1
|
Hedström AK, Hössjer O, Klareskog L, Alfredsson L. Interplay between alcohol, smoking and HLA genes in RA aetiology. RMD Open 2019; 5:e000893. [PMID: 31168412 PMCID: PMC6525609 DOI: 10.1136/rmdopen-2019-000893] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 01/02/2019] [Revised: 03/12/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives The relationship between alcohol consumption and risk for rheumatoid arthritis (RA) is incompletely understood. We aimed to determine the influence of alcohol on anticitrullinated protein antibody (ACPA) positive and ACPA-negative RA and investigate potential interactions between alcohol consumption, smoking and the presence of human leucocyte antigen (HLA)-DRB1-shared epitope (SE). Methods A Swedish population-based case–control study with incident cases of RA was used (3353 cases, 2836 matched controls). Subjects with different HLA-DRB1-SE status, smoking and alcohol consumption were compared regarding risk of ACPA-positive and ACPA-negative RA, by calculating OR with 95% CI employing logistic regression. Interaction on the additive scale between alcohol, HLA-DRB1-SE and smoking was estimated by calculating the attributable proportion (AP) due to interaction. Results Compared with non-drinking, low and moderate alcohol consumption was dose dependently associated with a reduced risk of ACPA-positive and ACPA-negative RA. Independent of smoking habits, non-drinking and the presence of HLA-DRB1-SE interacted to increase the risk of ACPA-positive RA. Among HLA-DRB1-SE positive subjects, there was also a significant interaction between non-drinking and smoking with regard to risk for ACPA-positive RA. A three-way interaction was observed between alcohol, smoking and HLA-DRB1-SE with regard to risk for ACPA-positive RA (AP 0.7, 95% CI 0.6 to 0.8) that remained significant when the influence from the two-way interactions was removed (AP 0.4, 95% CI 0.2 to 0.6). Conclusions Our findings emphasize the need to investigate complex interactions between several environmental and genetic factors in order to better understand the etiology of RA. Whereas of great interest in an aetiological perspective, the finding of a protective role of alcohol on risk for RA must, however, be interpreted with caution in a clinical and public health perspective.
Collapse
Affiliation(s)
- Anna Karin Hedström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Instititute of Environmental Medicine, Karolinska Institutet, Stockhom, Sweden
| | - Ola Hössjer
- Department of Mathematics, Stockholm university, Stockholm, Sweden
| | - Lars Klareskog
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Instititute of Environmental Medicine, Karolinska Institutet, Stockhom, Sweden
| |
Collapse
|
2
|
Guo J, Zhang T, Cao H, Li X, Liang H, Liu M, Zou Y, Zhang Y, Wang Y, Sun X, Hu F, Du Y, Mo X, Liu X, Yang Y, Yang H, Wu X, Zhang X, Jia H, Jiang H, Hou Y, Liu X, Su Y, Zhang M, Yang H, Wang J, Sun L, Liu L, Padyukov L, Lai L, Yamamoto K, Zhang X, Klareskog L, Xu X, Li Z. Sequencing of the MHC region defines HLA-DQA1 as the major genetic risk for seropositive rheumatoid arthritis in Han Chinese population. Ann Rheum Dis 2019; 78:773-780. [PMID: 30936065 DOI: 10.1136/annrheumdis-2018-214725] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The strong genetic contribution of the major histocompatibility complex (MHC) region to rheumatoid arthritis (RA) has been generally attributed to human leukocyte antigen (HLA)-DRB1. However, due to the high polymorphisms and linkage disequilibrium within MHC, it is difficult to define novel and/or independent genetic risks using conventional HLA genotyping or chip-based microarray technology. This study aimed to identify novel RA risk variants by performing deep sequencing for MHC. METHODS We first conducted target sequencing for the entire MHC region in 357 anticitrullinated protein antibodies (ACPA)-positive patients with RA and 1001 healthy controls, and then performed HLA typing in an independent case-control cohort consisting of 1415 samples for validation. All study subjects were Han Chinese. Genetic associations for RA susceptibility and severity were analysed. Comparative modelling was constructed to predict potential functions for the newly discovered RA association variants. RESULTS HLA-DQα1:160D conferred the strongest and independent susceptibility to ACPA-positive RA (p=6.16×10-36, OR=2.29). DRβ1:37N had an independent protective effect (p=5.81×10-16, OR=0.49). As predicted by comparative modelling, the negatively charged DQα1:160D stabilises the dimer of dimers, thus may lead to an increased T cell activation. The negatively charged DRβ1:37N encoding alleles preferentially bind with epitope P9 arginine, thus may result in a decreased RA susceptibility. CONCLUSIONS We provide the first evidence that HLA-DQα1:160D, instead of HLA-DRB1*0405, is the strongest and independent genetic risk for ACPA-positive RA in Han Chinese. Our study also illustrates the value of deep sequencing for fine-mapping disease risk variants in the MHC region.
Collapse
Affiliation(s)
- Jianping Guo
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China .,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Tao Zhang
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Hongzhi Cao
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,Shenzhen Digital Life Institute, Shenzhen, China.,iCarbonX, Shenzhen, China
| | - Xiaowei Li
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Hao Liang
- BNLMS, State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Peking-Tsinghua Center for Life Sciences at College of Chemistry and Molecular Engineering, and Center for Quantitative Biology, Peking University, Beijing, China
| | - Mengru Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yundong Zou
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yuanwei Zhang
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Yuxuan Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Xiaolin Sun
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Fanlei Hu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yan Du
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Xiaodong Mo
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Xu Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yue Yang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Huanjie Yang
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Xinyu Wu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Xuewu Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Huijue Jia
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Hui Jiang
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Yong Hou
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Xin Liu
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Yin Su
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Mingrong Zhang
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Huanming Yang
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,James D Watson Institute of Genome Sciences, Hangzhou, China
| | - Jian Wang
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China.,James D Watson Institute of Genome Sciences, Hangzhou, China
| | - Liangdan Sun
- Institute of Dermatology and Department of Dermatology, No 1 Hospital of Anhui Medical University, Hefei, China
| | - Liang Liu
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Luhua Lai
- BNLMS, State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Peking-Tsinghua Center for Life Sciences at College of Chemistry and Molecular Engineering, and Center for Quantitative Biology, Peking University, Beijing, China
| | - Kazuhiko Yamamoto
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Xuejun Zhang
- Institute of Dermatology and Department of Dermatology, No 1 Hospital of Anhui Medical University, Hefei, China .,Institute of Dermatology and Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lars Klareskog
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Xun Xu
- Beijing Genomics Institute (BGI)-Shenzhen, Shenzhen, China .,China National GeneBank-Shenzhen, BGI-Shenzhen, Shenzhen, China
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China .,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China.,State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
| |
Collapse
|
3
|
van Delft MAM, van der Woude D, Toes REM, Trouw LA. Secretory form of rheumatoid arthritis-associated autoantibodies in serum are mainly of the IgM isotype, suggesting a continuous reactivation of autoantibody responses at mucosal surfaces. Ann Rheum Dis 2018; 78:146-148. [PMID: 30108046 DOI: 10.1136/annrheumdis-2018-213724] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/20/2018] [Accepted: 07/22/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Myrthe A M van Delft
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - René E M Toes
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leendert A Trouw
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
4
|
Sohrabian A, Mathsson-Alm L, Hansson M, Knight A, Lysholm J, Cornillet M, Skriner K, Serre G, Larsson A, Weitoft T, Rönnelid J. Number of individual ACPA reactivities in synovial fluid immune complexes, but not serum anti-CCP2 levels, associate with inflammation and joint destruction in rheumatoid arthritis. Ann Rheum Dis 2018; 77:1345-1353. [PMID: 29895567 PMCID: PMC6104681 DOI: 10.1136/annrheumdis-2017-212627] [Citation(s) in RCA: 15] [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: 10/31/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Abstract
Introduction Individual patients with rheumatoid arthritis (RA) show divergent specific anti-citrullinated protein/peptide antibodies (ACPA) patterns, but hitherto no individual ACPA specificity has consistently been linked to RA pathogenesis. ACPA are also implicated in immune complexes (IC)-associated joint pathology, but until now, there has been no method to investigate the role of individual ACPA in RA IC formation and IC-associated pathogenesis. Methods We have developed a new technique based on IC binding to C1q-coated magnetic beads to purify and solubilise circulating IC in sera and synovial fluids (SF) from 77 patients with RA. This was combined with measurement of 19 individual ACPA in serum, SF and in the IC fractions from serum and SF. We investigated whether occurrence of individual ACPA as well as number of ACPA in these compartments was related to clinical and laboratory measures of disease activity and inflammation. Results The majority of individual ACPA reactivities were enriched in SF as compared with in serum, and levels of ACPA in IC were regulated independently of levels in serum and SF. No individual ACPA reactivity in any compartment showed a dominating association to clinical and laboratory measures of disease activity and severity. Instead, the number of individual ACPA reactivities in the IC fraction from SF associated with a number of markers of joint destruction and inflammation. Conclusions Our data highlight the polyclonality of ACPA in joint IC and the possibility that a broad ACPA repertoire in synovial fluid IC might drive the local inflammatory and matrix-degrading processes in joints, in analogy with antibody-induced rodent arthritis models.
Collapse
Affiliation(s)
- Azita Sohrabian
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Linda Mathsson-Alm
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Thermo Fischer Scientific, Uppsala, Sweden
| | - Monika Hansson
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Ann Knight
- Section of Rheumatology, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | | | - Martin Cornillet
- Laboratory of Epithelial Differentiation and Rheumatoid Autoimmunity, U1056 Inserm, Toulouse University, Toulouse, France
| | - Karl Skriner
- Department of Medicine, Charité University Hospital, Berlin, Germany
| | - Guy Serre
- Laboratory of Epithelial Differentiation and Rheumatoid Autoimmunity, U1056 Inserm, Toulouse University, Toulouse, France
| | - Anders Larsson
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Tomas Weitoft
- Department of Research and Development, Section of Rheumatology, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
5
|
Bondt A, Hafkenscheid L, Falck D, Kuijper TM, Rombouts Y, Hazes JMW, Wuhrer M, Dolhain RJEM. ACPA IgG galactosylation associates with disease activity in pregnant patients with rheumatoid arthritis. Ann Rheum Dis 2018; 77:1130-1136. [PMID: 29615411 DOI: 10.1136/annrheumdis-2018-212946] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/02/2018] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Patients with autoantibody-positive rheumatoid arthritis (RA) are less likely to experience pregnancy-induced improvement of RA disease activity (DAS28-C reactive protein (CRP)) compared with patients with autoantibody-negative RA. Anti-citrullinated protein antibodies (ACPAs) are the most specific autoantibodies for RA. We previously demonstrated that disease improvement is associated with changes in total IgG glycosylation, which regulate antibody effector function. Therefore, we sought to analyse the ACPA-IgG glycosylation profile during pregnancy with the aim to understand the lower change of pregnancy-induced improvement of the disease in patients with autoantibody-positive RA. METHODS ACPA-IgGs were purified from ACPA-positive patient sera (n=112) of the Pregnancy-induced Amelioration of Rheumatoid Arthritis cohort, a prospective study designed to investigate pregnancy-associated improvement of RA. The fragment crystallisable (Fc)glycosylation profile of ACPA-IgGs was characterised by mass spectrometry and compared with that of total IgG derived from the same patients or from ACPA-negative patients. RESULTS All ACPA-IgG subclasses display significant changes in the level of galactosylation and sialylation during pregnancy, although less pronounced than in total IgG. The pregnancy-induced increase in ACPA-IgG galactosylation, but not sialylation, associates with lower DAS28-CRP. In ACPA-positive patients, no such association was found with changes in the galactosylation of total IgG, whereas in ACPA-negative patients changes in disease activity correlated well with changes in the galactosylation of total IgG. CONCLUSIONS In ACPA-positive RA, the pregnancy-induced change in galactosylation of ACPA-IgG, and not that of total IgG, associates with changes in disease activity. These data may indicate that in ACPA-positive patients the galactosylation of ACPA-IgG is of more pathogenic relevance than that of total IgG.
Collapse
Affiliation(s)
- Albert Bondt
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lise Hafkenscheid
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - David Falck
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - T Martijn Kuijper
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yoann Rombouts
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Institut de Pharmacologie et Biologie Structurale, IPBS, Université de Toulouse, Toulouse, France
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
6
|
Just SA, Rostgaard K, Titlestad K, Edgren G, Erikstrup C, Ullum H, Pedersen OB, Nielsen KR, Askling J, Lindegaard H, Hjalgrim H. Transmission of rheumatoid arthritis through blood transfusion: a retrospective cohort study. Ann Rheum Dis 2018; 77:1536-1537. [PMID: 29496719 DOI: 10.1136/annrheumdis-2017-212844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/07/2018] [Accepted: 02/18/2018] [Indexed: 11/03/2022]
Affiliation(s)
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, The Blood Bank, Copenhagen, Denmark
| | | | - Kaspar Rene Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Johan Askling
- Department of Medicine, Solna, Clinical Epidemiology Section, Karolinska Institutet, Stockholm, Sweden.,Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Hanne Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
7
|
Alten R, Mariette X, Lorenz HM, Galeazzi M, Cantagrel A, Nüßlein HG, Chartier M, Elbez Y, Rauch C, Le Bars M. Real-world predictors of 12-month intravenous abatacept retention in patients with rheumatoid arthritis in the ACTION observational study. RMD Open 2017; 3:e000538. [PMID: 29435360 PMCID: PMC5761291 DOI: 10.1136/rmdopen-2017-000538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/23/2017] [Accepted: 12/01/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION An understanding of real-world predictors of abatacept retention is limited. We analysed retention rates and predictors of abatacept retention in biologic-naïve and biologic-failure patients in a 12-month interim analysis of the 2-yearAbataCepTIn rOutiNe clinical practice (ACTION) study. METHODS ACTION was an international, observational study of patients with moderate-to-severe rheumatoid arthritis (RA) who initiated intravenous abatacept. In this 12-month interim analysis, crude abatacept retention rates, predictors of retention and European League Against Rheumatism (EULAR) response were evaluated in both biologic-naïve and biologic-failure patients. Retention by rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) status was also assessed, in patients with or without baseline radiographic erosions, and by body mass index (BMI). RESULTS Overall, 2350/2364 enrolled patients were evaluable (674 biologic naїve; 1676 biologic failure). Baseline characteristics were largely similar in biologic-naïve and biologic-failure groups. Crude retention rates (95% CI) at 12 months were significantly higher in biologic-naїve (78.1%(74.7% to 81.2%)) versus biologic-failure patients (69.9%(67.6% to 72.1%); P<0.001). RF/anti-CCP double positivity predicted higher retention in both patient groups, and remained associated with higher retention in patients with erosive disease. BMI did not impact abatacept retention in either patient group, irrespective of RF/anti-CCP serostatus. Good/moderate EULAR response rate at 12 months was numerically higher in biologic-naїve (83.8%) versus biologic-failure (73.3%) patients. There were no new safety signals. CONCLUSION High levels of intravenous abatacept retention in clinical practice were confirmed, particularly in biologic-naïve patients, including in those with poor RA prognostic factors. Retention was unaffected by BMI, regardless of RF/anti-CCP serostatus. TRIAL REGISTRATION NUMBER NCT02109666; retrospectively registered 8 April 2014.
Collapse
Affiliation(s)
- Rieke Alten
- Department of Internal Medicine, Rheumatology, Clinical Immunology, and Osteology, Schlosspark-Klinik University Medicine, Berlin, Germany
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Sud, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris–Sud, INSERM U1184, Le Kremlin Bicêtre, Paris, France
| | | | - Mauro Galeazzi
- Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alain Cantagrel
- Department of Rheumatology, Purpan Hospital, Toulouse, France
| | - Hubert G Nüßlein
- Department of Internal Medicine and Rheumatology, University of Erlangen–Nuremberg, Nuremberg, Germany
| | - Melanie Chartier
- Department of Medical Affairs, Bristol–Myers Squibb, Rueil-Malmaison, France
| | | | - Christiane Rauch
- Department of Immunoscience, Bristol–Myers Squibb, Munich, Germany
| | - Manuela Le Bars
- Department of Medical Affairs, Bristol–Myers Squibb, Rueil-Malmaison, France
| |
Collapse
|
8
|
Shi J, Darrah E, Sims GP, Mustelin T, Sampson K, Konig MF, Bingham CO, Rosen A, Andrade F. Affinity maturation shapes the function of agonistic antibodies to peptidylarginine deiminase type 4 in rheumatoid arthritis. Ann Rheum Dis 2017; 77:141-148. [PMID: 29070531 DOI: 10.1136/annrheumdis-2017-211489] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The citrullinating enzyme peptidylarginine deiminase type 4 (PAD4) is the target of a polyclonal group of autoantibodies in patients with rheumatoid arthritis (RA). A subgroup of such antibodies, initially identified by cross-reactivity with peptidylarginine deiminase type 3 (PAD3), is strongly associated with progression of radiographic joint damage and interstitial lung disease and has the unique ability to activate PAD4. The features of these antibodies in terms of their T cell-dependent origin, genetic characteristics and effect of individual antibody specificities on PAD4 function remain to be defined. METHODS We used PAD4 tagged with the monomeric fluorescent protein mWasabi to isolate PAD4-specific memory B cells from anti-PAD4 positive patients with RA and applied single cell cloning technologies to obtain monoclonal antibodies. RESULTS Among 44 single B cells, we cloned five antibodies with PAD4-activating properties. Sequence analysis, germline reversion experiments and antigen specificity assays suggested that autoantibodies to PAD4 are not polyreactive and arise from PAD4-reactive precursors. Somatic mutations increase the agonistic activity of these antibodies at low calcium concentrations by facilitating their interaction with structural epitopes that modulate calcium-binding site 5 in PAD4. CONCLUSIONS PAD4-activating antibodies directly amplify a key process in disease pathogenesis, making them unique among other autoantibodies in RA. Understanding the molecular basis for their functionality may inform the design of future PAD4 inhibitors.
Collapse
Affiliation(s)
- Jing Shi
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erika Darrah
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gary P Sims
- Respiratory, Inflammation, and Autoimmunity, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Tomas Mustelin
- Respiratory, Inflammation, and Autoimmunity, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Kevon Sampson
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maximilian F Konig
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Clifton O Bingham
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Antony Rosen
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Felipe Andrade
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Rönnelid J, Hansson M, Mathsson-Alm L, Cornillet M, Reed E, Jakobsson PJ, Alfredsson L, Holmdahl R, Skriner K, Serre G, Lundberg K, Klareskog L. Anticitrullinated protein/peptide antibody multiplexing defines an extended group of ACPA-positive rheumatoid arthritis patients with distinct genetic and environmental determinants. Ann Rheum Dis 2017; 77:203-211. [PMID: 29070529 DOI: 10.1136/annrheumdis-2017-211782] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The second generation anticycliccitrullinated peptide (anti-CCP2) assay detects the majority but not all anticitrullinated protein/peptide antibodies (ACPA). Anti-CCP2-positive rheumatoid arthritis (RA) is associated with HLA-DRB1* shared epitope (SE) alleles and smoking. Using a multiplex assay to detect multiple specific ACPA, we have investigated the fine specificity of individual ACPA responses and the biological impact of additional ACPA reactivity among anti-CCP2-negative patients. METHODS We investigated 2825 patients with RA and 551 healthy controls with full data on anti-CCP2, HLA-DRB1* alleles and smoking history concerning reactivity against 16 citrullinated peptides and arginine control peptides with a multiplex array. RESULTS The prevalence of the 16 ACPA specificities ranged from 9% to 58%. When reactivity to arginine peptides was subtracted, the mean diagnostic sensitivity increased by 3.2% with maintained 98% specificity. Of the anti-CCP2-negative patients, 16% were found to be ACPA positive. All ACPA specificities associated with SE, and all but one with smoking. Correction for arginine reactivity also conveyed a stronger association with SE for 13/16 peptides. Importantly, when all ACPA specificities were analysed together, SE and smoking associated with RA in synergy among ACPA positive, but not among ACPA-negative subjects also in the anti-CCP2-negative subset. CONCLUSIONS Multiplexing detects an enlarged group of ACPA-positive but anti-CCP2-negative patients with genetic and environmental attributes previously assigned to anti-CCP2-positive patients. The individual correction for arginine peptide reactivity confers both higher diagnostic sensitivity and stronger association to SE than gross ACPA measurement.
Collapse
Affiliation(s)
- Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Monika Hansson
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Linda Mathsson-Alm
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Thermo Fisher Scientific, Uppsala, Sweden
| | - Martin Cornillet
- Laboratory of Epithelial Differentiation and Rheumatoid Autoimmunity, U1056 Inserm, Toulouse University, Toulouse, France
| | - Evan Reed
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Per-Johan Jakobsson
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rikard Holmdahl
- Department of Medical Inflammation Research, Karolinska Institutet, Stockholm, Sweden
| | - Karl Skriner
- Department of Medicine, Charité University Hospital, Berlin, Germany
| | - Guy Serre
- Laboratory of Epithelial Differentiation and Rheumatoid Autoimmunity, U1056 Inserm, Toulouse University, Toulouse, France
| | - Karin Lundberg
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Lars Klareskog
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
10
|
Vergroesen RD, Slot LM, Hafkenscheid L, Koning MT, van der Voort EIH, Grooff CA, Zervakis G, Veelken H, Huizinga TWJ, Rispens T, Scherer HU, Toes REM. B-cell receptor sequencing of anti-citrullinated protein antibody (ACPA) IgG-expressing B cells indicates a selective advantage for the introduction of N-glycosylation sites during somatic hypermutation. Ann Rheum Dis 2017; 77:956-958. [PMID: 28835463 DOI: 10.1136/annrheumdis-2017-212052] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Rochelle D Vergroesen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda M Slot
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lise Hafkenscheid
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marvyn T Koning
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Christine A Grooff
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - George Zervakis
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hendrik Veelken
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, Amsterdam, The Netherlands
| | - Hans U Scherer
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - René E M Toes
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|