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Dwivedi M, Tiwari S, Kemp EH, Begum R. Implications of regulatory T cells in anti-cancer immunity: from pathogenesis to therapeutics. Heliyon 2022; 8:e10450. [PMID: 36082331 PMCID: PMC9445387 DOI: 10.1016/j.heliyon.2022.e10450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/08/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Regulatory T cells (Tregs) play an essential role in maintaining immune tolerance and suppressing inflammation. However, Tregs present major hurdle in eliciting potent anti-cancer immune responses. Therefore, curbing the activity of Tregs represents a novel and efficient way towards successful immunotherapy of cancer. Moreover, there is an emerging interest in harnessing Treg-based strategies for augmenting anti-cancer immunity in different types of the disease. This review summarises the crucial mechanisms of Tregs’ mediated suppression of anti-cancer immunity and strategies to suppress or to alter such Tregs to improve the immune response against tumors. Highlighting important clinical studies, the review also describes current Treg-based therapeutic interventions in cancer, and discusses Treg-suppression by molecular targeting, which may emerge as an effective cancer immunotherapy and as an alternative to detrimental chemotherapeutic agents. Tregs are crucial in maintaining immune tolerance and suppressing inflammation. Tregs present a major obstacle to eliciting potent anti-tumor immune responses. The review summarizes current Treg-based therapeutic interventions in cancer. Treg can be an effective cancer immunotherapy target.
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Affiliation(s)
- Mitesh Dwivedi
- C. G. Bhakta Institute of Biotechnology, Faculty of Science, Uka Tarsadia University, Tarsadi, Surat, Gujarat, 394350, India
- Corresponding author.
| | - Sanjay Tiwari
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, Lucknow, 226002, Uttar Pradesh, India
| | - E. Helen Kemp
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, S10 2RX, UK
| | - Rasheedunnisa Begum
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, 390 002, Gujarat, India
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2
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Borysewicz-Sańczyk H, Sawicka B, Michalak J, Wójtowicz J, Dobreńko E, Konstantynowicz J, Kemp EH, Thakker RV, Allgrove J, Hannan FM, Bossowski A. Case report: a 10-year-old girl with primary hypoparathyroidism and systemic lupus erythematosus. J Pediatr Endocrinol Metab 2020; 33:1231-1235. [PMID: 32866121 DOI: 10.1515/jpem-2020-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/13/2020] [Indexed: 11/15/2022]
Abstract
Objectives Hypoparathyroidism is a rare disease in children that occurs as a result of autoimmune destruction of the parathyroid glands, a defect in parathyroid gland development or secondary to physical parathyroid gland disturbance. Typical symptoms of hypoparathyroidism present as hypocalcaemia and hyperphosphatemia due to decreased parathyroid hormone secretion and may lead to nerve and muscles disturbances resulting in clinical manifestation of tetany, arrhythmias and epilepsy. Currently, there is no conventional hormone replacement treatment for hypoparathyroidism and therapeutic approaches include normalising mineral levels using an oral calcium supplement and active forms of vitamin D. Case presentation We present the case of a 10-year-old girl with primary hypoparathyroidism who had no prior history of autoimmune disorders, but who subsequently developed systemic lupus erythematosus.
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Affiliation(s)
- Hanna Borysewicz-Sańczyk
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Beata Sawicka
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Justyna Michalak
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Jerzy Wójtowicz
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Elżbieta Dobreńko
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Białystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Białystok, Poland
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Jeremy Allgrove
- Department of Pediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - Fadil M Hannan
- Academic Endocrine Unit, Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
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Elder CJ, Vilela R, Johnson TN, Taylor RN, Kemp EH, Keevil BG, Cross AS, Ross RJ, Wright NP. Pharmacodynamic studies of nasal tetracosactide with salivary glucocorticoids for a noninvasive Short Synacthen Test. J Clin Endocrinol Metab 2020; 105:5850507. [PMID: 32593173 DOI: 10.1210/clinem/dgaa323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The Short Synacthen Test (SST) is the gold standard for diagnosing adrenal insufficiency. It requires invasive administration of Synacthen, venous sampling, and is resource-intensive. OBJECTIVE To develop a nasally administered SST, with salivary glucocorticoids measurement, to assess the adrenal response. DESIGN We conducted 5 studies: 4 open-label, sequence-randomized, crossover, pharmacodynamic studies testing 6 doses/formulations and a repeatability study. Additionally, pharmacokinetic analysis was undertaken using our chosen formulation, 500 µg tetracosactide with mucoadhesive chitosan, Nasacthin003, in our pediatric study. SETTING Adult and children's clinical research facilities. PARTICIPANTS A total of 36 healthy adult males and 24 healthy children. INTERVENTION We administered all 6 nasal formulations using an European regulator endorsed atomization device. The IV comparators were 250 µg or 1 µg SST. MAIN OUTCOME MEASURES We analyzed paired blood and saliva samples for plasma cortisol and salivary cortisol and cortisone. RESULTS The addition of chitosan to tetracosactide and dose escalation increased peak cortisol response (P = 0.01 and 0.001, respectively). The bioavailability of Nasacthin003 was 14.3%. There was no significant difference in plasma cortisol at 60 minutes between 500 µg Nasacthin003 and 250 µg IV Synacthen (P = 0.17). The repeatability coefficient at 60 minutes was 105 nmol/L for IV Synacthen and salivary cortisol and cortisone was 10.3 and 21.1 nmol/L, respectively. The glucocorticoid response in children was indistinguishable from that of adults. CONCLUSIONS Nasal administration of Nasacthin003 generates equivalent plasma cortisol values to the 250-µg IV SST and, with measurement at 60 minutes of salivary cortisol or cortisone, provides a noninvasive test for adrenal insufficiency.
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Affiliation(s)
- Charlotte J Elder
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Ruben Vilela
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | | | - Rosie N Taylor
- Statistical Services Unit, The University of Sheffield, Sheffield, United Kingdom
| | - E Helen Kemp
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Brian G Keevil
- Department of Clinical Biology, Manchester University NHS Trust, Manchester, United Kingdom
| | - Alexandra S Cross
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Richard J Ross
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Neil P Wright
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
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4
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Miñambres I, Corcoy R, Weetman AP, Kemp EH. Autoimmune Hypercalcemia Due to Autoantibodies Against the Calcium-sensing Receptor. J Clin Endocrinol Metab 2020; 105:5822860. [PMID: 32311038 DOI: 10.1210/clinem/dgaa219] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Autoimmune hypocalciuric hypercalcemia (AHH) is an acquired disorder caused by the presence of blocking autoantibodies against the calcium-sensing receptor (CaSR). Few cases of this condition have been described to date in the literature. OBJECTIVE The objectives of this study were to describe 2 patients in whom the presence of AHH was suspected and to assess the patients for the presence of CaSR antibodies. METHODS CaSR antibodies were detected and characterised by immunoprecipitation assays, CaSR peptide ELISAs, and functional assays based on the calcium-stimulated accumulation of inositol-1-phosphate in a mammalian cell line expressing the CaSR. RESULTS Both patients presented with an acquired form of hypocalciuric hypercalcemia. Mutational analyses of CASR, GNA11, and AP2S1 for familial hypocalciuric hypercalcemia were negative. According to the presence of Hashimoto's disease in 1 patient and latent autoimmune diabetes of adulthood and thyroid autoimmunity in the other, AHH was suspected. Immunoprecipitation assays detected CaSR antibodies in both patients. Analysis of the antibody binding sites revealed 2 main epitopes at amino acids 41-69 and 114-126. Preincubation with purified CaSR antibodies against epitope 114-126 resulted in a significant decrease in inositol-1-phophate accumulation upon calcium-stimulation of mammalian cells expressing the CaSR, suggesting that the antibodies had receptor-blocking activity. CONCLUSIONS AHH is to be suspected in patients with an acquired biochemical pattern of PTH-dependant hypocalciuric hypercalcemia, especially in those with other concomitant autoimmune diseases. Diagnosis by means of detecting CaSR antibodies may help to better characterise this probably under-reported condition.
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Affiliation(s)
- Inka Miñambres
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas (CIBER-DEM), Spain
| | - Rosa Corcoy
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Spain
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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5
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Böhm M, Kemp EH, Metze D, Muresan AM, Neufeld M, Luiten RM, Ruck T. Alemtuzumab-induced halo naevus-like hypopigmentation - new insights into secondary skin autoimmunity in response to an immune cell-depleting antibody. J Eur Acad Dermatol Venereol 2020; 35:e28-e30. [PMID: 32579750 DOI: 10.1111/jdv.16781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Böhm
- Department of Dermatology, University of Münster, Münster, Germany
| | - E H Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - D Metze
- Department of Dermatology, University of Münster, Münster, Germany
| | - A M Muresan
- Department of Dermatology, University of Münster, Münster, Germany
| | - M Neufeld
- Department of Dermatology, University of Münster, Münster, Germany
| | - R M Luiten
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - T Ruck
- Clinic of Neurology with Institute for Translational Neurology, University of Münster, Münster, Germany
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6
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Lupi I, Brancatella A, Cetani F, Latrofa F, Kemp EH, Marcocci C. Activating Antibodies to The Calcium-sensing Receptor in Immunotherapy-induced Hypoparathyroidism. J Clin Endocrinol Metab 2020; 105:5766692. [PMID: 32112105 DOI: 10.1210/clinem/dgaa092] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/26/2020] [Indexed: 12/25/2022]
Abstract
CONTEXT Immune checkpoint inhibitors (ICIs), such as programmed cell death protein-1 (PD-1), programmed cell death protein-ligand 1 (PD-L1), and cytotoxic T lymphocyte antigen-4 (CTLA-4) monoclonal antibodies, are approved for the treatment of some types of advanced cancer. Their main treatment-related side-effects are immune-related adverse events (irAEs), especially thyroid dysfunction and hypophysitis. Hypoparathyroidism, on the contrary, is an extremely rare irAE. OBJECTIVES The aim of the study was to investigate the etiology of autoimmune hypoparathyroidism in a lung cancer patient treated with pembrolizumab, an anti-PD-1. METHODS Calcium-sensing receptor (CaSR) autoantibodies, their functional activity, immunoglobulin (Ig) subclasses and epitopes involved in the pathogenesis of autoimmune hypoparathyroidism were tested. RESULTS The patient developed hypocalcemia after 15 cycles of pembrolizumab. Calcium levels normalized with oral calcium carbonate and calcitriol and no remission of hypocalcemia was demonstrated during a 9-month follow-up. The patient was found to be positive for CaSR-stimulating antibodies, of IgG1 and IgG3 subclasses, that were able to recognize functional epitopes on the receptor, thus causing hypocalcemia. CONCLUSION The finding confirms that ICI therapy can trigger, among other endocrinopathies, hypoparathyroidism, which can be caused by pathogenic autoantibodies.
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Affiliation(s)
- Isabella Lupi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessandro Brancatella
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Filomena Cetani
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco Latrofa
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Claudio Marcocci
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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7
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Piranavan P, Li Y, Brown E, Kemp EH, Trivedi N. Immune Checkpoint Inhibitor-Induced Hypoparathyroidism Associated With Calcium-Sensing Receptor-Activating Autoantibodies. J Clin Endocrinol Metab 2019; 104:550-556. [PMID: 30252069 DOI: 10.1210/jc.2018-01151] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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] [Received: 05/29/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Whereas therapy with immune checkpoint inhibitors (ICIs), such as nivolumab, have substantially improved survival in several types of cancer, increased attention has been given to adverse immune events associated with their use, including the development of endocrine autoimmunity. OBJECTIVES First, to describe a patient with a 2-year history of metastatic small cell lung cancer who had been treated with nivolumab a few months before presentation with the signs and symptoms of severe hypocalcemia and hypoparathyroidism. Second, to investigate the etiology of the patient's hypoparathyroidism, including the presence of activating autoantibodies against the calcium-sensing receptor (CaSR), as humoral and cellular immune responses against the CaSR have been reported in patients with autoimmune hypoparathyroidism. PARTICIPANTS A 61-year-old female was admitted with persistent nausea, vomiting, epigastric pain, constipation, and generalized weakness. Laboratory analyses showed low total serum calcium, ionized calcium, and parathyroid hormone (PTH). The patient was diagnosed with severe hypocalcemia as a result of autoimmune hypoparathyroidism after testing positive for CaSR-activating autoantibodies. INTERVENTIONS She was treated with intravenous calcium gluconate infusions, followed by a transition to oral calcium carbonate, plus calcitriol, which normalized her serum calcium. RESULTS Her serum PTH remained low during her hospitalization and initial outpatient follow-up, despite adequate repletion of magnesium. CONCLUSIONS This case illustrates autoimmune hypoparathyroidism induced by ICI blockade. As ICIs are now used to treat many cancers, clinicians should be aware of the potential risk for hypocalcemia that may be associated with their use.
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Affiliation(s)
| | - Yan Li
- Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Edward Brown
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Nitin Trivedi
- Division of Endocrinology, Saint Vincent Hospital, Worcester, Massachusetts
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8
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Chamberlin M, Kemp EH, Weetman AP, Khadka B, Brown EM. Immunosuppressive therapy of autoimmune hypoparathyroidism in a patient with activating autoantibodies against the calcium-sensing receptor. Clin Endocrinol (Oxf) 2019; 90:214-221. [PMID: 30358904 DOI: 10.1111/cen.13886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/02/2018] [Revised: 08/15/2018] [Accepted: 10/18/2018] [Indexed: 12/31/2022]
Abstract
CONTEXT Activating antibodies directed at the extracellular calcium-sensing receptor (CaSR) have been described in autoimmune hypoparathyroidism in the setting of isolated hypoparathyroidism or autoimmune polyglandular syndrome type 1. MATERIALS AND METHODS A 34-year-old female presented with hypocalcaemia (6.0 mg/dL) and hypomagnesaemia (1.1 mg/dL) accompanied by low serum PTH (2.4 pg/mL) as well as urinary calcium and magnesium wasting. She was diagnosed with hypoparathyroidism, which was refractory to standard therapy. She was started on 60 mg prednisone and 150 mg azathioprine treatment daily on suspicion of an autoimmune aetiology. The patient was tested for CaSR antibodies. RESULTS The patient was positive for CaSR antibodies of the IgG1 subtype, which stimulated phosphorylation of extracellular signal-regulated kinases 1 and 2 (ERK1/2) and inositol phosphate (IP) accumulation. Post-treatment with prednisone and azathioprine, her serum calcium and magnesium normalized, as did her CaSR antibody titre and antibody-mediated stimulation of ERK1/2 phosphorylation and IP accumulation. CONCLUSION This is the first demonstration of CaSR antibody-mediated hypoparathyroidism responsive to immunosuppressive therapy, adding to the evidence that autoimmune hypoparathyroidism can be, in some cases, reversible and not the result of autoimmune parathyroid destruction.
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Affiliation(s)
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Edward M Brown
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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9
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Habibullah M, Porter JA, Kluger N, Ranki A, Krohn KJE, Brandi ML, Brown EM, Weetman AP, Kemp EH. Calcium-Sensing Receptor Autoantibodies in Patients with Autoimmune Polyendocrine Syndrome Type 1: Epitopes, Specificity, Functional Affinity, IgG Subclass, and Effects on Receptor Activity. J Immunol 2018; 201:3175-3183. [PMID: 30381479 DOI: 10.4049/jimmunol.1701527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 09/27/2018] [Indexed: 11/19/2022]
Abstract
A major manifestation of autoimmune polyendocrine syndrome type 1 (APS1) is hypoparathyroidism, which is suggested to result from aberrant immune responses against the parathyroid glands. The calcium-sensing receptor (CaSR), which plays a pivotal role in maintaining calcium homeostasis by sensing blood calcium levels and regulating release of parathyroid hormone (PTH), is an autoantibody target in APS1. In this study, the aim was to characterize the binding sites, specificity, functional affinity, IgG subclass, and functional effects of CaSR autoantibodies using phage-display technology, ELISA, and bioassays. The results indicated that CaSR autoantibody binding sites were at aa 41-69, 114-126, 171-195, and 260-340 in the extracellular domain of the receptor. Autoantibodies against CaSR epitopes 41-69, 171-195, and 260-340 were exclusively of the IgG1 subclass. Autoantibody responses against CaSR epitope 114-126 were predominantly of the IgG1 with a minority of the IgG3 subclass. Only autoantibodies recognizing CaSR epitopes 114-126 and 171-195 affected receptor activity; inositol-phosphate accumulation was increased significantly in HEK293-CaSR cells, and PTH secretion from PTH-C1 cells was reduced significantly when either were incubated with purified Ab and Ca2+ compared with Ca2+ alone. In conclusion, although the majority of APS1 patients do not have CaSR-stimulating autoantibodies, the hypoparathyroid state in a small minority of patients is the result of functional suppression of the parathyroid glands.
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Affiliation(s)
- Mahmoud Habibullah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Julie A Porter
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Nicolas Kluger
- Department of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki and Helsinki University Central Hospital, 00250 Helsinki, Finland
| | - Annamari Ranki
- Department of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki and Helsinki University Central Hospital, 00250 Helsinki, Finland
| | - Kai J E Krohn
- Clinical Research Institute HUCH Ltd., 00250 Helsinki, Finland
| | - Maria L Brandi
- Department of Surgery and Translational Medicine, University of Florence, 50139 Florence, Italy; and
| | - Edward M Brown
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, MA 02115
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom;
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10
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Cross AS, Helen Kemp E, White A, Walker L, Meredith S, Sachdev P, Krone NP, Ross RJ, Wright NP, Elder CJ. International survey on high- and low-dose synacthen test and assessment of accuracy in preparing low-dose synacthen. Clin Endocrinol (Oxf) 2018; 88:744-751. [PMID: 29392744 DOI: 10.1111/cen.13559] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 12/14/2017] [Revised: 01/12/2018] [Accepted: 01/24/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The short synacthen test (SST) is widely used to assess patients for adrenal insufficiency, but the frequency and protocols used across different centres for the low-dose test (LDT) are unknown. This study aimed to survey centres and test the accuracy of ten different synacthen preparation strategies used for the LDT. METHODS Members of 6 international endocrine societies were surveyed regarding diagnostic tests used for adrenal insufficiency, and in particular the SST. Synacthen was diluted for the LDT and concentrations measured using a synacthen ELISA. RESULTS Survey responses were received from 766 individuals across 60 countries (52% adult, 45% paediatric endocrinologists). The SST is used by 98% of centres: 92% using high-dose (250 μg), 43% low-dose and 37% both. Ten low-dose dilution methods were assessed and variation in synacthen concentration was demonstrated with intramethod coefficients of variation (CV) ranging from 2.1% to 109%. The method using 5% dextrose as a diluent was the least variable (CV of 2.1%). The variation in dilution methods means that the dose of synacthen administered in a LDT may vary between 0.16 and 0.81 μg. CONCLUSIONS The high-dose SST is the most popular diagnostic test of adrenal insufficiency, but up to 72% of paediatric endocrinologists use a LDT. There is considerable variation observed both within and between low-dose synacthen dilution methods creating considerable risk of inaccurate dosing and thereby invalid results.
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Affiliation(s)
- Alexandra S Cross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Anne White
- School of Medical Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Leanne Walker
- School of Medical Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Suzanne Meredith
- School of Medical Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Pooja Sachdev
- Department of Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nils P Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Richard J Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Neil P Wright
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Charlotte J Elder
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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11
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Teulings HE, Tjin EPM, Willemsen KJ, van der Kleij S, ter Meulen S, Kemp EH, Krebbers G, van Noesel CJM, Franken CLMC, Drijfhout JW, Melief CJM, Nieuweboer-Krobotova L, Nieweg OE, van der Hage JA, van der Veen JPW, Relyveld GN, Luiten RM. Anti-Melanoma immunity and local regression of cutaneous metastases in melanoma patients treated with monobenzone and imiquimod; a phase 2 a trial. Oncoimmunology 2018; 7:e1419113. [PMID: 29632737 PMCID: PMC5889200 DOI: 10.1080/2162402x.2017.1419113] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/04/2022] Open
Abstract
Vitiligo development in melanoma patients during immunotherapy is a favorable prognostic sign and indicates breakage of tolerance against melanocytic/melanoma antigens. We investigated a novel immunotherapeutic approach of the skin-depigmenting compound monobenzone synergizing with imiquimod in inducing antimelanoma immunity and melanoma regression. Stage III-IV melanoma patients with non-resectable cutaneous melanoma metastases were treated with monobenzone and imiquimod (MI) therapy applied locally to cutaneous metastases and adjacent skin during 12 weeks, or longer. Twenty-one of 25 enrolled patients were evaluable for clinical assessment at 12 weeks. MI therapy was well-tolerated. Partial regression of cutaneous metastases was observed in 8 patients and stable disease in 1 patient, reaching the statistical endpoint of treatment efficacy. Continued treatment induced clinical response in 11 patients, including complete responses in three patients. Seven patients developed vitiligo-like depigmentation on areas of skin that were not treated with MI therapy, indicating a systemic effect of MI therapy. Melanoma-specific antibody responses were induced in 7 of 17 patients tested and melanoma-specific CD8+T-cell responses in 11 of 15 patients tested. These systemic immune responses were significantly increased during therapy as compared to baseline in responding patients. This study shows that MI therapy induces local and systemic anti-melanoma immunity and local regression of cutaneous metastases in 38% of patients, or 52% during prolonged therapy. This study provides proof-of-concept of MI therapy, a low-cost, broadly applicable and well-tolerated treatment for cutaneous melanoma metastases, attractive for further clinical investigation.
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Affiliation(s)
- Hansje-Eva Teulings
- Dept. of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Depts. of Dermatology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Esther P. M. Tjin
- Dept. of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karina J. Willemsen
- Dept. of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephanie van der Kleij
- Depts. of Dermatology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sylvia ter Meulen
- Surgical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E. Helen Kemp
- Dept. of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Gabrielle Krebbers
- Dept. of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Carel J. M. van Noesel
- Dept. of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis L. M. C. Franken
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W. Drijfhout
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ludmila Nieuweboer-Krobotova
- Dept. of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Depts. of Dermatology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Omgo E. Nieweg
- Surgical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos A. van der Hage
- Surgical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J. P. Wietze van der Veen
- Dept. of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Depts. of Dermatology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Germaine N. Relyveld
- Depts. of Dermatology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rosalie M. Luiten
- Dept. of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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12
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Kemp EH, Kahaly GJ, Porter JA, Frommer L, Weetman AP. Autoantibodies against the calcium-sensing receptor and cytokines in autoimmune polyglandular syndromes types 2, 3 and 4. Clin Endocrinol (Oxf) 2018; 88:139-145. [PMID: 28941288 DOI: 10.1111/cen.13482] [Citation(s) in RCA: 12] [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: 07/14/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The frequency of autoimmunity against the parathyroid glands in patients with polyglandular autoimmunity that is not due to autoimmune polyendocrine syndrome type 1 (APS1) is unclear. To investigate this, this study aimed to determine the prevalence of autoantibodies against parathyroid autoantigens, calcium-sensing receptor (CaSR) and NACHT leucine-rich-repeat protein 5 (NALP5), in a large group of patients with non-APS1 polyendocrine autoimmunity. Possible occult APS1 was investigated by cytokine autoantibody measurement and AIRE gene analysis. DESIGN, SUBJECTS AND MEASUREMENTS Subjects were 178 patients with APS2, 3 or 4, and 80 healthy blood donors. Autoantibodies against the CaSR, NALP5 and cytokines were measured by immunoprecipitation, radioligand binding assays or ELISA, respectively. RESULTS Four patient samples (2.2%), but none of the controls, were positive for CaSR autoantibodies. NALP5 autoantibodies were not detected in any participant. Eleven patients (6.2%) had cytokine autoantibodies, but none of the control samples was positive. None of the patients with cytokine autoantibodies had any known or novel mutations in the AIRE gene. CONCLUSIONS The low prevalence of CaSR autoantibodies indicate a very low level of subclinical parathyroid autoimmunity in APS types 2, 3 and 4. In addition, autoantibodies against cytokines constitute an uncommon feature of non-APS1 polyglandular autoimmunity.
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Affiliation(s)
- E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Centre, Mainz, Germany
| | - Julie A Porter
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lara Frommer
- Department of Medicine I, Johannes Gutenberg University Medical Centre, Mainz, Germany
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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13
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Dwivedi M, Ansarullah, Radichev I, Kemp EH. Alteration of Immune-Mechanisms by Human Microbiota and Development and Prevention of Human Diseases. J Immunol Res 2017; 2017:6985256. [PMID: 29445757 PMCID: PMC5763106 DOI: 10.1155/2017/6985256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/08/2017] [Indexed: 02/07/2023] Open
Affiliation(s)
- Mitesh Dwivedi
- 1C. G. Bhakta Institute of Biotechnology, Tarsadi, Uka Tarsadia University, Surat, Gujarat 394350, India
| | - Ansarullah
- 2Izmir International Biomedicine and Genome Institute (iBG-izmir), Dokuz Eylul University, Izmir, Turkey
| | - Ilian Radichev
- 3Children's Health Research Center, Sanford Research, 2301 East 60th Street-North, Sioux Falls, SD 57104, USA
| | - E. Helen Kemp
- 4Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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14
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Jin Y, Andersen G, Yorgov D, Ferrara TM, Ben S, Brownson KM, Holland PJ, Birlea SA, Siebert J, Hartmann A, Lienert A, van Geel N, Lambert J, Luiten RM, Wolkerstorfer A, Wietze van der Veen JP, Bennett DC, Taïeb A, Ezzedine K, Kemp EH, Gawkrodger DJ, Weetman AP, Kõks S, Prans E, Kingo K, Karelson M, Wallace MR, McCormack WT, Overbeck A, Moretti S, Colucci R, Picardo M, Silverberg NB, Olsson M, Valle Y, Korobko I, Böhm M, Lim HW, Hamzavi I, Zhou L, Mi QS, Fain PR, Santorico SA, Spritz RA. Genome-wide association studies of autoimmune vitiligo identify 23 new risk loci and highlight key pathways and regulatory variants. Nat Genet 2016; 48:1418-1424. [PMID: 27723757 PMCID: PMC5120758 DOI: 10.1038/ng.3680] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/29/2016] [Indexed: 12/15/2022]
Abstract
Vitiligo is an autoimmune disease in which depigmented skin results from destruction of melanocytes1, with epidemiologic association with other autoimmune diseases2. In previous linkage and genome-wide association studies (GWAS1, GWAS2), we identified 27 vitiligo susceptibility loci in patients of European (EUR) ancestry. We carried out a third GWAS (GWAS3) in EUR subjects, with augmented GWAS1 and GWAS2 controls, genome-wide imputation, and meta-analysis of all three GWAS, followed by an independent replication. The combined analyses, with 4,680 cases and 39,586 controls, identified 23 new loci and 7 suggestive loci, most encoding immune and apoptotic regulators, some also associated with other autoimmune diseases, as well as several melanocyte regulators. Bioinformatic analyses indicate a predominance of causal regulatory variation, some corresponding to eQTL at these loci. Together, the identified genes provide a framework for vitiligo genetic architecture and pathobiology, highlight relationships to other autoimmune diseases and melanoma, and offer potential targets for treatment.
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Affiliation(s)
- Ying Jin
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Genevieve Andersen
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel Yorgov
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, Colorado, USA
| | - Tracey M Ferrara
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Songtao Ben
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kelly M Brownson
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Paulene J Holland
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stanca A Birlea
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Anke Hartmann
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Anne Lienert
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Rosalie M Luiten
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Academic Medical Centre University of Amsterdam, Amsterdam, the Netherlands
| | - Albert Wolkerstorfer
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Academic Medical Centre University of Amsterdam, Amsterdam, the Netherlands
| | - J P Wietze van der Veen
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Academic Medical Centre University of Amsterdam, Amsterdam, the Netherlands.,Department of Dermatology, Medical Centre Haaglanden, The Hague, the Netherlands
| | - Dorothy C Bennett
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Alain Taïeb
- Centre de Référence des Maladies Rares de la Peau, Department of Dermatology, Hôpital St.-André, Bordeaux, France
| | - Khaled Ezzedine
- Centre de Référence des Maladies Rares de la Peau, Department of Dermatology, Hôpital St.-André, Bordeaux, France
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - David J Gawkrodger
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Sulev Kõks
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Külli Kingo
- Department of Dermatology, University of Tartu, Tartu, Estonia
| | - Maire Karelson
- Department of Dermatology, University of Tartu, Tartu, Estonia
| | - Margaret R Wallace
- Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Wayne T McCormack
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Silvia Moretti
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Roberta Colucci
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Mauro Picardo
- Laboratorio Fisiopatologia Cutanea, Istituto Dermatologico San Gallicano, Rome, Italy
| | - Nanette B Silverberg
- Department of Dermatology, Columbia University College of Physicians and Surgeons, New York, New York, USA.,Pediatric and Adolescent Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York, USA
| | - Mats Olsson
- International Vitiligo Center, Uppsala, Sweden
| | - Yan Valle
- Vitiligo Research Foundation, New York, New York, USA
| | - Igor Korobko
- Vitiligo Research Foundation, New York, New York, USA.,Institute of Gene Biology, Russian Academy of Sciences, Moscow, Russia
| | - Markus Böhm
- Department of Dermatology, University of Münster, Münster, Germany
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Li Zhou
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Qing-Sheng Mi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Pamela R Fain
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephanie A Santorico
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Richard A Spritz
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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15
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Astor MC, Løvås K, Debowska A, Eriksen EF, Evang JA, Fossum C, Fougner KJ, Holte SE, Lima K, Moe RB, Myhre AG, Kemp EH, Nedrebø BG, Svartberg J, Husebye ES. Epidemiology and Health-Related Quality of Life in Hypoparathyroidism in Norway. J Clin Endocrinol Metab 2016; 101:3045-53. [PMID: 27186861 PMCID: PMC4971340 DOI: 10.1210/jc.2016-1477] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [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] [Received: 02/25/2016] [Accepted: 05/12/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The epidemiology of hypoparathyroidism (HP) is largely unknown. We aimed to determine prevalence, etiologies, health related quality of life (HRQOL) and treatment pattern of HP. METHODS Patients with HP and 22q11 deletion syndrome (DiGeorge syndrome) were identified in electronic hospital registries. All identified patients were invited to participate in a survey. Among patients who responded, HRQOL was determined by Short Form 36 and Hospital Anxiety and Depression scale. Autoantibodies were measured and candidate genes (CaSR, AIRE, GATA3, and 22q11-deletion) were sequenced for classification of etiology. RESULTS We identified 522 patients (511 alive) and estimated overall prevalence at 102 per million divided among postsurgical HP (64 per million), nonsurgical HP (30 per million), and pseudo-HP (8 per million). Nonsurgical HP comprised autosomal dominant hypocalcemia (21%), autoimmune polyendocrine syndrome type 1 (17%), DiGeorge/22q11 deletion syndrome (15%), idiopathic HP (44%), and others (4%). Among the 283 respondents (median age, 53 years [range, 9-89], 75% females), seven formerly classified as idiopathic were reclassified after genetic and immunological analyses, whereas 26 (37% of nonsurgical HP) remained idiopathic. Most were treated with vitamin D (94%) and calcium (70%), and 10 received PTH. HP patients scored significantly worse than the normative population on Short Form 36 and Hospital Anxiety and Depression scale; patients with postsurgical scored worse than those with nonsurgical HP and pseudo-HP, especially on physical health. CONCLUSIONS We found higher prevalence of nonsurgical HP in Norway than reported elsewhere. Genetic testing and autoimmunity screening of idiopathic HP identified a specific cause in 21%. Further research is necessary to unravel the causes of idiopathic HP and to improve the reduced HRQOL reported by HP patients.
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Affiliation(s)
- Marianne C Astor
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Kristian Løvås
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Aleksandra Debowska
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Erik F Eriksen
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Johan A Evang
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Christian Fossum
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Kristian J Fougner
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Synnøve E Holte
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Kari Lima
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Ragnar B Moe
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Grethe Myhre
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - E Helen Kemp
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn G Nedrebø
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Johan Svartberg
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Eystein S Husebye
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
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Dwivedi M, Kumar P, Laddha NC, Kemp EH. Induction of regulatory T cells: A role for probiotics and prebiotics to suppress autoimmunity. Autoimmun Rev 2016; 15:379-92. [PMID: 26774011 DOI: 10.1016/j.autrev.2016.01.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/03/2016] [Indexed: 02/07/2023]
Abstract
Regulatory T cells (Tregs) are comprised of a heterogeneous population of cells that play a vital role in suppressing inflammation and maintaining immune tolerance. Given the crucial role of Tregs in maintaining immune homeostasis, it is probably not surprising that many microbial species and their metabolites have the potential to induce Tregs. There is now great interest in the therapeutic potential of probiotics and prebiotics based strategies for a range of autoimmune disorders. This review will summarise recent findings concerning the role of probiotics and prebiotics in induction of Tregs to ameliorate the autoimmune conditions. In addition, the article is focused to explain the different mechanisms of Treg induction and function by these probiotics and prebiotics, based on the available studies till date. The article further proposes that induction of Tregs by probiotics and prebiotics could lead to the development of new therapeutic approach towards curbing the autoimmune response and as an alternative to detrimental immunosuppressive drugs.
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Affiliation(s)
- Mitesh Dwivedi
- C. G. Bhakta Institute of Biotechnology, Uka Tarsadia University, Tarsadi, Surat, Gujarat -394350, India
| | - Prasant Kumar
- C. G. Bhakta Institute of Biotechnology, Uka Tarsadia University, Tarsadi, Surat, Gujarat -394350, India
| | - Naresh C Laddha
- Department of Molecular Biology, Unipath Specialty Laboratory Ltd., Ahmedabad, Gujarat, India
| | - E Helen Kemp
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.
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Pradhan V, Kemp EH, Nadkar M, Rajadhyaksha A, Lokhandwala K, Patwardhan M, Weetman AP, Nadkarni A, Ghosh K. Association between the angiotensin-converting enzyme gene insertion/deletion polymorphism and susceptibility to systemic lupus erythematosus in an Indian population. Scand J Rheumatol 2015; 44:425-7. [DOI: 10.3109/03009742.2015.1022214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- E H Kemp
- Department of Human Metabolism, University of Sheffield, Sheffield, S10 2RX, U.K.
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Dubucquoi S, Proust-Lemoine E, Kemp EH, Ryndak A, Lefèvre-Dutoit V, Bellart M, Saugier-Véber P, Duban-Deweer S, Wémeau JL, Prin L, Lefranc D. Serological proteome analysis reveals new specific biases in the IgM and IgG autoantibody repertoires in autoimmune polyendocrine syndrome type 1. Autoimmunity 2015; 48:532-41. [PMID: 26312540 DOI: 10.3109/08916934.2015.1077230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/29/2022]
Abstract
OBJECTIVE Autoimmune polyendocrine syndrome type 1 (APS 1) is caused by mutations in the AIRE gene that induce intrathymic T-cell tolerance breakdown, which results in tissue-specific autoimmune diseases. DESIGN To evaluate the effect of a well-defined T-cell repertoire impairment on humoral self-reactive fingerprints, comparative serum self-IgG and self-IgM reactivities were analyzed using both one- and two-dimensional western blotting approaches against a broad spectrum of peripheral tissue antigens. METHODS Autoantibody patterns of APS 1 patients were compared with those of subjects affected by other autoimmune endocrinopathies (OAE) and healthy controls. RESULTS Using a Chi-square test, significant changes in the Ab repertoire were found when intergroup patterns were compared. A singular distortion of both serum self-IgG and self-IgM repertoires was noted in APS 1 patients. The molecular characterization of these antigenic targets was conducted using a proteomic approach. In this context, autoantibodies recognized more significantly either tissue-specific antigens, such as pancreatic amylase, pancreatic triacylglycerol lipase and pancreatic regenerating protein 1α, or widely distributed antigens, such as peroxiredoxin-2, heat shock cognate 71-kDa protein and aldose reductase. As expected, a well-defined self-reactive T-cell repertoire impairment, as described in APS 1 patients, affected the tissue-specific self-IgG repertoire. Interestingly, discriminant IgM reactivities targeting both tissue-specific and more widely expressed antigens were also specifically observed in APS 1 patients. Using recombinant targets, we observed that post translational modifications of these specific antigens impacted upon their recognition. CONCLUSIONS The data suggest that T-cell-dependent but also T-cell-independent mechanisms are involved in the dynamic evolution of autoimmunity in APS 1.
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Affiliation(s)
- Sylvain Dubucquoi
- a CHRU Lille, Institut d'Immunologie - Centre de Biologie Pathologie et Génétique , Lille , France
- b UDSL, EA 2686, UFR Médecine , Lille , France
- c Univ Lille Nord de France , Lille , France
| | - Emmanuelle Proust-Lemoine
- b UDSL, EA 2686, UFR Médecine , Lille , France
- c Univ Lille Nord de France , Lille , France
- d CHRU Lille Service d'Endocrinologie , Lille , France
| | - E Helen Kemp
- e Department of Human Metabolism , University of Sheffield , Sheffield , UK
| | - Amélie Ryndak
- b UDSL, EA 2686, UFR Médecine , Lille , France
- c Univ Lille Nord de France , Lille , France
- d CHRU Lille Service d'Endocrinologie , Lille , France
| | - Virginie Lefèvre-Dutoit
- a CHRU Lille, Institut d'Immunologie - Centre de Biologie Pathologie et Génétique , Lille , France
- b UDSL, EA 2686, UFR Médecine , Lille , France
- c Univ Lille Nord de France , Lille , France
| | - Marine Bellart
- a CHRU Lille, Institut d'Immunologie - Centre de Biologie Pathologie et Génétique , Lille , France
- b UDSL, EA 2686, UFR Médecine , Lille , France
- c Univ Lille Nord de France , Lille , France
| | | | - Sophie Duban-Deweer
- c Univ Lille Nord de France , Lille , France
- g UArtois, LBHE , EA 2465 , Lens , France
| | - Jean-Louis Wémeau
- b UDSL, EA 2686, UFR Médecine , Lille , France
- c Univ Lille Nord de France , Lille , France
- d CHRU Lille Service d'Endocrinologie , Lille , France
| | - Lionel Prin
- a CHRU Lille, Institut d'Immunologie - Centre de Biologie Pathologie et Génétique , Lille , France
- b UDSL, EA 2686, UFR Médecine , Lille , France
- c Univ Lille Nord de France , Lille , France
| | - Didier Lefranc
- b UDSL, EA 2686, UFR Médecine , Lille , France
- c Univ Lille Nord de France , Lille , France
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Oftedal BE, Hellesen A, Erichsen MM, Bratland E, Vardi A, Perheentupa J, Kemp EH, Fiskerstrand T, Viken MK, Weetman AP, Fleishman SJ, Banka S, Newman WG, Sewell WAC, Sozaeva LS, Zayats T, Haugarvoll K, Orlova EM, Haavik J, Johansson S, Knappskog PM, Løvås K, Wolff ASB, Abramson J, Husebye ES. Dominant Mutations in the Autoimmune Regulator AIRE Are Associated with Common Organ-Specific Autoimmune Diseases. Immunity 2015; 42:1185-96. [PMID: 26084028 DOI: 10.1016/j.immuni.2015.04.021] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [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: 03/06/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 01/13/2023]
Abstract
The autoimmune regulator (AIRE) gene is crucial for establishing central immunological tolerance and preventing autoimmunity. Mutations in AIRE cause a rare autosomal-recessive disease, autoimmune polyendocrine syndrome type 1 (APS-1), distinguished by multi-organ autoimmunity. We have identified multiple cases and families with mono-allelic mutations in the first plant homeodomain (PHD1) zinc finger of AIRE that followed dominant inheritance, typically characterized by later onset, milder phenotypes, and reduced penetrance compared to classical APS-1. These missense PHD1 mutations suppressed gene expression driven by wild-type AIRE in a dominant-negative manner, unlike CARD or truncated AIRE mutants that lacked such dominant capacity. Exome array analysis revealed that the PHD1 dominant mutants were found with relatively high frequency (>0.0008) in mixed populations. Our results provide insight into the molecular action of AIRE and demonstrate that disease-causing mutations in the AIRE locus are more common than previously appreciated and cause more variable autoimmune phenotypes.
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Affiliation(s)
- Bergithe E Oftedal
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Alexander Hellesen
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Martina M Erichsen
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Eirik Bratland
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Ayelet Vardi
- Department of Immunology, The Weizmann Institute of Science, 76100 Rehovot, Israel
| | - Jaakko Perheentupa
- Hospital for Children and Adolescents, University of Helsinki, 00100 Helsinki, Finland
| | - E Helen Kemp
- Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Torunn Fiskerstrand
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Marte K Viken
- Department of Immunology, Oslo University Hospital and University of Oslo, 0316 Oslo, Norway
| | - Anthony P Weetman
- Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Sarel J Fleishman
- Department of Biological Chemistry, The Weizmann Institute of Science, 76100 Rehovot, Israel
| | - Siddharth Banka
- Manchester Centre for Genomic Medicine, University of Manchester, Manchester M13 9WL, UK; Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre, Manchester M13 9WL, UK
| | - William G Newman
- Manchester Centre for Genomic Medicine, University of Manchester, Manchester M13 9WL, UK; Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre, Manchester M13 9WL, UK
| | - W A C Sewell
- Path Links Immunology, Scunthorpe General Hospital, Scunthorpe DN15 7BH, UK
| | - Leila S Sozaeva
- Endocrinological Research Center, Institute of Pediatric Endocrinology, Moscow 117036, Russian Federation
| | - Tetyana Zayats
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, 5021 Bergen, Norway
| | | | - Elizaveta M Orlova
- Endocrinological Research Center, Institute of Pediatric Endocrinology, Moscow 117036, Russian Federation
| | - Jan Haavik
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, 5021 Bergen, Norway
| | - Stefan Johansson
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Per M Knappskog
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Kristian Løvås
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Anette S B Wolff
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Jakub Abramson
- Department of Immunology, The Weizmann Institute of Science, 76100 Rehovot, Israel
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway.
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Mathieu AL, Verronese E, Rice GI, Fouyssac F, Bertrand Y, Picard C, Chansel M, Walter JE, Notarangelo LD, Butte MJ, Nadeau KC, Csomos K, Chen DJ, Chen K, Delgado A, Rigal C, Bardin C, Schuetz C, Moshous D, Reumaux H, Plenat F, Phan A, Zabot MT, Balme B, Viel S, Bienvenu J, Cochat P, van der Burg M, Caux C, Kemp EH, Rouvet I, Malcus C, Méritet JF, Lim A, Crow YJ, Fabien N, Ménétrier-Caux C, De Villartay JP, Walzer T, Belot A. PRKDC mutations associated with immunodeficiency, granuloma, and autoimmune regulator-dependent autoimmunity. J Allergy Clin Immunol 2015; 135:1578-88.e5. [PMID: 25842288 PMCID: PMC4487867 DOI: 10.1016/j.jaci.2015.01.040] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 12/28/2014] [Accepted: 01/06/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND PRKDC encodes for DNA-dependent protein kinase catalytic subunit (DNA-PKcs), a kinase that forms part of a complex (DNA-dependent protein kinase [DNA-PK]) crucial for DNA double-strand break repair and V(D)J recombination. In mice DNA-PK also interacts with the transcription factor autoimmune regulator (AIRE) to promote central T-cell tolerance. OBJECTIVE We sought to understand the causes of an inflammatory disease with granuloma and autoimmunity associated with decreasing T- and B-cell counts over time that had been diagnosed in 2 unrelated patients. METHODS Genetic, molecular, and functional analyses were performed to characterize an inflammatory disease evocative of a combined immunodeficiency. RESULTS We identified PRKDC mutations in both patients. These patients exhibited a defect in DNA double-strand break repair and V(D)J recombination. Whole-blood mRNA analysis revealed a strong interferon signature. On activation, memory T cells displayed a skewed cytokine response typical of TH2 and TH1 but not TH17. Moreover, mutated DNA-PKcs did not promote AIRE-dependent transcription of peripheral tissue antigens in vitro. The latter defect correlated in vivo with production of anti-calcium-sensing receptor autoantibodies, which are typically found in AIRE-deficient patients. In addition, 9 months after bone marrow transplantation, patient 1 had Hashimoto thyroiditis, suggesting that organ-specific autoimmunity might be linked to nonhematopoietic cells, such as AIRE-expressing thymic epithelial cells. CONCLUSION Deficiency of DNA-PKcs, a key AIRE partner, can present as an inflammatory disease with organ-specific autoimmunity, suggesting a role for DNA-PKcs in regulating autoimmune responses and maintaining AIRE-dependent tolerance in human subjects.
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Affiliation(s)
- Anne-Laure Mathieu
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France; Inserm U1111, Lyon, France; Ecole Normale Supérieure de Lyon, Lyon, France; CNRS, UMR5308, Lyon, France
| | - Estelle Verronese
- Université de Lyon, INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Plateforme d'Innovation en Immuno-monitoring et Immunothérapie, Centre Léon Bérard, and in the framework of the LABEX DevWeCan (ANR-10-LABX-0061) of University de Lyon, within the program "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR), Lyon, France
| | - Gillian I Rice
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Fanny Fouyssac
- Pediatric Haematology and Oncology Department, Children Hospital-CHU NANCY Vandoeuvre les Nancy, Nancy, France
| | - Yves Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique (Hospices Civils de Lyon), Université Claude Bernard Lyon I, Lyon, France
| | - Capucine Picard
- Study Center for Primary Immunodeficiencies, Assistance Publique-Hôpitaux de Paris, Necker Hospital, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Sorbonne Paris Cité, Paris Descartes University, Imagine Institute, Paris Descartes University, Paris, France
| | - Marie Chansel
- INSERM UMR 1163, Laboratoire Dynamique du Génome et Système Immunitaire Université Paris Descartes-Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Jolan E Walter
- Pediatric Allergy & Immunology and the Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Luigi D Notarangelo
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Manish J Butte
- Department of Pediatrics, Division of Immunology, Allergy and Rheumatology, Stanford University, Stanford, Calif
| | - Kari Christine Nadeau
- Department of Pediatrics, Division of Immunology, Allergy and Rheumatology, Stanford University, Stanford, Calif
| | - Krisztian Csomos
- Pediatric Allergy & Immunology and the Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - David J Chen
- Division of Molecular Radiation Biology Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Karin Chen
- Department of Pediatrics, Division of Allergy, Immunology & Rheumatology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ana Delgado
- Université de Lyon, INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Plateforme d'Innovation en Immuno-monitoring et Immunothérapie, Centre Léon Bérard, and in the framework of the LABEX DevWeCan (ANR-10-LABX-0061) of University de Lyon, within the program "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR), Lyon, France
| | - Chantal Rigal
- Université de Lyon, INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Plateforme d'Innovation en Immuno-monitoring et Immunothérapie, Centre Léon Bérard, and in the framework of the LABEX DevWeCan (ANR-10-LABX-0061) of University de Lyon, within the program "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR), Lyon, France
| | - Christine Bardin
- Université de Lyon, INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Plateforme d'Innovation en Immuno-monitoring et Immunothérapie, Centre Léon Bérard, and in the framework of the LABEX DevWeCan (ANR-10-LABX-0061) of University de Lyon, within the program "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR), Lyon, France
| | - Catharina Schuetz
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Despina Moshous
- INSERM UMR 1163, Laboratoire Dynamique du Génome et Système Immunitaire Université Paris Descartes-Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Héloïse Reumaux
- Pediatric Rheumatology and Emergency Unit, Jeanne de Flandre Hospital, Lille, France
| | - François Plenat
- Pathology Department, Hémato-Oncologie Pédiatrique, CHU Nancy, Nancy, France
| | - Alice Phan
- Pediatric Rheumatology, Nephrology and Dermatology Department and EPICIME Hospices Civils de Lyon and Université Claude-Bernard Lyon 1, Lyon, France
| | | | - Brigitte Balme
- Pathology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Viel
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France; Inserm U1111, Lyon, France; Ecole Normale Supérieure de Lyon, Lyon, France; CNRS, UMR5308, Lyon, France; Immunobiology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Jacques Bienvenu
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France; Inserm U1111, Lyon, France; Ecole Normale Supérieure de Lyon, Lyon, France; CNRS, UMR5308, Lyon, France; Immunobiology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Pierre Cochat
- Pediatric Rheumatology, Nephrology and Dermatology Department and EPICIME Hospices Civils de Lyon and Université Claude-Bernard Lyon 1, Lyon, France
| | - Mirjam van der Burg
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christophe Caux
- Université de Lyon, INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Plateforme d'Innovation en Immuno-monitoring et Immunothérapie, Centre Léon Bérard, and in the framework of the LABEX DevWeCan (ANR-10-LABX-0061) of University de Lyon, within the program "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR), Lyon, France
| | - E Helen Kemp
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Isabelle Rouvet
- Biotechnology Department, Hospices Civils de Lyon, Lyon, France
| | - Christophe Malcus
- Cell Immunology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Annick Lim
- Immunoscope Group, Immunology Department, Institut Pasteur, Paris, France
| | - Yanick J Crow
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Nicole Fabien
- Immunobiology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Christine Ménétrier-Caux
- Université de Lyon, INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Plateforme d'Innovation en Immuno-monitoring et Immunothérapie, Centre Léon Bérard, and in the framework of the LABEX DevWeCan (ANR-10-LABX-0061) of University de Lyon, within the program "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR), Lyon, France
| | - Jean-Pierre De Villartay
- INSERM UMR 1163, Laboratoire Dynamique du Génome et Système Immunitaire Université Paris Descartes-Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Thierry Walzer
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France; Inserm U1111, Lyon, France; Ecole Normale Supérieure de Lyon, Lyon, France; CNRS, UMR5308, Lyon, France
| | - Alexandre Belot
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France; Inserm U1111, Lyon, France; Ecole Normale Supérieure de Lyon, Lyon, France; CNRS, UMR5308, Lyon, France; Pediatric Rheumatology, Nephrology and Dermatology Department and EPICIME Hospices Civils de Lyon and Université Claude-Bernard Lyon 1, Lyon, France.
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Kemp EH. Programmed death 1 expressing regulatory T cells in vitiligo. Br J Dermatol 2015; 172:847-8. [PMID: 25827728 DOI: 10.1111/bjd.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E H Kemp
- Department of Human Metabolism, University of Sheffield, Sheffield, S10 2RX, U.K..
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Dwivedi M, Kemp EH, Laddha NC, Mansuri MS, Weetman AP, Begum R. Regulatory T cells in vitiligo: Implications for pathogenesis and therapeutics. Autoimmun Rev 2015; 14:49-56. [PMID: 25308528 DOI: 10.1016/j.autrev.2014.10.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/10/2014] [Indexed: 02/07/2023]
Abstract
Vitiligo is a hypomelanotic autoimmune skin disease arising from a breakdown in immunological self-tolerance, which leads to aberrant immune responses against melanocytes. Regulatory T cells (Tregs) are crucial to the development of self-tolerance and so are major foci in the study of autoimmune pathogenesis of vitiligo. This review will summarise recent findings concerning the role of Tregs in the pathogenesis of vitiligo. In addition, as antigen-specific Tregs are a potential route for the reinstatement of immune tolerance, new strategies that expand or induce de novo generation of Tregs and which are currently being investigated as therapies for other autoimmune diseases, will be discussed. These approaches will highlight the opportunities for Treg cell-based therapeutics in vitiligo.
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24
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Bellacchio E, Palma A, Corrente S, Di Girolamo F, Helen Kemp E, Di Matteo G, Comelli L, Carsetti R, Cascioli S, Cancrini C, Fierabracci A. The possible implication of the S250C variant of the autoimmune regulator protein in a patient with autoimmunity and immunodeficiency: in silico analysis suggests a molecular pathogenic mechanism for the variant. Gene 2014; 549:286-94. [PMID: 25068407 DOI: 10.1016/j.gene.2014.07.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 09/16/2013] [Revised: 07/14/2014] [Accepted: 07/24/2014] [Indexed: 12/12/2022]
Abstract
Autoimmunity can develop from an often undetermined interplay of genetic and environmental factors. Rare forms of autoimmune conditions may also result from single gene mutations as for autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy, an autosomal recessive disease associated with mutated forms of the autoimmune regulator gene. It was proposed that genetic variability in the autoimmune regulator locus, in particular heterozygous loss-of-function mutations, might favor the development of organ-specific autoimmunity by affecting the presentation of self-antigens in the thymus. Indeed, heterozygous mutations of the autoimmune regulator gene were reported in patients with organ-specific autoimmunity. Also, in primary immunodeficiencies, a breakdown in central/peripheral tolerance frequently produces association with autoimmunity. The causative link may involve a common genetic background and several gene defects have been identified as putative culprits. We report a unique patient, a 14 year old male from Lazio region, affected by common variable immunodeficiency associated with autoimmune manifestations (alopecia, onychodystrophy) and heterozygote for the S250C variant located in the SAND domain of the autoimmune regulator gene protein. To our knowledge this is the first report of the S250C variant in a patient bearing this unusual combination of autoimmunity and immunodeficiency. To obtain insights into the possible molecular effects of the S250C variant, we have carried out an in silico analysis of the SAND domain structure of the autoimmune regulator protein. In particular, homology modeling has allowed us to observe that the cysteine introduced by the S250C variant is surrounded by cationic residues, and by means of molecular dynamics simulations together with pKa calculations, we have shown that these residues remain stably proximal to cysteine-250 lowering its pKa and thus conferring high chemical reactivity to the mutated residue. We propose that the enhanced reactivity of cysteine-250, which is likely to impair the protein function but probably insufficient to produce alone a phenotype as a heterozygous S250C variant due to compensation mechanisms, might become manifest when combined with other genetic/environmental factors. These results can provide the rationale for the patient's unusual phenotype, shedding new light into the pathogenesis of the clinical association of autoimmunity and immunodeficiency.
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Affiliation(s)
- Emanuele Bellacchio
- Research Laboratories, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Alessia Palma
- Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Stefania Corrente
- University Department of Paediatrics, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Francesco Di Girolamo
- Department of Laboratory Medicine, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - E Helen Kemp
- Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Gigliola Di Matteo
- Department of Systems Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Laura Comelli
- Proteomics Laboratory Istituto di Fisiologia Clinica, CNR Via Moruzzi, 1, 56124 Pisa, Italy
| | - Rita Carsetti
- Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Simona Cascioli
- Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Caterina Cancrini
- University Department of Paediatrics, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Alessandra Fierabracci
- Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy.
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25
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Teulings HE, Willemsen KJ, Glykofridis I, Krebbers G, Komen L, Kroon MW, Kemp EH, Wolkerstorfer A, van der Veen JPW, Luiten RM, Tjin EPM. The antibody response against MART-1 differs in patients with melanoma-associated leucoderma and vitiligo. Pigment Cell Melanoma Res 2014; 27:1086-96. [DOI: 10.1111/pcmr.12294] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/16/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Hansje-Eva Teulings
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Karin J. Willemsen
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Iris Glykofridis
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Gabrielle Krebbers
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Lisa Komen
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Marije W. Kroon
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - E. Helen Kemp
- Department of Human Metabolism; The Medical School; University of Sheffield; Sheffield UK
| | - Albert Wolkerstorfer
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - J. P. Wietze van der Veen
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
- Department of Dermatology; Medisch Centrum Haaglanden; The Hague The Netherlands
| | - Rosalie M. Luiten
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Esther P. M. Tjin
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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26
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Kemp EH, Habibullah M, Kluger N, Ranki A, Sandhu HK, Krohn KJE, Weetman AP. Prevalence and clinical associations of calcium-sensing receptor and NALP5 autoantibodies in Finnish APECED patients. J Clin Endocrinol Metab 2014; 99:1064-71. [PMID: 24423312 DOI: 10.1210/jc.2013-3723] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Previous studies have identified the calcium-sensing receptor (CaSR) and NALP5 as parathyroid autoantibody targets in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). However, although NALP5 antibodies have been associated with the occurrence of hypoparathyroidism (HP) in APECED, it is unclear whether CaSR antibodies are a specific or sensitive marker for APECED-associated HP. OBJECTIVE The objective of the study was to identify associations between the presence of CaSR and NALP5 antibodies and the disease manifestations and demographic characteristics of Finnish APECED patients. DESIGN, SUBJECTS, AND METHODS This was a case-control study including 44 APECED patients and 38 age- and sex-matched healthy controls. Antibodies against the CaSR and NALP5 were detected using immunoprecipitation assays and radioligand binding assays, respectively. RESULTS CaSR and NALP5 antibodies were detected in 16 of 44 (36%) and 13 of 44 (30%) patients, respectively. No statistically significant associations were found between the presence of CaSR or NALP5 antibodies and the disease manifestations of APECED including HP (P > .05). For the diagnosis of HP, CaSR and NALP5 antibodies had specificities of 83% and 50%, respectively, and sensitivities of 39% and 26%, respectively. A significant association between both a shorter APECED and HP duration (<10 y) and positivity for CaSR antibodies was noted (P = .019 and P = .0061, respectively). CONCLUSION Neither CaSR nor NALP5 antibodies were found to be specific or sensitive markers for HP in APECED. Further investigations are required to determine the exact role of the autoimmune response against the CaSR and NALP5 in the pathogenesis of this autoimmune syndrome.
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Affiliation(s)
- E Helen Kemp
- Department of Human Metabolism (E.H.K., M.H., H.K.S., A.P.W.), The Medical School, University of Sheffield, Sheffield S10 2RX, United Kingdom; Department of Dermatology, Allergology, and Venereology (N.K., A.R.), Institute of Clinical Medicine, University of Helsinki and Helsinki University Central Hospital, 00290 Helsinki, Finland; and Clinical Research Institute (K.J.E.K.), HUCH Ltd, 00029 HUS Helsinki, Finland
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27
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Patwardhan M, Pradhan V, Taylor LH, Thakkar V, Kharkar V, Khopkar U, Ghosh K, Gawkrodger DJ, Teare MD, Weetman AP, Kemp EH. The angiotensin-converting enzyme gene insertion/deletion polymorphism in Indian patients with vitiligo: a case-control study and meta-analysis. Br J Dermatol 2014; 168:1195-204. [PMID: 23278772 DOI: 10.1111/bjd.12177] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Vitiligo is a common, acquired, idiopathic depigmenting skin disorder. Although the exact pathogenesis remains unknown, genetic susceptibility and autoimmune responses play a role in vitiligo development. Previous studies have suggested that the D allele of the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with vitiligo in Indians and Koreans. Furthermore, significantly higher serum ACE levels have been demonstrated in patients with some autoimmune and autoinflammatory disorders. OBJECTIVES The objectives were to investigate any association between the ACE I/D polymorphism and vitiligo susceptibility in an Indian population, and to compare serum ACE levels in patients with vitiligo and healthy subjects. METHODS The ACE I/D genotypes of 79 patients with vitiligo and 100 normal individuals were determined by polymerase chain reaction amplification. A meta-analysis was done to compare the distribution of the ACE I/D alleles and genotypes in the current and three previous studies. Serum ACE levels were evaluated by enzyme-linked immunosorbent assay. RESULTS A significant increase in the frequency of the ACE I/D D allele was evident in patients with vitiligo in both the case-control study [P=0·005; odds ratio (OR) 1·87; 95% confidence intervals (CI) 1·22-2·85] and the meta-analysis (P=0·044; OR 1·44; 95% CI 1·01-2·06). Serum ACE levels were significantly increased in patients with vitiligo compared with healthy subjects (P<0·0001). CONCLUSIONS In agreement with earlier reports, the ACE I/D D allele is associated with vitiligo susceptibility in the Indian population. The significantly elevated serum ACE levels in our cohort of patients with vitiligo concur with those previously found in patients with some other autoimmune diseases.
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Affiliation(s)
- M Patwardhan
- Department of Clinical and Experimental Immunology, National Institute of Immunohaematology, Indian Council of Medical Research, Mumbai 400012, India
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28
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Godlewska M, Góra M, Buckle AM, Porebski BT, Kemp EH, Sutton BJ, Czarnocka B, Banga JP. A redundant role of human thyroid peroxidase propeptide for cellular, enzymatic, and immunological activity. Thyroid 2014; 24:371-82. [PMID: 23668778 PMCID: PMC3926150 DOI: 10.1089/thy.2013.0127] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyroid peroxidase (TPO) is a dimeric membrane-bound enzyme of thyroid follicular cells, responsible for thyroid hormone biosynthesis. TPO is also a common target antigen in autoimmune thyroid disease (AITD). With two active sites, TPO is an unusual enzyme, and thus there is much interest in understanding its structure and role in AITD. Homology modeling has shown TPO to be composed of different structural modules, as well as a propeptide sequence. During the course of studies to obtain homogeneous preparations of recombinant TPO for structural studies, we investigated the role of the large propeptide sequence in TPO. METHODS An engineered recombinant human TPO preparation expressed in Chinese hamster ovary (CHO) cells lacking the propeptide (TPOΔpro; amino acid residues 21-108) was characterized and its properties compared to wild-type TPO. Plasma membrane localization was determined by cell surface protein biotinylation, and biochemical studies were performed to evaluate enzymatic activity and the effect of deglycosylation. Immunological investigations using autoantibodies from AITD patients and other epitope-specific antibodies that recognize conformational determinants on TPO were evaluated for binding to TPOΔpro by flow cytometry, immunocytochemistry, and capture enzyme-linked immunosorbent assay. Molecular modeling and dynamics simulation of TPOΔpro comprising a dimer of myeloperoxidase-like domains was performed in order to investigate the impact of propeptide removal and the role of glycosylation. RESULTS The TPOΔpro was expressed on the cell surface at comparable levels to wild-type TPO. The TPOΔpro was enzymatically active and recognized by patients' autoantibodies and a panel of epitope-specific antibodies, confirming structural integrity of the two major conformational determinants recognized by autoantibodies. Faithful intracellular trafficking and N-glycosylation of TPOΔpro was also maintained. Molecular modeling and dynamics simulations were consistent with these observations. CONCLUSIONS Our results point to a redundant role for the propeptide sequence in TPO. The successful expression of TPOΔpro in a membrane-anchored, enzymatically active form that is insensitive to intramolecular proteolysis, and importantly is recognized by patients' autoantibodies, is a key advance for purification of substantial quantities of homogeneous preparation of TPO for crystallization, structural, and immunological studies.
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Affiliation(s)
- Marlena Godlewska
- Department of Biochemistry and Molecular Biology, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Monika Góra
- Department of Genetics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Ashley M. Buckle
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Monash University, Clayton, Australia
| | - Benjamin T. Porebski
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Monash University, Clayton, Australia
| | - E. Helen Kemp
- Department of Human Metabolism, School of Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Brian J. Sutton
- Randall Division of Cell & Molecular Biophysics, King's College London, London, United Kingdom
| | - Barbara Czarnocka
- Department of Biochemistry and Molecular Biology, Medical Center of Postgraduate Education, Warsaw, Poland
| | - J. Paul Banga
- Division of Diabetes and Nutritional Sciences, School of Medicine, King's College London, London, United Kingdom
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Kuo E, Kemp EH, Sandhu HK, Brown EM, Weetman AP, Huang CL. Acquired hypocalciuric hypercalcemia in a patient with CKD. Am J Kidney Dis 2013; 62:1151-4. [PMID: 23810542 DOI: 10.1053/j.ajkd.2013.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 04/16/2013] [Indexed: 12/30/2022]
Abstract
We present a case of an 82-year-old woman with elevated parathyroid hormone (PTH) levels, hypocalciuria, hypercalcemia, and stage 3 chronic kidney disease. Hypocalciuria initially was attributed to chronic kidney disease, and hypercalcemia was attributed to primary hyperparathyroidism. Subsequent laboratory studies showed autoantibodies in the patient's serum directed against the calcium-sensing receptor (CaSR). Functional testing in a CaSR-transfected human embryonic kidney-293 cell line showed that the patient's antibodies inhibited CaSR-mediated intracellular signaling that ordinarily would have been stimulated by extracellular calcium ions. Her serum calcium and PTH levels were normalized by treatment with the calcimimetic cinacalcet. We advise consideration of the presence of inhibitory autoantibodies directed at the CaSR in patients with hypercalcemic hyperparathyroidism and unexplained hypocalciuria or with confounding conditions affecting interpretation of urinary calcium measurement. A calcimimetic is an effective treatment for the hypercalcemia and elevated PTH levels in acquired hypocalciuric hypercalcemia caused by inhibitory anti-CaSR autoantibodies.
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Affiliation(s)
- Elizabeth Kuo
- Department of Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX.
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30
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Teulings HE, Tjin EPM, Willemsen KJ, Krebbers G, van Noesel CJ, Kemp EH, Nieuweboer-Krobotova L, van der Veen JPW, Luiten RM. Radiation-induced melanoma-associated leucoderma, systemic antimelanoma immunity and disease-free survival in a patient with advanced-stage melanoma: a case report and immunological analysis. Br J Dermatol 2013; 168:733-8. [PMID: 23421690 DOI: 10.1111/bjd.12136] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Melanoma is an immunogenic tumour. The development of skin depigmentation or melanoma-associated leucoderma (MAL) has been associated with favourable clinical outcome in patients with metastatic melanoma, especially after immunotherapy. Evidence for clinically meaningful enhancement of melanoma-directed autoimmunity, as indicated by MAL, after radiotherapy without immunotherapy has not yet been published. OBJECTIVES We investigated whether a patient with stage IV melanoma, who developed leucoderma in the irradiated skin areas following radiotherapy and experienced exceptional disease-free survival of 3 years despite brain metastasis, possessed antimelanoma immunity that could be linked to the favourable disease course. METHODS A detailed immunological analysis was performed consisting of immunohistochemistry of several melanoma tissues, and analyses of T cells isolated from the blood and MAL skin tissue for melanocyte/melanoma specificity and functionality, as well as the presence of a melanoma-specific antibody response. RESULTS Immunological analyses showed the presence of CD8+ T cells and antibody responses directed against melanocyte differentiation antigens expressed in the primary tumour, lymph node and brain metastasis, indicating adequate tumour recognition by activated T cells. CONCLUSION The immune responses found in this patient, probably enhanced by radiotherapy, are thought to have contributed to his favourable clinical course. Radiotherapy may act as local immunotherapy in patients with melanoma by destroying melanocytes, leading to the induction, or enhancement, of already existent antimelanoma immunity. As in patients treated with immunotherapy, this may lead to MAL, also at distant sites from the treated area. This patient is a clear example of the positive prognostic value of MAL, which is possibly induced by radiotherapy, for patients with melanoma.
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Affiliation(s)
- H E Teulings
- Department of Dermatology and the Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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31
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Kemp EH, Sandhu HK, Watson PF, Weetman AP. Low frequency of pendrin autoantibodies detected using a radioligand binding assay in patients with autoimmune thyroid disease. J Clin Endocrinol Metab 2013; 98:E309-13. [PMID: 23322815 DOI: 10.1210/jc.2012-3683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/19/2022]
Abstract
CONTEXT Pendrin is a transmembrane protein located at the apical end of the thyrocyte in which it mediates the efflux of iodide through the thyroid follicular cell. Recently pendrin was described as a significant antibody target in Japanese patients with Graves' disease (GD) or autoimmune hypothyroidism (AH) using an immunoblotting assay. However, a subsequent study failed to verify this in autoimmune thyroid disease (ATD) patients of Tunisian origin. OBJECTIVE The aim of the current study was to evaluate a UK population of patients with ATD for the presence of pendrin autoantibodies using a novel radioligand binding assay (RBA). RESULTS Sera from 71 GD and 66 AH patients and 28 healthy controls were evaluated for pendrin autoantibody reactivity in RBAs. The results indicated that 8.8% of patients with ATD (9.9% GD and 7.6% AH) were positive for pendrin autoantibodies. Overall, the frequency of pendrin autoantibodies did not differ significantly between the ATD patient cohorts and the healthy control group: P = .186 and P = .317 for GD and AH patients, respectively. CONCLUSION Pendrin autoantibodies, detected using a novel RBA, are not widely prevalent in UK patients with ATD, nor do they differ in frequency between GD and AH. These autoantibodies are therefore unlikely to be a useful marker for disease diagnosis, although the role that pendrin may play as an autoantigen in the initiation or maintenance of thyroid autoimmunity remains to be established.
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Affiliation(s)
- E Helen Kemp
- Department of Human Metabolism, The Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, United Kingdom.
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Jin Y, Birlea SA, Fain PR, Ferrara TM, Ben S, Riccardi SL, Cole JB, Gowan K, Holland PJ, Bennett DC, Luiten RM, Wolkerstorfer A, van der Veen JPW, Hartmann A, Eichner S, Schuler G, van Geel N, Lambert J, Kemp EH, Gawkrodger DJ, Weetman AP, Taïeb A, Jouary T, Ezzedine K, Wallace MR, McCormack WT, Picardo M, Leone G, Overbeck A, Silverberg NB, Spritz RA. Genome-wide association analyses identify 13 new susceptibility loci for generalized vitiligo. Nat Genet 2012; 44:676-80. [PMID: 22561518 PMCID: PMC3366044 DOI: 10.1038/ng.2272] [Citation(s) in RCA: 223] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/11/2012] [Indexed: 12/15/2022]
Abstract
In previous linkage and genome-wide association studies we identified 17 susceptibility loci for generalized vitiligo. By a second genome-wide association study, meta-analysis, and independent replication study, we have now identified 13 additional vitiligo-associated loci, including OCA2-HERC2, a region of 16q24.3 containing MC1R, a region of chromosome 11q21 near TYR, several immunoregulatory loci including IFIH1, CD80, CLNK, BACH2, SLA, CASP7, CD44, IKZF4, SH2B3, and a region of 22q13.2 where the causal gene remains uncertain. Functional pathway analysis shows that most vitiligo susceptibility loci encode immunoregulatory proteins or melanocyte components that likely mediate immune targeting and genetic relationships among vitiligo, malignant melanoma, and normal variation of eye, skin, and hair color.
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Affiliation(s)
- Ying Jin
- Human Medical Genetics Program, University of Colorado School of Medicine, Aurora, Colorado, USA
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Kroon MW, Kemp EH, Wind BS, Krebbers G, Bos JD, Gawkrodger DJ, Wolkerstorfer A, van der Veen JPW, Luiten RM. Melanocyte antigen-specific antibodies cannot be used as markers for recent disease activity in patients with vitiligo. J Eur Acad Dermatol Venereol 2012; 27:1172-5. [PMID: 22404127 DOI: 10.1111/j.1468-3083.2012.04501.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Objective parameters to assess disease activity in non-segmental vitiligo are lacking. Melanocyte antigen-specific antibodies are frequently found in the sera of patients with vitiligo and the presence of these antibodies may correlate with disease activity. OBJECTIVE To investigate the relationship between melanocyte antigen-specific antibodies and recent disease activity in patients with vitiligo and to evaluate the potential usefulness of this objective parameter in daily clinical practice. METHODS The prevalence of tyrosinase, melanoma antigen recognized by T-cells-1 (MART1), melanin-concentrating hormone receptor-1 (MCHR1), gp100 and tyrosine hydroxylase (TH) antibodies was evaluated in 21 patients with non-segmental vitiligo and in 20 healthy controls. RESULTS In 21 patients, nine (42.8%) showed antibody responses against tyrosinase, MART1, MCHR1, gp100 or TH. No antibody responses were found in the 20 controls. No correlation was found between the presence of antibodies and recent disease activity or other clinical characteristics such as age, gender, extension and duration of vitiligo. CONCLUSIONS In this study, 42.8% of the vitiligo patients showed an antibody response to melanocyte antigen-specific antigens. However, the presence of antibodies against melanocytes did not correlate with recent disease activity or other relevant disease parameters, and for the moment screening for these antibodies in individual patients does not appear to be clinically relevant.
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Affiliation(s)
- M W Kroon
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Pradhan V, Patwardhan M, Thakkar V, Kharkar V, Khopkar U, Ghosh K, Weetman AP, Gawkrodger DJ, Kemp EH. Vitiligo patients from India (Mumbai) show differences in clinical, demographic and autoantibody profiles compared to patients in western countries. J Eur Acad Dermatol Venereol 2011; 27:279-86. [PMID: 22122088 DOI: 10.1111/j.1468-3083.2011.04367.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vitiligo is a common, idiopathic skin disorder characterized by depigmented skin due to the loss of cutaneous melanocytes. Several studies have reported the clinical and demographic characteristics of Indian vitiligo patients, however, none has characterized their antibody profiles. OBJECTIVE To establish the clinical, demographic and serological details of a population of vitiligo patients from Mumbai, India, and to evaluate the data for any associations between clinical presentations and the occurrence of antibody responses. METHODS Vitiligo patients (n = 79) were recruited to the study and their clinical and demographic details recorded. Serum antibodies, including those against melanocyte-specific antigens, thyroid antigens and keratinocytes, were evaluated. RESULTS The prevalence of vitiligo was independent of sex, and non-segmental vitiligo was the most common form of the disease occurring in 65% of the patients. Patients with segmental vitiligo (mean age = 14.4 ± 4.6 years) presented at a younger age than those with non-segmental disease (mean age = 32.5 ± 17.8 years). Personal and family histories of other autoimmune diseases occurred in 3% and 8% of patients, respectively. Antibodies were detected against tyrosinase, tyrosine hydroxylase, thyroid peroxidase, thyroglobulin and keratinocytes at frequencies of 11%, 22%, 18%, 24% and 27%, respectively. Overall, antibodies were more common in patients with non-segmental vitiligo (50-67%) than in those with segmental disease (0-17%), and were detected more frequently in patients with shorter disease durations (<10 years). CONCLUSION Our study provides novel information relative to the clinical details, demographic features and serological parameters of a population of vitiligo patients from Mumbai, India. Important distinctions from similar surveys conducted in European patients were evident such as an infrequency of family history, a low prevalence of clinical autoimmune disease, and an absence of particular antibody specificities. These differences may have a bearing on the pathogenesis and course of the disease in Indian patients.
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Affiliation(s)
- V Pradhan
- Department of Autoimmune Disorders, National Institute of Immunohaematology, Indian Council of Medical Research, King Edward Memorial Hospital, Parel, Mumbai India Department of Dermatology, King Edward Memorial Hospital, Parel, Mumbai, India Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK Department of Dermatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Kemp EH, Emhemad S, Akhtar S, Watson PF, Gawkrodger DJ, Weetman AP. Autoantibodies against tyrosine hydroxylase in patients with non-segmental (generalised) vitiligo. Exp Dermatol 2011; 20:35-40. [PMID: 21158937 DOI: 10.1111/j.1600-0625.2010.01181.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Vitiligo is an acquired idiopathic hypomelanotic skin disorder characterised by depigmented macules because of loss of cutaneous melanocytes. Although the exact cause of vitiligo remains obscure, evidence suggests that autoimmunity plays a role in the pathogenesis of the disease. Previously, tyrosine hydroxylase (TH) was identified as a putative autoantigen in vitiligo using phage-display technology. In this study, the prevalence of TH antibodies in patients with vitiligo was investigated. A radioimmunoassay (RIA) was used to detect TH antibodies in sera from patients with either non-segmental vitiligo (n=79), segmental vitiligo (n=8) or other autoimmune diseases without concomitant vitiligo (n=91). Sera from healthy individuals (n=28) were also tested. Patients with segmental vitiligo, healthy controls and patients with other autoimmune diseases without concomitant vitiligo were all negative for TH antibody reactivity. Of 79 patients with non-segmental vitiligo, 18 (23%) were positive for TH antibodies in the RIA, and a significant increase in the prevalence of TH antibodies in patients with non-segmental vitiligo was evident when compared with controls (P=0.003). TH antibody prevalence was also significantly elevated in patients with active vitiligo compared to those with stable disease (P=0.009). Overall, the results indicate that TH is an antibody target in non-segmental but not in segmental vitiligo and that TH antibodies appear to be more frequent in patients with active vitiligo.
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Affiliation(s)
- E Helen Kemp
- Department of Human Metabolism, School of Medicine, University of Sheffield, Sheffield, UK.
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36
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Pallais JC, Kemp EH, Bergwitz C, Kantham L, Slovik DM, Weetman AP, Brown EM. Autoimmune hypocalciuric hypercalcemia unresponsive to glucocorticoid therapy in a patient with blocking autoantibodies against the calcium-sensing receptor. J Clin Endocrinol Metab 2011; 96:672-80. [PMID: 21159843 PMCID: PMC3047232 DOI: 10.1210/jc.2010-1739] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 11/04/2010] [Indexed: 12/24/2022]
Abstract
CONTEXT Autoantibodies directed against the calcium-sensing receptor (CaSR) have been reported in several individuals with various autoimmune disorders and PTH-mediated hypercalcemia. Previously, glucocorticoid treatment has been shown to decrease the CaSR autoantibody titers and normalize the hypercalcemia in a patient with autoimmune hypocalciuric hypercalcemia (AHH). OBJECTIVE The objective of the study was to evaluate a patient with AHH for the presence of blocking autoantibodies against the CaSR and to monitor her biochemical and serological responses to a trial of glucocorticoid therapy. RESULTS Glucocorticoid treatment had no effect on serum total or ionized calcium concentration or serum PTH levels, all of which remained at higher than normal levels. In contrast, on prednisone, urinary calcium excretion increased from overtly hypocalciuric levels to normal values. Anti-CaSR autoantibodies were detected at similar levels in the patient's serum before, during, and after glucocorticoid treatment. Functional testing of these antibodies showed that they inhibited the stimulatory effect of extracellular Ca(2+) on ERK1/2 but did not suppress the calcium-induced accumulation of inositol-1-phosphate. CONCLUSIONS We report a patient with AHH with frankly elevated PTH levels who was found to have autoantibodies against the CaSR. The hypercalcemia and CaSR autoantibody titers failed to respond to glucocorticoid therapy, unlike a previously reported patient with similar clinical and biochemical features. The anti-CaSR antibody-mediated inhibition of CaSR-stimulated ERK1/2 activity, but not of inositol-1-phosphate accumulation, suggests that ERK1/2 may mediate, at least in part, the regulation of PTH secretion and urinary calcium excretion by the CaSR.
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Affiliation(s)
- J Carl Pallais
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Jin Y, Birlea SA, Fain PR, Gowan K, Riccardi SL, Holland PJ, Bennett DC, Herbstman DM, Wallace MR, McCormack WT, Kemp EH, Gawkrodger DJ, Weetman AP, Picardo M, Leone G, Taïeb A, Jouary T, Ezzedine K, van Geel N, Lambert J, Overbeck A, Spritz RA. Genome-wide analysis identifies a quantitative trait locus in the MHC class II region associated with generalized vitiligo age of onset. J Invest Dermatol 2011; 131:1308-12. [PMID: 21326295 DOI: 10.1038/jid.2011.12] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Generalized vitiligo is a common autoimmune disease in which acquired patchy depigmentation of skin, hair, and mucous membranes results from loss of melanocytes from involved areas. Previous genetic analyses have focused on vitiligo susceptibility, and have identified a number of genes involved in disease risk. Age of onset of generalized vitiligo also involves a substantial genetic component, but has not previously been studied systematically. In this study, we report a genome-wide association study of vitiligo age of onset in 1,339 generalized vitiligo patients, with replication in an independent cohort of 677 cases. We identified a quantitative trait locus for vitiligo age of onset in the major histocompatibility complex (MHC) class II region, located near c6orf10-BTNL2 (rs7758128; P=8.14 × 10(-11)), a region that is also associated with generalized vitiligo susceptibility. In contrast, there was no association of vitiligo age of onset with any other MHC or non-MHC loci that are associated with vitiligo susceptibility. These findings highlight the differing roles played by genes involved in vitiligo susceptibility versus vitiligo age of onset, and illustrate that genome-wide analyses can be used to identify genes involved in quantitative aspects of disease natural history, as well as disease susceptibility per se.
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Affiliation(s)
- Ying Jin
- Human Medical Genetics Program, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA
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Cantòn I, Cole DM, Kemp EH, Watson PF, Chunthapong J, Ryan AJ, MacNeil S, Haycock JW. Development of a 3D human in vitro skin co-culture model for detecting irritants in real-time. Biotechnol Bioeng 2010; 106:794-803. [PMID: 20564616 DOI: 10.1002/bit.22742] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tissue engineered materials for clinical purposes have led to the development of in vitro models as alternatives to animal testing. The aim of this study was to understand the paracrine interactions arising between keratinocytes and fibroblasts for detecting and discriminating between an irritant-induced inflammatory reaction and cytotoxicity. We used two irritants [sodium dodecyl sulphate (SDS) and potassium diformate (Formi] at sub-toxic concentrations and studied interleukin-1 alpha (IL-1 alpha) release from human keratinocytes and activation of NF-kappaB in human fibroblasts. NF-kappaB activation in fibroblast 2D cultures required soluble factors released by prior incubation of keratinocytes with either SDS or Formi. Neither cell type responded directly to either agent, confirming a paracrine mechanism. Fibroblasts were then cultured in 3D microfiber scaffolds and transfected with an NF-kappaB reporter construct linked to GFP. Findings for 3D cultures were similar to those in 2D in that soluble factors released by prior incubation of keratinocytes with SDS or Formi was required for NF-kappaB activation in fibroblasts. Similarly, direct incubation with either agent did not directly activate NF-kappaB. A technical advantage of using transfected cells in 3D was an ability to detect NF-kappaB activation in live fibroblasts. To confirm paracrine signaling a twofold increase in IL-1 alpha was measured in keratinocyte-conditioned medium after incubation with SDS or Formi, which correlated with fibroblast NF-kappaB activity. In summary, this work has value for developing 3D tissue engineered co-culture models for the in vitro testing of irritant chemicals at sub-toxic concentrations, as an alternative to in vivo models.
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Affiliation(s)
- I Cantòn
- Department of Engineering Materials, University of Sheffield, Kroto Research Institute, Broad Lane, Sheffield, S3 7HQ, UK
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Jin Y, Birlea SA, Fain PR, Mailloux CM, Riccardi SL, Gowan K, Holland PJ, Bennett DC, Wallace MR, McCormack WT, Kemp EH, Gawkrodger DJ, Weetman AP, Picardo M, Leone G, Taïeb A, Jouary T, Ezzedine K, van Geel N, Lambert J, Overbeck A, Spritz RA. Common variants in FOXP1 are associated with generalized vitiligo. Nat Genet 2010; 42:576-8. [PMID: 20526340 PMCID: PMC2893242 DOI: 10.1038/ng.602] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 05/03/2010] [Indexed: 11/27/2022]
Abstract
In a recent genome-wide association study of generalized vitiligo, we identified ten confirmed susceptibility loci. By testing additional loci that showed suggestive association in the genome-wide study, using two replication cohorts of European descent, we observed replicated association of generalized vitiligo with variants at 3p13 encompassing FOXP1 (rs17008723, combined P=1.04x10(-8)) and with variants at 6q27 encompassing CCR6 (rs6902119, combined P=3.94x10(-7)).
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Affiliation(s)
- Ying Jin
- Human Medical Genetics Program, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Abstract
1. This investigation has been concerned with an analysis of brightness discrimination as it is influenced by the duration of ΔI. The durations used extend from 0.002 second to 0.5 second. 2. ΔI/I values at constant intensity are highest for the shortest duration and decrease with an increase in duration up to the limits of a critical exposure time. At durations longer than the critical duration the ratio ΔI/I remains constant. 3. The Bunsen-Roscoe law holds for the photolysis due to ΔI. This is shown by the fact that, within the limits of a critical duration, the product of ΔI and exposure time is constant for any value of prevailing intensity, I. 4. At durations greater than the critical duration the Bunsen-Roscoe law is superseded by the relation ΔI = Constant. This change of relation is considered in the light of Hartline's discussion (1934). 5. The critical duration is a function of intensity. As intensity increases the critical duration decreases. 6. Hecht's theory (1935) accounts for the data of this experiment if it be assumed that brightness discrimination is determined by a constant amount of photolysis.
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Affiliation(s)
- C H Graham
- Psychological Laboratory, Brown University, Providence
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Jin Y, Birlea SA, Fain PR, Gowan K, Riccardi SL, Holland PJ, Mailloux CM, Sufit AJD, Hutton SM, Amadi-Myers A, Bennett DC, Wallace MR, McCormack WT, Kemp EH, Gawkrodger DJ, Weetman AP, Picardo M, Leone G, Taïeb A, Jouary T, Ezzedine K, van Geel N, Lambert J, Overbeck A, Spritz RA. Variant of TYR and autoimmunity susceptibility loci in generalized vitiligo. N Engl J Med 2010; 362:1686-97. [PMID: 20410501 PMCID: PMC2891985 DOI: 10.1056/nejmoa0908547] [Citation(s) in RCA: 262] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Generalized vitiligo is an autoimmune disease characterized by melanocyte loss, which results in patchy depigmentation of skin and hair, and is associated with an elevated risk of other autoimmune diseases. METHODS To identify generalized vitiligo susceptibility loci, we conducted a genomewide association study. We genotyped 579,146 single-nucleotide polymorphisms (SNPs) in 1514 patients with generalized vitiligo who were of European-derived white (CEU) ancestry and compared the genotypes with publicly available control genotypes from 2813 CEU persons. We then tested 50 SNPs in two replication sets, one comprising 677 independent CEU patients and 1106 CEU controls and the other comprising 183 CEU simplex trios with generalized vitiligo and 332 CEU multiplex families. RESULTS We detected significant associations between generalized vitiligo and SNPs at several loci previously associated with other autoimmune diseases. These included genes encoding major-histocompatibility-complex class I molecules (P=9.05x10(-23)) and class II molecules (P=4.50x10(-34)), PTPN22 (P=1.31x10(-7)), LPP (P=1.01x10(-11)), IL2RA (P=2.78x10(-9)), UBASH3A (P=1.26x10(-9)), and C1QTNF6 (P=2.21x10(-16)). We also detected associations between generalized vitiligo and SNPs in two additional immune-related loci, RERE (P=7.07x10(-15)) and GZMB (P=3.44x10(-8)), and in a locus containing TYR (P=1.60x10(-18)), encoding tyrosinase. CONCLUSIONS We observed associations between generalized vitiligo and markers implicating multiple genes, some associated with other autoimmune diseases and one (TYR) that may mediate target-cell specificity and indicate a mutually exclusive relationship between susceptibility to vitiligo and susceptibility to melanoma.
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Affiliation(s)
- Ying Jin
- Human Medical Genetics Program, School of Medicine, University of Colorado, P.O. Box 6511, Mailstop 8300, Aurora, CO 80045, USA
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Kemp EH, Gavalas NG, Krohn KJE, Brown EM, Watson PF, Weetman AP. Activating autoantibodies against the calcium-sensing receptor detected in two patients with autoimmune polyendocrine syndrome type 1. J Clin Endocrinol Metab 2009; 94:4749-56. [PMID: 19837919 PMCID: PMC2795648 DOI: 10.1210/jc.2009-1080] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 08/27/2009] [Indexed: 11/19/2022]
Abstract
CONTEXT Autoimmune polyendocrine syndrome type 1 (APS1) is an autosomal recessive disorder caused by mutations in the autoimmune regulator (AIRE) gene. Hypoparathyroidism occurs in 80% of patients with APS1 and has been suggested to result from an autoimmune reaction against the calcium-sensing receptor (CaSR) in parathyroid cells. Anti-CaSR binding antibodies have previously been detected in patients with APS1. OBJECTIVE The aim of this study was to determine whether anti-CaSR antibodies present in APS1 patients could modulate the response of the CaSR to stimulation by Ca(2+). RESULTS The results indicated that two of the 14 APS1 patients included in the study had anti-CaSR antibodies that stimulated the receptor. These antibodies were detected by their ability to increase both Ca(2+)-dependent extracellular signal-regulated kinase phosphorylation and inositol phosphate accumulation in human embryonic kidney 293 cells expressing the CaSR. CONCLUSION An important implication of the present results is that although the majority of APS1 patients do not have CaSR-stimulating antibodies, there may be a small but substantial minority of patients in whom the hypoparathyroid state is the result of functional suppression of the parathyroid glands rather than their irreversible destruction.
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Affiliation(s)
- E Helen Kemp
- Department of Human Metabolism, School of Medicine, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
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Kemp EH, Weetman AP. Melanin-concentrating hormone and melanin-concentrating hormone receptors in mammalian skin physiopathology. Peptides 2009; 30:2071-5. [PMID: 19442695 DOI: 10.1016/j.peptides.2009.04.025] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 04/29/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022]
Abstract
To date, there is a dearth of evidence to support functions for melanin-concentrating hormone (MCH) and melanin-concentrating hormone receptors (MCH-R) in mammalian skin physiology including pigmentation, inflammation and immune responses and skin cell proliferation. Much research is therefore still needed to define the roles of the hormone and its receptors in mammalian skin. This will be a crucial step to identifying pathogenic mechanisms that may involve the MCH/MCH-R system in the context of inflammatory and autoimmune skin diseases as well as skin cancers. The following review summarizes the studies which have been carried out to examine the expression and function of MCH and MCH-R in mammalian skin. Recent findings with regard to humoral immune responses to the MCH-R1 in patients with the skin depigmenting disease vitiligo are also discussed.
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Affiliation(s)
- E Helen Kemp
- Department of Human Metabolism, University of Sheffield, United Kingdom.
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Gavalas NG, Gottumukkala RVSRK, Gawkrodger DJ, Watson PF, Weetman AP, Kemp EH. Mapping of melanin-concentrating hormone receptor 1 B cell epitopes predicts two major binding sites for vitiligo patient autoantibodies. Exp Dermatol 2009; 18:454-63. [PMID: 19320743 DOI: 10.1111/j.1600-0625.2008.00813.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The melanin-concentrating hormone receptor 1 (MCHR1) has been identified as a B cell autoantigen in vitiligo with antibodies to the receptor detectable in binding and function-blocking assays. Two epitope domains (amino acids 1-138 and 139-298) have been previously identified. In this study, we aimed to further define the epitope specificity of MCHR1 antibodies using phage-display technology and to identify the epitopes recognised by receptor antibodies detected in MCHR1 function-blocking assays. Antibody reactivity to MCHR1 peptides 51-80, 85-98, 154-158 and 254-260 was identified by phage-display and subsequently confirmed in phage ELISA in 2/12, 5/12, 3/12 and 6/12 of vitiligo patients, respectively. The results suggest that major autoantibody epitopes are localised in the 85-98 and 254-260 amino acid regions of MCHR1 with minor epitopes in amino acid sequences 51-80 and 154-158. Antibodies with MCHR1 function-blocking activity were determined to recognise epitope 254-260, this being the first epitope to be reported as a target site for antibodies that block the function of the receptor.
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Affiliation(s)
- Nikos G Gavalas
- School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
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Skinningsrud B, Husebye ES, Gervin K, Løvås K, Blomhoff A, Wolff AB, Kemp EH, Egeland T, Undlien DE. Mutation screening of PTPN22: association of the 1858T-allele with Addison's disease. Eur J Hum Genet 2008; 16:977-82. [PMID: 18301444 DOI: 10.1038/ejhg.2008.33] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The tyrosine-protein phosphatase non-receptor type 22 (PTPN22) gene was recently identified as an important genetic susceptibility factor in several autoimmune diseases. The increased risk has been broadly explained by the 1858T-allele (rs2476601). As two smaller studies on Addison's disease (AD) have shown diverging results, we aimed to elucidate the predisposing effect of the single-nucleotide polymorphism (SNP) 1858CT in a larger population of AD patients, especially focusing on the AD patients with known autoimmune etiology. We also screened for unknown rare or common variants in the PTPN22 gene that could predispose for AD. The case-control study of Norwegian AD patients (n=332) and controls (n=990) showed a significant association between autoimmune AD (n=302) and the PTPN22 1858T risk allele (P=0.016). The association of AD with 1858T was supported by a meta-analysis combining our genotype data with that of others published previously (P=0.003). The mutation screening of PTPN22 in AD patients (n=332) and controls (n=112) revealed eight missense variants, five of which have not been reported previously. In conclusion, the 1858T-allele is a PTPN22 genetic susceptibility factor for autoimmune AD. Other rare variants in PTPN22 do occur, and may also be involved in the pathogenesis.
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Affiliation(s)
- Beate Skinningsrud
- Institute of Medical Genetics, University of Oslo, Department of Medical Genetics, Ullevaal University Hospital, Oslo, Norway.
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Schallreuter KU, Bahadoran P, Picardo M, Slominski A, Elassiuty YE, Kemp EH, Giachino C, Liu JB, Luiten RM, Lambe T, Le Poole IC, Dammak I, Onay H, Zmijewski MA, Dell'Anna ML, Zeegers MP, Cornall RJ, Paus R, Ortonne JP, Westerhof W. Vitiligo pathogenesis: autoimmune disease, genetic defect, excessive reactive oxygen species, calcium imbalance, or what else? Exp Dermatol 2008; 17:139-40; discussion 141-60. [PMID: 18205713 DOI: 10.1111/j.1600-0625.2007.00666_1.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The pathobiology of vitiligo has been hotly disputed for as long as one remembers, and has been a magnet for endless speculation. Evidently, the different schools of thought--ranging, e.g. from the concept that vitiligo essentially is a free-radical disorder to that of vitiligo being a primary autoimmune disease--imply very different consequences for the best therapeutic strategies that one should adopt. As a more effective therapy for this common, often disfiguring pigmentary disorder is direly needed, we must strive harder to settle the pathogenesis debate definitively--on the basis of sound experimental evidence, rather than by a war of dogmatic theories. Recognizing, however, that it is theories which tend to guide our experimental designs and choice of study parameters, the various pathogenesis theories on the market deserve to be critically, yet unemotionally re-evaluated. This Controversies feature invites you to do so, and to ask yourself: is there something important or worthwhile exploring in other pathogenesis scenarios than those already favoured by you that may help you improve your own study design, next time you have a fresh look at vitiligo? Vitiligo provides a superb model for the study of many fundamental problems in skin biology and pathology. Therefore, even if it later turns out that, as far as your own vitiligo pathogenesis concept is concerned, you have barked-up the wrong tree most of the time, chances are that you shall anyway have generated priceless new insights into skin function along the way.
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Abstract
Vitiligo is a common dermatological disorder characterized by the presence on the skin of depigmented macules resulting from the destruction of cutaneous melanocytes. Autoimmunity is an important hypothesis with regard to vitiligo aetiology and the evidence for autoimmune responses being involved in the pathogenesis of this disorder will be discussed in the present review. All immune system compartments, including innate and adaptive immunity have been implicated in vitiligo development. Particularly relevant are autoantibodies and autoreactive T cells in vitiligo patients that have cytotoxic effects upon pigment cells. Furthermore, predisposition to vitiligo appears to be associated with certain alleles of the major histocompatibility complex class II antigens as well as with other autoimmune-susceptibility genes. Moreover, the association of vitiligo with autoimmune disorders, the animal models of the disease, and the positive response to immunosuppressive therapeutic agents emphasize the role of autoimmunity in the development of this disorder.
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Affiliation(s)
- N Rezaei
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Cantón I, Sarwar U, Kemp EH, Ryan AJ, MacNeil S, Haycock JW. Real-time detection of stress in 3D tissue-engineered constructs using NF-kappaB activation in transiently transfected human dermal fibroblast cells. ACTA ACUST UNITED AC 2007; 13:1013-24. [PMID: 17430089 DOI: 10.1089/ten.2006.0357] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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] [Indexed: 12/21/2022]
Abstract
The main objective of this study was to develop a nondestructive reporter system for assessing the response of human cells contained within a three-dimensional (3D) tissue-engineered construct to exogenous stress. Dermal fibroblasts were transiently transfected with a reporter construct linked to nuclear factor kappaB (NF-kappaB) activation which led to expression of a nonstable form of enhanced green fluorescent protein (d2EGFP) after stimulation. This led to a temporary production of fluorescence, which could be readily detected but was not intrinsically toxic, as cells were able to metabolize the initial cycle of d2EGFP produced. This permitted the model to be used for restimulation post recovery. To investigate the performance and predictive ability of this method for assessing cellular response to stress in 3D, we used a range of compounds known to have pro-inflammatory or oxidative properties. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-1-beta (IL-1beta) were selected for having a direct cytokine action; lipopolysaccharide (LPS) was selected for modeling bacterial-mediated inflammation; and hydrogen peroxide was selected as a crude method for delivering an oxidative stress. Transfected cells were stimulated with the above compounds in 3D and the synthesis of d2EGFP was detected as a measure of NF-kappaB activation. The resultant fluorescence was scored using a series of photomicrographs taken by epifluorescence microscopy. All agents activated NF-kappaB when cells were grown in 3D scaffolds but did not cause any significant reduction in cell viability as measured by a standard MTT-ESTA viability test. Parallel NF-kappaB activation and MTT measurements was also conducted in two-dimension (2D) and confirmed findings in 3D. The 3D model described using a fluorescent reporter gene is a highly sensitive and reliable method for detecting cellular stress and represents a key step in developing tissue engineering models with the potential for screening pharmaceutical and cosmetic compounds, as an alternative to existing in vitro and in vivo methods.
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Affiliation(s)
- Irene Cantón
- Department of Engineering Materials, Kroto Research Institute, University of Sheffield, and Northern General Hospital, Sheffield, United Kingdom
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