HLA-B27 did not protect against COVID-19 in patients with axial spondyloarthritis - data from the ReumaCov-Brasil Registry

BACKGROUND

Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients.

AIM

To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients.

METHODS

The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immune-mediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), and only those with known HLA-B27 status, were included in this ReumaCov-Brasil's subanalysis. After pairing them to sex and age, they were divided in two groups: with (cases) and without (control group) COVID-19 diagnosis. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanical ventilation, and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%.

RESULTS

From May 24th, 2020 to Jan 24th, 2021, a total of 153 axial SpA patients were included, of whom 85 (55.5%) with COVID-19 and 68 (44.4%) without COVID-19. Most of them were men (N = 92; 60.1%) with mean age of 44.0 ± 11.1 years and long-term disease (11.7 ± 9.9 years). Regarding the HLA-B27 status, 112 (73.2%) patients tested positive. There were no significant statistical differences concerning social distancing, smoking, BMI (body mass index), waist circumference and comorbidities. Regarding biological DMARDs, 110 (71.8%) were on TNF inhibitors and 14 (9.15%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 64, 75.3% vs. n = 48, 48%, respectively; p = 0.514). In addition, disease activity was similar before and after the infection. Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.1 ± 3.4 days, and although the number of hospitalization days was numerically higher in the B27 positive group, no statistically significant difference was observed (5.7 ± 4.11 for B27 negative patients and 13.5 ± 14.8 for B27 positive patients; p = 0.594). Only one HLA-B27 negative patient died. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups.

CONCLUSIONS

No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection.

TRIAL REGISTRATION

This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials - REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

Development of a catalogue of damage in Portuguese forest associated with extreme extratropical cyclones

In European forests, extreme wind events associated with severe extratropical cyclones are considered the main abiotic agent of forest vulnerability, leading to high economic losses in forests due to damage caused by the uprooting of trees and trunk breaks. Despite the importance recognized to severe cyclones and associated extreme phenomena, the impact on forest stocks is not always properly reported, leading to underestimation in the perception of losses, with direct consequences on forest governance decisions. This is particularly true in countries where other agents traditionally have a high impact, such as the countries under the influence of the Mediterranean, where wildfire is a recurrent menace with devastating effects. This work characterizes the situation observed in Portugal and presents the methodology followed to obtain information about forest damages and the procedure to identify the extreme extratropical cyclones responsible for those damages. As an example, available information and the recording of damage occurring in the Portuguese forest in winter 2017-2018 are presented and discussed. The study shows how difficult and demanding it is to obtain past information about the damage. In addition, there is high uncertainty about the precise identification of the event that caused the damage, as field records often occur several days or even weeks after the storm. To reduce the constraints, it is proposed to use a model whose skeleton of information has been designed to obtain useful information from traditional registries. The proposed model is useful for the characterization of losses and to support national policies to reduce the impact of damage associated with extreme wind events. The design of the catalogue can be used for recording information at the stand scale level by stakeholders and ensure compatibility with international databases for updating information purposes.

Anti-β2-glycoprotein I antibodies are highly prevalent in a large number of Brazilian leprosy patients

OBJECTIVES

To determine the prevalence of anticardiolipin (aCL) and anti-β2-glycoprotein I (anti-β2GPI) antibodies in leprosy patients, during and after specific multidrug therapy (MDT), and to evaluate a possible association between these antibodies and some clinical characteristics of leprosy, including clinical forms, reactional episodes and treatment.

METHODS

The study included 158 leprosy patients, 129 gender-and-age matched healthy individuals, and 38 women with primary antiphospholipid syndrome (APS). Clinical and demographic characteristic of leprosy patients were collected, and serum samples, obtained from all participants, were kept frozen at - 20°C. Antibodies were measured either by an in house-developed ELISA (aCL) or by a commercial ELISA (anti-β2GPI).

RESULTS AND CONCLUSIONS

Increased levels of aCL and anti-β2GPI antibodies were found in leprosy patients and in the APS group, however, in contrast to APS, the predominant isotype in leprosy was IgM. The frequency of aCL and anti-β2GPI antibodies was significantly higher in leprosy patients than in healthy individuals (15.8% vs. 3.1%; p>0.01; 46.2% vs. 9.4%, p>0.01), respectively. The lepromatous form predominated among aCL positive leprosy patients (p>0.01). There was no difference in aCL and anti-β2GPI positivity between leprosy patients taking MDT and those completed MDT as cured. Furthermore the duration of discharged period (period between discharge from MDT and the realization of the study) had no effect on anti-β2GPI positivity, and a slight increase in aCL positivity was observed in patients with longer follow up periods (p=0.04), suggesting that the presence of antiphospholipid antibodies (aPL) was not a transient phenomenon. Although aPL in leprosy were frequent and β2GPI-dependent as those found in APS, IgM was the predominant isotype, and there was no association with thrombosis or other APS manifestations.