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Fu Y, Kelly JA, Gopalakrishnan J, Pelikan RC, Tessneer KL, Pasula S, Grundahl K, Murphy DA, Gaffney PM. Massively parallel reporter assay confirms regulatory potential of hQTLs and reveals important variants in lupus and other autoimmune diseases. HGG Adv 2024; 5:100279. [PMID: 38389303 PMCID: PMC10943488 DOI: 10.1016/j.xhgg.2024.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 02/24/2024] Open
Abstract
We designed a massively parallel reporter assay (MPRA) in an Epstein-Barr virus transformed B cell line to directly characterize the potential for histone post-translational modifications, i.e., histone quantitative trait loci (hQTLs), expression QTLs (eQTLs), and variants on systemic lupus erythematosus (SLE) and autoimmune (AI) disease risk haplotypes to modulate regulatory activity in an allele-dependent manner. Our study demonstrates that hQTLs, as a group, are more likely to modulate regulatory activity in an MPRA compared with other variant classes tested, including a set of eQTLs previously shown to interact with hQTLs and tested AI risk variants. In addition, we nominate 17 variants (including 11 previously unreported) as putative causal variants for SLE and another 14 for various other AI diseases, prioritizing these variants for future functional studies in primary and immortalized B cells. Thus, we uncover important insights into the mechanistic relationships among genotype, epigenetics, and gene expression in SLE and AI disease phenotypes.
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Affiliation(s)
- Yao Fu
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Jennifer A Kelly
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Jaanam Gopalakrishnan
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; Neuro-Immune Regulome Unit, National Eye Institute, National Institute of Health, Bethesda, MD 20892, USA
| | - Richard C Pelikan
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Kandice L Tessneer
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Satish Pasula
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Kiely Grundahl
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - David A Murphy
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Patrick M Gaffney
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA.
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Fu Y, Kelly JA, Gopalakrishnan J, Pelikan RC, Tessneer KL, Pasula S, Grundahl K, Murphy DA, Gaffney PM. Massively Parallel Reporter Assay Confirms Regulatory Potential of hQTLs and Reveals Important Variants in Lupus and Other Autoimmune Diseases. bioRxiv 2023:2023.08.17.553722. [PMID: 37645944 PMCID: PMC10462090 DOI: 10.1101/2023.08.17.553722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Objective To systematically characterize the potential for histone post-translational modifications, i.e., histone quantitative trait loci (hQTLs), expression QTLs (eQTLs), and variants on systemic lupus erythematosus (SLE) and autoimmune (AI) disease risk haplotypes to modulate gene expression in an allele dependent manner. Methods We designed a massively parallel reporter assay (MPRA) containing ~32K variants and transfected it into an Epstein-Barr virus transformed B cell line generated from an SLE case. Results Our study expands our understanding of hQTLs, illustrating that epigenetic QTLs are more likely to contribute to functional mechanisms than eQTLs and other variant types, and a large proportion of hQTLs overlap transcription start sites (TSS) of noncoding RNAs. In addition, we nominate 17 variants (including 11 novel) as putative causal variants for SLE and another 14 for various other AI diseases, prioritizing these variants for future functional studies primary and immortalized B cells. Conclusion We uncover important insights into the mechanistic relationships between genotype, epigenetics, gene expression, and SLE and AI disease phenotypes.
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Affiliation(s)
- Yao Fu
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Jennifer A Kelly
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Jaanam Gopalakrishnan
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
- Neuro-Immune Regulome Unit, National Eye Institute, National Institute of Health, Bethesda, MD, 20892, USA
| | - Richard C Pelikan
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Kandice L Tessneer
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Satish Pasula
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Kiely Grundahl
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - David A Murphy
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Patrick M Gaffney
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
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Joachims ML, Khatri B, Li C, Tessneer KL, Ice J, Stolarczyk AM, Means N, Grundahl K, Glenn S, Kelly J, Lewis D, Radfar L, Stone D, Guthridge J, James JA, Scofield RH, Wiley GB, Wren J, Gaffney PM, Montgomery C, Sivils K, Rasmussen A, Farris AD, Adrianto I, Lessard C. POS0098 LINC01871, IMPLICATED IN SJÖGREN’S DISEASE PATHOGENESIS, IS REGULATED BY INTERFERON-G AND CALCINEURIN SIGNALING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSjögren’s disease (SjD) is an autoimmune disease characterized by exocrine gland dysfunction. Long non-coding RNAs (lncRNAs) are a functionally diverse class of non-protein coding RNAs that are longer than 200 nucleotides. Our previous study using whole blood RNA-seq found that lncRNA, LINC01871, is overexpressed in SjD relative to controls [1]. CRISPR-Cas9 targeting in HSB2 T cells yielded a LINC01871-/- clone with altered expression of many genes implicated in immune regulation [1].ObjectivesThe goal of this study was to analyze the gene expression perturbations resulting from the loss of LINC01871 and to characterize the regulation of LINC01871 in both the LINC01871-/- clone and primary human T cells in response to immune stimuli.MethodsFlow cytometry and LegendPlex bead assays were used to compare surface and secreted protein expression changes, respectively, in LINC01871-/- cells and the parental HSB2 cells. Parental HSB2 T cells, LINC01871-/- cells, Kasumi-3 myeloid cells, and primary human T cells were stimulated in vitro and changes in gene expression were measured over time using qRT-PCR. Responses to interferons (IFN) were assessed using universal type I IFN (IFNα) or IFNγ. TCR signaling responses were assessed using PMA/Ionomycin (PMA/I) or anti-CD3/CD28 stimulations in the presence or absence of the calcineurin inhibitor, FK506.ResultsPrevious RNA-seq analysis found 1166 differentially expressed (DE) transcripts (log2FC ≥1 or ≤-1; padj ≤0.05) in LINC01871-/- cells compared to parental HSB2 cells, including many prominent immune regulatory genes. Changes in the basal expression of 7 proteins in LINC01871-/- cells were confirmed using flow cytometry (significantly decreased: CD8a (p=0.0004), CD30 (p=0.0008), CXCR3 (p=0.037), T-Bet (p=0.0002), and Aiolos (p=0.02); significantly increased: CD226 (p=0.0059) and CD44 (p=0.024)). Analysis of LINC01871-/- cells revealed a growth inhibition in LINC01871-/- cells (p=0.0014 at 72h), in which multiple secreted growth and adhesion factors were significantly reduced: GM-CSF (p=2.0e-06), M-CSF (p=2.7e-09), IGBPF4 (p=1.2e-07), s-ICAM1 (p=0.015), MMP9 (p=3.0e-14), and MMP2 (p=6e-08). In contrast, the IL-6 cytokine family member, LIF, was significantly increased in LINC01871-/- cells (p=1.2e-07). Because HSB2 cells were not responsive to all IFNs, IFN-mediated regulation of LINC01871 expression was examined in the Kasumi-3 myeloid cell line. While LINC01871 expression was not modulated by type I IFN stimulation, it was robustly responsive to IFNγ treatment. Since LINC01871 was expressed in T cells and implicated in T cell pathways, responses to TCR signaling pathways were characterized in HSB2 cells or purified primary human T cells treated with PMA/I. In both cell types, LINC01871 exhibited a prolonged decrease in expression that was abrogated by concurrent treatment with FK506, indicating that LINC01871 is regulated by calcineurin signaling. Treatment of primary human T cells with anti-CD3/CD28 to mimic true TCR engagement resulted in a modest decrease of LINC01871 expression at early time points, followed by an increase in expression with longer stimulation (2d).ConclusionOur findings suggest that LINC01871 is a potential mediator of the dysregulated T cell inflammatory response pathways implicated in SjD pathogenesis. LINC01871 influences the expression of many important immune cell genes and growth factors, is inducible by IFNγ, and is regulated directly by calcineurin signaling and TCR ligand engagement. Although LINC01871 functions are still unknown, observed LINC01871 overexpression in whole blood of SjD cases and after prolonged TCR stimulation in primary human T cells suggests that it could be a biomarker of SjD.References[1]Joachims, et al. Annals of the Rheumatic Diseases 2020;79:90.Disclosure of InterestsMichelle L Joachims: None declared, Bhuwan Khatri: None declared, Chuang Li: None declared, Kandice L Tessneer: None declared, John Ice: None declared, Anna M Stolarczyk: None declared, Nicolas Means: None declared, Kiely Grundahl: None declared, Stuart Glenn: None declared, Jennifer Kelly: None declared, David Lewis: None declared, Lida Radfar: None declared, Donald Stone: None declared, Joel Guthridge: None declared, Judith A. James: None declared, R Hal Scofield: None declared, Graham B Wiley: None declared, Jonathan Wren: None declared, Patrick M Gaffney: None declared, Courtney Montgomery: None declared, Kathy Sivils Employee of: Current employee of Janssen., Astrid Rasmussen: None declared, A Darise Farris: None declared, Indra Adrianto: None declared, Christopher Lessard: None declared
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Witas R, Rasmussen A, Scofield RH, Radfar L, Stone DU, Grundahl K, Lewis D, Sivils KL, Lessard CJ, Farris AD, Nguyen CQ. Defective Efferocytosis in a Murine Model of Sjögren's Syndrome Is Mediated by Dysfunctional Mer Tyrosine Kinase Receptor. Int J Mol Sci 2021; 22:ijms22189711. [PMID: 34575873 PMCID: PMC8466327 DOI: 10.3390/ijms22189711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
Sjögren's syndrome (SjS) is a chronic autoimmune disease primarily involving the exocrine glands in which the involvement of the innate immune system is largely uncharacterized. Mer signaling has been found to be protective in several autoimmune diseases but remains unstudied in SjS. Here, we investigated the role of Mer signaling in SjS. Mer knockout (MerKO) mice were examined for SjS disease criteria. SjS-susceptible (SjSS) C57BL/6.NOD-Aec1Aec2 mice were assessed for defective Mer signaling outcomes, soluble Mer (sMer) levels, A disintegrin and metalloprotease 17 (ADAM17) activity, and Rac1 activation. In addition, SjS patient plasma samples were evaluated for sMer levels via ELISA, and sMer levels were correlated to disease manifestations. MerKO mice developed submandibular gland (SMG) lymphocytic infiltrates, SMG apoptotic cells, anti-nuclear autoantibodies (ANA), and reduced saliva flow. Mer signaling outcomes were observed to be diminished in SjSS mice, as evidenced by reduced Rac1 activation in SjSS mice macrophages in response to apoptotic cells and impaired efferocytosis. Increased sMer was also detected in SjSS mouse sera, coinciding with higher ADAM17 activity, the enzyme responsible for cleavage and inactivation of Mer. sMer levels were elevated in patient plasma and positively correlated with focus scores, ocular staining scores, rheumatoid factors, and anti-Ro60 levels. Our data indicate that Mer plays a protective role in SjS, similar to other autoimmune diseases. Furthermore, we suggest a series of events where enhanced ADAM17 activity increases Mer inactivation and depresses Mer signaling, thus removing protection against the loss of self-tolerance and the onset of autoimmune disease in SjSS mice.
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Affiliation(s)
- Richard Witas
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA;
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL 32608, USA
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (A.R.); (K.G.); (C.J.L.)
| | - Robert H. Scofield
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (R.H.S.); (K.L.S.); (A.D.F.)
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA
| | - Lida Radfar
- Department of Oral Diagnosis and Radiology, College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Donald U. Stone
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Kiely Grundahl
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (A.R.); (K.G.); (C.J.L.)
| | - David Lewis
- Department of Oral Pathology, College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Kathy L. Sivils
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (R.H.S.); (K.L.S.); (A.D.F.)
| | - Christopher J. Lessard
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (A.R.); (K.G.); (C.J.L.)
| | - A. Darise Farris
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (R.H.S.); (K.L.S.); (A.D.F.)
| | - Cuong Q. Nguyen
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA;
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL 32608, USA
- Center of Orphaned Autoimmune Diseases, University of Florida, Gainesville, FL 32611-0880, USA
- Correspondence: ; Tel.: +1-352-294-4180; Fax: +1-352-392-9704
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Oyelakin A, Horeth E, Song EAC, Min S, Che M, Marzullo B, Lessard CJ, Rasmussen A, Radfar L, Scofield RH, Lewis DM, Stone DU, Grundahl K, De Rossi SS, Kurago Z, Farris AD, Sivils KL, Sinha S, Kramer JM, Romano RA. Transcriptomic and Network Analysis of Minor Salivary Glands of Patients With Primary Sjögren's Syndrome. Front Immunol 2021; 11:606268. [PMID: 33488608 PMCID: PMC7821166 DOI: 10.3389/fimmu.2020.606268] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022] Open
Abstract
Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease characterized primarily by immune-mediated destruction of exocrine tissues, such as those of the salivary and lacrimal glands, resulting in the loss of saliva and tear production, respectively. This disease predominantly affects middle-aged women, often in an insidious manner with the accumulation of subtle changes in glandular function occurring over many years. Patients commonly suffer from pSS symptoms for years before receiving a diagnosis. Currently, there is no effective cure for pSS and treatment options and targeted therapy approaches are limited due to a lack of our overall understanding of the disease etiology and its underlying pathology. To better elucidate the underlying molecular nature of this disease, we have performed RNA-sequencing to generate a comprehensive global gene expression profile of minor salivary glands from an ethnically diverse cohort of patients with pSS. Gene expression analysis has identified a number of pathways and networks that are relevant in pSS pathogenesis. Moreover, our detailed integrative analysis has revealed a primary Sjögren’s syndrome molecular signature that may represent important players acting as potential drivers of this disease. Finally, we have established that the global transcriptomic changes in pSS are likely to be attributed not only to various immune cell types within the salivary gland but also epithelial cells which are likely playing a contributing role. Overall, our comprehensive studies provide a database-enriched framework and resource for the identification and examination of key pathways, mediators, and new biomarkers important in the pathogenesis of this disease with the long-term goals of facilitating earlier diagnosis of pSS and to mitigate or abrogate the progression of this debilitating disease.
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Affiliation(s)
- Akinsola Oyelakin
- Department of Oral Biology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Erich Horeth
- Department of Oral Biology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Eun-Ah Christine Song
- Department of Oral Biology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Sangwon Min
- Department of Oral Biology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Monika Che
- Department of Oral Biology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Brandon Marzullo
- Genomics and Bioinformatics Core, State University of New York at Buffalo, Buffalo, NY, United States
| | - Christopher J Lessard
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Astrid Rasmussen
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Lida Radfar
- College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - R Hal Scofield
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States.,Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.,Department of Veteran's Affairs Medical Center, Oklahoma City, OK, United States
| | - David M Lewis
- College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Donald U Stone
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Kiely Grundahl
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Scott S De Rossi
- Dental College of Georgia, Augusta University, Augusta, GA, United States
| | - Zoya Kurago
- Dental College of Georgia, Augusta University, Augusta, GA, United States
| | - A Darise Farris
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Kathy L Sivils
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Satrajit Sinha
- Department of Biochemistry, State University of New York at Buffalo, Buffalo, NY, United States
| | - Jill M Kramer
- Department of Oral Biology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Rose-Anne Romano
- Department of Oral Biology, State University of New York at Buffalo, Buffalo, NY, United States.,Department of Biochemistry, State University of New York at Buffalo, Buffalo, NY, United States
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Joachims ML, Leehan KM, Dozmorov MG, Georgescu C, Pan Z, Lawrence C, Marlin MC, Macwana S, Rasmussen A, Radfar L, Lewis DM, Stone DU, Grundahl K, Scofield RH, Lessard CJ, Wren JD, Thompson LF, Guthridge JM, Sivils KL, Moore JS, Farris AD. Sjögren's Syndrome Minor Salivary Gland CD4 + Memory T Cells Associate with Glandular Disease Features and have a Germinal Center T Follicular Helper Transcriptional Profile. J Clin Med 2020; 9:jcm9072164. [PMID: 32650575 PMCID: PMC7408878 DOI: 10.3390/jcm9072164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
To assess the types of salivary gland (SG) T cells contributing to Sjögren's syndrome (SS), we evaluated SG T cell subtypes for association with disease features and compared the SG CD4+ memory T cell transcriptomes of subjects with either primary SS (pSS) or non-SS sicca (nSS). SG biopsies were evaluated for proportions and absolute numbers of CD4+ and CD8+ T cells. SG memory CD4+ T cells were evaluated for gene expression by microarray. Differentially-expressed genes were identified, and gene set enrichment and pathways analyses were performed. CD4+CD45RA- T cells were increased in pSS compared to nSS subjects (33.2% vs. 22.2%, p < 0.0001), while CD8+CD45RA- T cells were decreased (38.5% vs. 46.0%, p = 0.0014). SG fibrosis positively correlated with numbers of memory T cells. Proportions of SG CD4+CD45RA- T cells correlated with focus score (r = 0.43, p < 0.0001), corneal damage (r = 0.43, p < 0.0001), and serum Ro antibodies (r = 0.40, p < 0.0001). Differentially-expressed genes in CD4+CD45RA- cells indicated a T follicular helper (Tfh) profile, increased homing and increased cellular interactions. Predicted upstream drivers of the Tfh signature included TCR, TNF, TGF-β1, IL-4, and IL-21. In conclusion, the proportions and numbers of SG memory CD4+ T cells associate with key SS features, consistent with a central role in disease pathogenesis.
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Affiliation(s)
- Michelle L. Joachims
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Kerry M. Leehan
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Mikhail G. Dozmorov
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Constantin Georgescu
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Zijian Pan
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Christina Lawrence
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - M. Caleb Marlin
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Susan Macwana
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Astrid Rasmussen
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Lida Radfar
- College of Dentistry, University of Oklahoma Health Sciences Center, 1201 N Stonewall Avenue, Oklahoma City, OK 73117, USA; (L.R.); (D.M.L.)
| | - David M. Lewis
- College of Dentistry, University of Oklahoma Health Sciences Center, 1201 N Stonewall Avenue, Oklahoma City, OK 73117, USA; (L.R.); (D.M.L.)
| | - Donald U. Stone
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA;
| | - Kiely Grundahl
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - R. Hal Scofield
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
- Department of Medicine, University of Oklahoma Health Sciences Center, 1100 N Lindsay Avenue, Oklahoma City, OK 73104, USA
- Department of Veteran’s Affairs Medical Center, 931 NE 13th Street, Oklahoma City, OK 73104, USA
| | - Christopher J. Lessard
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Jonathan D. Wren
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Linda F. Thompson
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Joel M. Guthridge
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Kathy L. Sivils
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Jacen S. Moore
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - A. Darise Farris
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
- Correspondence: ; Tel.: +1-405-271-7389
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Scofield RH, Sharma R, Pezant N, Kelly JA, Radfar L, Lewis DM, Kaufman CE, Cioli S, Harris J, Grundahl K, Rhodus NL, Wallace DJ, Weisman MH, Venuturupalli S, Brennan MT, Koelsch KA, Lessard CJ, Montgomery CG, Sivils KL, Rasmussen A. American Indians Have a Higher Risk of Sjögren's Syndrome and More Disease Activity Than European Americans and African Americans. Arthritis Care Res (Hoboken) 2020; 72:1049-1056. [PMID: 31199565 DOI: 10.1002/acr.24003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe the clinical and serologic manifestations of Sjögren's syndrome (SS) in ethnic groups of the US. METHODS This was a cross-sectional study of 648 patients with primary SS: 20 African American (AA), 164 American Indian (AI), 426 European American (EA), and 38 patients of other races evaluated in a multidisciplinary Sjögren's International Collaborative Clinical Alliance research clinic. RESULTS AA subjects comprised 3.1% of the SS cohort, much lower than the percentage of AA in the state of Oklahoma (P = 3.01 × E - 05), the US (P = 2.24E - 13), or a systemic lupus erythematosus (SLE) cohort at the same institution (P = 4.26 × 10E - 27). In contrast, the percentage of AI in the SS cohort (25.3%) was much higher than expected (P = 3.17E - 09 versus SLE cohort, P = 6.36 - 26 versus Oklahoma, and P = 8.14E - 96 versus US population). The SS classification criteria were similar between AA and EA, but subjects of AI ancestry had lower rates of abnormal tear and salivary flow, as well as anti-Ro/SSA and anti-La/SSB antibodies. Paradoxically, AI had higher levels of disease activity (mean ± SD European League Against Rheumatism Sjögren's Syndrome Disease Activity Index score 3.77 ± 4.78) in comparison to EA (2.90 ± 4.12; P = 0.011) and more extraglandular manifestations affecting mainly the articular and glandular domains. Meanwhile, AA patients were characterized by higher rates of hypergammaglobulinemia (odds ratio [OR] 1.39 [95% confidence interval (95% CI) 1.39-8.65]; P = 0.01), elevated erythrocyte sedimentation rate (ESR) (OR 3.95 [95% CI 1.46-9.95]; P = 0.009), and parotid enlargement (OR 4.40 [95% CI 1.49-13.07]; P = 0.02). CONCLUSION AI are affected at high rates with SS but present with few classical features, potentially preventing timely diagnosis. In contrast to SLE, SS is infrequent and not more severe among AA, but the triad of hypergammaglobulinemia, increased ESR, and parotid enlargement warrants extra vigilance for lymphomagenesis.
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Affiliation(s)
- R Hal Scofield
- Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, and Department of Veterans Affairs Medical Center, Oklahoma City
| | - Rohan Sharma
- University of Arkansas for Medical Sciences, Little Rock
| | | | | | - Lida Radfar
- University of Oklahoma College of Dentistry, Oklahoma City
| | - David M Lewis
- University of Oklahoma College of Dentistry, Oklahoma City
| | - C Erick Kaufman
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - Sarah Cioli
- Oklahoma Medical Research Foundation, Oklahoma City
| | - Judy Harris
- Oklahoma Medical Research Foundation, Oklahoma City
| | | | | | | | | | | | | | - Kristi A Koelsch
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City
| | | | | | | | - Astrid Rasmussen
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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8
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Farris AD, Joachims ML, Leehan KM, Dozmorov MG, Georgescu C, Pan Z, Rasmussen A, Radfar L, Lewis DM, Stone DU, Grundahl K, Scofield RH, Lessard CJ, Wren JD, Thompson LF, Sivils KL, Moore JS. Sjögren’s syndrome minor salivary gland CD4+ T cells associate with glandular disease features and have a germinal center T follicular helper transcriptional profile. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.142.7] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Objective
To assess the types of salivary gland (SG) T cells contributing to Sjögren’s syndrome (SS), we evaluated SG T cell subtypes for association with disease features and compared the SG CD4+ memory T cell transcriptomes of primary SS (pSS) and sicca subjects not meeting SS criteria (nSS).
Methods
SG biopsies of pSS and nSS subjects were evaluated for proportions (n=51 pSS, n=69 nSS) and absolute numbers (n=35 pSS, n=57 nSS) of CD4+ and CD8+ T cells. SG memory CD4+ T cells from focus score positive pSS (n=17) and focus score negative nSS subjects (n=15) were evaluated for gene expression by microarray. Differentially-expressed genes were identified and gene set enrichment and pathways analyses were performed.
Results
CD4+CD45RA− T cell frequencies were increased in pSS compared to nSS subjects (33.2 vs. 22.2%, p<0.0001), while CD8+CD45RA− T cells were decreased (38.5 vs. 46.0%, p=0.0014). SG fibrosis positively correlated with numbers of memory T cells, regardless of phenotype. Proportions of SG CD4+CD45RA− T cells correlated with focus score (r=0.43, p<0.0001), corneal damage (r=0.43, p<0.0001), and serum Ro antibodies (r=0.40, p<0.0001). Differentially expressed genes in CD4+CD45RA− cells of pSS versus nSS subjects indicated a T follicular helper (Tfh) profile, increased homing and increased cellular interactions. Predicted upstream drivers of the Tfh signature included TCR, TNF, TGF-β1, IL-4 and IL-21.
Conclusions
The proportions and numbers of SG memory CD4+ T cells associate with key SS features, consistent with a central role in disease pathogenesis. SG memory CD4+ T cells express a germinal center Tfh profile.
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Affiliation(s)
| | | | | | | | | | | | | | - Lida Radfar
- 2University of Oklahoma Health Sciences Center, College of Dentistry
| | - David M Lewis
- 2University of Oklahoma Health Sciences Center, College of Dentistry
| | - Donald U Stone
- 3University of Oklahoma Health Sciences Center, Dean McGee Eye Institute
- 4University of Oklahoma Health Sciences Center, Department of Medicine
| | | | - R. Hal Scofield
- 1Oklahoma Medical Research Foundation
- 4University of Oklahoma Health Sciences Center, Department of Medicine
- 5Department of Veterans Affairs Medical Center
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9
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Sharma R, Chaudhari KS, Kurien BT, Grundahl K, Radfar L, Lewis DM, Lessard CJ, Li H, Rasmussen A, Sivils KL, Scofield RH. Sjögren Syndrome without Focal Lymphocytic Infiltration of the Salivary Glands. J Rheumatol 2020; 47:394-399. [PMID: 31092717 PMCID: PMC7304293 DOI: 10.3899/jrheum.181443] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Accepted: 05/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Primary Sjögren syndrome (SS) is characterized by a focal lymphocytic infiltrate in exocrine glands. We describe patients who lacked this key feature. METHODS We evaluated patients with sicca in a comprehensive clinic at which medical, dental, and ophthalmological examinations were performed. All subjects underwent a minor salivary gland biopsy with focus score calculation. Extraglandular manifestations were also determined. We categorized subjects as high, intermediate, or low in terms of expression of interferon (IFN)-regulated genes. RESULTS About 20% (51 of 229, 22%) of those classified as having primary SS had a focus score of zero. Compared to those with anti-Ro positivity and a focus score > 1.0, the patients with focus score of zero (who by classification criteria must be anti-Ro-positive) were statistically less likely to have anti-La (or SSB) and elevated immunoglobulin, as well as less severe corneal staining. The focus score zero patients were less likely to have elevated expression of IFN-regulated genes in peripheral blood mononuclear cells than anti-Ro-positive SS patients with a focal salivary infiltrate. CONCLUSION There are only a few clinical differences between patients with primary SS with focus score zero and those with both anti-Ro and a focus score > 1.0. The small subset of focus score zero patients tested did not have elevated expression of IFN-regulated genes, but did have systemic disease. Thus, extraglandular manifestations are perhaps more related to the presence of anti-Ro than increased IFN. This may have relevance to pathogenesis of SS.
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Affiliation(s)
- Rohan Sharma
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Kaustubh S Chaudhari
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Biji T Kurien
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Kiely Grundahl
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Lida Radfar
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - David M Lewis
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Christopher J Lessard
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - He Li
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Astrid Rasmussen
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Kathy L Sivils
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - R Hal Scofield
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center.
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10
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Rasmussen A, Stone DU, Kaufman CE, Hefner KS, Fram NR, Siatkowski RL, Huang AJW, Chodosh J, Rasmussen PT, Fife DA, Pezant N, Grundahl K, Radfar L, Lewis DM, Weisman MH, Venuturupalli S, Wallace DJ, Rhodus NL, Brennan MT, Montgomery CG, Lessard CJ, Scofield RH, Sivils KL. Reproducibility of Ocular Surface Staining in the Assessment of Sjögren Syndrome-Related Keratoconjunctivitis Sicca: Implications on Disease Classification. ACR Open Rheumatol 2019; 1:292-302. [PMID: 31453437 PMCID: PMC6710016 DOI: 10.1002/acr2.1033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 11/06/2022] Open
Abstract
Objective The objective of this study was to assess the performance and reproducibility of the two currently used ocular surface staining scores in the assessment of keratoconjunctivitis sicca in Sjögren syndrome (SS) research classification. Methods In a multidisciplinary clinic for the evaluation of sicca, we performed all tests for the American European Consensus Group (AECG) and the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, including the van Bijsterveld score (vBS) and the Ocular Staining Score (OSS), in 994 participants with SS or with non-SS sicca. We analyzed the concordance between the scores, the diagnostic accuracy and correlation with clinical variables, and interrater and intrasubject reproducibility. Results A total of 308 (31.1%) participants had a discordant vBS and OSS that was due to extra corneal staining points in the OSS. The presence of one or more of the additional points was highly predictive of SS classification (odds ratio = 3.66; P = 1.65 × 10e-20) and was associated with abnormal results of all measures of autoimmunity and glandular dysfunction. Receiver operating characteristic curves showed optimal cutoff values of four for the vBS (sensitivity = 0.62; specificity = 0.71; Youden's J = 0.33) and five for the OSS (sensitivity = 0.56; specificity = 0.75; Youden's J = 0.31). Notably, there was very poor consistency in interobserver mean scores and distributions (P < 0.0001) and in intrasubject scores after a median of 5.5 years (35% changed status of the ocular criterion). Conclusion Ocular surface staining scores are useful for SS research classification; however, they are subject to significant interrater and intrasubject variability, which could result in changes in classification in 5%-10% of all subjects. These results highlight the need for objective and reproducible markers of disease that have thus far remained elusive for SS.
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Affiliation(s)
- Astrid Rasmussen
- Astrid Rasmussen, MD, PhD: Oklahoma Medical Research Foundation, Oklahoma City, and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Donald U Stone
- Donald U. Stone, MD: Johns Hopkins University, Baltimore, Maryland (current address: Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City)
| | - C Erick Kaufman
- C. Erick Kaufman, MD, Lida Radfar, DDS, MS, David M. Lewis, DDS: University of Oklahoma, Oklahoma City
| | - Kimberly S Hefner
- Kimberly S. Hefner, DO: Hefner Eye Care and Optical Center, Oklahoma City, Oklahoma
| | - Nicole R Fram
- Nicole R. Fram, MD: David Geffen School of Medicine, University of California, Los Angeles
| | - Rhea L Siatkowski
- Rhea L. Siatkowski, MD: University of Oklahoma and Dean McGee Eye Institute, Oklahoma City
| | - Andrew J W Huang
- Andrew J. W. Huang, MD: School of Medicine, Washington University in St. Louis, St. Louis, Missouri (current address: University of Minnesota)
| | - James Chodosh
- James Chodosh, MD, MPH: Massachusetts Eye and Ear and Harvard University, Boston (current address: Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City)
| | | | - Dustin A Fife
- Dustin A. Fife, PhD (current address: Oklahoma Medical Research Foundation, Oklahoma City), Nathan Pezant, MS, Kiely Grundahl, BS, Courtney G. Montgomery, PhD: Oklahoma Medical Research Foundation, Oklahoma City
| | - Nathan Pezant
- Dustin A. Fife, PhD (current address: Oklahoma Medical Research Foundation, Oklahoma City), Nathan Pezant, MS, Kiely Grundahl, BS, Courtney G. Montgomery, PhD: Oklahoma Medical Research Foundation, Oklahoma City
| | - Kiely Grundahl
- Dustin A. Fife, PhD (current address: Oklahoma Medical Research Foundation, Oklahoma City), Nathan Pezant, MS, Kiely Grundahl, BS, Courtney G. Montgomery, PhD: Oklahoma Medical Research Foundation, Oklahoma City
| | - Lida Radfar
- C. Erick Kaufman, MD, Lida Radfar, DDS, MS, David M. Lewis, DDS: University of Oklahoma, Oklahoma City
| | - David M Lewis
- C. Erick Kaufman, MD, Lida Radfar, DDS, MS, David M. Lewis, DDS: University of Oklahoma, Oklahoma City
| | - Michael H Weisman
- Michael H. Weisman, MD, Swamy Venuturupalli, MD, Daniel J. Wallace, MD: Cedars-Sinai Medical Center, Los Angeles, California
| | - Swamy Venuturupalli
- Michael H. Weisman, MD, Swamy Venuturupalli, MD, Daniel J. Wallace, MD: Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel J Wallace
- Michael H. Weisman, MD, Swamy Venuturupalli, MD, Daniel J. Wallace, MD: Cedars-Sinai Medical Center, Los Angeles, California
| | - Nelson L Rhodus
- Nelson L. Rhodus, DMD, MPH: School of Dentistry, University of Minnesota, Minneapolis
| | - Michael T Brennan
- Michael T. Brennan, DDS, MHS: Carolinas Medical Center, Charlotte, North Carolina
| | - Courtney G Montgomery
- Dustin A. Fife, PhD (current address: Oklahoma Medical Research Foundation, Oklahoma City), Nathan Pezant, MS, Kiely Grundahl, BS, Courtney G. Montgomery, PhD: Oklahoma Medical Research Foundation, Oklahoma City
| | - Christopher J Lessard
- Christopher J. Lessard, PhD, Kathy L. Sivils, PhD: Oklahoma Medical Research Foundation and University of Oklahoma, Oklahoma City
| | - R Hal Scofield
- R. Hal Scofield, MD: Oklahoma Medical Research Foundation, University of Oklahoma, and Department of Veterans Affairs Medical Center, Oklahoma City
| | - Kathy L Sivils
- Christopher J. Lessard, PhD, Kathy L. Sivils, PhD: Oklahoma Medical Research Foundation and University of Oklahoma, Oklahoma City
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11
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Leehan KM, Pezant NP, Rasmussen A, Grundahl K, Moore JS, Radfar L, Lewis DM, Stone DU, Lessard CJ, Rhodus NL, Segal BM, Scofield RH, Sivils KL, Montgomery C, Farris AD. Minor salivary gland fibrosis in Sjögren's syndrome is elevated, associated with focus score and not solely a consequence of aging. Clin Exp Rheumatol 2018; 36 Suppl 112:80-88. [PMID: 29148407 PMCID: PMC5913007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Evaluate the presence of minor salivary gland (SG) fibrosis in primary Sjögren's syndrome (pSS) as a function of disease pathology or a consequence of ageing. METHODS Subjects with sicca symptoms attending a Sjögren's research clinic were classified by American European Consensus Group (AECG) criteria as either pSS or non-SS (nSS). Discovery (n=34 pSS, n=28 nSS) and replication (n=35 pSS, n=31 nSS) datasets were evaluated. Minor SG cross-sections from haematoxylin and eosin stained slides were imaged, digitally reconstructed and analysed for percent area fibrosis. Relationships between SG fibrosis, age, and clinical measures were evaluated using Spearman correlations. Association with SS was assessed by: ROC curve, Variable Selection Using Random Forests (VSURF) and uni- and bi-variate regression analyses. RESULTS SS subjects had significantly more fibrotic tissue in their minor labial salivary glands (median 24.39%, range 5.12-51.67%) than nSS participants (median 16.7%, range 5.97-38.65%, p<0.0001); age did not differ between groups (average ± SD pSS 50.2 ±13.9 years, nSS 53.8±12.4 years). In both the discovery and replication data sets, multiple regression models showed that the area of minor salivary gland fibrosis predicted pSS significantly better than age alone. Age-corrected linear regression revealed that the area of minor salivary gland fibrosis positively associated with vanBijsterveld score (p=0.042) and biopsy focus score (p=0.002). ROC curve and VSURF analyses ranked fibrosis as a significantly more important variable for subject discrimination than age. CONCLUSIONS SG fibrosis is an element of pSS pathology that is related to focus score and is not solely attributable to age.
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Affiliation(s)
- Kerry M Leehan
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF); Department of Pathology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Nathan P Pezant
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, OK, USA
| | - Astrid Rasmussen
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, OK, USA
| | - Kiely Grundahl
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, OK, USA
| | - Jacen S Moore
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, OK, USA
| | - Lida Radfar
- College of Dentistry, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - David M Lewis
- College of Dentistry, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Donald U Stone
- Department of Ophthalmology, Johns Hopkins University, Baltimore, MD,USA; and King Khaled Eye Specialist Hospital, Riyadh, KSA
| | - Christopher J Lessard
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF); Department of Pathology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Nelson L Rhodus
- Division of Oral Medicine and Diagnosis, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, MN, USA
| | - Barbara M Segal
- Division of Rheumatic and Autoimmune Diseases, University of Minnesota, MN, USA
| | - R Hal Scofield
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; Department of Medicine, University of Oklahoma Health Sciences Center; Department of Veteran's Affairs Medical Center, Oklahoma City, OK, USA
| | - Kathy L Sivils
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF); Department of Pathology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Courtney Montgomery
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, OK, USA
| | - A Darise Farris
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF); Department of Pathology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA.
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12
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Leehan KM, Pezant NP, Rasmussen A, Grundahl K, Moore JS, Radfar L, Lewis DM, Stone DU, Lessard CJ, Rhodus NL, Segal BM, Kaufman CE, Scofield RH, Sivils KL, Montgomery C, Farris AD. Fatty infiltration of the minor salivary glands is a selective feature of aging but not Sjögren's syndrome. Autoimmunity 2017; 50:451-457. [PMID: 28988489 DOI: 10.1080/08916934.2017.1385776] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Determine the presence and assess the extent of fatty infiltration of the minor salivary glands (SG) of primary SS patients (pSS) as compared to those with non-SS sicca (nSS). METHODS Minor SG biopsy samples from 134 subjects with pSS (n = 72) or nSS (n = 62) were imaged. Total area and fatty replacement area for each glandular cross-section (n = 4-6 cross-sections per subject) were measured using Image J (National Institutes of Health, Bethesda, MD). The observer was blinded to subject classification status. The average area of fatty infiltration calculated per subject was evaluated by logistic regression and general linearized models (GLM) to assess relationships between fatty infiltration and clinical exam results, extent of fibrosis and age. RESULTS The average area of fatty infiltration for subjects with pSS (median% (range) 4.97 (0.05-30.2)) was not significantly different from that of those with nSS (3.75 (0.087-41.9). Infiltration severity varied widely, and subjects with fatty replacement greater than 6% were equivalently distributed between pSS and nSS participants (χ2 p = .50). Age accounted for all apparent relationships between fatty infiltration and fibrosis or reduced saliva flow. The all-inclusive GLM for prediction of pSS versus non-SS classification including fibrosis, age, fatty replacement, and focus score was not significantly different from any desaturated model. In no iteration of the model did fatty replacement exert a significant effect on the capacity to predict pSS classification. CONCLUSIONS Fatty infiltration is an age-associated phenomenon and not a selective feature of Sjögren's syndrome. Sicca patients who do not fulfil pSS criteria have similar rates of fatty infiltration of the minor SG.
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Affiliation(s)
- Kerry M Leehan
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA.,b Department of Pathology , University of Oklahoma Health Sciences Center (OUHSC) , Oklahoma City , OK , USA
| | - Nathan P Pezant
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA
| | - Astrid Rasmussen
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA
| | - Kiely Grundahl
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA
| | - Jacen S Moore
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA
| | - Lida Radfar
- c College of Dentistry , OUHSC , Oklahoma City , OK , USA
| | - David M Lewis
- c College of Dentistry , OUHSC , Oklahoma City , OK , USA
| | - Donald U Stone
- d Department of Ophthalmology , Johns Hopkins University , Baltimore , MD , USA
| | - Christopher J Lessard
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA.,b Department of Pathology , University of Oklahoma Health Sciences Center (OUHSC) , Oklahoma City , OK , USA
| | - Nelson L Rhodus
- e Division of Oral Medicine and Diagnosis, Department of Diagnostic and Biological Sciences, School of Dentistry , University of Minnesota , Minneapolis , MN , USA
| | - Barbara M Segal
- f Division of Rheumatic and Autoimmune Diseases , University of Minnesota , Minneapolis , MN , USA
| | | | - R Hal Scofield
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA.,g Department of Medicine , OUHSC , Oklahoma City , OK , USA.,h Department of Veteran's Affairs Medical Center , Oklahoma City , OK , USA
| | - Kathy L Sivils
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA.,b Department of Pathology , University of Oklahoma Health Sciences Center (OUHSC) , Oklahoma City , OK , USA
| | - Courtney Montgomery
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA
| | - A Darise Farris
- a Arthritis and Clinical Immunology Program , Oklahoma Medical Research Foundation (OMRF) , Oklahoma City , OK , USA.,b Department of Pathology , University of Oklahoma Health Sciences Center (OUHSC) , Oklahoma City , OK , USA
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13
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Wolska N, Rybakowska P, Rasmussen A, Brown M, Montgomery C, Klopocki A, Grundahl K, Scofield RH, Radfar L, Stone DU, Anaya JM, Ice JA, Lessard CJ, Lewis DM, Rhodus NL, Gopalakrishnan R, Huang AJW, Hughes PJ, Rohrer MD, Weisman MH, Venuturupalli S, Guthridge JM, James JA, Sivils KL, Bagavant H, Deshmukh US. Brief Report: Patients With Primary Sjögren's Syndrome Who Are Positive for Autoantibodies to Tripartite Motif-Containing Protein 38 Show Greater Disease Severity. Arthritis Rheumatol 2016; 68:724-9. [PMID: 26636433 DOI: 10.1002/art.39497] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/29/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Autoantibodies reactive with Ro52 (tripartite motif-containing protein 21 [TRIM21]) are detected in 70% of patients with primary Sjögren's syndrome (SS). TRIM21 belongs to a 34-member C-IV family of TRIM proteins. Although autoantibodies against other TRIM proteins within the C-IV family have been detected in the sera of patients with primary SS, their clinical relevance remains unclear. This study was undertaken to investigate the frequency of anti-TRIM38 in patients with primary SS and evaluate its association with various clinical measures of the disease. METHODS Serum samples from patients with primary SS (n = 235) and controls (n = 50) were analyzed for reactivity with in vitro-transcribed and -translated (35) S-methionine-labeled TRIM38 protein. The associations of anti-TRIM38 with various laboratory and clinical measures of primary SS were evaluated. Reactivity of anti-TRIM38 with different structural domains of TRIM38 was analyzed. Affinity-purified anti-TRIM38 antibodies were used to immunoprecipitate TRIM21. RESULTS TRIM38-reactive autoantibodies were detected in the sera of 24 of the 235 patients with primary SS and 2 of the 50 controls. Anti-TRIM38 positivity was significantly associated with the presence of anti-Ro60, anti-Ro52, anti-La, rheumatoid factor, and hypergammaglobulinemia. Clinically, anti-TRIM38 was associated with significantly higher ocular surface staining scores, lower Schirmer's test scores, and minor labial salivary gland biopsy focus scores of ≥3.0. Anti-TRIM38 antibodies mainly recognized the cortactin-binding protein 2 (CortBP-2; amino acids 128-238) and the B30.2/SPRY (amino acids 268-465) domains on TRIM38. Affinity-purified antibodies to TRIM38-CortBP-2 and TRIM38-B30.2/SPRY domains reacted with TRIM21. CONCLUSION Our data demonstrate that anti-TRIM38 specificity arising in a subset of patients with primary SS is associated with increased severity of the disease.
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Affiliation(s)
- Nina Wolska
- Oklahoma Medical Research Foundation, Oklahoma City
| | | | | | | | | | | | | | - Robert H Scofield
- Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, and VAMC, Oklahoma City
| | - Lida Radfar
- University of Oklahoma College of Dentistry, Oklahoma City
| | - Donald U Stone
- University of Oklahoma Health Sciences Center, Oklahoma City
| | | | - John A Ice
- Oklahoma Medical Research Foundation, Oklahoma City
| | | | - David M Lewis
- University of Oklahoma College of Dentistry, Oklahoma City
| | | | | | | | | | | | | | | | | | - Judith A James
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City
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14
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Rasmussen A, Radfar L, Lewis D, Grundahl K, Stone DU, Kaufman CE, Rhodus NL, Segal B, Wallace DJ, Weisman MH, Venuturupalli S, Kurien BT, Lessard CJ, Sivils KL, Scofield RH. Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus. Rheumatology (Oxford) 2016; 55:1195-201. [PMID: 26998859 DOI: 10.1093/rheumatology/kew023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The diagnosis of SS is often difficult and many patients are symptomatic for years with other diagnoses before confirmation of SS. Our aim was to determine whether overlapping clinical and serologic features with RA and SLE may in part drive the misdiagnoses. METHODS A total of 1175 sicca patients were evaluated in a multidisciplinary clinic and classified as having SS based on the American-European Consensus Group Criteria. They were interrogated for a past history of suspicion or diagnosis of RA, SLE or SSc. These diseases were confirmed or ruled out by applying the corresponding classification criteria if the patients responded affirmatively. RESULTS Of these, 524 (44.6%) subjects reported previous diagnosis or suspicion of RA, SLE or SSc, which was confirmed in 130 (24.8%) but excluded in 394 (75.2%) subjects. Of those previously diagnosed with another illness, 183 (34.9%) met the criteria for primary SS. RF was present in 70/191 patients with previous diagnosis of RA compared with 445/845 without a prior RA diagnosis (P = 3.38E-05), while 128/146 with a diagnosis of SLE had positive ANA compared with 622/881 without the diagnosis (P = 8.77E-06). Age also influenced former diagnoses: people with suspected RA were older than those without the diagnosis (P = 5.89E-06), while patients with SLE suspicion were younger (P = 0.0003). Interestingly, the previous diagnoses did not significantly delay a final classification of SS. CONCLUSION Among subjects classified as SS, the presence of a positive ANA or RF was associated with a previous, apparently erroneous diagnosis of SLE or RA, respectively.
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Affiliation(s)
- Astrid Rasmussen
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation
| | - Lida Radfar
- Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry
| | - David Lewis
- Department of Oral Pathology, University of Oklahoma College of Dentistry, Oklahoma City, OK
| | - Kiely Grundahl
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation
| | - Donald U Stone
- Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - C Erick Kaufman
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Nelson L Rhodus
- Department of Oral Surgery, University of Minnesota School of Dentistry
| | - Barbara Segal
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Daniel J Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Biji T Kurien
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation College of Medicine, Department of Medicine, Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center and
| | | | - Kathy L Sivils
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation
| | - R Hal Scofield
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation College of Medicine, Department of Medicine, Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center and Department of Medicine, The Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
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15
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Szczerba BM, Kaplonek P, Wolska N, Podsiadlowska A, Rybakowska PD, Dey P, Rasmussen A, Grundahl K, Hefner KS, Stone DU, Young S, Lewis DM, Radfar L, Scofield RH, Sivils KL, Bagavant H, Deshmukh US. Interaction between innate immunity and Ro52-induced antibody causes Sjögren's syndrome-like disorder in mice. Ann Rheum Dis 2015; 75:617-22. [PMID: 25906316 DOI: 10.1136/annrheumdis-2014-206297] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 07/16/2014] [Accepted: 01/13/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Autoantibodies reactive with Ro52 are often found in sera of patients with Sjögren's syndrome (SS). This study was undertaken to investigate the role of Ro52-induced immune responses in pathogenesis of SS. METHODS New Zealand Mixed (NZM) 2758 mice were immunised with Ro52 in alum adjuvant. Control mice were immunised either with maltose-binding protein or injected with alum alone. Mice were monitored for anti-Ro52 antibody, sialoadenitis and pilocarpine-induced salivation. Antibody binding to salivary gland (SG) cells was analysed in vivo and in vitro by immunofluorescence. Sera from immunised mice were passively transferred into untreated or alum injected NZM2758 mice. RESULTS By day 30 post-immunisation, Ro52 immunised mice generated immunoprecipitating anti-Ro52 antibodies and they had the maximum drop in saliva production. Both Ro52 immunised and control mice showed evidence of mild sialoadenitis. However, only Ro52 immunised mice had antibody deposition in their SG. Passive transfer of Ro52-immune sera induced SG dysfunction in recipient mice, only if the recipients were primed with alum. In vitro, antibodies from Ro52-immune sera were internalised by a SG cell line and this uptake was inhibited by cytochalasin D treatment. CONCLUSIONS Our data show for the first time that antibodies induced by Ro52 are capable of inducing SG dysfunction, and that this phenomenon is dependent on the activation of innate immunity. The mouse model described in this study implies that autoantibody deposition in the SG might be an important step in the induction of xerostomia and pathogenesis of SS.
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Affiliation(s)
- Barbara M Szczerba
- Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA University of Basel, Basel, Switzerland
| | - Paulina Kaplonek
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Nina Wolska
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Anna Podsiadlowska
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Paulina D Rybakowska
- Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Paromita Dey
- Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA
| | - Astrid Rasmussen
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Kiely Grundahl
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | | | - Donald U Stone
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Stephen Young
- University of Oklahoma College of Dentistry, Oklahoma City, Oklahoma, USA
| | - David M Lewis
- Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry, Oklahoma City, Oklahoma, USA
| | - Lida Radfar
- Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry, Oklahoma City, Oklahoma, USA
| | - R Hal Scofield
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA Department of Veterans, Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Kathy L Sivils
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Harini Bagavant
- Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Umesh S Deshmukh
- Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
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Rasmussen A, Ice JA, Li H, Grundahl K, Kelly JA, Radfar L, Stone DU, Hefner KS, Anaya JM, Rohrer M, Gopalakrishnan R, Houston GD, Lewis DM, Chodosh J, Harley JB, Hughes P, Maier-Moore JS, Montgomery CG, Rhodus NL, Farris AD, Segal BM, Jonsson R, Lessard CJ, Scofield RH, Moser Sivils KL. Comparison of the American-European Consensus Group Sjogren's syndrome classification criteria to newly proposed American College of Rheumatology criteria in a large, carefully characterised sicca cohort. Ann Rheum Dis 2014; 73:31-8. [PMID: 23968620 PMCID: PMC3855629 DOI: 10.1136/annrheumdis-2013-203845] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the performance of the American-European Consensus Group (AECG) and the newly proposed American College of Rheumatology (ACR) classification criteria for Sjögren's Syndrome (SS) in a well-characterised sicca cohort, given ongoing efforts to resolve discrepancies and weaknesses in the systems. METHODS In a multidisciplinary clinic for the evaluation of sicca, we assessed features of salivary and lacrimal gland dysfunction and autoimmunity as defined by tests of both AECG and ACR criteria in 646 participants. Global gene expression profiles were compared in a subset of 180 participants. RESULTS Application of the AECG and ACR criteria resulted in classification of 279 and 268 participants with SS, respectively. Both criteria were met by 244 participants (81%). In 26 of the 35 AECG+/ACR participants, the minor salivary gland biopsy focal score was ≥1 (74%), while nine had positive anti-Ro/La (26%). There were 24 AECG-/ACR+ who met ACR criteria mainly due to differences in the scoring of corneal staining. All patients with SS, regardless of classification, had similar gene expression profiles, which were distinct from the healthy controls. CONCLUSIONS The two sets of classification criteria yield concordant results in the majority of cases and gene expression profiling suggests that patients meeting either set of criteria are more similar to other SS participants than to healthy controls. Thus, there is no clear evidence for increased value of the new ACR criteria over the old AECG criteria from the clinical or biological perspective. It is our contention, supported by this report, that improvements in diagnostic acumen will require a more fundamental understanding of the pathogenic mechanisms than is at present available.
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Affiliation(s)
- Astrid Rasmussen
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - John A. Ice
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - He Li
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kiely Grundahl
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Jennifer A. Kelly
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Lida Radfar
- Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry, Oklahoma City, OK, USA
| | - Donald U. Stone
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Michael Rohrer
- Hard Tissue Research Laboratory, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Rajaram Gopalakrishnan
- Division of Oral Pathology, Department of Developmental and Surgical Science, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Glen D. Houston
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - David M. Lewis
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - James Chodosh
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B. Harley
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- US Department of Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Pamela Hughes
- Division of Oral and Maxillofacial Surgery, Department of Developmental and Surgical Science, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Jacen S. Maier-Moore
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Courtney G. Montgomery
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Nelson L. Rhodus
- Department of Oral Surgery, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - A. Darise Farris
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen and Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Christopher J. Lessard
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - R. Hal Scofield
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Kathy L. Moser Sivils
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
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Rasmussen A, Ice J, Li H, Grundahl K, Kelly J, Radfar L, Stone D, Hefner K, Anaya JM, Rohrer M, Houston G, Lewis D, Chodosh J, Harley J, Maier-Moore J, Montgomery C, Rhodus N, Farris D, Segal B, Lessard C, Scofield RH, Sivils K. THU0292 Comparison of the Aecg Sjogren’s Syndrome Classification Criteria to the Newly Proposed ACR Criteria in a Large, Carefully Characterized Sicca Cohort. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mullen GP, Mathews EA, Vu MH, Hunter JW, Frisby DL, Duke A, Grundahl K, Osborne JD, Crowell JA, Rand JB. Choline transport and de novo choline synthesis support acetylcholine biosynthesis in Caenorhabditis elegans cholinergic neurons. Genetics 2007; 177:195-204. [PMID: 17603106 PMCID: PMC2013710 DOI: 10.1534/genetics.107.074120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/18/2022] Open
Abstract
The cho-1 gene in Caenorhabditis elegans encodes a high-affinity plasma-membrane choline transporter believed to be rate limiting for acetylcholine (ACh) synthesis in cholinergic nerve terminals. We found that CHO-1 is expressed in most, but not all cholinergic neurons in C. elegans. cho-1 null mutants are viable and exhibit mild deficits in cholinergic behavior; they are slightly resistant to the acetylcholinesterase inhibitor aldicarb, and they exhibit reduced swimming rates in liquid. cho-1 mutants also fail to sustain swimming behavior; over a 33-min time course, cho-1 mutants slow down or stop swimming, whereas wild-type animals sustain the initial rate of swimming over the duration of the experiment. A functional CHO-1GFP fusion protein rescues these cho-1 mutant phenotypes and is enriched at cholinergic synapses. Although cho-1 mutants clearly exhibit defects in cholinergic behaviors, the loss of cho-1 function has surprisingly mild effects on cholinergic neurotransmission. However, reducing endogenous choline synthesis strongly enhances the phenotype of cho-1 mutants, giving rise to a synthetic uncoordinated phenotype. Our results indicate that both choline transport and de novo synthesis provide choline for ACh synthesis in C. elegans cholinergic neurons.
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Affiliation(s)
- Gregory P Mullen
- Program in Molecular, Cell and Developmental Biology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma 73104, USA
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19
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Abstract
The cha-1 gene of Caenorhabditis elegans encodes choline acetyl-transferase (the acetylcholine synthetic enzyme). The C. elegans unc-17 gene encodes a synaptic vesicle-associated acetylcholine transporter. The two genes thus define sequential biochemical steps in the metabolism of the neurotransmitter acetylcholine. Cloning, sequencing, and molecular analysis of the unc-17 region indicate that cha-1 and unc-17 transcripts share a 5' untranslated exon, and the rest of the unc-17 transcript is nested within the long first intron of cha-1. Thus, two proteins with related functions but with no sequences in common are produced as a result of alternative splicing of a common mRNA precursor. The structure of this transcription unit suggests a novel type of coordinate gene expression, and a temporal processing model is proposed for the regulation of cha-1 and unc-17 expression.
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Affiliation(s)
- A Alfonso
- Program in Molecular and Cell Biology, Oklahoma Medical Research Foundation, Oklahoma City 73104
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20
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Alfonso A, Grundahl K, McManus JR, Rand JB. Cloning and characterization of the choline acetyltransferase structural gene (cha-1) from C. elegans. J Neurosci 1994; 14:2290-300. [PMID: 8158270 PMCID: PMC6577154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We have cloned the cha-1 gene from Caenorhabditis elegans using the method of transposon tagging, cha-1 is the structural gene for ChAT, the enzyme that synthesizes ACh. Sequence analysis of cDNAs predicts a protein of 71.5 kDa; comparison of the deduced amino acid sequence with ChAT sequences from other species confirms that cha-1 encodes ChAT. Comparison of cDNA and genomic sequences reveals that transcription is from right to left on the genetic map, and that some of the transcripts may result from trans-splicing of the 22-base spliced leader SL 1. The cha-1 gene is organized into 11 exons. The first exon contains only untranslated sequences, and is followed by an extremely long intron. The coding sequence of the cha-1 transcript is disrupted by mutations in the cha-1 gene. We have determined the sites of four transposon insertions and the end-points of two deletions that lead to the cha-1 mutant phenotype; one of the deletions appears to eliminate gene function completely. Comparison of the Drosophila, rat, and C. elegans genes reveals conserved motifs and conserved intron sites.
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Affiliation(s)
- A Alfonso
- Program in Molecular and Cell Biology, Oklahoma Medical Research Foundation, Oklahoma City 73104
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Abstract
Mutations in the unc-17 gene of the nematode Caenorhabditis elegans produce deficits in neuromuscular function. This gene was cloned and complementary DNAs were sequenced. On the basis of sequence similarity to mammalian vesicular transporters of biogenic amines and of localization to synaptic vesicles of cholinergic neurons in C. elegans, unc-17 likely encodes the vesicular transporter of acetylcholine. Mutations that eliminated all unc-17 gene function were lethal, suggesting that the acetylcholine transporter is essential. Molecular analysis of unc-17 mutations will allow the correlation of specific parts of the gene (and the protein) with observed functional defects. The mutants will also be useful for the isolation of extragenic suppressors, which could identify genes encoding proteins that interact with UNC-17.
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Affiliation(s)
- A Alfonso
- Program in Molecular and Cell Biology, Oklahoma Medical Research Foundation, Oklahoma City 73104
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Abstract
Synaptotagmin is an abundant synaptic vesicle-associated protein proposed to be involved in calcium-mediated neurotransmitter release. Our molecular and genetic results demonstrate that, although synaptotagmin is required for the proper function of the presynaptic nerve terminal in C. elegans, some neurotransmitter release persists in synaptogamin mutants. In C. elegans neurons, synaptotagmin is localized to regions known to be rich in synapses and appears to be associated with synaptic vesicles. Mutants defective in the synaptotagmin gene, called snt-1, exhibit severe behavioral abnormalities that are characteristic of deficiencies in synaptic function, including severe locomotion, feeding, and defecation defects. The mutants are defective in exocytosis, since they accumulate acetylcholine, and are resistant to cholinesterase inhibitors, but they nevertheless remain sensitive to cholinergic receptor agonists. In spite of these exocytic defects, snt-1 mutants are capable of coordinated motor movements, indicating that the mutants do not have a complete block of neurotransmitter release.
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Affiliation(s)
- M L Nonet
- Department of Molecular and Cell Biology, University of California, Berkeley 94720
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