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Dol C, Granel B, Resseguier N, Kaplanski G, Reynaud-Gaubert M, Schleinitz N, Grob JJ, Delaporte E, Lafforgue P, Rossi P, Bardin N, Benyamine A. [High anti-topoisomerase-1 autoantibodies levels are associated with the extension of skin fibrosis and vascular progression in patients with systemic sclerosis]. Rev Med Interne 2024; 45:126-131. [PMID: 38355359 DOI: 10.1016/j.revmed.2023.11.006] [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: 03/15/2023] [Revised: 10/29/2023] [Accepted: 11/04/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Anti-centromere antibodies, anti-topoisomerase-1 antibodies (ATA), and anti-RNA-polymerase III antibodies are three Systemic Sclerosis (SSc)-specific autoantibodies. Their detection is helpful in determining the prognosis. We aimed to evaluate whether ATA levels were associated with disease severity at diagnosis or disease progression during follow-up in ATA positive patients. METHODS We conducted a single-centre French retrospective observational study, between 2014 and 2021. ATA positive patients fulfilling the ACR/EULAR 2013 classification criteria for SSc with a minimal follow-up of 1 year and 2 ATA dosages were included. SSc patients with high IgG ATA levels at baseline (>240IU/mL) were compared with SSc patients with low levels (≤240IU/mL), at inclusion and at 1 and 3 years. A variation of at least 30 % of ATA levels was considered significant. RESULTS Fifty-nine SSc patients were included and analysed. There was a predominance of women and of patients with diffuse interstitial lung disease. Patients with high ATA levels exhibited a higher skin sclerosis assessed by the modified Rodnan skin score (P=0.0480). They had a lower carbon monoxide transfer coefficient (P=0.0457), a lower forced vital capacity (FVC) (P=0.0427) and more frequently had a FVC under 80 %, when compared to patients with low ATA levels (P=0.0423). Initial high ATA levels were associated with vascular progression at one year (21.95 % vs. 0 %; P=0.0495). CONCLUSION ATA levels are associated with skin sclerosis and vascular progression in SSc. Beyond the detection of ATA, quantifying this autoantibody might be of interest in predicting disease severity and prognosis in SSc.
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Affiliation(s)
- C Dol
- Service de médecine interne, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France
| | - B Granel
- Service de médecine interne, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France
| | - N Resseguier
- Épidémiologie et économie de la santé, hôpital de la Timone, AP-HM, Aix-Marseille université (AMU), 13005 Marseille, France
| | - G Kaplanski
- Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France; Service de médecine interne et immunologie clinique, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - M Reynaud-Gaubert
- Service de pneumologie, équipe de transplantation pulmonaire, centre de compétences des maladies pulmonaires rares, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), Aix-Marseille université (AMU), 13015 Marseille, France
| | - N Schleinitz
- Service de médecine interne, hôpital de la Timone, Assistance publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - J-J Grob
- Service de dermatologie, hôpital de la Timone, Assistance publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - E Delaporte
- Service de dermatologie, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), 13015 Marseille, France
| | - P Lafforgue
- Service de rhumatologie, hôpital Sainte-Marguerite, Assistance publique des Hôpitaux de Marseille (AP-HM), 13009 Marseille, France
| | - P Rossi
- Service de médecine interne, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France
| | - N Bardin
- Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France; Laboratoire d'immunologie, biogénopole, hôpital de la Timone, Assistance publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - A Benyamine
- Service de médecine interne, hôpital Nord, Marseille, Assistance publique des Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France; Inserm, INRA, C2VN, Aix-Marseille université (AMU), 13005 Marseille, France.
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Lampropoulou E, Benz C, Kahaly GJ, Führer D. Thyroid Inflammation and Immunity During the COVID-19 Pandemic: A Comprehensive Review and Case Study. Horm Metab Res 2024; 56:111-117. [PMID: 38049146 DOI: 10.1055/a-2222-6300] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the development of various vaccines. Reports have emerged suggesting a possible association between SARS-CoV-2 vaccination and the onset of thyroid diseases. This review explores the clinical aspects of thyroid disorders following SARS-CoV-2 vaccination, including a case report of a patient with concomitant subacute thyroiditis (SAT) and Graves' disease (GD) with blocking thyrotropin receptor autoantibodies (TSH-R-Ab) following SARS-CoV-2 vaccination. SAT, characterized by transient inflammation of the thyroid gland, has been reported after SARS-CoV-2 vaccination. GD, an autoimmune hyperthyroidism, has also been observed post-vaccination, often with stimulating TSH-R-Ab. Graves' orbitopathy (GO) has been associated with SARS-CoV-2 vaccination in patients with a history of immune thyroid disease. The unique case underscores a very rare thyroid condition of functional hypothyroidism in possible relation to SARS-CoV-2 vaccination and the usefulness of functional analysis of TSH-R-Ab that can provide valuable insights into disease pathogenesis and help to guide treatment. This review highlights the need for continued monitoring and awareness of potential thyroid-related complications following SARS-CoV-2 vaccination.
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Affiliation(s)
- Eleni Lampropoulou
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, Essen, Germany
| | - Claus Benz
- Department of Gastroenterology, Ev. Klinikum Koeln-Weyertal, Koeln, Germany
| | - George J Kahaly
- Dept. of Medicine I, Gutenberg University Hospital, Mainz, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, Essen, Germany
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McMahan ZH, Kulkarni S, Andrade F, Perin J, Zhang C, Hooper JE, Wigley FM, Rosen A, Pasricha PJ, Casciola-Rosen L. Anti-Gephyrin Antibodies: A Novel Specificity in Patients With Systemic Sclerosis and Lower Bowel Dysfunction. Arthritis Rheumatol 2024; 76:92-99. [PMID: 37530745 PMCID: PMC10834854 DOI: 10.1002/art.42667] [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: 09/01/2022] [Revised: 06/01/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Autoantibodies are clinically useful in phenotyping patients with systemic sclerosis (SSc). Gastrointestinal (GI) function is regulated by the enteric nervous system (ENS) and commonly impaired in SSc, suggesting that the SSc autoimmune response may target ENS antigens. We sought to identify novel anti-ENS autoantibodies with an aim to clinically phenotype SSc GI dysfunction. METHODS Serum from a patient with SSc with GI dysfunction but without defined SSc-associated autoantibodies was used for autoantibody discovery. Immunoprecipitations performed with murine myenteric plexus lysates were on-bead digested, and autoantigens were identified by mass spectrometry. Prevalence was determined, and clinical features associated with novel autoantibodies were evaluated in a SSc cohort using regression analyses. The expression of gephyrin in human GI tract tissue was examined by immunohistochemistry. RESULTS We identified gephyrin as a novel SSc autoantigen. Anti-gephyrin antibodies were present in 9% of patients with SSc (16/188) and absent in healthy controls (0/46). Anti-gephyrin antibody-positive patients had higher constipation scores (1.00 vs 0.50, P = 0.02) and were more likely to have severe constipation and severe distention/bloating (46% vs 15%, P = 0.005; 54% vs 25%, P = 0.023, respectively). Anti-gephyrin antibody levels were significantly higher among patients with severe constipation (0.04 vs 0.00; P = 0.001) and severe distention and bloating (0.03 vs 0.004; P = 0.010). Severe constipation was associated with anti-gephyrin antibodies even in the adjusted model. Importantly, gephyrin was expressed in the ENS, which regulates gut motility. CONCLUSION Gephyrin is a novel ENS autoantigen that is expressed in human myenteric ganglia. Anti-gephyrin autoantibodies are associated with the presence and severity of constipation in patients with SSc.
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Affiliation(s)
| | - Subhash Kulkarni
- Beth Israel Deaconess Medical Center and Harvard Medical School, Massachusetts, Boston
| | | | - Jamie Perin
- Johns Hopkins University, Maryland, Baltimore
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Anees A, Ayeni FE, Eslick GD, Edirimanne S. TSH receptor autoantibody levels post-total thyroidectomy in Graves' ophthalmopathy: a meta-analysis. Langenbecks Arch Surg 2023; 408:415. [PMID: 37870639 PMCID: PMC10593610 DOI: 10.1007/s00423-023-03153-3] [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: 10/12/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND TSH receptor autoantibodies (TRAbs) are pathognomonic for Graves' disease and are thought to also underly the pathogenesis of Graves' ophthalmopathy (GO). A decline in TRAb levels has been documented post-total thyroidectomy (TTx) in GO, however with conflicting correlations with disease outcomes. The aim of the study was to compare the effectiveness of TTx to other treatment modalities of Graves' disease and examine whether the lowering of TRAbs is associated with GO improvements. METHOD We searched electronic databases including Medline, Embase, Scopus, and Web of Science until 31 September 2022 using a broad range of keywords. Patients with GO undergoing TTx with measurements of both TRAbs and progression of the disease using a validated GO scoring system were included. Fourteen studies encompassing data from 1047 patients with GO met our eligibility criteria. The PRISMA guidelines were followed, and five studies had comparable data that were suitable for a meta-analysis. RESULTS The Cochrane Risk of Bias tool for RCTs showed low risk of bias across most domains. The pooled odds ratio showed that more patients significantly had normalized TRAb levels post-TTx as compared to other interventions (OR: 1.36, 95% CI: 1.02-1.81, p = 0.035). But, there was no significant difference in GO improvement post-TTx as compared with other intervention groups. CONCLUSIONS This meta-analysis shows that TRAb levels may decline largely post-TTx, but may not predict added improvements to the progression of GO. Thus, future studies with uniform designs are required to assess the minimal significant GO improvements.
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Affiliation(s)
- Arsalan Anees
- Department of Surgery, Nepean Hospital, Penrith, 2750, Australia
| | - Femi E Ayeni
- Department of Surgery, Nepean Hospital, Penrith, 2750, Australia.
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby St, Penrith, NSW, 2750, Australia.
| | - Guy D Eslick
- Sydney Medical School, The University of Sydney, Sydney, Australia
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Bastiaansen AEM, van Steenhoven RW, Te Vaarwerk ES, van der Flier WM, Teunissen C, de Graaff E, Nagtzaam MMP, Paunovic M, Franken SC, Schreurs MWJ, Leypoldt F, Smitt PAE, de Vries JM, Seelaar H, van Swieten J, Jan de Jong F, Pijnenburg YAL, Titulaer MJ. Antibodies Associated With Autoimmune Encephalitis in Patients With Presumed Neurodegenerative Dementia. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200137. [PMID: 37311646 PMCID: PMC10265404 DOI: 10.1212/nxi.0000000000200137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/08/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND & OBJECTIVES Autoimmune encephalitis (AIE) may present with prominent cognitive disturbances without overt inflammatory changes in MRI and CSF. Identification of these neurodegenerative dementia diagnosis mimics is important because patients generally respond to immunotherapy. The objective of this study was to determine the frequency of neuronal antibodies in patients with presumed neurodegenerative dementia and describe the clinical characteristics of the patients with neuronal antibodies. METHODS In this retrospective cohort study, 920 patients were included with neurodegenerative dementia diagnosis from established cohorts at 2 large Dutch academic memory clinics. In total, 1,398 samples were tested (both CSF and serum in 478 patients) using immunohistochemistry (IHC), cell-based assays (CBA), and live hippocampal cell cultures (LN). To ascertain specificity and prevent false positive results, samples had to test positive by at least 2 different research techniques. Clinical data were retrieved from patient files. RESULTS Neuronal antibodies were detected in 7 patients (0.8%), including anti-IgLON5 (n = 3), anti-LGI1 (n = 2), anti-DPPX, and anti-NMDAR. Clinical symptoms atypical for neurodegenerative diseases were identified in all 7 and included subacute deterioration (n = 3), myoclonus (n = 2), a history of autoimmune disease (n = 2), a fluctuating disease course (n = 1), and epileptic seizures (n = 1). In this cohort, no patients with antibodies fulfilled the criteria for rapidly progressive dementia (RPD), yet a subacute deterioration was reported in 3 patients later in the disease course. Brain MRI of none of the patients demonstrated abnormalities suggestive for AIE. CSF pleocytosis was found in 1 patient, considered as an atypical sign for neurodegenerative diseases. Compared with patients without neuronal antibodies (4 per antibody-positive patient), atypical clinical signs for neurodegenerative diseases were seen more frequently among the patients with antibodies (100% vs 21%, p = 0.0003), especially a subacute deterioration or fluctuating course (57% vs 7%, p = 0.009). DISCUSSION A small, but clinically relevant proportion of patients suspected to have neurodegenerative dementias have neuronal antibodies indicative of AIE and might benefit from immunotherapy. In patients with atypical signs for neurodegenerative diseases, clinicians should consider neuronal antibody testing. Physicians should keep in mind the clinical phenotype and confirmation of positive test results to avoid false positive results and administration of potential harmful therapy for the wrong indication.
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Affiliation(s)
- Anna E M Bastiaansen
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Robin W van Steenhoven
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Esmee S Te Vaarwerk
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Wiesje M van der Flier
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Charlotte Teunissen
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Esther de Graaff
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Mariska M P Nagtzaam
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Manuela Paunovic
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Suzanne C Franken
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Marco W J Schreurs
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Frank Leypoldt
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Peter A E Smitt
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Juna M de Vries
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Harro Seelaar
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - John van Swieten
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Frank Jan de Jong
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Yolande A L Pijnenburg
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands
| | - Maarten J Titulaer
- From the Department of Neurology (A.E.M.B., R.W.S., M.M.P.N., M.P., S.C.F., P.A.E.S., J.M.V., H.S., J.S., F.J.J., M.J.T.), Erasmus University Medical Center, Rotterdam; Department of Neurology (R.W.S.), Amsterdam UMC Location VUmc; Clinical Neuropsychology (E.S.V.), Leiden University; Alzheimer Center Amsterdam (W.M.F.), Neurology, Amsterdam UMC Location VUmc; Amsterdam Neuroscience (W.M.F., C.T., Y.A.L.P.), Neurodegeneration; Neurochemistry Laboratory (C.T.), Department of Chemistry, Amsterdam UMC Location VUmc; Department of Biology (E.G.), Faculty of Science, Utrecht University; Department of Immunology (M.W.J.S.), Erasmus University Medical Center, Rotterdam, The Netherlands; Institute of Clinical Chemistry (F.L.), University Hospital Schleswig-Holstein, Germany; Alzheimer Center Erasmus MC (H.S., J.S., F.J.J.), Erasmus MC University Medical Center, Rotterdam; and Alzheimer Center Amsterdam (Y.A.L.P.), Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, The Netherlands.
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Hamedani AG, McPherson TO, Aban I, Lee I, Kupersmith MJ, Wolfe GI, Kaminski HJ. Attitudes and Beliefs Toward Thymectomy in the Myasthenia Gravis Patient Registry. J Clin Neuromuscul Dis 2023; 24:222-228. [PMID: 37219866 DOI: 10.1097/cnd.0000000000000449] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate patient attitudes and beliefs toward thymectomy for myasthenia gravis (MG). METHODS The Myasthenia Gravis Foundation of America administered a questionnaire to the MG Patient Registry, an ongoing longitudinal survey of adult MG patients. Questions assessed reasons for or against thymectomy and how hypothetical scenarios would have affected their decision. RESULTS Of 621 respondents, 190 (31%) reported a history of thymectomy. Of those who underwent thymectomy for nonthymomatous MG, 97 (51.6%) ranked symptom improvement as most important and 100 (53.2%) ranked reducing medication as least important. Among 431 nonthymectomy patients, the most frequent reason for not undergoing thymectomy was that their doctor did not discuss it (152 of 431 = 35.2%) and 235 (56.8%) said that they would have considered it more strongly if their doctor spent more time discussing it. CONCLUSIONS Thymectomies are motivated more by symptoms than by medication, and a lack of neurologist discussion is the most common barrier to thymectomy.
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Affiliation(s)
- Ali G Hamedani
- Departments of Neurology and Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Tarrant O McPherson
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham AL
| | - Inmaculada Aban
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham AL
| | - Ikjae Lee
- Department of Neurology, Columbia University, New York, NY
| | - Mark J Kupersmith
- Departments of Neurology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary, New York, NY
| | - Gil I Wolfe
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; and
| | - Henry J Kaminski
- Department of Neurology, George Washington University, Washington, DC
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7
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Mistry S, Gouripeddi R, Raman V, Facelli JC. Stratifying risk for onset of type 1 diabetes using islet autoantibody trajectory clustering. Diabetologia 2023; 66:520-534. [PMID: 36446887 PMCID: PMC10097474 DOI: 10.1007/s00125-022-05843-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022]
Abstract
AIMS/HYPOTHESIS Islet autoantibodies can be detected prior to the onset of type 1 diabetes and are important tools for aetiologic studies, prevention trials and disease screening. Current risk stratification models rely on the positivity status of islet autoantibodies alone, but additional autoantibody characteristics may be important for understanding disease onset. This work aimed to determine if a data-driven model incorporating characteristics of islet autoantibody development, including timing, type and titre, could stratify risk for type 1 diabetes onset. METHODS Data on autoantibodies against GAD (GADA), tyrosine phosphatase islet antigen-2 (IA-2A) and insulin (IAA) were obtained for 1,415 children enrolled in The Environmental Determinants of Diabetes in the Young study with at least one positive autoantibody measurement from years 1 to 12 of life. Unsupervised machine learning algorithms were trained to identify clusters of autoantibody development based on islet autoantibody timing, type and titre. Risk for type 1 diabetes across each identified cluster was evaluated using time-to-event analysis. RESULTS We identified 2-4 clusters in each year cohort that differed by autoantibody timing, titre and type. During the first 3 years of life, risk for type 1 diabetes onset was driven by membership in clusters with high titres of all three autoantibodies (1-year risk: 20.87-56.25%, 5-year risk: 67.73-69.19%). Type 1 diabetes risk transitioned to type-specific titres during ages 4 to 8, as clusters with high titres of IA-2A (1-year risk: 20.88-28.93%, 5-year risk: 62.73-78.78%) showed faster progression to diabetes compared with high titres of GADA (1-year risk: 4.38-6.11%, 5-year risk: 25.06-31.44%). The importance of high GADA titres decreased during ages 9 to 12, with clusters containing high titres of IA-2A alone (1-year risk: 14.82-30.93%) or both GADA and IA-2A (1-year risk: 8.27-25.00%) demonstrating increased risk. CONCLUSIONS/INTERPRETATION This unsupervised machine learning approach provides a novel tool for stratifying risk for type 1 diabetes onset using multiple autoantibody characteristics. These findings suggest that age-dependent changes in IA-2A titres modulate risk for type 1 diabetes onset across 12 years of life. Overall, this work supports incorporation of islet autoantibody timing, type and titre in risk stratification models for aetiologic studies, prevention trials and disease screening.
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Affiliation(s)
- Sejal Mistry
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Ramkiran Gouripeddi
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
- Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA
| | - Vandana Raman
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Julio C Facelli
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
- Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA.
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8
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Grötzinger C. Applications of Peptide Microarrays in Autoantibody, Infection, and Cancer Detection. Methods Mol Biol 2023; 2578:1-15. [PMID: 36152276 DOI: 10.1007/978-1-0716-2732-7_1] [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] [Indexed: 06/16/2023]
Abstract
The diversity of the antigen-specific humoral immune response reflects the interaction of the immune system with pathogens and autoantigens. Peptide microarray analysis opens up new perspectives for the use of antibodies as diagnostic biomarkers and provides unique access to a more differentiated view on humoral responses to disease. This review focuses on the latest applications of peptide microarrays for the serologic medical diagnosis of autoimmunity, infectious diseases (including COVID-19), and cancer.
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Affiliation(s)
- Carsten Grötzinger
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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9
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Anis S, Fatima A, Abdul Jabbar S, Arain T. ANA-specific antibodies, ANA patterns, anti-ds-DNA results, and clinical diagnosis: a laboratory and clinical audit. Immunol Res 2022; 71:267-275. [PMID: 36456720 DOI: 10.1007/s12026-022-09347-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
The diagnosis of systemic autoimmune diseases (SAID) is challenging, due to overlapping features with other non-immune disorders. Anti-nuclear antibodies (ANA)/anti-cellular antibodies are the sensitive screening tests but anti-double-stranded-deoxyribonucleic acid-antibody (anti-ds-DNA) and ANA-specific antibodies are specific for SAID. We aimed to look at ANA-specific antibodies in our patients and correlated them with ANA patterns, anti-ds-DNA, and clinical diagnosis for proper interpretation and better patient management cost-effectively. A retrospective data analysis of 641 patients was done (1st of February 2019 to 31st of July 2021) who were tested for ANA-specific antibodies at the Immunology Department of Indus Hospital and Health Network. ANA and anti-ds-DNA results and clinical diagnosis were also analyzed for ANA-specific antibody-positive patients. Descriptive data were presented in mean ± standard deviation and frequency percentages whereas inferential data were analyzed with a chi-square test for association between ANA-specific antibodies status, ANA, anti-ds-DNA, and clinical features. ANA-specific antibodies test revealed positivity for at least one autoantibody in 245 (38.2%) patients. Of these, ANA was tested in 206 patients reactive for ANA-specific antibodies and found positive in 195 (95%) as compared to negative (< 0.001). Speckled and homogenous were predominant ANA patterns in ANA-specific antibody-positives (56% and 42% respectively). Multiple ANA patterns were found in 18 patients most commonly with systemic lupus erythematosus (SLE) and mixed connective tissue disorder (MCTD). Anti-SSA were the most common ANA-specific antibodies (50%) and were mostly found in sera with speckled (61/97) and homogenous (38/97) patterns and associated mostly with SLE (48%) and Sjogren's syndrome (86%). Among ANA-negative patients, anti-SSA were the most common antibodies (n = 5). Anti-ds-DNA was found in 66% of SLE patients along with another ANA-specific antibody. This study showed that testing for ANA-specific antibodies cannot be gated on ANA patterns. Also, there is a redundancy of these antibodies with various clinical diagnoses. Moreover, they are useful in making a diagnosis in ANA-negative patients as well with clinical suspicion.
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Affiliation(s)
- Sabiha Anis
- Department of Pathology and Department of Medicine and Allied, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan.
| | - Areej Fatima
- Department of Pathology, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan
| | - Sidra Abdul Jabbar
- Department of Pathology, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan
| | - Tayyab Arain
- Department of Pathology, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan
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10
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Li RR, Wang Y, Guo X, Li Y, Zhang LL, Meng Y, Ren HQ, He S, Lu RX, Zhu XL, Zhao R, Sun X. [Clinical significance of autoantibodies against ubiquitin carboxyl hydrolase L1 epitopes in the screening and diagnosis of Sjögren syndrome]. Zhonghua Yi Xue Za Zhi 2022; 102:2590-2595. [PMID: 36058683 DOI: 10.3760/cma.j.cn112137-20220311-00508] [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: 06/15/2023]
Abstract
Objective: To study the clinical significance of autoantibodies against different ubiquitin carboxyl hydrolase L1 (UCH-L1) epitopes in Sjogren syndrome (SS). Methods: The serum levels of different UCH-L1 epitope autoantibodies in 98 SS patients [SS group, 17 males and 81 females, aged (49.1±12.3) years] in the Fifth Affiliated Hospital of Zhengzhou University and Peking University People's Hospital from January 2017 to January 2020 and 37 healthy controls [control group, 6 males and 31 females, aged (46.3±5.8) years] were determined by enzyme-linked immunosorbent assay (ELISA). Three potential epitopes of UCH-L1 protein were analyzed and synthesized and anti-UCH-L1203-214 and anti-UCH-L158-69 antibodies were studied between the two groups. The levels of the two anti-UCH-L1 antibodies in the two groups were compared. The correlation between the levels of UCH-L1 antibodies and clinical data of SS patients were analyzed by Pearson correlation analysis. Results: The serum levels of anti-UCH-L1203-214 and anti-UCH-L158-69 antibody in SS patients were significantly higher than those in healthy controls (HCs) (anti-UCH-L1203-214: 108.2±54.3 vs 78.9±25.8, P<0.001, anti-UCH-L158-69: 86.8±33.3 vs 60.4±21.5, P<0.001). The positive rates of anti-UCH-L1203-214 and anti-UCH-L158-69 antibodies in serums of SS patients were 27.6 % (27/98) and 25.5% (25/98), and those in HCs were 2.7%(1/37) and 5.4 %(2/37), respectively. In SS patients with positive serum anti-UCH-L158-69 antibody, the levels of IgG, γ globulin and rheumatoid factor (RF) and anti-SS-related antigen B (anti-SSB) antibody positive rate were all significantly higher than those in patients with negative antibody (all P<0.05). In SS patients with negative antinuclear antibody (ANA), anti-RNA binding protein (anti-RNP) antibody, anti-SS-related antigen A (anti-SSA) antibody and anti-SSB antibody, the positive rates of anti-UCH-L1203-214 antibody was 32.1%(9/28), 27.2%(25/92), 36.4%(12/33), 28.6%(18/63), respectively; and the positive rates of anti-UCH-L158-69 antibody was 21.4%(6/28), 30.4%(28/92), 30.3%(10/33), 20.6%(13/63), respectively. The level of serum anti-UCH-L1203-214 antibody in SS patients was positively correlated with the IgA level (r=0.21, P=0.024). The level of anti-UCH-L158-69 antibody in SS patients was positively correlated with the levels of γ-globulin, IgG and RF (r=0.35, 0.33, 0.32, all P<0.01). Conclusion: Autoantibodies against UCH-L1 epitopes are correlated with some clinical parameters of SS patients, which is of promising significance in the screening and diagnosis of SS.
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Affiliation(s)
- R R Li
- Department of Rheumatology and Immunology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y Wang
- Department of Rheumatology and Immunology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - X Guo
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - Y Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - L L Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - Y Meng
- Department of Rheumatology and Immunology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - H Q Ren
- Department of Rheumatology and Immunology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - S He
- Department of Rheumatology and Immunology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - R X Lu
- Department of Rheumatology and Immunology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - X L Zhu
- Department of Rheumatology and Immunology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Ruixiao Zhao
- Department of Rheumatology and Immunology, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Xiaolin Sun
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
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11
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Li W, Sun Y. Analysis of Risk Factors for Rheumatoid Arthritis in Yunnan: A Small-Scale Case-Control Study. Comput Intell Neurosci 2022; 2022:3948448. [PMID: 35785088 PMCID: PMC9246626 DOI: 10.1155/2022/3948448] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Abstract
Objective To study the risk factors of rheumatoid arthritis (RA) in Yunnan and provide reference for its clinical prevention and treatment. Methods From January 2014 to February 2022, a total of 249 RA patients who were admitted to the First People's Hospital of Yunnan Province were selected and 149 healthy people were selected as the controls. The medical records, clinical data of blood test results of anticyclic citrullinated polypeptide (anti-CCP) antibody, antikeratin antibody (AKA), and antiperinuclear factor (APF) were collected. Logistic regression and receiver operating curve (ROC) were used to analyze the correlation between blood anti-CCP antibody, AKA, and APF and the occurrence of RA. Results Univariate analysis showed that the age, proportion of hypertension, and diabetes patients in RA patients were significantly different from those in the control group (p < 0.05), but there was no statistical difference in sex (p > 0.05). The area under the curve (AUC) of the serum anti-CCP antibody level in the diagnosis of RA was 0.76 (95% CI: 0.72-0.81, p < 0.01), the sensitivity was 85.23%, the specificity was 61.45%, and the cutoff value was 18.07AU/mL. The positive rates of AKA (33.73%) and APF (43.37%) in the RA patients were significantly higher than those in the controls (4.03% and 6.04%), and the differences were statistically significant (p < 0.001). After adjusting for age, sex, hypertension, and diabetes, logistic regression analysis showed that anti-CCP positivity, AKA positive, and APF positive were all independent risk factors for RA (OR = 20.24, 95% CI: 9.36-43.77, p < 0.01; OR = 4.33, 95% CI: 1.62-11.60, p < 0.01; OR = 5.28, 95% CI: 2.33-11.99, p < 0.01). Conclusion Anti-CCP positive, AKA positive, and APF positive are independent risk factors for the occurrence of RA. Serum anti-CCP level has high sensitivity but low specificity in the diagnosis of RA.
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Affiliation(s)
- Wenrun Li
- Department of Medical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yi Sun
- Department of Medical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
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12
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Li N, Zhang J, Meng X, Yao W. Clinical Application Value of High-Frequency Ultrasound Combined with Detection of Serum High Mobility Group Box 1, Soluble IL-2 Receptor, and Thyroglobulin Antibody in Diagnosing Thyroid Cancer. J Healthc Eng 2022; 2022:7851436. [PMID: 35392142 PMCID: PMC8983246 DOI: 10.1155/2022/7851436] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/13/2022]
Abstract
Objective The aim of this study is to explore the clinical application value of high-frequency ultrasound combined with detection of serum high mobility group box (HMGB-1), soluble IL-2 receptor (SIL-2R), and thyroglobulin antibody (TgAb) in diagnosing thyroid cancer. Methods By means of retrospective study, 50 thyroid cancer patients treated in our hospital from January 2019 to January 2021 were selected as the thyroid cancer group, 50 patients with benign thyroid lesions were included in the benign lesion group, and 50 healthy individuals examined in our hospital in the same period were included in the control group. All study objects received high-frequency ultrasound examination, and at the same time, their serum HMGB-1, SIL-2R, and TgAb levels were measured. After that, the results of high-frequency ultrasound examination were analyzed, the diagnostic efficacy of different diagnosis methods was explored, and receiver operating characteristic (ROC) curves were plotted. Results According to the results of high-frequency ultrasound examination, there were significant differences in echogenicity surrounding and inside the lesion, calcification, blood flow distribution, and blood flow parameters between the thyroid cancer group and the benign lesion group (P < 0.001); the HMGB-1, SIL-2R, and TgAb levels were statistically different among the three groups (P < 0.001), and the level values of HMGB-1, SIL-2R, and TgAb of the thyroid cancer group were, respectively, (12.26 ± 1.32) ng/ml, (108.65 ± 9.75) pmol/L, and (690.65 ± 34.47) IU/mL; the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of high-frequency ultrasound combined with detection of serum HMGB-1, SIL-2R, and TgAb were, respectively, 98.0%, 95.0%, 90.7%, and 99.0%, and AUC (95%CI) = 0.965 (0.931-0.999). Conclusion High-frequency ultrasound combined with detection of serum HMGB-1, SIL-2R, and TgAb has a good value in diagnosing thyroid cancer, which should be promoted in practice.
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Affiliation(s)
- Ning Li
- Department of Ultrasound Medicine, Zibo Central Hospital, 255022 Zibo, Shandong Province, China
| | - Jiahui Zhang
- Department of Public Health, Zibo Central Hospital, 255022 Zibo, Shandong Province, China
| | - Xiaojiao Meng
- Department of Ultrasound Medicine, Zibo Central Hospital, 255022 Zibo, Shandong Province, China
| | - Wenliang Yao
- Department of Nuclear Medicine, Zibo Central Hospital, 255022 Zibo, Shandong Province, China
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Abstract
[Figure: see text].
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Khayeka-Wandabwa C, Ma X, Jia Y, Bureik M. Monitoring of autoantibodies against CYP4Z1 in patients with colon, ovarian, or prostate cancer. Immunobiology 2022; 227:152174. [PMID: 34999392 DOI: 10.1016/j.imbio.2021.152174] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 12/09/2022]
Abstract
We have previously monitored the detection of autoantibodies (aAbs) directed against CYP4Z1 in the sera of breast and lung cancer patients. In the present study, the occurence of anti-CYP4Z1 aAbs in patients suffering from colon (n = 100), ovarian (n = 72), or prostate (n = 85) cancer was examined. Determination of aAbs was done using our previously established ELISA method. On average, the levels of anti-CYP4Z1 aAbs detected in sera from all cancer patients were not significantly higher than controls. No correlations were found with respect to gender or tumor stage. However, a subgroup of colon cancer patients with increased anti-CYP4Z1 aAb titers exhibited positive fecal occult blood test (FOBT) results and higher levels of both carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). These results do not suggest that anti-CYP4Z1 aAbs have value as an independent biomarker for the detection of either colon, ovarian, or prostate cancer. However, they might be useful in combination with other biomarkers for the identification of a subset of colon cancers. Investigations involving a more powered sample size of this subgroup are needed to support this notion.
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Affiliation(s)
| | - Xiaoshuang Ma
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, China
| | - Yingjie Jia
- Dept. of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Matthias Bureik
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, China.
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Urriola N, Blazek K, Adelstein S. Subunit-specific autoantibodies in autoimmune autonomic ganglionopathy. J Neuroimmunol 2022; 363:577805. [PMID: 34995917 DOI: 10.1016/j.jneuroim.2021.577805] [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: 11/29/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
Autoimmune Autonomic Ganglionopathy (AAG) is a disorder that causes autonomic failure and is associated with alpha3-ganglionic acetylcholine-receptor (gnACHR) antibodies. Assays that detect antibodies to whole gnACHR or subunits are available. We compared in-house subunit-specific immunoassays using bacterially-expressed alpha3 and beta4 subunits against an immunomodulation assay to detect antibodies in patients with AAG or control groups in a novel 2-step clinical-characteristic unblinding protocol. Only 1/8 patients with seropositive-AAG had subunit-specific antibodies, with sensitivity, specificity, false-negative and positive rates of 12.5, 85.2, 78.6 and 13.4% respectively. Subunit-specific antibody-derived false-positive results can lead to misdiagnosis, as autonomic failure is not specific to AAG.
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Affiliation(s)
- Nicolás Urriola
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Katrina Blazek
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Stephen Adelstein
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Central Sydney Immunopathology Laboratory, Pathology East, NSW Health Pathology, Australia
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Sarić Matutinović M, Diana T, Nedeljković Beleslin B, Ćirić J, Žarković M, Kahaly GJ, Ignjatović S. Clinical value of functional thyrotropin receptor antibodies in Serbian patients with Graves' orbitopathy. J Endocrinol Invest 2022; 45:189-197. [PMID: 34324163 DOI: 10.1007/s40618-021-01652-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/24/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Thyrotropin receptor autoantibodies (TSH-R-Ab) are heterogeneous in their biological function and play a significant role in the pathophysiology of both Graves' disease and Graves' orbitopathy (GO). The clinical significance and utility of determining functional TSH-R-Ab in a Serbian collective were evaluated. METHODS 91 consecutive patients with GO were included in this study. Total TSH-R-Ab concentration, referred to as TSH-R binding inhibitory immunoglobulins (TBII) was detected using a competitive-binding immunoassay. Stimulating and blocking TSH-R-Ab (TSAb and TBAb) were measured with cell-based bioassays. RESULTS Stimulating TSAb activity and TBII positivity were detected in 85 of 91 (93.4%) and 65 of 91 (71.4%) patients with GO (P < 0.001). Blocking TBAb activity was observed in only one patient who expressed dual stimulating and blocking TSH-R-Ab activity. The sensitivity rates for differentiating between clinically active versus inactive and mild versus moderate-to-severe GO were 100% and 100% for TSAb, respectively. In contrast, these were 82% and 87% only for TBII. Seven of eight (87.5%) and one of eight (12.5%) euthyroid patients with GO were TSAb and TBII positive, respectively (P < 0.031). TSAb serum levels significantly predicted GO activity compared to TBII (odds ratio, OR, 95%CI: 3.908, 95%CI 1.615-9.457, P = 0.003; versus 2.133, 0.904-5.032, P = 0.084, univariate analysis; and OR 4.341, 95%CI 1.609-11.707, P = 0.004; versus 2.337, 0.889-6.145, P = 0.085 multivariate analysis). CONCLUSION Stimulating TSAb are highly prevalent in patients with GO and show superior clinical characteristics and predictive potential compared to the traditionally used TBII.
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Affiliation(s)
| | - T Diana
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - B Nedeljković Beleslin
- Clinic of Endocrinology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - J Ćirić
- Clinic of Endocrinology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - M Žarković
- Clinic of Endocrinology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - G J Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - S Ignjatović
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
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Krieger CC, Kahaly GJ, Azam A, Klubo-Gwiezdzinska J, Neumann S, Gershengorn MC. Graves' Autoantibodies Exhibit Different Stimulating Activities in Cultures of Thyrocytes and Orbital Fibroblasts Not Reflected by Clinical Assays. Thyroid 2022; 32:90-96. [PMID: 34714162 PMCID: PMC8792498 DOI: 10.1089/thy.2021.0326] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: The pathogenesis of Graves' hyperthyroidism (GH) and associated Graves' orbitopathy (GO) appears to involve stimulatory autoantibodies (thyrotropin receptor [TSHR]-stimulating antibodies [TSAbs]) that bind to and activate TSHRs on thyrocytes and orbital fibroblasts. In general, measurement of circulating TSHR antibodies by clinical assays correlates with the status of GH and GO. However, most clinical measurements of TSHR antibodies use competitive binding assays that do not distinguish between TSAbs and antibodies that bind to but do not activate TSHRs. Moreover, clinical assays for TSAbs measure stimulation of only one signaling pathway, the cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA) pathway, in engineered cells that are not thyrocytes or orbital fibroblasts. We determined whether measuring TSAbs by a cAMP-PKA readout in engineered cells accurately reveals the efficacies of stimulation by these antibodies on thyrocytes and orbital fibroblasts. Methods: We measured TSAb stimulation of normal human thyrocytes and orbital fibroblasts from patients with GO in primary cultures in vitro. In thyrocytes, we measured secretion of thyroglobulin (TG) and in orbital fibroblasts secretion of hyaluronan (hyaluronic acid [HA]). We also measured stimulation of cAMP production in engineered TSHR-expressing cells in an assay similar to clinical assays. Furthermore, we determined whether there were differences in stimulation of thyrocytes and orbital fibroblasts by TSAbs from patients with GH alone versus from patients with GO understanding that patients with GO have accompanying GH. Results: We found a positive correlation between TSAb stimulation of cAMP production in engineered cells and TG secretion by thyrocytes as well as HA secretion by orbital fibroblasts. However, TSAbs from GH patients stimulated thyrocytes more effectively than TSAbs from GO patients, whereas TSAbs from GO patients were more effective in activating orbital fibroblasts than TSAbs from GH patients. Conclusions: Clinical assays of stimulation by TSAbs measuring activation of the cAMP-PKA pathway do correlate with stimulation of thyrocytes and orbital fibroblasts; however, they do not distinguish between TSAbs from GH and GO patients. In vitro, TSAbs exhibit selectivity in activating TSHRs since TSAbs from GO patients were more effective in stimulating orbital fibroblasts and TSAbs from GH patients were more effective in stimulating thyrocytes.
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Affiliation(s)
- Christine C. Krieger
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - George J. Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Asma Azam
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Joanna Klubo-Gwiezdzinska
- Metabolic Diseases Branch, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Susanne Neumann
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Marvin C. Gershengorn
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Address correspondence to: Marvin C. Gershengorn, MD, Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Davies TF, Morshed SA, Mezei M, Latif R. Brief Report - Monoclonal Antibodies Illustrate the Difficulties in Measuring Blocking TSH Receptor Antibodies. Front Endocrinol (Lausanne) 2022; 13:943459. [PMID: 35909553 PMCID: PMC9335193 DOI: 10.3389/fendo.2022.943459] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
TSH receptor (TSHR) antibodies are the cause of Graves' disease and may also be found in patients with Hashimoto's thyroiditis. They come in at least three varieties: thyroid stimulating, thyroid blocking and neutral. The measurement of TSH receptor antibodies in Graves' disease and Hashimoto's thyroiditis is a common clinical activity and can be useful in diagnosis and prognosis. We show that it is not possible to detect the blocking variety of TSHR antibody in patients with Graves' disease because the stimulating antibody may overwhelm the measurement of blocking in the bioassays available for their measurement and may blind the valid interpretation of the results. To help explain this in more detail we show a series of studies with monoclonal TSHR antibodies which support this conclusion.
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Khan SR, Peeters RP, van Hagen PM, Dalm V, Chaker L. Determinants and Clinical Implications of Thyroid Peroxidase Antibodies in Middle-Aged and Elderly Individuals: The Rotterdam Study. Thyroid 2022; 32:78-89. [PMID: 34779279 DOI: 10.1089/thy.2021.0403] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Thyroid peroxidase antibodies (TPO-Abs) play an important role in autoimmune thyroid disease, but are also prevalent in healthy individuals. However, it is unclear what determinants may influence the occurrence of TPO-Abs in healthy individuals and how TPO-Abs may affect health outcomes in these individuals. We aimed to identify determinants of TPO-Abs in a large, prospective population-based cohort of middle-aged and elderly individuals and to subsequently assess the association between TPO-Abs and risk of overall and cause-specific mortality. Methods: We performed binomial and multinomial logistic regression analyses to obtain odds ratios (ORs) and 95% confidence intervals [95% CIs] for the association of potential determinants based on previous literature with TPO-Ab positivity (>35 kU/L), TPO-Ab detectability (>5 kU/L), and TPO-Ab categories. Cox proportional hazards regression analyses were performed to obtain hazard ratios (HRs) and CIs for the association between TPO-Abs and mortality risk. Results: In 9685 participants (57% women, median baseline age 63.3 years, median follow-up time 10.1 years), we identified female sex (OR = 2.47 [CI 2.13-2.86]) and current smoking (OR = 3.10 [CI 2.66-3.62]) as determinants of TPO-Ab positivity and TPO-Ab detectability, respectively. Higher age (OR = 0.98 [CI 0.97-0.98]) and all categories of alcohol consumption (ORs ranging from 0.71-0.78) were associated with lower odds of TPO-Ab detectability. TPO-Ab detectability was associated with a higher risk of overall (HR = 1.09 [CI 1.01-1.17]), cancer-related (HR = 1.18 [CI 1.01-1.38]), and cardiovascular mortality (HR = 1.21 [CI 1.01-1.45]). Interestingly, this was more prominent in men compared with women (HR for cardiovascular mortality 1.50 vs. 0.99, respectively). Conclusions: In community-dwelling middle-aged and elderly individuals, female sex and current smoking are the most important determinants associated with TPO-Ab levels in the detectable and positive range, whereas alcohol consumption is associated with lower odds of TPO-Abs. The clinical importance of detectable TPO-Ab levels is illustrated by the association with an increased mortality risk, mainly in men. Our results warrant further exploration of the clinical applicability of detectable TPO-Ab levels, potentially as a marker for low-grade inflammation. The Rotterdam Study has been entered into the Netherlands National Trial Register (NTR; www.trialregister.nl) and into the WHO International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/network/primary/en/) under shared catalogue number NTR6831.
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Affiliation(s)
- Samer R Khan
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Petrus Martin van Hagen
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Virgil Dalm
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Myagkova MA, Orlova EA, Petrochenko SN, Bobrova ZV, Bachurin SO. Measurement of Immunological Parameters to Assess Human Body Readiness for Physical Load. Bull Exp Biol Med 2021; 172:218-222. [PMID: 34855086 DOI: 10.1007/s10517-021-05366-2] [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: 04/28/2021] [Indexed: 11/25/2022]
Abstract
We measured the level of natural antibodies (nAb) to glutamate and GABA reflecting the balance of excitation and inhibition systems and involved in the adaptation processes in athletes receiving normalized physical activity in the dynamics of training (figure skaters, football players, and people actively involved in sports). It was found that each subject has an individual immunological profile and its parameters change in accordance with the training load. The measured levels of nAbs to GABA and glutamate correlate the physical activity of a person. The surveyed football players were divided into 3 groups according to the results of the analysis. Subjects of the first group had reliably high immunological indices in comparison with the control and were at the peak of physical form; in the third group, low immunological indices relative to the control indicated exhaustion and fatigue. The indicators of the second group corresponded to normal and demonstrated the resource of adaptation to load. The developed method can be used for assessing person's readiness for physical activity.
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Affiliation(s)
- M A Myagkova
- Department of Biochemical Research, Laboratory of Immunochemistry, Institute of Physiologically Active Substances, Russian Academy of Sciences, Chernogolovka, Moscow Region, Russia
| | - E A Orlova
- Department of Biochemical Research, Laboratory of Immunochemistry, Institute of Physiologically Active Substances, Russian Academy of Sciences, Chernogolovka, Moscow Region, Russia
| | - S N Petrochenko
- Department of Biochemical Research, Laboratory of Immunochemistry, Institute of Physiologically Active Substances, Russian Academy of Sciences, Chernogolovka, Moscow Region, Russia.
| | - Z V Bobrova
- Department of Biochemical Research, Laboratory of Immunochemistry, Institute of Physiologically Active Substances, Russian Academy of Sciences, Chernogolovka, Moscow Region, Russia
| | - S O Bachurin
- Department of Biochemical Research, Laboratory of Immunochemistry, Institute of Physiologically Active Substances, Russian Academy of Sciences, Chernogolovka, Moscow Region, Russia
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Dilek SÖ, Gürbüz F, Turan İ, Celiloğlu C, Yüksel B. Changes in the presentation of newly diagnosed type 1 diabetes in children during the COVID-19 pandemic in a tertiary center in Southern Turkey. J Pediatr Endocrinol Metab 2021; 34:1303-1309. [PMID: 34291625 DOI: 10.1515/jpem-2021-0287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/29/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The COVID-19 pandemic is a global health problem with high morbidity and mortality. This study aimed to investigate patients who were diagnosed with type 1 diabetes during the pandemic and evaluate the effect of the pandemic on the clinical findings of these patients by comparing them with findings from a year prior. METHODS Patients diagnosed with type 1 diabetes mellitus between 2019 and 2021 were separated into two groups: Patients diagnosed prepandemic and those diagnosed during the pandemic. RESULTS The number of newly diagnosed diabetes cases increased from 46 in the prepandemic period to 74 in the pandemic period. The number of cases diagnosed with diabetic ketoacidosis (DKA) in the clinic increased from 58.7 to 91.9%. We found that moderate and severe DKA rates from 18.5 and 14.8% to 23.5 and 22.1%, respectively. Besides, the average HbA1c was higher, while the average bicarbonate was lower in cases diagnosed during the pandemic period compared to the prepandemic period (p=0.048 and p<0.001, respectively). We found that celiac autoantibody positivity antibodies to glutamic acid decarboxylase (anti GAD) positivity, and islet cell antibodies (ICA), ICA and anti GAD positivity coexistence were higher (p=0.045, p=0.008, and p=0.007, respectively) among the patients diagnosed during the pandemic. CONCLUSIONS We observed an increase in the number of patients newly diagnosed with type 1 diabetes mellitus, an increase in autoantibody positivity, and higher rates and severity of DKA during the COVID-19 pandemic period compared to the prepandemic period.
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Affiliation(s)
- Semine Özdemir Dilek
- Division of Pediatric Endocrinology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Fatih Gürbüz
- Division of Pediatric Endocrinology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - İhsan Turan
- Division of Pediatric Endocrinology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Can Celiloğlu
- Division of Pediatric Endocrinology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Bilgin Yüksel
- Division of Pediatric Endocrinology, Cukurova University Faculty of Medicine, Adana, Turkey
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Wu XW, Li G, Cheng XB, Wang M, Wang LL, Wang HH, Yang JY, Hu XJ. Association of Angiotensin II Type 1 Receptor Agonistic Autoantibodies With Outcomes in Patients With Acute Aortic Dissection. JAMA Netw Open 2021; 4:e2127587. [PMID: 34596673 PMCID: PMC8486983 DOI: 10.1001/jamanetworkopen.2021.27587] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Angiotensin II is significantly associated with the pathogenesis of acute aortic dissection. Angiotensin II type 1 receptor agonistic autoantibodies (AT1-AAs) can mimic the effect of angiotensin II. OBJECTIVE To investigate the association between AT1-AAs and all-cause and cause-specific mortality risk in patients with acute aortic dissection. DESIGN, SETTING, AND PARTICIPANTS A total of 662 patients with clinically suspected aortic dissection from 3 medical centers in Wuhan, China, were enrolled in this cohort study from August 1, 2014, to July 31, 2016. Of these, 315 patients were included in the 3-year follow-up study. Follow-up was mainly performed via telephone interviews and outpatient clinic visits. Data analysis was conducted from March 1 to May 31, 2020. MAIN OUTCOMES AND MEASURES The primary outcomes of interest were all-cause mortality, death due to aortic dissection, and late aortic-related adverse events. RESULTS The full study cohort included 315 patients with AAD (mean [SD] age, 56.2 [12.7] years; 230 men [73.0%]). Ninety-two patients (29.2%) were positive for AT1-AAs. The mortality of AT1-AA-positive patients was significantly higher than that of AT1-AA-negative patients (40 [43.5%] vs 37 [16.6%]; P < .001). The mortality risk in AT1-AA-positive patients was always significantly higher than that in AT1-AA-negative patients in patients with both type A and type B dissection. Multivariable analysis showed that the risk of AT1-AA-positive patients for type A dissection was significantly higher than that of AT1-AA-negative patients (odds ratio [OR], 1.88; 95% CI, 1.12-3.13; P = .02). The Cox proportional hazards regression model showed a significant increase of all-cause mortality risk (OR, 2.27; 95% CI, 1.44-3.57; P < .001) and late aortic-related adverse events (OR, 1.58; 95% CI, 1.06-2.36; P = .03) among AT1-AA-positive patients during the follow-up period compared with AT1-AA-negative patients. CONCLUSIONS AND RELEVANCE This cohort study first detected AT1-AAs in patients with acute aortic dissection. The presence of AT1-AAs was associated with significantly higher all-cause and cause-specific mortality during a follow-up period of 3 years. The antibodies may be a risk factor for aortic dissection.
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Affiliation(s)
- Xiao-wei Wu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Li
- Emergency Department, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
| | - Xiao-bin Cheng
- Emergency Department, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Min Wang
- Emergency Department, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Liu-lin Wang
- Emergency Department, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Hai-hao Wang
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian-ye Yang
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing-jian Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chiang HL, Tung CH, Huang KY, Hsu BB, Wu CH, Hsu CW, Lu MC, Lai NS. Association between clinical phenotypes of dermatomyositis and polymyositis with myositis-specific antibodies and overlap systemic autoimmune diseases. Medicine (Baltimore) 2021; 100:e27230. [PMID: 34664863 PMCID: PMC8448045 DOI: 10.1097/md.0000000000027230] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/23/2021] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the association between clinical phenotypes of dermatomyositis (DM) and polymyositis (PM) with myositis-specific antibodies (MSAs), and overlap diagnosis of systemic autoimmune diseases.This cross-sectional study was conducted on 67 patients with DM and 27 patients with PM recruited from a regional hospital in southern Taiwan. Clinical phenotypes of DM and PM were assessed and MSAs were measured using a commercial line blot assay. The association of clinical phenotypes of DM and PM with MSAs and overlap diagnosis of systemic autoimmune diseases was performed using univariate and multiple logistic regression analyses.Clinically, patients with DM and PM and overlap diagnosis of systemic sclerosis were associated with a higher risk of interstitial lung diseases (ILDs) (odds ratio [OR] = 6.73; P = .048), Raynaud phenomenon (OR = 7.30; P = .034), and malignancy (OR = 350.77; P = .013). The risk of malignancy was also associated with older age (OR 1.31; P = .012), and male patients were associated with a higher risk of fever. For MSAs, anti-aminoacyl-tRNA synthetase antibodies were associated with ILD, antinuclear antibody were associated with a lower risk of arthritis, anti-transcription intermediary factor 1-gamma antibodies were associated with milder symptoms of muscle weakness, anti-Ku antibodies were associated with overlap diagnosis of systemic lupus erythematosus, and anti-Ro52 antibodies were associated with the development of Raynaud phenomenon and Sjögren syndrome.MSAs and overlap diagnosis of systemic sclerosis were significantly associated with clinical phenotypes of DM and PM. Physicians should be vigilant for malignancy in older DM and PM patients with overlap diagnosis of systeic sclerosis. The possibility of developing ILD in patients with overlap diagnosis of systemic sclerosis or serum positivity of anti-aminoacyl-tRNA synthetase antibodies should be considered.
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Affiliation(s)
- Hui-Ling Chiang
- Division of Immunology, Allergy and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
| | - Chien-Hsueh Tung
- Division of Immunology, Allergy and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan
| | - Kuang-Yung Huang
- Division of Immunology, Allergy and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan
| | - Bao-Bao Hsu
- Division of Immunology, Allergy and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
| | - Cheng-Han Wu
- Division of Immunology, Allergy and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
| | - Chia-Wen Hsu
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
| | - Ming-Chi Lu
- Division of Immunology, Allergy and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
| | - Ning-Sheng Lai
- Division of Immunology, Allergy and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan
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Tackley G, Kong Y, Minne R, Messina S, Winkler A, Cavey A, Everett R, DeLuca GC, Weir A, Craner M, Tracey I, Palace J, Stagg CJ, Emir U. An In-vivo 1H-MRS short-echo time technique at 7T: Quantification of metabolites in chronic multiple sclerosis and neuromyelitis optica brain lesions and normal appearing brain tissue. Neuroimage 2021; 238:118225. [PMID: 34062267 PMCID: PMC7611458 DOI: 10.1016/j.neuroimage.2021.118225] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/09/2021] [Accepted: 05/29/2021] [Indexed: 11/05/2022] Open
Abstract
Magnetic Resonance Spectroscopy (MRS) allows for the non-invasive quantification of neurochemicals and has the potential to differentiate between the pathologically distinct diseases, multiple sclerosis (MS) and AQP4Ab-positive neuromyelitis optica spectrum disorder (AQP4Ab-NMOSD). In this study we characterised the metabolite profiles of brain lesions in 11 MS and 4 AQP4Ab-NMOSD patients using an optimised MRS methodology at ultra-high field strength (7T) incorporating correction for T2 water relaxation differences between lesioned and normal tissue. MS metabolite results were in keeping with the existing literature: total N-acetylaspartate (NAA) was lower in lesions compared to normal appearing brain white matter (NAWM) with reciprocal findings for myo-Inositol. An unexpected subtlety revealed by our technique was that total NAA differences were likely driven by NAA-glutamate (NAAG), a ubiquitous CNS molecule with functions quite distinct from NAA though commonly quantified together with NAA in MRS studies as total NAA. Surprisingly, AQP4Ab-NMOSD showed no significant differences for total NAA, NAA, NAAG or myo-Inositol between lesion and NAWM sites, nor were there any differences between MS and AQP4Ab-NMOSD for a priori hypotheses. Post-hoc testing revealed a significant correlation between NAWM Ins:NAA and disability (as measured by EDSS) for disease groups combined, driven by the AP4Ab-NMOSD group. Utilising an optimised MRS methodology, our study highlights some under-explored subtleties in MRS profiles, such as the absence of myo-Inositol concentration differences in AQP4Ab-NMOSD brain lesions versus NAWM and the potential influence of NAAG differences between lesions and normal appearing white matter in MS.
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Affiliation(s)
- George Tackley
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, CF24 4HQ, United Kingdom.
| | - Yazhuo Kong
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; CAS Key Laboratory of Behavioural Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Rachel Minne
- School of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN 47907, (765) 494-1419, United States
| | - Silvia Messina
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Anderson Winkler
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Ana Cavey
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Rosie Everett
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Gabriele C DeLuca
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Andrew Weir
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Matthew Craner
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Jacqueline Palace
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; MRC Brain Network Dynamics Unit, University of Oxford, Oxford, OX1 3TH, United Kingdom
| | - Uzay Emir
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; School of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN 47907, (765) 494-1419, United States; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
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25
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Kitao R, Fukumoto T, Hashimoto T, Izumi K, Jimbo H, Takemori C, Nishigori C. Dipeptidyl peptidase-4 inhibitor-related bullous pemphigoid showing positive autoantibody responses to multiple epitopes. J Dermatol Sci 2021; 103:190-192. [PMID: 34489165 DOI: 10.1016/j.jdermsci.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Rikuma Kitao
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Takashi Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kentaro Izumi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Haruki Jimbo
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Chihiro Takemori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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26
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Muir CA, Clifton-Bligh RJ, Long GV, Scolyer RA, Lo SN, Carlino MS, Tsang VHM, Menzies AM. Thyroid Immune-related Adverse Events Following Immune Checkpoint Inhibitor Treatment. J Clin Endocrinol Metab 2021; 106:e3704-e3713. [PMID: 33878162 DOI: 10.1210/clinem/dgab263] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Thyroid dysfunction occurs commonly following immune checkpoint inhibition. The etiology of thyroid immune-related adverse events (irAEs) remains unclear and clinical presentation can be variable. OBJECTIVE This study sought to define thyroid irAEs following immune checkpoint inhibitor (ICI) treatment and describe their clinical and biochemical associations. METHODS We performed a retrospective cohort study of thyroid dysfunction in patients with melanoma undergoing cytotoxic T-lymphocyte antigen-4 (CTLA-4) and/or programmed cell death protein-1 (PD-1) based ICI treatment from November 1, 2009, to December 31, 2019. Thyroid function was measured at baseline and at regular intervals following the start of ICI treatment. Clinical and biochemical features were evaluated for associations with ICI-associated thyroid irAEs. The prevalence of thyroid autoantibodies and the effect of thyroid irAEs on survival were analyzed. RESULTS A total of 1246 patients were included with a median follow-up of 11.3 months. Five hundred and eighteen (42%) patients developed an ICI-associated thyroid irAE. Subclinical thyrotoxicosis (n = 234) was the most common thyroid irAE, followed by overt thyrotoxicosis (n = 154), subclinical hypothyroidism (n = 61), and overt hypothyroidism (n = 39). Onset of overt thyrotoxicosis occurred a median of 5 weeks (interquartile range [IQR] 2-8) after receipt of a first dose of ICI. Combination immunotherapy was strongly associated with development of overt thyrotoxicosis (odds ratio [OR] 10.8, 95% CI 4.51-25.6 vs CTLA-4 monotherapy; P < .001), as was female sex (OR 2.02, 95% CI 1.37-2.95; P < .001) and younger age (OR 0.83 per 10 years, 95% CI 0.72-0.95; P = .007). By comparison, median onset of overt hypothyroidism was 14 weeks (IQR 8-25). The frequency of overt hypothyroidism did not differ between different ICI types. The strongest associations for hypothyroidism were higher baseline thyroid-stimulating hormone (OR 2.33 per mIU/L, 95% CI 1.61-3.33; P < .001) and female sex (OR 3.31, 95% CI 1.67-6.56; P = .01). Overt thyrotoxicosis was associated with longer progression free survival (hazard ratio [HR] 0.68, 95% CI 0.49-0.94; P = .02) and overall survival (HR 0.57, 95% CI 0.39-0.84; P = .005). There was no association between hypothyroidism and cancer outcomes. CONCLUSION Thyroid irAEs are common and there are multiple distinct phenotypes. Different thyroid irAE subtypes have unique clinical and biochemical associations, suggesting potentially distinct etiologies for thyrotoxicosis and hypothyroidism arising in this context.
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Affiliation(s)
- Christopher A Muir
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cancer Genetics, Kolling Institute of Medical Research, Sydney, Australia
| | - Roderick J Clifton-Bligh
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cancer Genetics, Kolling Institute of Medical Research, Sydney, Australia
- Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia
| | - Georgina V Long
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Department of Medical Oncology, Mater Hospital, Sydney, Australia
| | - Richard A Scolyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Department of Tissue Pathology & Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Matteo S Carlino
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Venessa H M Tsang
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cancer Genetics, Kolling Institute of Medical Research, Sydney, Australia
- Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia
| | - Alexander M Menzies
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Department of Medical Oncology, Mater Hospital, Sydney, Australia
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27
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van Wanrooij RLJ, Neefjes-Borst EA, Bontkes HJ, Schreurs MWJ, Langerak AW, Mulder CJJ, Bouma G. Adult-Onset Autoimmune Enteropathy in an European Tertiary Referral Center. Clin Transl Gastroenterol 2021; 12:e00387. [PMID: 34333499 PMCID: PMC8323799 DOI: 10.14309/ctg.0000000000000387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Adult-onset autoimmune enteropathy (AIE) is a rare cause of severe chronic diarrhea because of small intestinal villous atrophy. We report on patients with adult-onset AIE in an European referral center. METHODS Retrospective study including patients diagnosed with AIE in the Amsterdam UMC, location VUmc, between January 2003 and December 2019. Clinical, serological, and histological features and response to treatment were reported. The specificity of antienterocyte antibodies (AEA) was evaluated by examining the prevalence of AEA in (i) controls (n = 30) and in patients with (ii) AIE (n = 13), (iii) celiac disease (CD, n = 52), (iv) refractory celiac disease type 2 (n = 18), and (v) enteropathy-associated T-cell lymphoma (EATL, n = 10). RESULTS Thirteen AIE patients were included, 8 women (62%), median age of 52 years (range 23-73), and 6 (46%) with an autoimmune disease. AEA were observed in 11 cases (85%), but were also found in CD (7.7%), refractory celiac disease type 2 (16.7%), and EATL (20%). Ten patients (77%) were human leukocyte antigen DQ2.5 heterozygous. Total parenteral nutrition was required in 8 cases (62%). Steroids induced clinical remission in 8 cases (62%). Step-up therapy with rituximab, cyclosporine, infliximab, and cladribine in steroid-refractory patients was only moderately effective. Four patients died (31%), but 4 (31%) others are in long-term drug-free remission after receiving immunosuppressive treatment, including 1 patient who underwent autologous stem cell transplantation. DISCUSSION Adult-onset AIE is a rare but severe enteropathy that occurs in patients susceptible for autoimmune disease. Four patients (31%) died secondary to therapy-refractory malabsorption, while immunosuppressive therapy leads to a long-lasting drug-free remission in one-third of patients.
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Affiliation(s)
- Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Institute, Amsterdam, the Netherlands
| | | | - Hetty J Bontkes
- Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam UMC, AGEM Research Institute, AI & I Institute, Amsterdam, the Netherlands
| | - Marco W J Schreurs
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Anton W Langerak
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Chris J J Mulder
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Institute, Amsterdam, the Netherlands
| | - Gerd Bouma
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Institute, Amsterdam, the Netherlands
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28
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Smith LB, Lynch KF, Driscoll KA, Johnson SB. Parental monitoring for type 1 diabetes in genetically at-risk young children: The TEDDY study. Pediatr Diabetes 2021; 22:717-728. [PMID: 33704891 PMCID: PMC8771863 DOI: 10.1111/pedi.13173] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/15/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We examined parental diabetes monitoring behaviors in a cohort of children at increased genetic risk for type 1 diabetes. We hypothesized that being informed of a positive islet autoantibody (IA) would increase monitoring behaviors. RESEARCH DESIGN AND METHODS The Environmental Determinants of Diabetes in the Young (TEDDY) study follows 8676 children with high-risk human leucocyte antigen-DQ genotypes from birth to age 15, including general population (GP) children and those with a first-degree relative (FDR) with diabetes. Data on parental monitoring behaviors were solicited yearly. Serum samples were tested for IA and parents were informed of child results. We examined parental monitoring behaviors during the first 7 years of TEDDY. RESULTS In IA- children, the most common monitoring behavior was participating in TEDDY study tasks; up to 49.8% and 44.2% of mothers and fathers, respectively, reported this. Among FDRs, 7%-10% reported watching for diabetes symptoms and 7%-9% reported monitoring the child's glucose, for mothers and fathers, respectively. After IA+ notification, all monitoring behaviors significantly increased in GP parents; only glucose monitoring increased in FDR parents and these behaviors continued for up to 4 years. FDR status, accurate diabetes risk perception, and anxiety were associated with glucose monitoring in IA+ and IA- cohorts. CONCLUSIONS Many parents view TEDDY participation as a way to monitor for type 1 diabetes, a benefit of enrollment in a longitudinal study with no prevention offered. IA+ notification increases short- and long-term monitoring behaviors. For IA- and IA+ children, FDR parents engage in glucose monitoring, even when not instructed to do so.
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Affiliation(s)
- Laura B. Smith
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kristian F. Lynch
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Kimberly A. Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Suzanne Bennett Johnson
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
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29
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Colquhoun M, Penn H. Salt-and-Pepper Skin Changes in Systemic Sclerosis. N Engl J Med 2021; 385:357. [PMID: 34289279 DOI: 10.1056/nejmicm2103390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Henry Penn
- Northwick Park Hospital, Harrow, United Kingdom
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30
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Korpos É, Kadri N, Loismann S, Findeisen CR, Arfuso F, Burke GW, Richardson SJ, Morgan NG, Bogdani M, Pugliese A, Sorokin L. Identification and characterisation of tertiary lymphoid organs in human type 1 diabetes. Diabetologia 2021; 64:1626-1641. [PMID: 33912981 PMCID: PMC8187221 DOI: 10.1007/s00125-021-05453-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/28/2021] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS We and others previously reported the presence of tertiary lymphoid organs (TLOs) in the pancreas of NOD mice, where they play a role in the development of type 1 diabetes. Our aims here are to investigate whether TLOs are present in the pancreas of individuals with type 1 diabetes and to characterise their distinctive features, in comparison with TLOs present in NOD mouse pancreases, in order to interpret their functional significance. METHODS Using immunofluorescence confocal microscopy, we examined the extracellular matrix (ECM) and cellular constituents of pancreatic TLOs from individuals with ongoing islet autoimmunity in three distinct clinical settings of type 1 diabetes: at risk of diabetes; at/after diagnosis; and in the transplanted pancreas with recurrent diabetes. Comparisons were made with TLOs from 14-week-old NOD mice, which contain islets exhibiting mild to heavy leucocyte infiltration. We determined the frequency of the TLOs in human type 1diabetes with insulitis and investigated the presence of TLOs in relation to age of onset, disease duration and disease severity. RESULTS TLOs were identified in preclinical and clinical settings of human type 1 diabetes. The main characteristics of these TLOs, including the cellular and ECM composition of reticular fibres (RFs), the presence of high endothelial venules and immune cell subtypes detected, were similar to those observed for TLOs from NOD mouse pancreases. Among 21 donors with clinical type 1 diabetes who exhibited insulitis, 12 had TLOs and had developed disease at younger age compared with those lacking TLOs. Compartmentalised TLOs with distinct T cell and B cell zones were detected in donors with short disease duration. Overall, TLOs were mainly associated with insulin-containing islets and their frequency decreased with increasing severity of beta cell loss. Parallel studies in NOD mice further revealed some differences in so far as regulatory T cells were essentially absent from human pancreatic TLOs and CCL21 was not associated with RFs. CONCLUSIONS/INTERPRETATION We demonstrate a novel feature of pancreas pathology in type 1 diabetes. TLOs represent a potential site of autoreactive effector T cell generation in islet autoimmunity and our data from mouse and human tissues suggest that they disappear once the destructive process has run its course. Thus, TLOs may be important for type 1 diabetes progression.
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Affiliation(s)
- Éva Korpos
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster, Germany.
- Cells-in-Motion Interfaculty Centre, University of Muenster, Muenster, Germany.
| | - Nadir Kadri
- Science for Life Laboratory, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Sophie Loismann
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster, Germany
- Cells-in-Motion Interfaculty Centre, University of Muenster, Muenster, Germany
| | - Clais R Findeisen
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster, Germany
- Cells-in-Motion Interfaculty Centre, University of Muenster, Muenster, Germany
| | - Frank Arfuso
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster, Germany
- Cells-in-Motion Interfaculty Centre, University of Muenster, Muenster, Germany
| | - George W Burke
- Department of Surgery, Division of Transplantation, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Sarah J Richardson
- Institute of Biomedical & Clinical Science, University of Exeter, Exeter, UK
| | - Noel G Morgan
- Institute of Biomedical & Clinical Science, University of Exeter, Exeter, UK
| | - Marika Bogdani
- Matrix Biology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Alberto Pugliese
- Diabetes Research Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Microbiology and Immunology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Lydia Sorokin
- Institute of Physiological Chemistry and Pathobiochemistry, University of Muenster, Muenster, Germany
- Cells-in-Motion Interfaculty Centre, University of Muenster, Muenster, Germany
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31
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Johnson RK, Tamura R, Frank N, Uusitalo U, Yang J, Niinistö S, Andrén Aronsson C, Ziegler AG, Hagopian W, Rewers M, Toppari J, Akolkar B, Krischer J, Virtanen SM, Norris JM. Maternal food consumption during late pregnancy and offspring risk of islet autoimmunity and type 1 diabetes. Diabetologia 2021; 64:1604-1612. [PMID: 33783586 PMCID: PMC8187332 DOI: 10.1007/s00125-021-05446-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/05/2021] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS We aimed to investigate the association between maternal consumption of gluten-containing foods and other selected foods during late pregnancy and offspring risk of islet autoimmunity (IA) and type 1 diabetes in The Environmental Determinants of Diabetes in the Young (TEDDY) study. METHODS The TEDDY study recruited children at high genetic risk for type 1 diabetes at birth, and prospectively follows them for the development of IA and type 1 diabetes (n = 8556). A questionnaire on the mother's diet in late pregnancy was completed by 3-4 months postpartum. The maternal daily intake was estimated from a food frequency questionnaire for eight food groups: gluten-containing foods, non-gluten cereals, fresh milk, sour milk, cheese products, soy products, lean/medium-fat fish and fatty fish. For each food, we described the distribution of maternal intake among the four participating countries in the TEDDY study and tested the association of tertile of maternal food consumption with risk of IA and type 1 diabetes using forward selection time-to-event Cox regression. RESULTS By 28 February 2019, 791 cases of IA and 328 cases of type 1 diabetes developed in TEDDY. There was no association between maternal late-pregnancy consumption of gluten-containing foods or any of the other selected foods and risk of IA, type 1 diabetes, insulin autoantibody-first IA or GAD autoantibody-first IA (all p ≥ 0.01). Maternal gluten-containing food consumption in late pregnancy was higher in Sweden (242 g/day), Germany (247 g/day) and Finland (221 g/day) than in the USA (199 g/day) (pairwise p < 0.05). CONCLUSIONS/INTERPRETATION Maternal food consumption during late pregnancy was not associated with offspring risk for IA or type 1 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT00279318.
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Affiliation(s)
- Randi K Johnson
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Roy Tamura
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Nicole Frank
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Ulla Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jimin Yang
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sari Niinistö
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Carin Andrén Aronsson
- The Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmo, Sweden
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany
| | | | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jorma Toppari
- Institute of Biomedicine, Research Centre for Integrated Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Suvi M Virtanen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
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Abstract
Life is about timing. -Carl LewisThe understanding of autoimmune type 1 diabetes is increasing, and examining etiology separate from pathogenesis has become crucial. The components to explain type 1 diabetes development have been known for some time. The strong association with HLA has been researched for nearly 50 years. Genome-wide association studies added another 60+ non-HLA genetic factors with minor contribution to risk. Insulitis has long been known to be present close to clinical diagnosis. T and B cells recognizing β-cell autoantigens are detectable prior to diagnosis and in newly diagnosed patients. Islet autoantibody tests against four major autoantigens have been standardized and used as biomarkers of islet autoimmunity. However, to clarify the etiology would require attention to time. Etiology may be defined as the cause of a disease (i.e., type 1 diabetes) or abnormal condition (i.e., islet autoimmunity). Timing is everything, as neither the prodrome of islet autoimmunity nor the clinical onset of type 1 diabetes tells us much about the etiology. Rather, the islet autoantibody that appears first and persists would mark the diagnosis of an autoimmune islet disease (AID). Events after the diagnosis of AID would represent the pathogenesis. Several islet autoantibodies without (stage 1) or with impaired glucose tolerance (stage 2) or with symptoms (stage 3) would define the pathogenesis culminating in clinical type 1 diabetes. Etiology would be about the timing of events that take place before the first-appearing islet autoantibody.
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Affiliation(s)
- Åke Lernmark
- Department of Clinical Sciences, Lund University Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
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Wang EY, Mao T, Klein J, Dai Y, Huck JD, Jaycox JR, Liu F, Zhou T, Israelow B, Wong P, Coppi A, Lucas C, Silva J, Oh JE, Song E, Perotti ES, Zheng NS, Fischer S, Campbell M, Fournier JB, Wyllie AL, Vogels CBF, Ott IM, Kalinich CC, Petrone ME, Watkins AE, Dela Cruz C, Farhadian SF, Schulz WL, Ma S, Grubaugh ND, Ko AI, Iwasaki A, Ring AM. Diverse functional autoantibodies in patients with COVID-19. Nature 2021; 595:283-288. [PMID: 34010947 DOI: 10.1038/s41586-021-03631-y] [Citation(s) in RCA: 491] [Impact Index Per Article: 163.7] [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: 12/04/2020] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
COVID-19 manifests with a wide spectrum of clinical phenotypes that are characterized by exaggerated and misdirected host immune responses1-6. Although pathological innate immune activation is well-documented in severe disease1, the effect of autoantibodies on disease progression is less well-defined. Here we use a high-throughput autoantibody discovery technique known as rapid extracellular antigen profiling7 to screen a cohort of 194 individuals infected with SARS-CoV-2, comprising 172 patients with COVID-19 and 22 healthcare workers with mild disease or asymptomatic infection, for autoantibodies against 2,770 extracellular and secreted proteins (members of the exoproteome). We found that patients with COVID-19 exhibit marked increases in autoantibody reactivities as compared to uninfected individuals, and show a high prevalence of autoantibodies against immunomodulatory proteins (including cytokines, chemokines, complement components and cell-surface proteins). We established that these autoantibodies perturb immune function and impair virological control by inhibiting immunoreceptor signalling and by altering peripheral immune cell composition, and found that mouse surrogates of these autoantibodies increase disease severity in a mouse model of SARS-CoV-2 infection. Our analysis of autoantibodies against tissue-associated antigens revealed associations with specific clinical characteristics. Our findings suggest a pathological role for exoproteome-directed autoantibodies in COVID-19, with diverse effects on immune functionality and associations with clinical outcomes.
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Affiliation(s)
- Eric Y Wang
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Tianyang Mao
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Jon Klein
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Yile Dai
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - John D Huck
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Jillian R Jaycox
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Feimei Liu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Ting Zhou
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Benjamin Israelow
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Patrick Wong
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Andreas Coppi
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Carolina Lucas
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Julio Silva
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Ji Eun Oh
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Eric Song
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Emily S Perotti
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Neil S Zheng
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Suzanne Fischer
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Melissa Campbell
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
| | - John B Fournier
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
| | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Chantal B F Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Isabel M Ott
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Chaney C Kalinich
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Mary E Petrone
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Anne E Watkins
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Charles Dela Cruz
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Shelli F Farhadian
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
| | - Wade L Schulz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Shuangge Ma
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Albert I Ko
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA.
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
- Howard Hughes Medical Institute, Chevy Chase, MD, USA.
| | - Aaron M Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA.
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, USA.
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Zhao L, Liu Y, Su H, Shi X. Relationship between autoimmune thyroid disease and nephropathy: A clinicopathological study. Medicine (Baltimore) 2021; 100:e26273. [PMID: 34115025 PMCID: PMC8202655 DOI: 10.1097/md.0000000000026273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/05/2020] [Indexed: 11/25/2022] Open
Abstract
The association of nephropathy with autoimmune thyroid disease (AITD) has been reported previously. However, there is limited information on the relationship between thyroid autoantibodies and nephropathy. A retrospective study was conducted using the medical records of 246 patients with nephropathy, 82 of whom had concurrent AITD. General characteristics, thyroid function, autoantibodies, and the pathological types of nephropathy were analyzed. Immunohistochemistry was used to detect the thyroglobulin antibody (TG-Ab) and thyroid peroxidase antibody (TPO-Ab) in the kidneys. We found nephropathy patients with AITD exhibited higher serum levels of TPO-Ab, TG-Ab, thyroid-stimulating hormone receptor antibody (TR-Ab), and immunoglobulin G (IgG) (P < .05). Compared with the nephropathy without AITD group, the nephropathy with AITD group exhibited higher proportions of membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS), and relatively lower proportions of mesangial proliferative glomerulonephritis (MsPGN) and minimal change nephropathy (MCN) (P = .005). TPO-Ab and TG-Ab levels in the kidney were more prevalent in nephropathy patients with AITD than those without AITD (P = .015 and P = .026, respectively). Subgroup analysis demonstrated that serum levels of thyroid stimulating hormone (TSH), TG-Ab, TPO-Ab, immunoglobulin M (IgM), and IgG in the MN group were significantly higher, whereas the levels of free thyroxine (FT4) and estimated glomerular filtration rate (eGFR) were lower, as compared with MN with Hashimoto thyroiditis (HT) group (P < .05). TPO-Ab and TG-Ab expression levels in the kidneys were more prevalent in the MN group than in the MN with HT group (P = .034). The expression levels of FT4, TG-Ab, TPO-Ab, and thyroid-stimulating hormone receptor antibody (TSHR-Ab) in the serum were significantly higher in the MN group than in the MN with Graves disease (GD) group (P < .05). The expression of TPO-Ab in the kidneys was more prevalent in the MN group than in the MN with GD group (P = .011). In sum, the expressions of TPO-Ab and TG-Ab were more prevalent in the kidneys of patients with nephropathy and AITD. Our findings indicate that TPO-Ab and TG-Ab may play a role in the development of AITD-related nephropathy.
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Tang W, Liang H, Cheng Y, Yuan J, Huang G, Zhou Z, Yang L. Diagnostic value of combined islet antigen-reactive T cells and autoantibodies assays for type 1 diabetes mellitus. J Diabetes Investig 2021; 12:963-969. [PMID: 33064907 PMCID: PMC8169367 DOI: 10.1111/jdi.13440] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/16/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Abstract
AIMS/INTRODUCTION Type 1 diabetes mellitus is a T cell-mediated autoimmune disease. However, the determination of the autoimmune status of type 1 diabetes mellitus relies on islet autoantibodies (Abs), as T-cell assay is not routinely carried out. This study aimed to investigate the diagnostic value of combined assay of islet antigen-specific T cells and Abs in type 1 diabetes mellitus patients. MATERIALS AND METHODS A total of 54 patients with type 1 diabetes mellitus and 56 healthy controls were enrolled. Abs against glutamic acid decarboxylase (GAD), islet antigen-2 and zinc transporter 8 were detected by radioligand assay. Interferon-γ-secreting T cells responding to glutamic acid decarboxylase 65 and C-peptide (CP) were measured by enzyme-linked immunospot. RESULTS The positive rate for T-cell responses was significantly higher in patients with type 1 diabetes mellitus than that in controls (P < 0.001). The combined positive rate of Abs and T-cell assay was significantly higher than that of Abs assay alone (85.2% vs 64.8%, P = 0.015). A significant difference in fasting CP level was found between the T+ and T- groups (0.07 ± 0.05 vs 0.11 ± 0.09 nmol/L, P = 0.033). Furthermore, levels of fasting CP and postprandial CP were both lower in the Ab- T+ group than the Ab- T- group (fasting CP 0.06 ± 0.05 vs 0.16 ± 0.12 nmol/L, P = 0.041; postprandial CP 0.12 ± 0.13 vs 0.27 ± 0.12 nmol/L, P = 0.024). CONCLUSIONS Enzyme-linked immunospot assays in combination with Abs detection could improve the diagnostic sensitivity of autoimmune diabetes.
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Affiliation(s)
- Wei Tang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South UniversityChangshaHunanChina
- Department of Metabolism and EndocrinologyThe First People’s Hospital of HuaihuaHuaihuaHunanChina
| | - Huiying Liang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South UniversityChangshaHunanChina
- Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital)DongguanGuangdongChina
| | - Ying Cheng
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Jiao Yuan
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Gan Huang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Lin Yang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South UniversityChangshaHunanChina
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Abstract
PURPOSE To evaluate the clinical and genetic characteristics of 3 children with Haploinsufficiency of A20 (HA20). METHODS The clinical and genetic testing data of 3 children with HA20 treated at Capital Institute of Pediatrics (CIP) between August 2016 and October 2019 were retrospectively analysed. RESULT Patient 1 presented with arthritis and inflammatory bowel disease, patient 2 presented with axial spinal arthritis and lupus-like syndrome, and patient 3 presented with recurrent oral ulcers, gastrointestinal ulcers, and perianal abscesses. Regarding laboratory tests, patients were found to have elevated white blood cell (WBC) count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The CRP and ESR was reported to be high in all the patients. The WBC was reported to be high in patient 1 and 3. Patient 2 was positive for antinuclear antibodies, anti-Sjögren's syndrome antigen A, dsDNA, rheumatoid factor and Coombs test. Genetic testing showed that all three patients had heterozygous mutation in TNFAIP3 gene. As for the treatment, patient 1 was treated with TNFα antagonist, patient 2 was treated with TNF α antagonist and sulfasalazine, and patient 3 was treated with corticosteroids and thalidomide. Patients 1 and 2 were followed for four and 3 months, respectively. There was an improvement in joint and gastrointestinal symptoms; inflammatory indices and rheumatoid factor (RF) were normal, and dsDNA and Coombs test became negative. Patient 3 was treated at another hospital and showed gradual improvement in oral ulcers and perianal abscesses. CONCLUSION HA20 is a single-gene auto-inflammatory disease caused by mutation in tumour necrosis factor (TNF)-α-induced protein 3 (TNFAIP3) gene. It may present as Behçet-like syndrome and resemble various other autoimmune diseases as well. Corticosteroids and immunosuppressive agents are effective treatments, and cytokine antagonists can be used in refractory cases. Whole-exome genetic testing should be proactively performed for children with early-age onset or Behçet-like syndrome to achieve early diagnosis and accurate treatment.
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Affiliation(s)
- Dan Zhang
- Capital Institute of Pediatrics, 2 yabao road, Chaoyang District, Beijing, China
| | - Gaixiu Su
- Capital Institute of Pediatrics, 2 yabao road, Chaoyang District, Beijing, China
| | - Zhixuan Zhou
- Capital Institute of Pediatrics, 2 yabao road, Chaoyang District, Beijing, China
| | - Jianming Lai
- Capital Institute of Pediatrics, 2 yabao road, Chaoyang District, Beijing, China
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Krummenacher M, Lee FJ, Wienholt L, Hissaria P. Lack of standardisation in interpretation and reporting of autoantibody assays: a survey analysis of Australasian laboratories with focus on line immunoassays. Pathology 2021; 53:883-888. [PMID: 33994175 DOI: 10.1016/j.pathol.2021.01.018] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/23/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022]
Abstract
Autoantibody assays are reported in a variety of formats. Results only slightly above established cut-offs provide lower likelihood ratios; therefore, their clinical significance may be more uncertain, which is not readily communicated with dichotomous qualitative reporting. Line immunoassays (LIA) are a common method for detecting antibodies to extractable nuclear antigens (ENA) and myositis-associated antibodies. However, recommended positive cut-offs are contentious. We distributed a survey via e-mail to participants in the Royal College of Pathologists of Australasia Quality Assurance Program (RCPAQAP) Immunology modules and to a dedicated immunology mailing list in Australasia. Questions explored general viewpoints surrounding autoantibody reporting, as well as current laboratory practices, with particular focus on interpretation and reporting of the most commonly used ENA LIA manufactured by Euroimmun. There were 31 responders, representative of at least 17 unique laboratories across Australia (8 public, 5 private) and New Zealand (4 laboratories). Responses suggest that autoantibody reporting is not standardised; there was variation in general viewpoints and reporting practices, particularly regarding the interpretation of and positive cut-offs used for the Euroimmun ENA LIA, which were contrary to the manufacturer's guidelines in a majority of the responses. Interpretative qualitative reporting based on results from other investigations and the clinical history was a common theme. There is large variation in the reporting of autoantibody assays within Australasia, especially by LIA. A majority of respondents report the most commonly used ENA LIA contrary to manufacturer's guidelines; alternative positive cut-offs are commonly utilised. LIA reports should indicate the level of positivity to enhance their relevance in the clinical decision-making process.
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Affiliation(s)
- Matthew Krummenacher
- SA Pathology, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Frederick J Lee
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Louise Wienholt
- The Royal College of Pathologists Australasia Quality Assurance Programs (RCPAQAP), St Leonards, NSW, Australia
| | - Pravin Hissaria
- SA Pathology, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia.
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Yang Z, Yan C, Liu W, Xu W, Li C, Yan M, Liu B, Zhu Z. Identification of novel autoantibodies in ascites of relapsed paclitaxel-resistant gastric cancer with peritoneal metastasis using immunome protein microarrays and proteomics. Cancer Biomark 2021; 31:329-338. [PMID: 33896831 DOI: 10.3233/cbm-203142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gastric cancer (GC) patients with peritoneal metastasis usually have extremely poor prognosis. Intraperitoneal infusion of paclitaxel (PTX) provides an effective treatment, but relapse and PTX-resistance are unavoidable disadvantages, and it is difficult to monitor the occurrence of PTX-resistance. OBJECTIVE The aim of this study was to explore novel autoantibodies in the ascites of individuals with relapsed PTX-resistant GC with peritoneal metastasis. METHODS Ascites samples were collected before PTX infusion and after the relapse in 3 GC patients. To determine the expression of significantly changed proteins, we performed autoantibody profiling with immunome protein microarrays and tandem mass tag (TMT) quantitative proteomics, and then, the overlapping proteins were selected. RESULTS Thirty-eight autoantibodies that were differentially expressed between the ascites in the untreated group and relapsed PTX-resistant group were identified. For confirmation of the results, TMT quantitative proteomics was performed, and 842 dysregulated proteins were identified. Four proteins, TPM3, EFHD2, KRT19 and vimentin, overlapped between these two assays. CONCLUSIONS Our results first revealed that TPM3, EFHD2, KRT19 and vimentin were novel autoantibodies in the ascites of relapsed PTX-resistant GC patients. These autoantibodies may be used as potential biomarkers to monitor the occurrence of PTX-resistance.
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Ayesha B, Fernandez-Ruiz R, Shrock D, Snyder BM, Lieberman SM, Tuetken R, Field E, Singh N. Clinical and laboratory features of patients with focal lymphocytic sialadenitis on minor salivary gland biopsy for sicca symptoms: A single-center experience. Medicine (Baltimore) 2021; 100:e25325. [PMID: 33787627 PMCID: PMC8021287 DOI: 10.1097/md.0000000000025325] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/01/2021] [Indexed: 01/04/2023] Open
Abstract
Minor salivary gland biopsy (MSGB) is often used in patients lacking specific autoantibodies (seronegative patients) to confirm the presence of focal lymphocytic sialadenitis (FLS), which would suggest a diagnosis of Sjogren syndrome. There are no current guidelines indicating when to refer patients for MSGB. The objective of our study was to ascertain distinguishing clinical and laboratory features among individuals with sicca symptoms based on their serologic and histopathologic status, and to identify factors associated with FLS.Using a cross-sectional study design, patients ages 18 years or older with sicca symptoms who had MSGB performed at the University of Iowa from January 2000 to December 2016 were selected for chart reviews. The clinical and laboratory features of patients with and without FLS were analyzed using exact univariate and multivariable logistic regression, with Bonferroni correction for multiple comparisons.We identified 177 patients who had MSGB performed and available clinical data. A total of 133 patients had FLS, 37 (27.8%) were seropositive (positive-anti-Sjogren syndrome type A [SSA] and/or anti-Sjogren syndrome type B) and 96 (72.2%) were seronegative. Dry eyes (unadjusted odds ratio [OR]: 5.17, 95% confidence interval [CI]: 1.16-26.30; adjusted odds ratio [aOR]: 12.58, 95% CI: 1.70-167.77) and the presence of anti-SSA (OR: 7.16, 95% CI: 1.70-64.24; aOR: 8.82, 95% CI: 1.73-93.93) were associated with FLS. Smoking (aOR 0.27, 95% CI: 0.11-0.63) and antihistamine use (aOR 0.23, 95% CI: 0.08-0.63) were associated with lower odds of FLS.Our study suggests that dry eyes and anti-SSA positivity are associated with FLS. Smoking and antihistamine use were associated with lower odds of FLS. In the appropriate clinical context, seronegative patients with sicca symptoms and no smoking history could be considered for MSGB. A thorough medication and smoking history should be performed in all patients before referral for MSGB.
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Affiliation(s)
- Bibi Ayesha
- Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY
| | - Ruth Fernandez-Ruiz
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
- Division of Rheumatology, New York University Langone Health, New York, NY
| | - Devin Shrock
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brittney M. Snyder
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Rebecca Tuetken
- Division of Immunology, University of Iowa Hospitals and Clinics
| | - Elizabeth Field
- Division of Immunology, University of Iowa Hospitals and Clinics and VA Medical Center, Iowa City, IA
| | - Namrata Singh
- Division of Rheumatology, University of Washington School of Medicine, Seattle, Washington
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Kokuina E. Can Anti-Ribosomal Antibodies Improve Systemic Lupus Erythematosus Diagnosis? MEDICC Rev 2021; 23:90-91. [PMID: 33780429 DOI: 10.37757/mr2021.v23.n1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022]
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Radanova M, Roumenina LT, Vasilev V. Detection of Anti-C3b Autoantibodies by ELISA. Methods Mol Biol 2021; 2227:133-139. [PMID: 33847938 DOI: 10.1007/978-1-0716-1016-9_13] [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] [Indexed: 06/12/2023]
Abstract
Autoantibodies against complement proteins are involved in the pathological process of many diseases, including lupus nephritis, C3 glomerulopathies, and atypical hemolytic uremic syndrome. This method describes the detection of autoantibodies targeting the central complement component C3 by ELISA. These autoantibodies (IgG) are detected in up to 30% of the patients with lupus nephritis and more rarely in cases with C3 glomerulopathies. These autoantibodies recognize the active fragment C3b and have overt functional consequences. They enhance the formation of the C3 convertase and prevent the inactivation of C3b by Factor H and complement receptor 1. Moreover, they enhance the deposition of complement activation fragments on activator surfaces, such as apoptotic cells. The data currently available on the relations of anti-C3 autoantibodies with clinical, laboratory, and histological markers for activity of lupus nephritis, as well as the relations of anti-C3 with classical immunological markers for activity of autoimmune process in patients with lupus nephritis, such as hypocomplementemia and high levels of anti-dsDNA, could identify these autoantibodies as a potential marker for evaluation the activity of lupus nephritis. These autoantibodies correlate with the disease severity and can be used to identify patients with lupus nephritis who were prone to flare. Therefore, the detection of such autoantibodies could guide the clinicians to evaluate and predict the severity and to manage the therapy of lupus nephritis.
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Affiliation(s)
- Maria Radanova
- Department of Biochemistry, Molecular Medicine and Nutrigenomics, Medical University of Varna, Varna, Bulgaria.
| | - Lubka T Roumenina
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Sorbonne Universités, Université de Paris, Paris, France
| | - Vasil Vasilev
- Clinic of Nephrology, University Hospital-"Tzaritza Yoanna-ISUL", Medical University of Sofia, Sofia, Bulgaria
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Pacaud D, Nucci AM, Cuthbertson D, Becker DJ, Virtanen SM, Ludvigsson J, Ilonen J, Knip M. Association between family history, early growth and the risk of beta cell autoimmunity in children at risk for type 1 diabetes. Diabetologia 2021; 64:119-128. [PMID: 33026463 PMCID: PMC7716821 DOI: 10.1007/s00125-020-05287-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/07/2020] [Indexed: 12/30/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to examine the relationship between family history of type 1 diabetes, birthweight, growth during the first 2 years and development of multiple beta cell autoantibodies in children with a first-degree relative with type 1 diabetes and HLA-conferred disease susceptibility. METHODS In a secondary analysis of the Trial to Reduce IDDM in the Genetically at Risk (TRIGR), clinical characteristics and development of beta cell autoantibodies were compared in relation to family history of type 1 diabetes (mother vs father vs sibling) in 2074 children from families with a single affected family member. RESULTS Multiple autoantibodies (≥2 of 5 measured) developed in 277 (13%) children: 107 (10%), 114 (16%) and 56 (18%) born with a mother, father or sibling with type 1 diabetes, respectively (p < 0.001). The HR for time to multiple autoimmunity was 0.54 (95% CI 0.39, 0.75) in offspring of affected mothers (n = 107/1046, p < 0.001) and 0.81 (95% CI 0.59, 1.11) (n = 114/722, p = 0.19) in offspring of affected fathers, compared with participants with a sibling with type 1 diabetes (comparator group n = 56/306). The time to the first autoantibody present (to insulin, GAD, tyrosine phosphatase-related insulinoma-associated 2 molecules, islet cell or zinc transporter 8) was similar in the three groups. Height velocity (z score/year) in the first 24 months was independently associated with developing multiple antibodies in the total cohort (HR 1.31 [95% CI 1.01, 1.70], p = 0.04). A higher birthweight in children born to an affected mother vs affected father or an affected sibling was not related to the risk of multiple autoimmunity. CONCLUSIONS/INTERPRETATION The risk of developing multiple autoantibodies was lower in children with maternal type 1 diabetes. For the whole group, this risk of developing multiple autoantibodies was independent of birthweight but was greater in those with increased height velocity during the first 2 years of life. However, the risk associated with paternal type 1 diabetes was not linked to differences in birthweight or early growth. TRIAL REGISTRATION ClinicalTrials.gov NCT00179777 Graphical abstract.
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Affiliation(s)
- Danièle Pacaud
- Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB Canada
| | - Anita M. Nucci
- Department of Nutrition, Georgia State University, Atlanta, GA USA
| | - David Cuthbertson
- Pediatrics Epidemiology Center, University of South Florida, Tampa, FL USA
| | - Dorothy J. Becker
- Division of Endocrinology, University of Pittsburgh and UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Suvi M. Virtanen
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences/Health, Tampere University, Tampere, Finland
- Center for Child Health Research, Tampere University, Tampere, Finland
- Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland
| | - Johnny Ludvigsson
- Crown Princess Victoria Children’s Hospital, Region Östergötland and Division of Pediatrics, Department of Clinical Experimental Medicine, Linkoping University, Linkoping, Sweden
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
- Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Mikael Knip
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Chuzho N, Kumar N, Mishra N, Tandon N, Kanga U, Kaur G, Singh P, Mishra G, Sharma S, Mehra NK. Differential HLA Association of GAD65 and IA2 Autoantibodies in North Indian Type 1 Diabetes Patients. J Diabetes Res 2021; 2021:4012893. [PMID: 34988229 PMCID: PMC8723877 DOI: 10.1155/2021/4012893] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
The human leucocyte antigen (HLA) association with type 1 diabetes (T1D) is well known but there are limited studies investigating the association between β-cell autoantibodies and HLA genes. We evaluated the prevalence of GAD65 and IA-2 autoantibodies (GADA and IA2A) in 252 T1D patients from North India and investigated the genetic association of GADA and IA2A with HLA class I and class II genes/haplotypes. GADA and IA2A were detected in 50.79% and 15.87% of T1D patients, respectively, while only 8.73% had both GADA and IA2A. HLA-DRB1∗03 was observed to be significantly higher in GADA+ T1D patients as compared to GADA- (91.41% vs. 66.13%, Bonferroni-corrected P (P c) = 1.11 × 10-5; OR = 5.45; 95% CI: 2.67-11.08). Similarly, HLA-DQB1∗02 was found to be significantly increased in GADA+ patients (94.53%, P c = 2.19 × 10-5; OR = 6.27; 95% CI: 2.7-14.49) as compared to GADA- (73.39%). The frequencies of HLA-DRB1∗04 and DQB1∗03 were increased in IA2A+ patients (45.0% and 52.5%, respectively) as compared to that in IA2A- (25.94% and 33.96%, respectively). Further, the frequency of DRB1∗03-DQB1∗02 haplotype was found to be significantly increased in GADA+ T1D patients as compared to GADA- (60.55% vs. 41.94%, P = 3.94 × 10-5; OR = 2.13; 95%CI = 1.49-3.03). Similarly, HLA-DRB1∗04-DQB1∗03 haplotype was found to be significantly increased in IA2A+ T1D patients compared to IA2A- patients (22.5% vs. 12.97%; P = 0.041; OR = 1.95; 95%CI = 1.08-3.52). None of the HLA class I genes (HLA-A, B, and Cw) was found to be associated with GADA or IA2A in people with T1D. Our findings suggest that HLA-DRB1∗03/DQB1∗02 and HLA-DRB1∗04/DQB1∗03 might play an important role in the development of GADA and IA2A, respectively.
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Affiliation(s)
- Neihenuo Chuzho
- Indian Council of Medical Research (ICMR)-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Neeraj Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Neetu Mishra
- Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kanga
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Gurvinder Kaur
- Laboratory Oncology Unit, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Paras Singh
- Department of Molecular Medicine, National Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India
| | - Gunja Mishra
- Indian Council of Medical Research (ICMR)-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Shreya Sharma
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Narinder K. Mehra
- Emeritus Scientist (ICMR), and Former Dean (Research), All India Institute of Medical Sciences, New Delhi, India
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Dumestre-Pérard C, Thielens NM. Anti-Ficolin-2 and Anti-Ficolin-3 Autoantibody Detection by ELISA. Methods Mol Biol 2021; 2227:121-132. [PMID: 33847937 DOI: 10.1007/978-1-0716-1016-9_12] [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] [Indexed: 06/12/2023]
Abstract
Ficolins are recognition proteins of the lectin pathway of the complement system and also play an important role in innate immunity and in the maintenance of tissue homeostasis. They deserve special attention in the context of autoimmunity since they are involved in the uptake of dying cells. Because the monitoring of systemic lupus erythematosus (SLE) patients is particularly difficult, it is crucial to find new relevant serum biomarkers. The ability to detect autoantibodies in the patients' sera provides a diagnostic and prognostic advantage. We describe in this chapter quantitative enzyme linked immunosorbent assays (ELISA) to detect the presence of autoantibodies targeting ficolin-2 and ficolin-3 in human sera. Recombinant ficolins produced in a mammalian expression system are used as coating antigens. The described in-house ELISAs provide a valuable tool to efficiently quantify anti-ficolin autoantibodies in the sera of SLE patients.
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Affiliation(s)
- Chantal Dumestre-Pérard
- Laboratoire d'Immunologie, Pôle de Biologie, CHU Grenoble Alpes, Grenoble Cedex 9, France.
- BNI TIMC-IMAG, UMR5525, CNRS-Université Grenoble Alpes, Grenoble Cedex 9, France.
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Pöllänen PM, Ryhänen SJ, Toppari J, Ilonen J, Vähäsalo P, Veijola R, Siljander H, Knip M. Dynamics of Islet Autoantibodies During Prospective Follow-Up From Birth to Age 15 Years. J Clin Endocrinol Metab 2020; 105:5901133. [PMID: 32882033 PMCID: PMC7686032 DOI: 10.1210/clinem/dgaa624] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/31/2020] [Indexed: 01/23/2023]
Abstract
CONTEXT We set out to characterize the dynamics of islet autoantibodies over the first 15 years of life in children carrying genetic susceptibility to type 1 diabetes (T1D). We also assessed systematically the role of zinc transporter 8 autoantibodies (ZnT8A) in this context. DESIGN HLA-predisposed children (N = 1006, 53.0% boys) recruited from the general population during 1994 to 1997 were observed from birth over a median time of 14.9 years (range, 1.9-15.5 years) for ZnT8A, islet cell (ICA), insulin (IAA), glutamate decarboxylase (GADA), and islet antigen-2 (IA-2A) antibodies, and for T1D. RESULTS By age 15.5 years, 35 (3.5%) children had progressed to T1D. Islet autoimmunity developed in 275 (27.3%) children at a median age of 7.4 years (range, 0.3-15.1 years). The ICA seroconversion rate increased toward puberty, but the biochemically defined autoantibodies peaked at a young age. Before age 2 years, ZnT8A and IAA appeared commonly as the first autoantibody, but in the preschool years IA-2A- and especially GADA-initiated autoimmunity increased. Thereafter, GADA-positive seroconversions continued to appear steadily until ages 10 to 15 years. Inverse IAA seroconversions occurred frequently (49.3% turned negative) and marked a prolonged delay from seroconversion to diagnosis compared to persistent IAA (8.2 vs 3.4 years; P = .01). CONCLUSIONS In HLA-predisposed children, the primary autoantibody is characteristic of age and might reflect the events driving the disease process toward clinical T1D. Autoantibody persistence affects the risk of T1D. These findings provide a framework for identifying disease subpopulations and for personalizing the efforts to predict and prevent T1D.
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Affiliation(s)
- Petra M Pöllänen
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Samppa J Ryhänen
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, and Institute of Biomedicine and Centre for Population Health Research, University of Turku, Turku, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku and Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Paula Vähäsalo
- Department of Pediatrics, PEDEGO Research Group, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Riitta Veijola
- Department of Pediatrics, PEDEGO Research Group, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heli Siljander
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mikael Knip
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Correspondence and Reprint Requests: Mikael Knip, MD, PhD, Children’s Hospital, University of Helsinki, P.O. Box 22 (Stenbäckinkatu 11), FI-00014 Helsinki, Finland. E-mail:
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Iriki J, Yamamoto K, Senju H, Nagaoka A, Yoshida M, Iwasaki K, Ashizawa N, Hirayama T, Tashiro M, Takazono T, Imamura Y, Miyazaki T, Izumikawa K, Yanagihara K, Tsujino A, Fukuoka J, Uetani M, Satoh M, Mukae H. Influenza A (H3N2) infection followed by anti-signal recognition particle antibody-positive necrotizing myopathy: A case report. Int J Infect Dis 2020; 103:33-36. [PMID: 33217572 DOI: 10.1016/j.ijid.2020.11.153] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/13/2023] Open
Abstract
A 60-year-old Japanese woman presented with subacute progressive muscle pain and weakness in her proximal extremities. She was diagnosed with influenza A (H3N2) infection a week before the onset of muscle pain. At the time of admission, she exhibited weakness in the proximal muscles of the upper and lower limbs, elevated serum liver enzymes and creatinine kinase, and myoglobinuria. She did not manifest renal failure and cardiac abnormalities, indicating myocarditis. Electromyography revealed myogenic changes, and magnetic resonance imaging of the upper limb showed abnormal signal intensities in the muscles, suggestive of myopathy. Muscle biopsy of the biceps revealed numerous necrotic regeneration fibers and mild inflammatory cell infiltration, suggesting immune-mediated necrotizing myopathy (IMNM). Necrotized muscle cells were positive for human influenza A (H3N2). Autoantibody analysis showed the presence of antibodies against the signal recognition particle (SRP), and the patient was diagnosed with anti-SRP-associated IMNM. She was resistant to intravenous methylprednisolone pulse therapy but recovered after administration of oral systemic corticosteroids and immunoglobulins. We speculate that the influenza A (H3N2) infection might have triggered her IMNM. Thus, IMNM should be considered as a differential diagnosis in patients with proximal muscle weakness that persists after viral infections.
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Affiliation(s)
- Jun Iriki
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Kazuko Yamamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan; Infection Control and Education Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan.
| | - Hiroaki Senju
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Atsushi Nagaoka
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Masataka Yoshida
- Department of Respiratory Medicine, Sasebo City General Hospital, 9-3 Hirasemachi, Sasebo City, Japan
| | - Keisuke Iwasaki
- Department of Pathology, Sasebo City General Hospital, 9-3 Hirasemachi, Sasebo City, Japan
| | - Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Tatsuro Hirayama
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Masato Tashiro
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Yoshifumi Imamura
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Masataka Uetani
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Japan
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Sciascia S, Radin M, Ramirez C, Seaman A, Bentow C, Casas S, Cecchi I, Rubini E, Foddai SG, Baldovino S, Fenoglio R, Menegatti E, Roccatello D, Mahler M. Evaluation of novel assays for the detection of autoantibodies in antiphospholipid syndrome. Autoimmun Rev 2020; 19:102641. [PMID: 32801044 DOI: 10.1016/j.autrev.2020.102641] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 12/31/2022]
Abstract
Patients with antiphospholipid syndrome (APS) present with clinical features of recurrent thrombosis and pregnancy morbidity and persistently test positive for the presence of antiphospholipid antibodies (aPL). At least one clinical (vascular thrombosis or pregnancy morbidity) and one lab-based (positive test result for lupus anticoagulant, anticardiolipin antibodies and/or anti-β2-glycoprotein 1 antibodies) criterion have to be met for a patient to be classified as having APS. Nevertheless, the clinical variety of APS encompasses additional signs and symptoms, potentially affecting any organ, that cannot be explained exclusively by a prothrombotic state. Those manifestations, also known as extra-criteria manifestations, include haematologic (thrombocytopenia and haemolytic anaemia), neurologic (chorea, myelitis and migraine) manifestations as well as the presence of livedo reticularis, nephropathy and valvular heart disease. The growing body of evidence describing the clinical aspect of the syndrome has been paralleled over the years by emerging research interest focusing on the development of novel biomarkers that might improve the diagnostic accuracy for APS when compared to the current aPL tests. This review will focus on the clinical utility of extra-criteria aPL specificities. Besides, the promising role of a new technology using particle based multi-analyte testing that supports aPL panel algorithm testing will be discussed. Diagnostic approaches to difficult cases, including real-world case studies investigating the diagnostic added value of extra criteria aPL, particularly anti-phosphatidylserine/prothrombin, will also be examined.
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Affiliation(s)
- Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy.
| | - Massimo Radin
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | | | | | | | | | - Irene Cecchi
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Elena Rubini
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Silvia Grazietta Foddai
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Simone Baldovino
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Roberta Fenoglio
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Elisa Menegatti
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
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Pan S, Wu T, Shi X, Xie Z, Huang G, Zhou Z. Organ-specific autoantibodies in Chinese patients newly diagnosed with type 1 diabetes mellitus. Endocr J 2020; 67:793-802. [PMID: 32295990 DOI: 10.1507/endocrj.ej20-0002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study aims to investigate the prevalence of islet autoantibodies and other organ-specific autoantibodies in type 1 diabetes mellitus (T1DM) patients and characterize their clinical features. Glutamic acid decarboxylase antibody (GADA), insulinoma antigen 2 antibody (IA-2A), zinc transporter 8 antibody (ZnT8A) and tetraspanin7 antibody (TSPAN7A) were assayed by radioligand or luciferase immunoprecipitation system assays in 205 newly diagnosed acute-onset T1DM patients and 170 healthy controls. Other organ-specific autoantibodies, including thyroid peroxidase antibody (TPOA), thyroglobulin antibody (TGA), tissue transglutaminase antibody (tTGA) and 21-hydroxylase antibody (21-OHA), were also measured. The prevalence of GADA, IA-2A, ZnT8A, TSPAN7A, TPOA, TGA and 21-OHA was higher in T1DM patients than in healthy controls. The combinational assay of various islet autoantibodies could increase the frequency of autoantibody positivity in T1DM to 85.4%. GADA+ IA-2A+ T1DM patients preferentially had TPOA and TGA, while IA-2A+ patients often had tTGA. Patients positive for two or more islet autoantibodies often had TPOA and TGA. BMI of multiple islet autoantibody-positive patients was lower than that of patients with single or no islet autoantibodies, and there were no significant differences in C-peptide and glycated hemoglobin between patients positive for islet autoantibodies combined with other organ-specific antibodies and noncombined patients. Younger female patients who were islet autoantibody positive were more likely to have TPOA and TGA. The frequency of Graves' disease was much higher in T1DM patients than in healthy controls. T1DM usually occurs together with other organ-specific autoantibodies. Measuring of other organ-specific autoantibodies will be beneficial for T1DM patients.
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Affiliation(s)
- Shan Pan
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Ting Wu
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Xiajie Shi
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Zhiguo Xie
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Gan Huang
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, China
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Packova B, Kovalcikova P, Pavlovsky Z, Bartusek D, Prokesova J, Dolina J, Kroupa R. Non-invasive prediction of persistent villous atrophy in celiac disease. World J Gastroenterol 2020; 26:3780-3791. [PMID: 32774057 PMCID: PMC7383850 DOI: 10.3748/wjg.v26.i26.3780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/13/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Celiac disease (CD) is an immune-mediated enteropathy that is primarily treated with a gluten-free diet (GFD). Mucosal healing is the main target of the therapy. Currently, duodenal biopsy is the only way to evaluate mucosal healing, and non-invasive markers are challenging. Persistent elevation of anti-tissue transglutaminase antibodies (aTTG) is not an ideal predictor of persistent villous atrophy (VA). Data regarding prediction of atrophy using anti-deamidated gliadin peptide antibodies (aDGP) and abdominal ultrasonography are lacking.
AIM To evaluate the ability of aTTG, aDGP, small bowel ultrasonography, and clinical and laboratory parameters in predicting persistent VA determined using histology.
METHODS Patients with CD at least 1 year on a GFD and available follow-up duodenal biopsy, levels of aTTG and aDGP, and underwent small bowel ultrasonography were included in this retrospective cohort study. We evaluated the sensitivity, specificity, and positive and negative predictive values of aTTG, aDGP, small bowel ultrasonography, laboratory and clinical parameters to predict persistent VA. A receiver operating characteristic (ROC) curve analysis of antibody levels was used to calculate cut off values with the highest accuracy for atrophy prediction.
RESULTS Complete data were available for 82 patients who were followed up over a period of four years (2014-2018). Among patients included in the analysis, women (67, 81.7%) were predominant and the mean age at diagnosis was 33.8 years. Follow-up biopsy revealed persistent VA in 19 patients (23.2%). The sensitivity and specificity of aTTG using the manufacturer’s diagnostic cutoff value to predict atrophy was 50% and 85.7%, respectively, while the sensitivity and specificity of aDGP (using the diagnostic cutoff value) was 77.8% and 75%, respectively. Calculation of an optimal cutoff value using ROC analysis (13.4 U/mL for aTTG IgA and 22.6 U/mL for aDGP IgA) increased the accuracy and reached 72.2% [95% confidence interval (CI): 46.5-90.3] sensitivity and 90% (95%CI: 79.5-96.2) specificity for aDGP IgA and 66.7% (95%CI: 41.0-86.7) sensitivity and 93.7% (95%CI: 84.5-98.2) specificity for aTTG IgA. The sensitivity and specificity of small bowel ultrasonography was 64.7% and 73.5%, respectively. A combination of serology with ultrasound imaging to predict persistent atrophy increased the positive predictive value and specificity to 88.9% and 98% for aTTG IgA and to 90.0% and 97.8% for aDGP IgA. Laboratory and clinical parameters had poor predictive values.
CONCLUSION The sensitivity, specificity, and negative predictive value of aTTG and aDGP for predicting persistent VA improved by calculating the best cutoff values. The combination of serology and experienced bowel ultrasound examination may achieve better accuracy for the detection of atrophy.
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Affiliation(s)
- Barbora Packova
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Petra Kovalcikova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Zdenek Pavlovsky
- Department of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Daniel Bartusek
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Jitka Prokesova
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Jiri Dolina
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
| | - Radek Kroupa
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
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Tanaka K, Kawamura M, Sakimura K, Kato N. Significance of Autoantibodies in Autoimmune Encephalitis in Relation to Antigen Localization: An Outline of Frequently Reported Autoantibodies with a Non-Systematic Review. Int J Mol Sci 2020; 21:ijms21144941. [PMID: 32668637 PMCID: PMC7404295 DOI: 10.3390/ijms21144941] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
Autoantibodies related to central nervous system (CNS) diseases propel research on paraneoplastic neurological syndrome (PNS). This syndrome develops autoantibodies in combination with certain neurological syndromes and cancers, such as anti-HuD antibodies in encephalomyelitis with small cell lung cancer and anti-Yo antibodies in cerebellar degeneration with gynecological cancer. These autoantibodies have roles in the diagnosis of neurological diseases and early detection of cancers that are usually occult. Most of these autoantibodies have no pathogenic roles in neuronal dysfunction directly. Instead, antigen-specific cytotoxic T lymphocytes are thought to have direct roles in neuronal damage. The recent discoveries of autoantibodies against neuronal synaptic receptors/channels produced in patients with autoimmune encephalomyelitis have highlighted insights into our understanding of the variable neurological symptoms in this disease. It has also improved our understanding of intractable epilepsy, atypical psychosis, and some demyelinating diseases that are ameliorated with immune therapies. The production and motility of these antibodies through the blood-brain barrier into the CNS remains unknown. Most of these recently identified autoantibodies bind to neuronal and glial cell surface synaptic receptors, potentially altering the synaptic signaling process. The clinical features differ among pathologies based on antibody targets. The investigation of these antibodies provides a deeper understanding of the background of neurological symptoms in addition to novel insights into their basic neuroscience.
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Affiliation(s)
- Keiko Tanaka
- Department of Animal Model Development, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata 951-8585, Japan; (M.K.); (K.S.)
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, School of Medicine, 1 Hikarigaoka, Fukushima 960-1247, Japan
- Correspondence: ; Tel.: +81-25-227-0624; Fax: +81-25-227-0816
| | - Meiko Kawamura
- Department of Animal Model Development, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata 951-8585, Japan; (M.K.); (K.S.)
| | - Kenji Sakimura
- Department of Animal Model Development, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata 951-8585, Japan; (M.K.); (K.S.)
| | - Nobuo Kato
- Department of Physiology, Kanazawa Medical University, Ishikawa 920-0293, Japan;
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