Study of clinical utility of antibodies to phosphatidylserine/prothrombin complex in Asian-Indian patients with suspected APS

Clinical Rheumatology - Antiphospholipid syndrome (APS) is the most common acquired pro-thrombotic disorder, also associated with obstetric complications. Phosphatidylserine/Prothrombin complex...     

Y RNA derived small RNAs in Sjögren's syndrome: Candidate biomarkers?

Anti‐Ro and anti‐La antibodies are important in pathogenesis and diagnosis of Sjögren's syndrome (SS). Ro60, Ro52 and La are RNA binding proteins of Y RNA, which were discovered more than three decades ago. Significance of Y RNA is not appreciated as much as Ro and La in SS. It can be hypothesised that 5′‐YsRNA, short fragment derived from Y RNA may be recognized by TLR7 in pDC, which induces type I interferon signature in SS. New genomics tools, namely RNA seq, enables assay of 5′‐YsRNA in blood. 5′‐YsRNA has the potential to be a novel biomarker of SS.     

Younger patients with primary Sjögren’s syndrome are more likely to have salivary IgG anti-muscarinic acetylcholine receptor type 3 antibodies

Acetylcholine type 3 receptor (M3R) is recognized as an autoantigen in primary Sjögren’s syndrome (pSS). Assay of anti-M3R antibody levels in serum is fraught with low sensitivity for diagnosis of pSS. Salivary assay is more likely to improve the diagnostic accuracy. Patients with pSS classified either by the American European Consensus Group (AECG) or American college of Rheumatology (ACR) criteria, attending rheumatology clinic between October 2014 and July 2015 were included. Hospital staff and lupus patients constituted healthy and disease controls, respectively. Evaluation of pSS included clinical evaluation, laboratory tests, ESSDAI and ESSPRI scoring. Unstimulated saliva was collected by the spitting method. Salivary IgG antibody against M3R (anti-M3R) was quantified by indirect ELISA. In this study, 43 patients with pSS, 34 with lupus and 42 healthy controls were recruited. The frequency of anti-M3R antibody levels was 55.81, 17.64 and 7 % for pSS, lupus and healthy controls, respectively. Area under the Receiver Operator Characteristic was 0.7791 (95 % CI,, 0.67–0.87). Sensitivity and specificity of the assay for diagnosis of pSS were 44.19 and 88.16 %, respectively. Salivary anti-M3R IgG antibody positivity was associated with lower age, shorter disease duration and higher globulin levels in our cohort. Salivary anti-M3R IgG antibody assay has high specificity in pSS; younger patients and those with hyperglobulinemia more frequently tested positive for this antibody.     

Gut inflammation and microbiome in spondyloarthritis

Spondyloarthritis (SpA) is chronic inflammatory disease involving joints and the spine. Bowel inflammation is common in SpA, which may be classified as acute or chronic. Chronic gut inflammation is most common in SpA patients with axial involvement as compared to those presenting with peripheral involvement alone. The pathogenesis of gut inflammation in SpA could be explained by two factors—over-activation of immunological cells and altered gut microbiome. This is exemplified by SpA animal models, namely HLA-B27-expressing transgenic animals and SKG mice models. Immunological mechanisms include homing of activated T cells from gut into synovium, excess pro-inflammatory cytokines secretion by immune cells such as IL-23 and genetic variations in immunological genes. The evidence for role of gut microbiome in SpA is gradually emerging. Recently, metagenomic study of gut microbiome by sequencing of microbial nucleic acids has enabled identification of new microbial taxa and their functions in gut of patients with SpA. In SpA, the gut microbiome could emerge as diagnostic and prognostic marker of disease. Modulation of gut microbiome is slated to have therapeutic potential as well.     

Distinct phenotype of a Wilson disease mutation reveals a novel trafficking determinant in the copper transporter ATP7B

Wilson disease (WD) is a monogenic autosomal-recessive disorder of copper accumulation that leads to liver failure and/or neurological deficits. WD is caused by mutations in ATP7B, a transporter that loads Cu(I) onto newly synthesized cupro-enzymes in the trans-Golgi network (TGN) and exports excess copper out of cells by trafficking from the TGN to the plasma membrane. To date, most WD mutations have been shown to disrupt ATP7B activity and/or stability. Using a multidisciplinary approach, including clinical analysis of patients, cell-based assays, and computational studies, we characterized a patient mutation, ATP7B^S653Y, which is stable, does not disrupt Cu(I) transport, yet renders the protein unable to exit the TGN. Bulky or charged substitutions at position 653 mimic the phenotype of the patient mutation. Molecular modeling and dynamic simulation suggest that the S653Y mutation induces local distortions within the transmembrane (TM) domain 1 and alter TM1 interaction with TM2. S653Y abolishes the trafficking-stimulating effects of a secondary mutation in the N-terminal apical targeting domain. This result indicates a role for TM1/TM2 in regulating conformations of cytosolic domains involved in ATP7B trafficking. Taken together, our experiments revealed an unexpected role for TM1/TM2 in copper-regulated trafficking of ATP7B and defined a unique class of WD mutants that are transport-competent but trafficking-defective. Understanding the precise consequences of WD-causing mutations will facilitate the development of advanced mutation-specific therapies.Copper is essential for the normal development and function of human cells because it serves as a cofactor for many important metabolic enzymes. However, intracellular levels of copper must be tightly regulated (1, 2) because excess copper is toxic. Inborn mutations in the Cu(I)-ATPases, ATP7A [Online Mendelian Inheritance in Man (OMIM) accession no.*606882] or ATP7B (OMIM *300011) result in either systemic copper deficiency or copper accumulation in several tissues, causing Menkes disease or Wilson disease (WD), respectively. WD (OM#277900) is an autosomal-recessive disorder with a heterogeneous clinical presentation; in the absence of family history, diagnosis of WD requires multiple clinical and laboratory studies (3). The large number of rare mutations in the ATP7B gene [>500, (www.hgmd.cf.ac.uk/ac/gene.php?gene=ATP7B)] contribute to the difficulty in making genotype-phenotype associations. Presently, about two dozen mutations found in WD patients have been characterized in detail (4–7). These studies revealed that the most common effect of a WD mutation is ATP7B misfolding, which results in retention of newly synthesized ATP7B in the endoplasmic reticulum (ER), a marked decrease in protein stability, and loss of Cu(I)-transport activity (8, 9). Destabilization and inactivation of ATP7B explain the common phenotypic manifestations in WD, such as impaired copper export from the liver and the lack of copper incorporation into secreted cuproenzymes, such as ceruloplasmin (CPN).ATP7B and the highly homologous ATP7A (Menkes disease protein) play central roles in maintaining copper levels in cells. These proteins belong to the evolutionarily conserved family of P_1B-ATPases, which use the energy of ATP hydrolysis to transport copper from the cytosol across cellular membranes (Fig. 1A). ATP7A and ATP7B load copper onto newly synthesized cupro-proteins in the late Golgi and remove excess copper from the cytosol after relocating to vesicles, which in turn traffic to the plasma membrane to release copper into the extracellular milieu. In low and basal copper, ATP7A and ATP7B are located predominantly in a subcompartment of the trans-Golgi network (TGN) marked by syntaxin 6 (10). When copper levels increase, ATP7A and ATP7B exit the TGN in distinct vesicles; ATP7B vesicles move to the apical region in polarized epithelia, whereas ATP7A vesicles move to the basolateral region. Because copper-dependent ATP7B trafficking is a complex process, the precise sequence of events and the function of trafficking determinants in ATP7B’s structure are yet to be fully understood.Open in a separate windowFig. 1.Hypothetical ATP7B model and multiple species alignment of the conserved regions, amino acids 621–668, in the two Cu-ATPases. (A) A hypothetical ATP7B ribbon model, generated by UCSF Chimera, showing the conserved core organization (20). The two large cytoplasmic loops in the core structure are: the A domain (actuator, green), between TM4 and TM5, which contains the phosphatase activity; and the N and P domains (nucleotide binding and phosphorylation, red) between TM6 and TM7, which bind ATP (N), catalyzing formation of a phosphorylated intermediate (P) as part of the catalytic cycle. The eight TMs (yellow are): TM1 (amino acids 645–670), TM2 (including the platform helix, amino acids 694–722), TM3 (amino acids 729–749), TM4 (amino acids 765–786), TM5 (amino acids 916–942), TM6 (amino acids 967–1004), TM7 (amino acids 1307–1345), and TM8 (amino acids 1352–1373). The six N-terminal MBDs (blue, N-MBDs, also referred to as the N-terminal domain of ATP7B, N-ATP7B) (61, 62) were manually positioned onto the published model. The box approximates the region of the multiple species alignment shown in B. (B) A multiple species alignment of human ATP7B sequence 621–668 (Upper) and ATP7A sequence 621–668 (Lower). WD patient mutations are underlined and in bold. The ATP7B S653 position is marked with an asterisk (bold). Portions of MBD6 and TMD 1 are bracketed. In ATP7A, the bracketed sequence shows the deleted region that is replaced with two amino acids (IR) in a patient with Occipital Horn Syndrome. The deleted sequence of ATP7A is underlined and in bold (35). Alignments were obtained using ClustalW (63). Amino acids that are identical (*), conserved (:), and semiconserved (.) are shown.We previously developed a comprehensive set of cell-based assays that use both polarized hepatic cells and fibroblasts lacking ATP7B and ATP7A (derived from a Menkes disease patient) to evaluate the activity, stability, and trafficking of ATP7B and its mutants (11, 12). In this study, we combined these assays with additional mutational analysis and computational studies to dissect the molecular phenotype of WD mutations found in a highly conserved region of ATP7B, G⁶²¹-S⁶⁶⁸. We demonstrate that the S653Y mutation has a distinct “transport-competent/trafficking-defective” phenotype. We also show that the transmembrane segment (TM) that harbors S653 has an important and previously unanticipated role in regulating exit of ATP7B from the TGN in response to copper elevation.     

Faecal microbiota composition in vegetarians: comparison with omnivores in a cohort of young women in southern India

The effect of vegetarian diets on faecal microbiota has been explored largely through culture-based techniques. The present study compared the faecal microbiota of vegetarian and omnivorous young women in southern India. Faecal samples were obtained from thirty-two lacto-vegetarian and twenty-four omnivorous young adult women from a similar social and economic background. Macronutrient intake and anthropometric data were collected. Faecal microbiota of interest was quantified by real-time PCR with SYBR Green using primers targeting 16S rRNA genes of groups, including: Clostridium coccoides group (Clostridium cluster XIVa), Roseburia spp.-Eubacterium rectale, Bacteroides--Prevotella group, Bifidobacterium genus, Lactobacillus group, Clostridium leptum group (Clostridium cluster IV), Faecalibacterium prausnitzii, Ruminococcus productus--C. coccoides, Butyrivibrio, Enterococcus species and Enterobacteriaceae. The groups were matched for age, socio-economic score and anthropometric indices. Intake of energy, complex carbohydrates and Ca were significantly higher in the omnivorous group. The faecal microbiota of the omnivorous group was enriched with Clostridium cluster XIVa bacteria, specifically Roseburia-E. rectale. The relative proportions of other microbial communities were similar in both groups. The butyryl-CoA CoA-transferase gene, associated with microbial butyrate production, was present in greater amounts in the faeces of omnivores, and the levels were highly correlated with Clostridium cluster XIVa and Roseburia-E. rectale abundance and to a lesser extent with Clostridium leptum and F. prausnitzii abundance and with crude fibre intake. Omnivores had an increased relative abundance of Clostridium cluster XIVa bacteria and butyryl-CoA CoA-transferase gene compared with vegetarians, but we were unable to identify the components of the diet responsible for this difference.     

Exposure to hookworms in patients with Crohn's disease: a case-control study

Aliment Pharmacol Ther 2011; 34: 923–930

Summary

Background Helminths have been used to inhibit intestinal inflammation in patients with Crohn’s disease. Aim This study was undertaken to determine if there is a protective association of prior hookworm infection with Crohn’s disease, in a region where there is epidemiological transition from parasitic and infectious diseases to increased auto‐inflammatory diseases. Methods Hookworm exposure was assessed by peripheral blood mononuclear cell (PBMC) activation by hookworm antigens in 78 patients with Crohn’s disease and 75 healthy control participants. The change in proportion of T cells exhibiting CD69 after exposure to crude hookworm antigens was measured. Interferon‐γ ELISPOT response to a panel of six recombinant hookworm antigens was analysed. Results Patients with Crohn’s disease were more often from an urban background (P = 0.005) compared to controls, while their socioeconomic status was not significantly different. T cell activation (increase in CD3⁺CD69⁺ population) by hookworm antigen was significantly higher in controls compared to Crohn’s disease patients (P = 0.017), while activation by the nonspecific mitogen phytohemagglutinin was similar in both groups. Circulating T memory cells (CD3⁺CD45RO⁺) after exposure to hookworm antigens were not significantly different between the two groups. Mirroring these changes, interferon‐γ ELISPOT responses to hookworm antigens were seen in 36 of 75 controls compared to 20 of 78 Crohn’s disease patients (Fisher’s exact P = 0.005). Multivariate analysis indicated that CD3CD69 shifts (P = 0.019), ELISPOT reactivity (P = 0.039) and place of residence (P = 0.024) were all independently associated with Crohn’s disease. Conclusion The inverse association between Crohn’s disease and hookworm antigen reactivity is consistent with the hygiene hypothesis, but requires further exploration.