Atypical lymphoplasmacytic and immunoblastic proliferation from systemic lupus erythematosus. A case report

A case of atypical lymphoplasmacytic and immunoblastic proliferation (ALPIBP) in the lymph nodes associated with well-documented systemic lupus erythematosus (SLE) is presented. A 30-year-old Japanese female with an 18-year history of SLE presented with right neck lymphadenopathy of 3 months duration. A biopsy specimen showed a diffuse effaced lymph node architecture without follicles and minimal sinuses. At high power field, a polymorphous population of small- to medium-sized lymphocytes, plasma cells, plasmacytoid cells, as well as large, basophilic transformed lymphocytes and immunoblasts diffusely infiltrated the paracortical area. Interestingly, the immunohistochemical study demonstrated large, irregularly shaped accumulations of follicular dendritic cells (FDCs) surrounding the small vessels, which is an immunohistochemical finding characteristic of angioimmunoblastic T-cell lymphoma (AILT). However, the present lesion showed the following differences to AILT: (a) absence of CD3+, CD4+ and CD10+ clear cells, which are tumor cells of AILT; (b) absence of pronounced arborizing vascular proliferation; (c) on molecular analysis, the present case demonstrated a polyclonal pattern converse to the monoclonal T-cell receptor gamma chain gene rearrangement in most AILTs (d) absence of EBV infected lymphoid cells, which are frequently detected AILT. As previously suggested, the present case indicates that a clinical correlation as well as immunohistologic and genotypic studies may be necessary to discriminate between ALPIBPs and AILT.     

周期性机械拉伸对类风湿关节炎成纤维样滑膜细胞增殖的影响

目的探讨周期性机械拉伸对类风湿关节炎成纤维样滑膜细胞(RA-FLSs)增殖能力的影响。方法实验组细胞在周期性机械拉伸频率为1.0 Hz、拉伸幅度为3%、6%和9%的条件下,分别对RA-FLSs加载2、6和12 h。对照组细胞在保持与实验组培养条件一致的情况下不进行拉伸刺激。机械拉伸后,用流式细胞术和MTS检测细胞的增殖和活性。RT-PCR检测加载后细胞周期调控因子(CyclinD1、CyclinE1、CDK2、P27)在基因水平上的表达变化。结果 6%和9%的拉伸刺激持续作用6、12 h使RA-FLSs增殖和活性显著降低(P<0.05),同时CDK2和CyclinE1的mRNA表达降低,P27 mRNA的表达增高(P<0.05),周期性机械拉伸对CyclinD1表达的影响相对较小。结论周期性机械拉伸对RA-FLSs增殖能力的影响与拉伸强度以及持续的时间有关,6%和9%的机械拉伸刺激可以抑制RA-FLSs的增殖,而这种增殖抑制作用可能是通过调控CyclinE1,CDK2和P27的表达来实现的。本研究对于探讨力学刺激在类风湿性关节炎的发病机制以及临床防治中的作用具有一定意义。     

Circulating interleukin 10 and interleukin-6 serum levels in rheumatoid arthritis patients treated with methotrexate or gold salts: Preliminary report

In order to evaluate the relationship between serum concentrations of interleukin-10 (IL-10), IL-6, and acute phase proteins in rheumatoid arthritis (RA) patients treated with methotrexate (MTX) or intramuscular gold (IMG) we determined IL-10, IL-6, C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP) and alpha-1-antichymotrypsin (ACT) in the sera of 35 RA patients. IL-10 and IL-6 levels were evaluated using an enzyme-linked immunoassay (ELISA). AGP and ACT level were measured using rocket immunoelectrophoresis. IL-10 serum level was not increased in RA patients as compared to controls (58.7 ± 18.1 pg/ml vs. 57.2 ± 11.9 pg/ml). IL-6 level was significantly elevated (91.6 ± 46.9 pg/ml vs. 45 ± 19 pg/ml, p < 0.05). CRP was significantly increased as compared to healthy controls (35 ± 19 mg/l vs. 3 ± 2 mg/l, p < 0.05). Patients treated with MTX or IMG presented an increased level of IL-10 and decreased amounts of IL-6, as compared to those treated with NSAID only. However, only changes between patients treated with IMG and NSAID were found to be statistically significant. A good negative correlation between IL-10 and IL-6 serum level was found (r = –0.75, p < 0.05). A positive significant correlation between IL-6 serum level and CRP (r = 0.62, p < 0.05), AGP (r = 0.78, p < 0.05) and ACT (r = 0.45, p < 0.05) was established. On the other hand, a negative correlation between IL-10 and serum level of CRP (r = –0.76, p < 0.05), AGP (r = –0.64, p < 0.05) and ACT (r = –0.38, p < 0.05) was also observed. Moreover, these relationships were maintained when patients treated with MTX, IMG, or NSAID were analyzed independently. According to the data thus far obtained, it seems that IL-10 decreases IL-6 production, and thereby indirectly affects the acute phase response, decreasing CRP, AGP, and ACT concentration in RA patients.Abbreviations ACT -1-antichymotrypsin - AGP ₁-acid glycoprotein - APP acute phase protein - CRP C-reactive protein - CSF colony stimulating factor - IFN interferon - IL interleukin - IMG intramuscular gold - MTX methotrexate - NSAID non-steroidal anti-inflammatory drug - RA rheumatoid arthritis     

类风湿关节炎药物治疗基因多态性研究进展

类风湿关节炎(RA)是一种系统性疾病,可致关节破坏和残疾.治疗以传统DMARDs和生物制剂为主.药物疗效与患者基因多态性密切相关.药物主要包括甲氨蝶呤、来氟米特、柳氮磺胺吡啶和生物制剂如TNF拮抗剂、妥珠单抗、力妥昔单抗等.RA患者遗传背景是影响药物疗效的重要因素,必然对个体化治疗产生深远影响,因而研究基因多态性与RA患者疗效反应的相关机制具有重要意义.     

TRPC6在IL-1β诱导类风湿关节炎成纤维细胞样滑膜细胞增殖中的作用

目的:应用RNA干扰技术研究瞬时受体电位通道6(TRPC6)对IL-1β诱导的类风湿关节炎(RA)成纤维细胞样滑膜细胞(RA-FLS)增殖的影响。方法:RT-qPCR法检测RA和骨关节炎(OA)患者滑膜组织中TRPC6 mRNA的表达水平。组织块联合酶消化法培养RA-FLS。流式细胞术鉴定RA-FLS。将不同浓度(0、0.25、0.5、1、2、4、8、16μg/L)的重组人IL-1β与RA-FLS共培养36 h,CCK-8法检测细胞活力的改变;16μg/L的IL-1β作用RA-FLS不同时间(12、24、36、48、60、72 h),CCK-8法检测细胞活力的改变。特异性TRPC6-siRNA转染RA-FLS后,采用RT-qPCR和Western blotting检测沉默效率。在IL-1β存在和不存在的条件下,CCK-8法、Ed U标记法和流式细胞术检测TRPC6干扰组与对照组的细胞活力、Ed U阳性细胞比率和(G_2/M+S)期比率的差异。结果:RA患者滑膜组织中TRPC6的mRNA表达水平相对于OA患者明显增加(P0.05)。TRPC6-siRNA能显著降低RA-FLS中TRPC6 mRNA和蛋白的表达(P0.05)。IL-1β能诱导RA-FLS增殖(P0.05)。沉默TRPC6后,在IL-1β的诱导环境下,特异性干扰组RA-FLS的活力、Ed U阳性细胞比率和(G_2/M+S)期比率与空白组和对照组相比均明显降低(P0.05),而在不含IL-1β的条件下,干扰组与空白组和对照组相比差异均无统计学显著性。结论:TRPC6参与IL-1β诱导的RA-FLS增殖过程,沉默TRPC6能降低IL-1β诱导的RA-FLS增殖水平。     

电针治疗联合甲氨蝶呤对类风湿关节炎大鼠JAK-STAT信号通路及VEGF表达的影响

目的探讨电针治疗联合甲氨蝶呤对胶原诱导性(CIA)类风湿关节炎大鼠的治疗作用及其机制。方法采用弗氏佐剂与牛Ⅱ型胶原皮下注射复制CIA大鼠模型,并将60只大鼠随机分为对照组、模型组、甲氨蝶呤组、电针组和联合治疗组。在各组大鼠治疗12周后,采用Pelletier评分和Mankin评分对大鼠大体和组织学改变进行评分;ELISA法检测血清中TNF-α、IL-6的水平;RT-PCR检测软骨细胞Ⅱ型胶原m RNA水平,TUNNEL法测定软骨细胞凋亡率,RT-PCR、Western blot和免疫组化检测软骨中JAk-3、STAT-3、VEGF的表达量。结果模型组Pelletier和Mankin评分、软骨细胞凋亡率、血清中IL-6、TNF-α的水平、软骨中JAk-3、STAT-3、VEGF表达量较对照组均明显增高(P<0.05),软骨细胞Ⅱ型胶原m RNA表达水平较对照组明显降低(P<0.05)。甲氨蝶呤组、电针组和联合治疗组Pelletier和Mankin评分、软骨细胞凋亡率、血清中IL-6、TNF-α的水平、软骨中JAk-3、STAT-3、VEGF表达量较模型组均明显降低(P<0.05);其中联合治疗组较甲氨蝶呤组和电针组降低更明显(P<0.05);电针组与甲氨蝶呤组比较无统计学差异(P>0.05)。甲氨蝶呤组、电针组和联合治疗组软骨细胞Ⅱ型胶原mRNA表达水平较模型组均明显升高(P<0.05);其中联合治疗组较甲氨蝶呤组和电针治疗组升高更明显(P<0.05);电针组与甲氨蝶呤组比较无统计学差异(P>0.05)。结论电针治疗类风湿关节炎疗效明确,联合甲氨蝶呤治疗作用更佳,其作用机制可能与抑制JAK-STAT信号通路和VEGF的表达有关。     

Genetic influences on rheumatoid arthritis in african americans

Rheumatoid arthritis is a common autoimmune disease characterized by inflammation of the synovial membrane of diarthrodial joints, which often leads to joint damage and disability. There are known associations between major histocompatibility complex class II alleles and susceptibility to rheumatoid arthritis and its severity in Caucasians. African Americans, an admixed population in the United States, has been underrepresented in genetic studies of the susceptibility and severity of rheumatoid arthritis. With the advent of biologic agents, which target specific molecules of the immune system (e.g., tumor necrosis factor, interleukin-1), biologic markers of treatment response in Caucasians and in African Americans would be clinically useful.     

MicroRNA-16对类风湿关节炎患者滑膜成纤维细胞增殖、侵袭及细胞因子分泌的影响

 目的:研究microRNA-16（miR-16）对类风湿关节炎（rheumatoid arthritis,RA）患者滑膜成纤维细胞（rheumatoid arthritis synovial fibroblasts,RASFs）增殖、侵袭及细胞因子分泌的影响。方法: 体外分离培养RASFs,脂质体转染化学合成的miR-16 mimic或miR-16抑制剂,分别采用MTT法、Transwell小室法和流式细胞术检测其对RASFs增殖、侵袭及凋亡的影响;RT-PCR和Western blotting检测miR-16对RASFs基质金属蛋白酶3/13（matrix metalloproteinase 3/13,MMP3/13）及白细胞介素1β（interleukin 1β,IL-1β）表达的影响。结果:增殖实验结果表明miR-16可显著抑制RASFs的增殖;细胞侵袭结果表明miR-16可显著抑制RASFs的侵袭;流式细胞术检测发现miR-16对RASFs凋亡无显著影响;miR-16可下调MMP3/13及IL-1β的表达水平。结论:  miR-16在RA的发生中起着重要作用,它可能通过下调MMP3/13及IL-1β的表达抑制RASFs增殖和侵袭。这为进一步研究miR-16在RA中的作用机制奠定了基础。     

IL-18与类风湿性关节炎

IL-18是一种多功能的炎性细胞因子，可强烈诱生IFN-γ，加强FasL介导的细胞毒效应，具有重要的免疫调节功能。近年研究发现，IL-18有增强免疫、抗肿瘤等作用，同时也参与某些自身免疫病、变态反应性疾病的发生，如类风湿性关节炎，它通过多种途径诱导IFN-γ产生，在类风湿性关节炎的发病机制中起着重要的作用。     

亚甲基四氢叶酸还原酶单核苷酸多态性与老年类风湿关节炎合并高血压病相关性研究

目的检测我国南方汉族老年人类风湿关节炎（RA）合并高血压病（HT）者的亚甲基四氢叶酸还原酶（MTHFR）677C/T和1298A/C2个单核苷酸多态性的表达,并分析两个单核苷酸多态性（SNP）位点与HT、RA及RA合并HT的关系。方法研究对象共169人,其中对照91人,RA患者78人,应用聚合酶链式反应-限制性片段长度多态性（PCR-RFLP）技术检测基因型和等位基因的分布频率,群体数理遗传学方法分析MTHFR SNP的遗传平衡吻合度和相互间连锁不平衡关系。结果经Hardy-Weinberg检验,所研究的2个SNP位点各基因频率达到遗传平衡。677CC、CT、TT基因型在高血压病组中分别占59.2%、33.8%和6.9%,在非高血压病组中分别为79.5%、17.9%和2.6%,两组总的频率分布无显著性差异（χ^2=5.402,P〉0.05）,但将少见T等位基因携带者CT与TT合为一组后两组比较有统计学差异,（χ^2=5.337,P〈0.05）说明携带677T等位基因与高血压病可能存在相关关系。OR为1.579（95%CI：1.066～2.339,P=0.029）,进一步比较RA合并高血压病与对照者高血压病组,两组总的频率分布及将CT与TT合为一组后比较均无显著性差异（χ^2=3.606,P〉0.05）说明677C/T与RA及RA合并高血压病均无关联。1298A/C位点在高血压病组中分别占54.6%、40.8%和4.6%,在非高血压病组中分别为51.3%、43.6%和5.1%,两组总的频率分布无显著性差异（χ^2=0.136,P〉0.05）,将AC与CC合为一组后比较亦无统计学差异。1298A/C位点在RA合并高血压病与对照者高血压病组,两组总的频率分布及将AC与CC合为一组后均无统计学差异,说明1298A/C位点与高血压病及RA合并高血压病均无关系。结论MTHFR677CT、TT基因型与高血压病存在相关关系,可能是高血压病的危险易感因子,1298A/C与HT无关联。合并RA高血压病组与不合并RA高血压病组研究结果基本一致。677C/T和1298A/C与RA无明显关联。老年RA患者中高血压病患病率高。     

Kinase inhibitors: A new tool for the treatment of rheumatoid arthritis

Despite aggressive immunosuppression with biologics and traditional DMARDs, achieving disease remission remains an unmet goal for most rheumatoid arthritis (RA) patients. In this context, there is a demand for novel treatment strategies, with kinase inhibitors expected to enrich the existing therapeutic armamentarium. In RA some kinases participate in the generation of pathogenic signaling cascades. Pharmacologic inhibition of kinases that mediate pathogenic signal transduction heralds a new era for RA therapeutics. Oral inhibitors of JAKs, Syk, PI3Ks, MAPKs and Btk are under development or in clinical trials in patients with RA. In this review, we discuss the scientific rationale for the use of kinase inhibitors in RA and summarize the experience from clinical trials.     

Mannose-binding lectin deficiency and miscarriages in rheumatoid arthritis

Objective: To investigate the association between mannose-binding lectin (MBL) serum level and MBL2 polymorphisms, and the frequency of spontaneous miscarriages in rheumatoid arthritis (RA) patients.

Methods: One hundred seventy seven women (mean age 50?years) with RA from Southern Brazil were studied and 4.5% had a history of abortion (8/177). The MBL levels were determined by ELISA. MBL2 polymorphisms in the promoter (?550H/L, ?221X/Y), 5′ untranslated region (4?P/Q) and exon 1 (p.Gly54Asp: B allele, p.Arg52Cys: D allele and p.Gly57Glu: C allele; collectively labelled O) were genotyped by sequencing.

Results: Mannose-binding lectin levels of RA patients ranged from ≤100?ng/mL to 6640?ng/mL (median 541.5?ng/mL). There was a significant difference in MBL median levels (100?ng/mL vs. 625?ng/mL, respectively, p?=?.001) and frequency of MBL deficiency (75.0% vs. 24.1%, p?=?.007, OR?=?10.3, 95%CI?=?1.9–55.4), in patients with a history of miscarriage vs those without it. Patients with RA and miscarriage had more frequently haplotypes related with low MBL levels (p?=?.007, OR?=?10.5, 95%CI?=?1.3–84) than high producers. Moreover, LYPB haplotype and O allele were significantly associated with the occurrence of miscarriage (p?=?.001, OR?=?9.7, 95%CI?=?2.4–39.1 and p?=?.009, OR?=?5.9, 95%CI?=?1.4–23.4, respectively).

Conclusions: The results suggest that MBL deficiency and the presence of MBL2 gene polymorphisms that lead to MBL deficiency are risk factors for the occurrence of miscarriage in patients with RA.     

Intra-articular treatment of inflammatory arthritis with microsphere formulations of methotrexate: pharmacokinetics and efficacy determination in antigen-induced arthritic rabbits

Introduction  Methotrexate (MTX) encapsulated microspheres release MTX in the joint in a slow, controlled manner following intra-articular injection in healthy rabbits. The objective of this study was to determine the pharmacokinetics of MTX and to evaluate the efficacy following intra-articular treatment of MTX-loaded microspheres in an antigen-induced inflammatory arthritis rabbit model. Methods  Arthritis was induced in both knee joints of rabbits using ovalbumin. Rabbits were intra-articularly treated with MTX solution or MTX microspheres and plasma concentrations of MTX were determined in the first 8 h following intra-articular treatment. Rabbits were killed 14 days following treatment and histological analysis of rabbit joints was conducted to determine efficacy. Results  Arthritis was successfully induced in the joints of rabbits with the observation of histopathological features resembling rheumatoid arthritis. No significant differences were detected between MTX solution and MTX microspheres treated groups compared to phosphate buffered saline (control) animals. Conclusions  MTX microspheres effectively delivered the drug to the intra-articular space. However, a high degree of inter-animal variability, the severity of the disease induced and insufficient length of the observation period were suggested to be possible causes for the lack of therapeutic responses to MTX-loaded microspheres treatment.     

Intravascular large B-cell lymphoma secondary to lymphoplasmacytic lymphoma: a case report and review of literature with clonality analysis

Intravascular large B-cell lymphoma (IVLBCL) can be a fatal malignancy mainly because of difficulty in early detection. Due to the lack of specific clinical manifestations, early detection of IVLBCL remains a challenge, especially in the presence of comorbidities. Lymphoplasmacytic lymphoma (LPL) is an indolent B-cell lymphoma accompanied by monoclonal immunoglobulin M protein in most patients, and known to be associated with high risk of secondary hematological malignancies. Here, we report a patient who developed IVLBCL during treatment for LPL that presented a diagnostic challenge. Rearrangement analysis of the immunoglobulin heavy chain revealed the different clonal origins of two lymphomas, implying a predisposition of LPL to develop unrelated secondary lymphoma. Secondary lymphoma including IVLBCL during the treatment for LPL deserves consideration in order to facilitate early diagnosis and intervention.     

Tissue factor expression in rheumatoid synovium: a potential role in pannus invasion of rheumatoid arthritis

Angiogenesis, as well as pannus formation within the joint, plays an important role in the erosion of articular cartilage and bone in the pathological process of rheumatoid arthritis (RA). Tissue factor (TF), an essential initiator of the extrinsic pathway of blood coagulation, is also involved in the angiogenesis and the pannus formation of RA progression. In the present study, we used immunofluorescence and confocal scanning methods to characterize TF immunolocalization in RA synovium. We showed that positive staining of TF could be immunolocalized in synoviocytes, CD19⁺ B cells and CD68⁺ macrophages, whereas weak or negative staining of tissue factor could be found in CD34⁺ endothelial cells of neo-vessels, CD3⁺ T cells and CD14⁺ monocytes in RA synovium tissues. Our study demonstrates a detailed local expression of TF in the rheumatoid synovium, and supports the notion that TF, expressed not only by the synoviocytes themselves, but also the infiltrating CD19⁺ B cells and CD68⁺ macrophages, is involved in the pannus invasion in the progression of rheumatoid arthritis.     

Cyr61促进RA滑膜细胞增殖及炎症因子调控研究

目的:采用类风湿性关节炎(RA)患者滑膜细胞的体外培养,研究基质蛋白Cyr61在RA滑膜细胞增殖中的作用及其机制。方法:通过Real-time PCR、Western blot和免疫组化检测RA病人的滑膜组织和细胞中Cyr61的表达情况;用3H-TdR掺入法检测滑膜液(SF)对滑膜细胞增殖的影响;用ELISA方法检测RA患者滑膜液中Cyr61蛋白的水平。结果:RA病人的滑膜组织和细胞中高表达Cyr61;SF能刺激滑膜细胞发生明显增殖;且RA患者滑膜液中含高浓度的Cyr61蛋白。用SiRNA干扰技术抑制滑膜细胞中Cyr61基因表达,再加入滑膜液后,则滑膜细胞增殖明显降低。同时,将SF与anti-Cyr61抗体共同孵育后再刺激滑膜细胞,FLS也不再发生明显增殖。进一步研究滑膜液中与上调Cyr61表达有关的炎症细胞因子,发现SF中IFNγ-和TNFα-具有上调Cyr61蛋白表达的作用。结论:Cyr61蛋白是促进滑膜细胞增殖的重要调控基因;RA患者滑膜液中含有高浓度的炎症因子IFNγ-和TNFα-,通过上调Cyr61蛋白表达而促进滑膜细胞增殖,可能是促进RA病理性滑膜增生的重要因素之一。     

雌激素对RA滑膜细胞增殖和炎性介质表达的影响

目的探讨雌激素对类风湿关节炎(rheumatoid arthritis,RA)患者成纤维型滑膜细胞增殖和炎性细胞因子产生的影响,明确雌激素在RA病理过程中的作用。方法处于活动期、有膝关节积液的9例女性RA患者作为研究对象,无菌采集膝关节液,分离培养成纤维型滑膜细胞,待细胞传至第3～4代时,用终浓度分别为10-10、10-9、10-8、10-7、10-6 mol/L的雌二醇(E2)处理48 h,同时设未加E2的空白孔作为对照组,MTT法测定细胞增殖率,ELISA法检测培养上清中IL-1、IL-6、GM-CSF、MMP1、MMP2和MMP3水平。结果①与对照组相比,E2浓度为10-6、10-7、10-8 mol/L时RA滑膜细胞增殖率显著增高,并具有浓度依赖性,而E2浓度为10-9、10-10 mol/L时细胞增殖率没有显著改变。②不同浓度E2处理后,培养上清中IL-1水平显著高于对照组(P<0.05);E2浓度为10-6、10-7、10-8、10-9 mol/L时,IL-6和MMP-2浓度显著升高(P<0.05);培养上清中均未测得GM-CSF和MMP-1、MMP3,说明三者在体外培养的RA滑膜细胞中低表达。结论雌激素在RA的发生发展中具有重要作用,其机理可能是通过刺激RA滑膜细胞增殖和促进某些致炎细胞因子的分泌而导致RA患者关节滑膜增生和炎性病变。     

The B lymphocyte in rheumatoid arthritis: analysis of rearranged Vx genes from B cells infiltrating the synovial membrane

The participation of the humoral immune system in rheumatoid arthritis (RA) is characterized by the production of rheumatoid factors (RF). RF are autoantibodies against the Fc part of IgG which are encoded by diverse germ-line genes. Most of the RF-encoding genes are unmutated, but in RA, a substantial quantity is encoded by somatically mutated genes. In addition, the synovial membranes (SM) of the diseased joints of RA patients are infiltrated by B lymphocytes which form germinal center-like aggregates. To analyze the local immune response, B cell foci from two RA SM were isolated by micromanipulation. From DNA of these foci, the rearranged kappa light chain variable region (Vx) genes were amplified by polymerase chain reaction (PCR), cloned and sequenced. The amplification of different Vx-Jx combinations of different foci suggested oligoclonal expansion of B lymphocytes, which was confirmed by sequence analysis: each PCR product contained members of a single B cell clone. The sequence analysis of 29 different clones revealed rearrangements of diverse Vx genes. Both frequent representatives of the Vx3 and the Vx1 family, as well as rarely used genes such as the L10 and B2 genes of the Vx2 and Vx5 families were found. Of the eleven potentially functional gene rearrangements, eight were significantly mutated, indicating their derivation from antigen-selected B cells. Intraclonal diversity in one of these clones may suggest ongoing mutation in the diseased synovial membrane of patients with RA.     

T细胞与类风湿性关节炎

类风湿性关节炎(RA)是一种慢性、炎症性自身免疫性疾病,发病机制非常复杂,至今尚未阐明.尽管多种免疫细胞和分子被证实参与了RA的关节炎症反应和组织破坏,但抗原特异性T细胞的激活始终被认为是RA发病起始和进展的中心环节.不同亚群T细胞在RA发病中发挥不同作用,以往认为,自身抗原诱导的促炎性Th1细胞活化是RA发病的主要因...     

Immunogenetics of rheumatoid arthritis: Understanding functional implications

The last decade has seen a dramatic technological revolution. The characterisation of the majority of the common variations in our genetic code in 2003 precipitated the discovery of the genetic risk factors predisposing to Rheumatoid Arthritis development and progression. Prior to 2007, only a handful of genetic risk factors had been identified, HLA, PTPN22 and CTLA4. Since then, over 100 genetic risk loci have been described, with the prediction that an ever-increasing number of risk alleles with consistently decreasing effect sizes will be discovered in the years to come. Each risk locus harbours multiple candidate genes and the proof of causality of each of these candidates is as yet unknown. An enrichment of these RA-associated genes is found in three pathways: T-cell receptor signalling, JAK-STAT signalling and the NF-κB signalling cascade, and currently drugs targeting these pathways are available for the treatment of RA. However, the role that RA-associated genes have in these pathways and how they contribute to disease is not always clear. Major efforts in understanding the contribution of genetic risk factors are currently under way with studies querying the role of genetic variation in gene expression of coding and non-coding genes, epigenetic marks and other regulatory mechanisms yielding ever more valuable insights into mechanisms of disease. Recent work has suggested a possible enrichment of non-coding RNAs as well as super-enhancers in RA genetic loci indicating possible new insights into disease mechanism. This review brings together these emerging genetic data with an emphasis on the immunogenetic links these findings have provided and what we expect the future will bring.