Histone-Specific CD4+ T Cell Plasticity in Active and Quiescent Systemic Lupus Erythematosus

OBJECTIVE

The aim of this study was to assess whether circulating histone-specific T cells represent tools for precision medicine in systemic lupus erythematosus (SLE).

METHODS

Seroprevalence of autoantibodies and HLA-DR beta (DRB) 1 profile were assessed among 185 patients with SLE and combined with bioinformatics and literature evidence to identify HLA-peptide autoepitope couples for ex vivo detection of antigen-specific T cells through flow cytometry. T cell differentiation and polarization was investigated in patients with SLE, patients with Takayasu arteritis, and healthy controls carrying HLA-DRB1*03:01 and/or HLA-DRB1*11:01. SLE Disease Activity Index 2000 and Lupus Low Disease Activity State were used to estimate disease activity and remission.

RESULTS

Histone-specific CD4+ T cells were selectively detected in patients with SLE. Among patients with a history of anti-DNA antibodies, 77% had detectable histone-specific T cells, whereas 50% had lymphocytes releasing cytokines or upregulating activation markers after in vitro challenge with histone peptide antigens. Histone-specific regulatory and effector T helper (Th) 1-, Th2-, and atypical Th1/Th17 (Th1*)-polarized cells were significantly more abundant in patients with SLE with quiescent disease. In contrast, total Th1-, Th2-, and Th1*-polarized and regulatory T cells were similarly represented between patients and controls or patients with SLE with active versus quiescent disease. Histone-specific effector memory T cells accumulated in the blood of patients with quiescent SLE, whereas total effector memory T cell counts did not change. Immunosuppressants were associated with expanded CD4+ histone-specific naive T (TN) and terminally differentiated T cells.

CONCLUSION

Histone-specific T cells are selectively detected in patients with SLE, and their concentration in the blood varies with disease activity, suggesting that they represent innovative tools for patient stratification and therapy.

Rationale and design of the CV-PREVITAL study: an Italian multiple cohort randomised controlled trial investigating innovative digital strategies in primary cardiovascular prevention

INTRODUCTION

Prevention of cardiovascular disease (CVD) is of key importance in reducing morbidity, disability and mortality worldwide. Observational studies suggest that digital health interventions can be an effective strategy to reduce cardiovascular (CV) risk. However, evidence from large randomised clinical trials is lacking.

METHODS AND ANALYSIS

The CV-PREVITAL study is a multicentre, prospective, randomised, controlled, open-label interventional trial designed to compare the effectiveness of an educational and motivational mobile health (mHealth) intervention versus usual care in reducing CV risk. The intervention aims at improving diet, physical activity, sleep quality, psycho-behavioural aspects, as well as promoting smoking cessation and adherence to pharmacological treatment for CV risk factors. The trial aims to enrol approximately 80 000 subjects without overt CVDs referring to general practitioners' offices, community pharmacies or clinics of Scientific Institute for Research, Hospitalization and Health Care (Italian acronym IRCCS) affiliated with the Italian Cardiology Network. All participants are evaluated at baseline and after 12 months to assess the effectiveness of the intervention on short-term endpoints, namely improvement in CV risk score and reduction of major CV risk factors. Beyond the funded life of the study, a long-term (7 years) follow-up is also planned to assess the effectiveness of the intervention on the incidence of major adverse CV events. A series of ancillary studies designed to evaluate the effect of the mHealth intervention on additional risk biomarkers are also performed.

ETHICS AND DISSEMINATION

This study received ethics approval from the ethics committee of the coordinating centre (Monzino Cardiology Center; R1256/20-CCM 1319) and from all other relevant IRBs and ethics committees. Findings are disseminated through scientific meetings and peer-reviewed journals and via social media. Partners are informed about the study's course and findings through regular meetings.

TRIAL REGISTRATION NUMBER

NCT05339841.

New Italian version of the Wilkins Rate of Reading Test: Materials for repeated-measure designs in optometry and neuropsychological research

PURPOSE

To develop a series of equivalent passages of text in Italian, according to the principles of the Wilkins Rate of Reading Test (WRRT), suitable for both clinical examination and scientific research when equivalent stimuli are needed to compare performance in repeated-measure designs.

METHOD

Fifteen high-frequency Italian words (matched for grammatical class and length to the English WRRT) were used to generate 15 different 10-line meaningless passages, according to the design principles of the English WRRT. Thirty-two healthy Italian-speaking higher education students read the passages aloud according to a fixed randomisation schedule. Performance was recorded digitally to measure reading speed and accuracy offline. Equivalence between the passages and the practice and fatigue effects for both reading speed and accuracy were examined as well as test-retest reliability.

RESULTS

No significant difference in reading speed and accuracy was found between the passages. There was a significant practice effect on reading speed but not accuracy, with the first presented passage read significantly slower than the others. There was no evidence of a fatigue effect. Reading speed, the reference metric for the WRRT, showed good test-retest reliability.

CONCLUSIONS

The passages of the Italian version of the WRRT were equivalent to each other. The practice effect suggests that familiarisation with the test (i.e., reading at least one matrix of words) should be carried out before consecutive/repeated reading of different passages for experimental or clinical purposes.

Adverse effect of PNPLA3 p.I148M genetic variant on kidney function in middle-aged individuals with metabolic dysfunction

BACKGROUND

The PNPLA3 p.I148M variant is the main genetic determinant of nonalcoholic fatty liver disease, and PNPLA3 silencing is being evaluated to treat this liver condition. Data suggest that the p.I148M variant predisposes to kidney damage, but the relative contribution to kidney function, compared to overall genetic susceptibility, is not defined.

AIMS

We aimed to assess the effect of PNPLA3 p.I148M on the estimated glomerular filtration rate (eGFR) in individuals with metabolic dysfunction.

METHODS

We included 1144 middle-aged individuals from the Liver-Bible-2022 cohort. Glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. The effect of PNPLA3 p.I148M on eGFR_CKD-EPI levels was tested under additive genetic models adjusted for clinical predictors, ethnicity and a polygenic risk score of chronic kidney disease (PRS-CKD). In a subset of 144 individuals, we examined the effect of PNPLA3 p.I148M on eGFR_CKD-EPI over a median follow-up of 17 months.

RESULTS

The p.I148M variant was associated with lower eGFR_CKD-EPI levels (-1.24 mL/min/1.73 m² per allele, 95% CI: -2.32 to -0.17; p = 0.023), independent of age, sex, height, waist circumference, systolic blood pressure, LDL-cholesterol, transaminases, fasting insulin, albuminuria, lipid-lowering drugs, ethnicity and PRS-CKD score. In the prospective evaluation, the p.I148M variant was independently associated with faster eGFR_CKD-EPI decline (ΔeGFR_CKD-EPI -3.57 mL/min/1.73 m² per allele, 95% CI: -6.94 to -0.21; p = 0.037).

CONCLUSIONS

We found a detrimental impact of the PNPLA3 p.I148M variant on eGFR_CKD-EPI levels in middle-aged individuals with metabolic dysfunction. This association was independent of established risk factors, ethnicity and genetic predisposition to CKD. PNPLA3 p.I148M silencing may protect against kidney damage progression in carriers.