Neutrophil proteases degrade autoepitopes of NET-associated proteins

Neutrophils can form neutrophil extracellular traps (NETs) to capture microbes and facilitate their clearance. NETs consist of decondensed chromatin decorated with anti-microbial proteins. Here, we describe the effect of neutrophil proteases on the protein content of NETs. We show that the neutrophil serine proteases degrade several neutrophil proteins associated with NETs. Interestingly, the anti-bacterial proteins associated with NETs, such as myeloperoxidase, calgranulin B and neutrophil elastase (NE), seem to be less susceptible to proteolytic degradation than other NET proteins, such as actin and MNDA. NETs have been proposed to play a role in autoimmune reactions. Our data demonstrate that a large number of the autoepitopes of NET proteins that are recognized by autoantibodies produced by systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients are also removed by the proteases. In conclusion, neutrophil serine proteases have a major impact on the NET proteome and the proteolytic changes of NET-associated proteins may counteract autoimmune reactions to NET components.     

胡蜂毒提取物对胶原诱导性类风湿性关节炎大鼠的作用研究

目的建立胶原诱导性类风湿关节炎(collagen-induced arthritis,CIA)大鼠模型来探讨胡蜂毒提取物对大鼠类风湿性关节炎(rheumatoid arthritis,RA)的治疗作用。方法将SD大鼠随机分为正常组、模型组、阳性对照组(注射用蜂毒冻干粉,1.25 mg·kg^-1)和胡蜂毒提取物低、中、高剂量(0.125、0.25、0.5 mg·kg^-1)组,除正常组外,其余各组采用多点注射鸡Ⅱ型胶原加完全弗氏佐剂的方法来诱导大鼠RA模型,每7 d一次,共14 d。造模结束后,各给药组于足趾皮下注射对应剂量的药物,连续给药14 d。分别于造模前、造模第14天和给药第14天测量大鼠踝关节直径和周长,并进行AI评分;观察大鼠脏器指数和踝关节组织HE染色的变化;采用酶联免疫吸附测定(ELISA)检测大鼠血清中相关炎症因子白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α、IL-8、前列腺素(PG)E-2、环氧化酶(COX)-2和类风湿因子免疫球蛋白(Ig)G、Ig A、Ig M的含量变化;利用流式细胞术检测大鼠脾脏T细胞亚群的变化。结果与模型组比较,胡蜂毒提取物对CIΑ大鼠的关节肿胀(直径及周长)抑制效果显著(P<0.01),能明显降低其AI评分(P<0.01或P<0.05),能不同程度恢复大鼠的脏器指数(P<0.01或P<0.05),改善踝关节组织病理学结构病变,降低大鼠血清中各炎症因子和类风湿因子的表达(P<0.01或P<0.05),调节和改善T细胞亚群比例的紊乱(P<0.01或P<0.05)。结论胡蜂毒提取物对CIA大鼠具有较好的治疗作用,这与其对炎症细胞因子网络的调控和对免疫的调节有关系。     

High dose trivalent influenza vaccine compared to standard dose vaccine in patients with rheumatoid arthritis receiving TNF-alpha inhibitor therapy and healthy controls: Results of the DMID 10-0076 randomized clinical trial

IntroductionSubjects with rheumatoid arthritis (RA) receiving tumor necrosis factor-inhibiting (TNFi) therapies are at risk for severe influenza, and may respond less well to influenza vaccine. We examined the safety and immunogenicity of high dose influenza vaccine (HD) compared to standard dose vaccine (SD) in participants with RA receiving stable TNFi.MethodsA randomized, double-blinded, Phase II study was conducted in adults with RA receiving TNFi, and healthy, gender and age-matched control subjects. Participants were immunized with HD (Sanofi Pasteur Fluzone High Dose [60 mcg × 3 strains]) or SD (Sanofi Pasteur Fluzone® [15 mcg × 3 strains]) intramuscularly (IM). A self-administered memory aid recorded temperature and systemic and local adverse events (AEs) for 8 days, and safety was evaluated and serum obtained to measure HAI activity on days 7, 21 and 180 days following vaccination.ResultsA greater proportion of RA subjects who received HD seroconverted at day 21 compared to SD, although this was not statistically significant. GMT antibody responses in RA subjects who received HD compared to SD were greater for all strains on day 21, and this was significant for H1N1. Seroconversion rates and GMT values were not different between RA subjects and control subjects. There were no safety concerns for HD or SD in RA subjects, and RA-related symptoms did not differ between SD and HD recipients by a RA-symptom questionnaire (RAPID 3).ConclusionsTNF-inhibitor therapy in people with RA did not appear to influence the immunogenicity of either SD or HD. Influenza seroconversion and GMT values were higher among RA subjects receiving HD compared to SD; however, differences were small and a larger study is needed to validate these findings. Given the apparent risk of increased influenza-related morbidity and mortality among immune compromised subjects, the higher GMT values generated by HD may be beneficial.     

Ankle distraction arthroplasty (ADA): A brief review and technical pearls

Ankle distraction arthroplasty (ADA) is a procedure based on the concept that mechanical unloading of an arthritic joint will initiate a healing response in the subchondral bone and articular cartilage. ADA utilizes the patient's own healing response, preserves joint motion, and is a great option for patients with osteoarthritis who are not ready for prosthetic arthroplasty or fusion. The procedure is well described and technically simple and adjunctive biologic therapies are exciting for joint regeneration. Complications are minor, and more serious adverse events are avoidable. Supramalleolar osteotomy pairs well with ankle distraction but requires some analysis and planning.     

From confusion to consensus: Need for multi disciplinary team approach in rheumatology: An orthopaedic surgeons's perpective

Aim of joint surgeries in rheumatoid arthritis is to restore function and quality of life, prevent joint deterioration, relieve pain and correct deformity in patients afflicted with rheumatoid disorders With advent of newer therapeutic modalities, the need for joint surgeries in cases of rheumatoid disorders has drastically reduced over the past two decades. Decision-making and timing for orthopaedic intervention are complex issues because of polyarticular involvement in rheumatoid disorder. Optimal results from the surgery demands close team work between the rheumatologists and the orthopaedic surgeon. However, as studies, have indicated, there appears to be divergent views amongst rheumatologist and the orthopaedic surgeon as regards indications, timing and effectiveness of rheumatoid joint surgery. This is to the detriment of the patient's best interest. Therefore, it is imperative that a multidisciplinary team approach be adopted towards managing each patient. The need of the hour is evolution of integrated Rheumatology Team comprising of rheumatologist, orthopaedic surgeon, pain care specialist, physiotherapist and nurse, a close synergy of interests to provide holistic care to patients of inflammatory joint disorders.