University of Bahrain, Zallaq, Bahrain
| | - Mark A Little
- Trinity Health Kidney Centre, TTMI, Trinity College, Dublin, Ireland.,Irish Centre for Vascular Biology, Trinity College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St James' Hospital, Dublin, Ireland.,Neonatology, Coombe Women and Infant's University Hospital, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland.,Neonatology, Children's Hospital Ireland (CHI) at Crumlin, Dublin, Ireland.,Paediatrics, CHI at Tallaght, Tallaght University Hospital, Dublin, Ireland
| |
Collapse
|
35
|
Leacy E, Brady G, Little MA. Pathogenesis of ANCA-associated vasculitis: an emerging role for immunometabolism. Rheumatology (Oxford) 2021; 59:iii33-iii41. [PMID: 32348520 DOI: 10.1093/rheumatology/keaa023] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/02/2020] [Indexed: 12/16/2022] Open
Abstract
ANCA-associated vasculitis (AAV) is a severe systemic autoimmune disease. A key feature of AAV is the presence of Anti-Neutrophil Cytoplasmic Antibodies (ANCA) directed against myeloperoxidase (MPO) or proteinase-3 (PR3). ANCA are key to the pathogenesis of AAV, where they activate innate immune cells to drive inflammation. Pre-activation or 'priming' of immune cells appears to be important for complete cellular activation in AAV. The burgeoning field of immunometabolism has illuminated the governance of immune cell function by distinct metabolic pathways. There is ample evidence that the priming events synonymous with AAV alter immune cell metabolism. In this review we discuss the pathogenesis of AAV and its intersection with recent insights into immune cell metabolism.
Collapse
Affiliation(s)
- Emma Leacy
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Gareth Brady
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
36
|
Moiseev S, Kronbichler A, Makarov E, Bulanov N, Crnogorac M, Direskeneli H, Galesic K, Gazel U, Geetha D, Guillevin L, Hrušková Z, Little MA, Ahmed A, McAdoo SP, Mohammad AJ, Moran S, Novikov P, Pusey CD, Rahmattulla C, Satrapová V, Silva J, Terrier B, Tesař V, Westman K, Jayne DRW. Association of venous thromboembolic events with skin, pulmonary and kidney involvement in ANCA-associated vasculitis: a multinational study. Rheumatology (Oxford) 2021; 60:4654-4661. [PMID: 33523099 DOI: 10.1093/rheumatology/keab071] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 10/21/2020] [Revised: 12/24/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To investigate the occurrence of venous thromboembolic events (VTE) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, Turkey, Russia, UK, and North America. METHODS Patients with a definite diagnosis of AAV who were followed for at least 3 months and had sufficient documentation were included. Data on VTE, including either deep vein thrombosis or pulmonary embolism, were collected retrospectively from tertiary vasculitis centers. Univariate and multivariate regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Over a median follow up of 63 (29; 101) months, VTE occurred in 278 (9.7%) of 2869 AAV patients with a similar frequency across different countries (from 6.3% to 13.7%), and AAV subtype (granulomatosis with polyangiitis: 9.8%; 95% CI 8.3-11.6, microscopic polyangiitis: 9.6%; 95% CI 7.9-11.4, and eosinophilic granulomatosis with polyangiitis: 9.8%; 95% CI 7.0-13.3). Most VTE (65.6%) were reported in the first-year post diagnosis. Multiple factor logistic regression analysis adjusted for sex and age showed that skin (OR 1.71, 95% CI 1.01-2.92), pulmonary (OR 1.78, 95% CI 1.04-3.14) and kidney involvement (eGFR 15-60 mL/min/1.73 m2, OR 2.86, 95% CI 1.27-6.47; eGFR < 15 mL/min/1.73 m2, OR 6.71, 95% CI 2.94-15.33) were independent variables associated with a higher occurrence of VTE. CONCLUSION Two thirds of VTE occurred during the initial phase of active disease. We confirmed previous findings from smaller studies that a decrease in kidney function, skin involvement and pulmonary disease are independently associated with VTE.
Collapse
Affiliation(s)
- Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Egor Makarov
- Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Nikolay Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Matija Crnogorac
- Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Kresimir Galesic
- Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Ummugulsum Gazel
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Loic Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Zdenka Hrušková
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Prague, Czech Republic, in
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland.,Irish Centre for Vascular Biology, Tallaght University Hospital, Dublin, Ireland
| | | | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London, UK
| | - Aladdin J Mohammad
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden, Vasculitis and Lupus Clinic, Addenbrooke's Hospital Cambridge University Hospitals, Cambridge, UK
| | - Sarah Moran
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Charles D Pusey
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London, UK
| | - Chinar Rahmattulla
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Veronika Satrapová
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Prague, Czech Republic, in
| | - Joana Silva
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London, UK
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Vladimír Tesař
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Prague, Czech Republic, in
| | - Kerstin Westman
- Department of Clinical Sciences Lund, Nephrology, Lund University, Lund, Sweden
| | - David R W Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
37
|
Leacy E, Brady G, Conlon N, Scott J, Dunne J, Phelan T, McCormack WJ, Griffin MD, Kennedy A, Verrelli A, Molloy E, O'Sullivan D, Power J, Clarkson M, Zgaga L, O'Saughnessy M, Little MA. Study Protocol for DeCOmPRESS: Defining the Disease Course and Immune Profile of COVID-19 in the Immunosuppressed Patient. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13094.1] [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: 11/20/2022] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Current advisory guidelines for high-risk groups—including people with autoimmune disease taking immunosuppressive therapies—are to take increased precautions and avoid any unnecessary contacts. The aim of the DeCOmPRESS study is to define the disease course and immune profile of COVID-19 in immunosuppressed patients. We will clinically phenotype patients with ANCA-associated vasculitis (AAV) who develop COVID-19 using a customized REDCap data collection instrument embedded within the Rare Kidney Disease (RKD) Biobank. This dataset will be interoperable with the rheum-COVID, Global Rheumatology Alliance, and SPRINT-SARI datasets, facilitating international data linkage. Acute and convalescent blood samples will be analysed by flow cytometry and ELISA to define the immunophenotype and cytokine profile. Patients will track COVID-19 and AAV symptoms through a bespoke smartphone app. DeCOmPRESS study findings will rapidly inform management of immunosuppressed patients who contract COVID-19 by defining the natural history and immunological manifestations of the disease in these patients. We will also determine whether pre-existing immunosuppressant therapy lessens the cytokine storm associated with severe COVID-19 disease, thereby paradoxically improving rather than worsening clinical outcomes. This protocol document details the procedures for end-to-end completion of the DeCOmPRESS project and is complemented by an associated comprehensive Study Manual (accessible at: https://www.tcd.ie/medicine/thkc/decompress/).
Collapse
|
38
|
Abstract
BACKGROUND Approximately 17% of young adults currently use tobacco, most commonly cigarettes and/or electronic cigarettes (e-cigarettes), followed by other products (i.e., cigarillos, pipe/hookah, smokeless tobacco). Cigarettes have been historically used to control weight. Little is known about use of non-cigarette products for weight control, particularly among non-college young adults. Tobacco use in the military is higher than civilians, and personnel have increased motivation for weight control due to military fitness standards. This population might be vulnerable to use tobacco for this purpose. Purpose: Exploring prevalence, as well as demographic and behavioral correlates, of using tobacco products for weight control, among a large, diverse sample of military young adults. Methods: U.S. Air Force recruits (N = 24,543) completed a questionnaire about tobacco use. Among users of tobacco products, recruits reported if they had ever used that product to maintain their weight. Results: Smokeless tobacco was most commonly used for weight control (12.2%), followed by cigarettes (7.3%), e-cigarettes (5.5%), cigarillos (3.3%), and hookah/pipe (3.2%). Using tobacco for weight control was associated with fewer harm beliefs and more regular use of that product. Among e-cigarette users, having a higher BMI and a lower educational background was associated with ever using this product for weight control. Conclusions: The belief that a tobacco product helps control one's weight might increase the prevalence, and frequency of use, of that product among military young adults. Tobacco cessation programs should assess for this motivation of use and provide education about tobacco harm and alternative strategies for weight maintenance.
Collapse
Affiliation(s)
- M C Fahey
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - M A Little
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - R C Klesges
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - G W Talcott
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - P A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - K Mehmet
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - R A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
39
|
Scott J, Hartnett J, Mockler D, Little MA. Environmental risk factors associated with ANCA associated vasculitis: A systematic mapping review. Autoimmun Rev 2020; 19:102660. [PMID: 32947040 DOI: 10.1016/j.autrev.2020.102660] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/29/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is a rare multi-system autoimmune disease, characterised by a pauci-immune necrotising small-vessel vasculitis, with a relapsing and remitting course. Like many autoimmune diseases, the exact aetiology of AAV, and the factors that influence relapse are unknown. Evidence suggests a complex interaction of polygenic genetic susceptibility, epigenetic influences and environmental triggers. This systematic mapping review focuses on the environmental risk factors associated with AAV. The aim was to identify gaps in the literature, thus informing further research. METHODS Articles that examined any environmental risk factor in AAV disease activity (new onset disease or relapse) were included. Studies had to make explicit reference to AAV, which includes the 3 clinico-pathological phenotypes (GPA, MPA and EGPA), rather than isolated ANCA-positivity. All articles identified were English-language, full manuscripts involving adult humans (>16 years). There was no restriction on publication date and all study designs, except single case reports, were included. The systematic search was performed on 9th December 2019, using the following databases: EMBASE, Medline (Ovid), Cochrane Library, CINAHL and Web of Science. RESULTS The search yielded a total of 2375 articles. 307 duplicates were removed, resulting in the title and abstract of 2068 articles for screening. Of these, 1809 were excluded. Thus, 259 remained for full-text review, of which 181 were excluded. 78 articles were included in this review. The most notable findings support the role of various pollutants - primarily silica and other environmental antigens released during natural disasters and through farming. Assorted geoepidemiological triggers were also identified including seasonality and latitude-dependent factors such as UV radiation. Finally, infection was tightly associated, but the exact microorganism(s) is not clear - Staphylococcus aureus is the most presently convincing. CONCLUSION The precise aetiology of AAV has yet to be elucidated. It is likely that different triggers, and the degree to which they influence disease activity, vary by subgroup (e.g. ANCA subtype, geographic region). There is a need for more interoperable disease registries to facilitate international collaboration and hence large-scale epidemiological studies, with novel analytical techniques.
Collapse
Affiliation(s)
- Jennifer Scott
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Jack Hartnett
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, School of Medicine, Trinity College Dublin, Ireland
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; ADAPT Centre, Trinity College Dublin, Ireland.
| |
Collapse
|
40
|
O'Brien EC, White CA, Wyse J, Leacy E, Porter RK, Little MA, Hickey FB. Pro-inflammatory Stimulation of Monocytes by ANCA Is Linked to Changes in Cellular Metabolism. Front Med (Lausanne) 2020; 7:553. [PMID: 33015103 PMCID: PMC7509421 DOI: 10.3389/fmed.2020.00553] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/03/2020] [Indexed: 01/09/2023] Open
Abstract
Clinical and experimental data suggest that pathogenesis in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is driven by ANCA-mediated activation of neutrophils and monocytes. While the role of neutrophils has been extensively investigated, the function of monocytes remains relatively understudied. We have previously demonstrated that stimulation of monocytes with anti-myeloperoxidase (MPO), but not anti-proteinase-3 (PR3), antibodies results in production of the pro-inflammatory cytokine IL-1β. Changes in cellular metabolism, particularly a switch to glycolysis, have recently been linked to activation of immune cells and production of IL-1β. Therefore, we investigated the metabolic profile of monocytes following ANCA stimulation. We found a significant increase in glucose uptake in anti-MPO stimulated monocytes. Interestingly, both anti-MPO and anti-PR3 stimulation resulted in an immediate increase in glycolysis, measured by Seahorse extracellular flux analysis. However, this increase in glycolysis was sustained (for up to 4 h) in anti-MPO- but not anti-PR3-treated cells. In addition, only anti-MPO-treated cells exhibited increased oxidative phosphorylation, a metabolic response that correlated with IL-1β production. These data indicate that monocyte metabolism is altered by ANCA, with divergent responses to anti-MPO and anti-PR3 antibodies. These metabolic changes may underlie pathologic immune activation in ANCA associated vasculitis, as well as potentially contributing to the differing clinical phenotype between PR3- and MPO-ANCA positive patients. These metabolic pathways may therefore be potential targets for therapeutic intervention.
Collapse
Affiliation(s)
- Eóin C O'Brien
- Department of Clinical Medicine, Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Carla A White
- Department of Clinical Medicine, Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Jason Wyse
- Discipline of Statistics and Information Systems, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Emma Leacy
- Department of Clinical Medicine, Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Richard K Porter
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute (TBSI), Trinity College Dublin, Dublin, Ireland
| | - Mark A Little
- Department of Clinical Medicine, Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Fionnuala B Hickey
- Department of Clinical Medicine, Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
41
|
Little MA, Pebley K, Porter K, Talcott GW, Krukowski RA. 'I Think Smoking's the Same, but the Toys Have Changed.' Understanding Facilitators of E-Cigarette Use among Air Force Personnel. J Addict Prev 2020; 8:7. [PMID: 33204766 PMCID: PMC7668561] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The military has stringent anti-tobacco regulations for new recruits. While most tobacco products have declined in recent years, e-cigarette use has tripled among this population. However, little is known about the factors facilitating this inverse relationship. OBJECTIVES Examine the facilitators of e-cigarette use during a high risk period following initial enlistment among young adults. METHODS Focus groups were conducted with Airmen, Military Training Leaders (MTLs) and Technical Training Instructors (TTIs) to qualitatively explore unique characteristics of e-cigarettes leading to use in Technical Training. RESULTS The most commonly used tobacco product across participants was cigarettes (42.7%), followed by e-cigarettes (28.0%) and smokeless tobacco (22.6%). Almost a third (28.7%) of participants reported using more than one tobacco product. E-cigarette use was much more common among Airmen (76.1%), compared to MTLs (10.9%) and TTIs (13.0%).Four main facilitators around e-cigarette use were identified including: 1) There is no reason not to use e-cigarettes; 2) Using e-cigarettes helps with emotion management; 3) Vaping is a way of fitting in; and 4) Existing tobacco control policies don't work for vaping. E-cigarettes were not perceived as harmful to self and others, which could explain why Airmen were much less likely to adhere to existing tobacco control regulations. Subversion was viewed as the healthy option compared to utilizing designated tobacco use areas due to the potential exposure to traditional tobacco smoke. This coupled with a lack of understanding about e-cigarette regulations and difficulties with enforcement, promoted use among this young adult population. CONCLUSION Findings suggest that e-cigarettes are used for similar reasons as traditional tobacco products, but their unique ability to be concealed promotes their widespread use and circumvents existing tobacco control policies. In order to see reductions in use, environmental policies may need to be paired with behavioral interventions at the personal and interpersonal level.
Collapse
Affiliation(s)
- MA Little
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA,Address for Correspondence Little MA,
University of Virginia, School of Medicine, Department of Public Health
Sciences, 560 Ray C. Hunt Drive, Rm 2119 Charlottesville, VA, USA, 22903;
| | - K Pebley
- University of Memphis, Department of Psychology, 400
Innovation Drive, Memphis, TN, USA, 38152
| | - K Porter
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - GW Talcott
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA,Wilford Hall Ambulatory Surgical Center, 59 MDW/ 59 SGOWMP,
1100 Wilford Hall Loop, Bldg 4554, Joint Base Lackland AFB, TX, USA 78236
| | - RA Krukowski
- Department of Preventive Medicine, University of Tennessee
Health Science Center, 66 North Pauline Street, Memphis, TN, USA 38163
| |
Collapse
|
42
|
Moiseev S, Cohen Tervaert JW, Arimura Y, Bogdanos DP, Csernok E, Damoiseaux J, Ferrante M, Flores-Suárez LF, Fritzler MJ, Invernizzi P, Jayne D, Jennette JC, Little MA, McAdoo SP, Novikov P, Pusey CD, Radice A, Salama AD, Savige JA, Segelmark M, Shoenfeld Y, Sinico RA, Sousa MJ, Specks U, Terrier B, Tzioufas AG, Vermeire S, Zhao MH, Bossuyt X. 2020 international consensus on ANCA testing beyond systemic vasculitis. Autoimmun Rev 2020; 19:102618. [PMID: 32663621 DOI: 10.1016/j.autrev.2020.102618] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/08/2020] [Indexed: 02/07/2023]
Abstract
This document follows up on a 2017 revised international consensus on anti-neutrophil cytoplasm antibodies (ANCA) testing in granulomatosis with polyangiitis and microscopic polyangiitis and focuses on the clinical and diagnostic value of ANCA detection in patients with connective tissue diseases, idiopathic interstitial pneumonia, autoimmune liver diseases, inflammatory bowel diseases, anti-glomerular basement membrane (GBM) disease, infections, malignancy, and during drug treatment. Current evidence suggests that in certain settings beyond systemic vasculitis, ANCA may have clinical, pathogenic and/or diagnostic relevance. Antigen-specific ANCA targeting proteinase-3 and myeloperoxidase should be tested by solid phase immunoassays in any patient with clinical features suggesting ANCA-associated vasculitis and in all patients with anti-GBM disease, idiopathic interstitial pneumonia, and infective endocarditis associated with nephritis, whereas in patients with other aforementioned disorders routine ANCA testing is not recommended. Among patients with autoimmune liver diseases or inflammatory bowel diseases, ANCA testing may be justified in patients with suspected autoimmune hepatitis type 1 who do not have conventional autoantibodies or in case of diagnostic uncertainty to discriminate ulcerative colitis from Crohn's disease. In these cases, ANCA should be tested by indirect immunofluorescence as the target antigens are not yet well characterized. Many questions concerning the optimal use of ANCA testing in patients without ANCA-associated vasculitis remain to be answered.
Collapse
Affiliation(s)
- Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Jan Willem Cohen Tervaert
- Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton, Canada and Maastricht University, Maastricht, The Netherlands
| | - Yoshihiro Arimura
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Elena Csernok
- Department of Internal Medicine, Rheumatology and Immunology, Vasculitis-Center Tübingen-Kirchheim, Medius Klinik Kirchheim, University of Tübingen, Kirchheim-Teck, Germany
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marc Ferrante
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
| | - Luis Felipe Flores-Suárez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pietro Invernizzi
- Division Gastroenterology and Center for Autoimmune Liver Diseases, University of Milano-Bicocca School of Medicine, Monza, Italy
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - J Charles Jennette
- Division of Nephropathology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London, UK
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Charles D Pusey
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London, UK
| | - Antonella Radice
- Microbiology and Virology Institute, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milan, Italy
| | - Alan D Salama
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Judith A Savige
- Department of Medicine, Melbourne Health, University of Melbourne, Melbourne, Australia
| | - Mårten Segelmark
- Department of Clinical Sciences, Lund University, Department of Nephrology and Rheumatology, Skane University Hospital, Lund, Sweden
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Renato A Sinico
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Maria-José Sousa
- Immunopathology and Autoimmunity Department, Centro de Medicina Laboratorial Germano de Sousa, Lisbon, Portugal
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Athanasios G Tzioufas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Severine Vermeire
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Peking-Tsinghua Centre for Life Sciences, Beijing, China
| | - Xavier Bossuyt
- Laboratory Medicine, University Hospitals Leuven, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| |
Collapse
|
43
|
Moiseev S, Bossuyt X, Arimura Y, Blockmans D, Csernok E, Damoiseaux J, Emmi G, Flores-Suárez LF, Hellmich B, Jayne D, Jennette JC, Little MA, Mohammad AJ, Moosig F, Novikov P, Pagnoux C, Radice A, Sada KE, Segelmark M, Shoenfeld Y, Sinico RA, Specks U, Terrier B, Tzioufas AG, Vaglio A, Zhao MH, Cohen Tervaert JW. International Consensus on ANCA Testing in Eosinophilic Granulomatosis with Polyangiitis. Am J Respir Crit Care Med 2020; 202:1360-1372. [PMID: 32584187 DOI: 10.1164/rccm.202005-1628so] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022] Open
Abstract
An international consensus on anti-neutrophil cytoplasm antibodies (ANCA) testing in eosinophilic granulomatosis with polyangiitis (EGPA) is presented. ANCA, specific for myeloperoxidase (MPO), can be detected in 30-35% of EGPA patients. MPO-ANCA should be tested with antigen-specific immunoassays in any patient with eosinophilic asthma and clinical features suggesting EGPA, including constitutional symptoms, purpura, polyneuropathy, unexplained heart, gastrointestinal or kidney disease, and/or pulmonary infiltrates or hemorrhage. A positive MPO-ANCA result contributes to the diagnostic work‑up for EGPA. Patients with MPO-ANCA associated EGPA have more frequently vasculitis features, such as glomerulonephritis, neuropathy, and skin manifestations than patients with ANCA negative EGPA. However, the presence of MPO-ANCA is neither sensitive nor specific enough to identify whether a patient should be subclassified as having "vasculitic" or "eosinophilic" EGPA. At present, ANCA status cannot guide treatment decisions, that is, whether cyclophosphamide, rituximab or mepolizumab should be added to conventional glucocorticoid treatment. In EGPA, monitoring of ANCA is only useful when MPO-ANCA was tested positive at disease onset.
Collapse
Affiliation(s)
- Sergey Moiseev
- Sechenov First Moscow State Medical University, Tareev Clinic of Internal Diseases, Moscow, Russian Federation;
| | - Xavier Bossuyt
- KU Leuven University Hospitals Leuven, 60182, Leuven, Belgium
| | | | | | | | - Jan Damoiseaux
- Maastricht University Medical Centre+, 199236, Maastricht, Netherlands
| | - Giacomo Emmi
- University of Florence, 9300, Department of Experimental and Clinical Medicine, Firenze, Italy
| | | | - Bernhard Hellmich
- Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim-unter-Teck, Germany
| | - David Jayne
- University of Cambridge, 2152, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - J Charles Jennette
- University of North Carolina at Chapel Hill, 2331, Chapel Hill, North Carolina, United States
| | - Mark A Little
- Trinity Translational Medicine Institute, Dublin, Ireland
| | | | | | - Pavel Novikov
- Sechenov First Moscow State Medical University, Tareev Clinic of Internal Diseases, Moscow, Russian Federation
| | | | | | - Ken-Ei Sada
- Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 199491, Okayama, Japan
| | | | | | - Renato A Sinico
- Università degli Studi di Milano-Bicocca, 9305, Milano, Italy
| | | | | | | | | | - Ming-Hui Zhao
- Peking University First Hospital, 26447, Beijing, China
| | - Jan Willem Cohen Tervaert
- University of Alberta, Medicine, Edmonton, Alberta, Canada
- Maastricht University, MHeNS, Maastricht, Netherlands
| |
Collapse
|
44
|
Salama AD, Little MA. Coaxing Anti-Inflammatory Granulocytes to Prevent Ischemic Kidney Injury: A Fine Balance. J Am Soc Nephrol 2020; 31:668-670. [PMID: 32149721 DOI: 10.1681/asn.2020020146] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Alan D Salama
- University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Saint James's Hospital Campus, Dublin, Ireland
| |
Collapse
|
45
|
Dekkema GJ, Abdulahad WH, Bijma T, Moran SM, Ryan L, Little MA, Stegeman CA, Heeringa P, Sanders JSF. Urinary and serum soluble CD25 complements urinary soluble CD163 to detect active renal anti-neutrophil cytoplasmic autoantibody-associated vasculitis: a cohort study. Nephrol Dial Transplant 2020; 34:234-242. [PMID: 29506265 DOI: 10.1093/ndt/gfy018] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/15/2018] [Indexed: 12/28/2022] Open
Abstract
Background Early detection of renal involvement in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is of major clinical importance to allow prompt initiation of treatment and limit renal damage. Urinary soluble cluster of differentiation 163 (usCD163) has recently been identified as a potential biomarker for active renal vasculitis. However, a significant number of patients with active renal vasculitis test negative using usCD163. We therefore studied whether soluble CD25 (sCD25), a T cell activation marker, could improve the detection of renal flares in AAV. Methods sCD25 and sCD163 levels in serum and urine were measured by enzyme-linked immunosorbent assay in 72 patients with active renal AAV, 20 with active extrarenal disease, 62 patients in remission and 18 healthy controls. Urinary and blood CD4+ T and CD4+ T effector memory (TEM) cell counts were measured in 22 patients with active renal vasculitis. Receiver operating characteristics (ROC) curves were generated and recursive partitioning was used to calculate whether usCD25 and serum soluble CD25 (ssCD25) add utility to usCD163. Results usCD25, ssCD25 and usCD163 levels were significantly higher during active renal disease and significantly decreased after induction of remission. A combination of usCD25, usCD163 and ssCD25 outperformed all individual markers (sensitivity 84.7%, specificity 95.1%). Patients positive for sCD25 but negative for usCD163 (n = 10) had significantly higher C-reactive protein levels and significantly lower serum creatinine and proteinuria levels compared with the usCD163-positive patients. usCD25 correlated positively with urinary CD4+ T and CD4+ TEM cell numbers, whereas ssCD25 correlated negatively with circulating CD4+ T and CD4+ TEM cells. Conclusion Measurement of usCD25 and ssCD25 complements usCD163 in the detection of active renal vasculitis.
Collapse
Affiliation(s)
- Gerjan J Dekkema
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wayel H Abdulahad
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Theo Bijma
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah M Moran
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Louise Ryan
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Coen A Stegeman
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Heeringa
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Stephan F Sanders
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
46
|
Cormican S, Connaughton DM, Kennedy C, Murray S, Živná M, Kmoch S, Fennelly NK, O'Kelly P, Benson KA, Conlon ET, Cavalleri G, Foley C, Doyle B, Dorman A, Little MA, Lavin P, Kidd K, Bleyer AJ, Conlon PJ. Autosomal dominant tubulointerstitial kidney disease (ADTKD) in Ireland. Ren Fail 2020; 41:832-841. [PMID: 31509055 PMCID: PMC6746258 DOI: 10.1080/0886022x.2019.1655452] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction: Autosomal dominant tubulointerstitial kidney disease (ADTKD) is a rare genetic cause of renal impairment resulting from mutations in the MUC1, UMOD, HNF1B, REN, and SEC61A1 genes. Neither the national or global prevalence of these diseases has been determined. We aimed to establish a database of patients with ADTKD in Ireland and report the clinical and genetic characteristics of these families. Methods: We identified patients via the Irish Kidney Gene Project and referral to the national renal genetics clinic in Beaumont Hospital who met the clinical criteria for ADTKD (chronic kidney disease, bland urinary sediment, and autosomal dominant inheritance). Eligible patients were then invited to undergo genetic testing by a variety of methods including panel-based testing, whole exome sequencing and, in five families who met the criteria for diagnosis of ADTKD but were negative for causal genetic mutations, we analyzed urinary cell smears for the presence of MUC1fs protein. Results: We studied 54 individuals from 16 families. We identified mutations in the MUC1 gene in three families, UMOD in five families, HNF1beta in two families, and the presence of abnormal MUC1 protein in urine smears in three families (one of which was previously known to carry the genetic mutation). We were unable to identify a mutation in 4 families (3 of whom also tested negative for urinary MUC1fs). Conclusions: There are 4443 people with ESRD in Ireland, 24 of whom are members of the cohort described herein. We observe that ADTKD represents at least 0.54% of Irish ESRD patients.
Collapse
Affiliation(s)
- S Cormican
- Nephrology Department, Beaumont Hospital , Dublin , Ireland
| | - D M Connaughton
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Boston Children's Hospital, Harvard Medical School , Boston , MA , USA.,Trinity Health Kidney Centre, Trinity Translational Medicine Institute , Dublin , Ireland
| | - C Kennedy
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Royal College of Surgeons , Dublin , Ireland
| | - S Murray
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Royal College of Surgeons , Dublin , Ireland
| | - M Živná
- Department of Pediatrics and Adolescent Medicine, Research Unit for Rare Diseases, First Faculty of Medicine, Charles University , Prague , Czech Republic
| | - S Kmoch
- Department of Pediatrics and Adolescent Medicine, Research Unit for Rare Diseases, First Faculty of Medicine, Charles University , Prague , Czech Republic
| | - N K Fennelly
- Pathology Department, Beaumont Hospital , Dublin , Ireland
| | - P O'Kelly
- Nephrology Department, Beaumont Hospital , Dublin , Ireland
| | - K A Benson
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Royal College of Surgeons , Dublin , Ireland
| | - E T Conlon
- Nephrology Department, Beaumont Hospital , Dublin , Ireland
| | - G Cavalleri
- Department of Medicine, Royal College of Surgeons , Dublin , Ireland
| | - C Foley
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute , Dublin , Ireland.,Clinical Research Centre, Royal College of Surgeons , Dublin , Ireland
| | - B Doyle
- Pathology Department, Beaumont Hospital , Dublin , Ireland
| | - A Dorman
- Pathology Department, Beaumont Hospital , Dublin , Ireland
| | - M A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute , Dublin , Ireland.,Trinity Health Kidney Centre, Tallaght Hospital , Dublin , Ireland
| | - P Lavin
- Trinity Health Kidney Centre, Tallaght Hospital , Dublin , Ireland
| | - K Kidd
- Section on Nephrology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - A J Bleyer
- Section on Nephrology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - P J Conlon
- Nephrology Department, Beaumont Hospital , Dublin , Ireland.,Department of Medicine, Royal College of Surgeons , Dublin , Ireland
| |
Collapse
|
47
|
Cormican S, Kennedy C, Connaughton DM, O'Kelly P, Murray S, Živná M, Kmoch S, Fennelly NK, Benson KA, Conlon ET, Cavalleri GL, Foley C, Doyle B, Dorman A, Little MA, Lavin P, Kidd K, Bleyer AJ, Conlon PJ. Renal transplant outcomes in patients with autosomal dominant tubulointerstitial kidney disease. Clin Transplant 2020; 34:e13783. [PMID: 31958169 DOI: 10.1111/ctr.13783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/30/2019] [Accepted: 01/07/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Autosomal dominant tubulointerstitial kidney disease (ADTKD) is a rare genetic cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD). We aimed to compare renal transplant outcomes in people with ESRD due to ADTKD to those with other causes of renal failure. METHODS Patients with clinical characteristics consistent with ADTKD by the criteria outlined in the 2015 KDIGO consensus were included. We compared ADTKD transplant outcomes with those of 4633 non-ADTKD renal transplant recipients. RESULTS We included 31 patients who met diagnostic criteria for ADTKD in this analysis, 23 of whom had an identified mutation (28 were categorized as definite-ADTKD and 3 as suspected ADTKD). Five patients received a second transplant during follow-up. In total, 36 grafts were included. We did not identify significant differences between groups in terms of graft or patient survival after transplantation. Twenty-five transplant biopsies were performed during follow-up, and none of these showed signs of recurrent ADTKD post-transplant. CONCLUSION In patients with ESRD due to ADTKD, we demonstrate that transplant outcomes are comparable with the general transplant population. There is no evidence that ADTKD can recur after transplantation.
Collapse
Affiliation(s)
- Sarah Cormican
- Nephrology Department, Beaumont Hospital, Dublin, Ireland
| | - Claire Kennedy
- Nephrology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
| | - Dervla M Connaughton
- Nephrology Department, Beaumont Hospital, Dublin, Ireland.,Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Susan Murray
- Nephrology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
| | - Martina Živná
- Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stanislav Kmoch
- Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Katherine A Benson
- Nephrology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
| | - Eoin T Conlon
- Nephrology Department, Beaumont Hospital, Dublin, Ireland
| | | | - Claire Foley
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,Clinical Research Centre, Royal College of Surgeons, Dublin, Ireland
| | - Brendan Doyle
- Pathology Department, Beaumont Hospital, Dublin, Ireland
| | - Anthony Dorman
- Royal College of Surgeons, Dublin, Ireland.,Pathology Department, Beaumont Hospital, Dublin, Ireland
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,Trinity Health Kidney Centre, Tallaght Hospital, Dublin, Ireland
| | - Peter Lavin
- Trinity Health Kidney Centre, Tallaght Hospital, Dublin, Ireland
| | - Kendrah Kidd
- Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Section on Nephrology, Wake Forest School of Medicine, Medical Centre Blvd., Winston-Salem, NC, USA
| | - Anthony J Bleyer
- Section on Nephrology, Wake Forest School of Medicine, Medical Centre Blvd., Winston-Salem, NC, USA
| | - Peter J Conlon
- Nephrology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
| |
Collapse
|
48
|
Moran SM, Monach PA, Zgaga L, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland L, Pagnoux C, Seo P, Specks U, Sreih A, Wyse J, Ytterberg SR, Merkel PA, Little MA. Urinary soluble CD163 and monocyte chemoattractant protein-1 in the identification of subtle renal flare in anti-neutrophil cytoplasmic antibody-associated vasculitis. Nephrol Dial Transplant 2020; 35:283-291. [PMID: 30380100 PMCID: PMC8205505 DOI: 10.1093/ndt/gfy300] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 04/12/2018] [Accepted: 08/18/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prior work has shown that urinary soluble CD163 (usCD163) displays excellent biomarker characteristics for detection of active renal vasculitis using samples that included new diagnoses with highly active renal disease. This study focused on the use of usCD163 in the detection of the more clinically relevant state of mild renal flare and compared results of usCD163 testing directly to testing of urinary monocyte chemoattractant protein-1 (uMCP-1). METHODS Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV, n = 88) were identified within a serially sampled, longitudinal and multicentre cohort. Creatinine-normalized usCD163 and uMCP-1 levels were measured by enzyme-linked immunosorbent assay and, both alone and in combination, were compared between times of active renal AAV and during remission and/or active non-renal AAV. RESULTS Samples from 320 study visits included times of active renal vasculitis (n = 39), remission (n = 233) and active extrarenal vasculitis (n = 48). Median creatinine levels were 0.9 mg/dL [interquartile range (IQR) 0.8-1.2] in remission and 1.4 mg/dL (IQR 1.0-1.8) during renal flare. usCD163 levels were higher in patients with active renal vasculitis compared with patients in remission and those with active extrarenal vasculitis, with median values of 162 ng/mmol (IQR 79-337), 44 (17-104) and 38 (7-76), respectively (P < 0.001). uMCP-1 levels were also higher in patients with active renal vasculitis compared with patients in remission and those with active extrarenal vasculitis, with median values of 10.6 pg/mmol (IQR 4.6-23.5), 4.1 (2.5-8.4) and 4.1 (1.9-6.8), respectively (P < 0.001). The proposed diagnostic cut-points for usCD163 and uMCP-1 were 72.9 ng/mmol and 10.0 pg/mmol, respectively. usCD163 and uMCP-1 levels were marginally correlated (r2 = 0.11, P < 0.001). Combining novel and existing biomarkers using recursive tree partitioning indicated that elevated usCD163 plus either elevated uMCP-1 or new/worse proteinuria improved the positive likelihood ratio (PLR) of active renal vasculitis to 19.2. CONCLUSION A combination of usCD163 and uMCP-1 measurements appears to be useful in identifying the diagnosis of subtle renal vasculitis flare.
Collapse
Affiliation(s)
- Sarah M Moran
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Paul A Monach
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
- Rheumatology Section, VA Boston Healthcare System, Boston, MA, USA
| | - Lina Zgaga
- Department of Public Health and General Practice, Trinity College Dublin, Dublin, Ireland
| | - David Cuthbertson
- Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Nader A Khalidi
- Division of Rheumatology, St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
| | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | | | - Carol A McAlear
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry Moreland
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Specks
- Division of Pulmonology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Antoine Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Wyse
- Discipline of Statistics, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland
- Irish Centre for Vascular Biology, Trinity College Dublin, Dublin, Ireland
| | | |
Collapse
|
49
|
Papa R, Cant A, Klein C, Little MA, Wulffraat NM, Gattorno M, Ruperto N. Towards European harmonisation of healthcare for patients with rare immune disorders: outcome from the ERN RITA registries survey. Orphanet J Rare Dis 2020; 15:33. [PMID: 32000824 PMCID: PMC6993334 DOI: 10.1186/s13023-020-1308-x] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
The Rare Immunodeficiency, AutoInflammatory and AutoImmune Disease (RITA) network is a European Research Network (ERN) that brings together the leading centres for rare immune disorders. On April 2018 an online survey was sent to all RITA members in order to facilitate the harmonization of data collection in rare immune disorders registries. Currently, as many as 52 different registries collect data on rare immune disorders, of whom 30 (58%) are dedicated primarily to autoimmune diseases, 15 (29%) to primary immunodeficiencies and 12 (23%) to autoinflammatory disorders. Improving data on patient safety, outcome, and quality of life measures is warranted to unfold the full potential of RITA registries.
Collapse
Affiliation(s)
- Riccardo Papa
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrew Cant
- Great North Children's Hospital & Institute for Cellular Medicine, University of Newcastle, Newcastle upon Tyne, UK
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Mark A Little
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, Ireland
| | - Nico M Wulffraat
- Department of Pediatrics, Section Pediatric Rheumatology, Wilhelmina Children's Hospital, University Medical Centrum Utrecht, Utrecht, Netherlands
| | - Marco Gattorno
- Centre for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicolino Ruperto
- UOSID Centro Trial, PRINTO, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | | |
Collapse
|
50
|
Walls CA, Basu N, Hutcheon G, Erwig LP, Little MA, Kidder D. A novel 4-dimensional live-cell imaging system to study leukocyte-endothelial dynamics in ANCA-associated vasculitis. Autoimmunity 2019; 53:148-155. [PMID: 31865776 DOI: 10.1080/08916934.2019.1704274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Neutrophils, monocytes and the endothelium are critical to ANCA-associated vasculitis (AAV) pathogenesis. This study aimed to develop a 4-dimensional (4D) live-cell imaging system that would enable investigation of spatial and temporal dynamics of these cells in health and disease. We further aimed to validate this system using autologous donor serum from AAV patients and polyclonal ANCA IgG, as well as exploring its potential in the pre-clinical testing of putative therapeutic compounds. Neutrophils and monocytes were isolated from peripheral venous blood of AAV patients or healthy controls and co-incubated on an endothelial monolayer in the presence of autologous serum. Alternatively, polyclonal ANCA IgG was used, following TNF-α priming, and imaged in 4-dimensions for 3 h using a spinning disc confocal microscope. Volocity 6.3® analysis software was used for quantification of leukocyte dynamics. The use of autologous serum resulted in increased neutrophil degranulation (p = .002), transmigration (p = .0096) and monocyte transcellular transmigration (p = .0013) in AAV patients. Polyclonal MPO-ANCA IgG induced neutrophil degranulation (p < .001) in this system. C5aR1 antagonism reduced neutrophil degranulation (p < .0002). We have developed a novel 4D in vitro system that allows accurate quantification of multiple neutrophil- and monocyte-endothelial interactions in AAV in a single assay. This system has the potential to highlight dynamics key to pathophysiology of disease, as well investigating the impact of potential therapeutics on these functions.
Collapse
Affiliation(s)
- Catriona A Walls
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Neil Basu
- Institute of Infection, Imunology and Inflammation, University of Glasgow, Glasgow, Scotland
| | - Gayle Hutcheon
- Clinical Pharmacology, Royal Infirmary, Aberdeen, Scotland
| | - Lars P Erwig
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Dana Kidder
- Renal Unit, Aberdeen Royal Infirmary, Aberdeen, Scotland
| |
Collapse
|