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Gu H, Yu H, Qin L, Yu H, Song Y, Chen G, Zhao D, Wang S, Xue W, Wang L, Ai Z, Xu B, Peng A. MSU crystal deposition contributes to inflammation and immune responses in gout remission. Cell Rep 2023; 42:113139. [PMID: 37756161 DOI: 10.1016/j.celrep.2023.113139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/22/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
As a prominent feature of gout, monosodium urate (MSU) crystal deposition induces gout flares, but its impact on immune inflammation in gout remission remains unclear. Using single-cell RNA sequencing (scRNA-seq), we characterize the transcription profiling of peripheral blood mononuclear cells (PBMCs) among intercritical remission gout, advanced remission gout, and normal controls. We find systemic inflammation in gout remission with MSU crystal deposition at the intercritical and advanced stages, evidenced by activated inflammatory pathways, strengthened inflammatory cell-cell interactions, and elevated arachidonic acid metabolic activity. We also find increased HLA-DQA1high classic monocytes and PTGS2high monocytes in advanced gout and overactivated CD8+ T cell subtypes in intercritical and advanced gout. Additionally, the osteoclast differentiation pathway is significantly enriched in monocytes, T cells, and B cells from advanced gout. Overall, we demonstrate systemic inflammation and distinctive immune responses in gout remission with MSU crystal deposition, allowing further exploration of the underlying mechanism and clinical significance in conversion from intercritical to advanced stage.
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Affiliation(s)
- Hongchen Gu
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Hanqing Yu
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Ling Qin
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Hanjie Yu
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yaxiang Song
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Guangqi Chen
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Dake Zhao
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Shu Wang
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Wen Xue
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Ling Wang
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Zisheng Ai
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai 200092, China
| | - Bei Xu
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
| | - Ai Peng
- Center for Nephrology and Clinical Metabolomics, Division of Nephrology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
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Abstract
Gout is the most common inflammatory arthropathy caused by the deposition of monosodium urate (MSU) crystals. The burden of gout is substantial with increasing prevalence of gout globally. The prevalence of Gout in the United States has increased by over 7% in the last two decades. Initially, it was believed that MSU crystal deposits occur only in the joints with the involvement of the periarticular soft tissues, but recent studies have shown the presence of MSU crystal deposition in extra-articular sites as well. Human plasma becomes supersaturated with uric acid at 6.8 mg/dl, a state called hyperuricemia. Beyond this level, uric acid crystals precipitate out of the plasma and deposit in soft tissues, joints, kidneys, etc. If left untreated, hyperuricemia leads to chronic gout characterized by the deposition of tophi in soft tissues such as the joints, tendons, and bursae. With the advent of newer imaging techniques such as DECT, MSU crystals can be visualized in various extra-articular sites. Extra-articular deposition of MSU crystals is believed to be the causative factor for the development of multiple comorbidities in gout patients. Here, we review the literature on extra-articular deposition of urate crystals and the role of dual-energy computed tomography (DECT) in elucidating multi-organ involvement. DECT has emerged as an invaluable alternative for accurate and efficient MSU crystal deposition detection. Future studies using DECT can help determine the clinical consequences of extra-articular deposition of MSU in gout patients.
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Affiliation(s)
- Muhammad Israr Ahmad
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Salman Masood
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Daniel Moreira Furlanetto
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Yuan Y, Liu C, Xiang X, Yuan TL, Qiu L, Liu Y, Luo YB, Zhao Y, Herrmann M. Ultrasound scans and dual energy CT identify tendons as preferred anatomical location of MSU crystal depositions in gouty joints. Rheumatol Int 2018; 38:801-11. [PMID: 29442150 DOI: 10.1007/s00296-018-3994-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 02/05/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The present study was performed to localize the articular deposition of monosodium urate (MSU) crystal in joints. We compare the detection efficiencies of dual-energy CT (DECT) and ultrasound scans. METHODS Analyses by DECT and ultrasound were performed with 184 bilateral joints of the lower limbs of 54 consecutive gout patients. All joints were categorized into (1) knee, (2) ankle, (3) MTP1, and (4) MTP2, and sorted into those with and those without detectable MSU deposition. The comparison of the positive rate between DECT and ultrasound and the agreement was performed using the McNemar test and the Cohen's κ coefficient, respectively. Next, we listed the MSU crystal deposition as assessed by ultrasound between the DECT-positive and -negative joints according to their interior structure. We included tendons, synovia, cartilage, subcutaneous tissue, etc. RESULTS: Among all joints, the percentages with MSU crystal deposition detected by DECT (99/184, 53.8%) and ultrasound (106/184, 57.6%) were comparable (P = 0.530 > 0.05). For MTP1 (21/34, 61.8%; 12/34, 35.3%; P < 0.05) and MTP2-5 (17/34, 50.0%; 10/34, 29.4%, P < 0.05), ultrasound and DECT were more efficient, respectively. The data concordance in 46 of 50 joints (92.00%; κ = 0.769, P < 0.05) for knee; and 27 of 34 joints (79.41%; κ = 0.588, P < 0.05) for MTP2-5 and suggested that tendons were the most frequent anatomical location of MSU crystal deposition. CONCLUSIONS The tendons are the most frequent anatomical location of MSU crystal depositions. The concordance rate of knee joints and MTP2-5 joints shows good agreement between DECT and ultrasound depending on the location.
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