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Biologic predictors of extension of oligoarticular juvenile idiopathic arthritis as determined from synovial fluid cellular composition and gene expression.

ABSTRACT: OBJECTIVE: To identify biomarkers in the first synovial fluid (SF) aspirate obtained from children with oligoarticular juvenile idiopathic arthritis (JIA), which could be used to identify children whose disease is likely to extend to a more severe phenotype. METHODS: Patients with recent-onset oligoarticular JIA were identified and grouped according to those whose mild disease persisted (persistent disease) or those whose disease would extend from a mild to more severe phenotype (extended-to-be disease) at 1 year after diagnosis. Flow cytometry was used to delineate differences in the mononuclear cell populations between the first blood sample and first SF aspirate from the same patient and between outcome (persistent versus extended-to-be) groups. Proportions of lymphocytes in the joint were modeled on chemotaxis of lymphocytes to CCL5, using Transwell migration assays. Levels of CCL5 in the SF were quantified by enzyme-linked immunosorbent assay. RNA profiles of SF mononuclear cells were compared between groups using the Affymetrix GeneChip hybridization protocol and hierarchical clustering analyses. RESULTS: Compared with peripheral blood mononuclear cells, SF mononuclear cells displayed an expansion of CD8+ T cells, reduced proportion of B cells, and expansion of CD16- natural killer cells. The lower CD4:CD8 ratio in the SF was recapitulated in vitro by the observed migration of blood T cells in response to CCL5. Synovial CCL5 levels were higher in children whose disease extended to a more severe phenotype. The CD4:CD8 ratio in the SF was significantly lower in patients with extended-to-be oligoarticular JIA (0.57 compared with 0.90 in the persistent disease group, difference 0.33, 95% confidence interval 0.04-0.62; P = 0.009). Gene expression profiling revealed that 344 genes were >1.5-fold differentially expressed between outcome groups (P < 0.05), and these included genes associated with inflammation and macrophage differentiation, which showed increased levels in patients with extended disease at 1 year, and genes associated with immune regulation, which showed increased levels in patients with persistent disease at 1 year. CONCLUSION: Analyses of the proportions of synovial lymphocytes, levels of CCL5, and differential gene expression yielded potential biomarkers with which to predict the likelihood of extension of oligoarticular JIA to a more severe disease phenotype.

SUBMITTER: Hunter PJ

PROVIDER: S-EPMC2860766 | biostudies-literature | 2010 Mar

REPOSITORIES: biostudies-literature

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Biologic predictors of extension of oligoarticular juvenile idiopathic arthritis as determined from synovial fluid cellular composition and gene expression.

Hunter Patricia J PJ Nistala Kiran K Jina Nipurna N Eddaoudi Ayad A Thomson Wendy W Hubank Mike M Wedderburn Lucy R LR

Arthritis and rheumatism 20100301 3

<h4>Objective</h4>To identify biomarkers in the first synovial fluid (SF) aspirate obtained from children with oligoarticular juvenile idiopathic arthritis (JIA), which could be used to identify children whose disease is likely to extend to a more severe phenotype.<h4>Methods</h4>Patients with recent-onset oligoarticular JIA were identified and grouped according to those whose mild disease persisted (persistent disease) or those whose disease would extend from a mild to more severe phenotype (ex ...[more]

PMID: 20127724

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Project description:BackgroundNeutrophils are the most prevalent immune cells in the synovial fluid in inflamed joints of children with oligoarticular juvenile idiopathic arthritis (JIA). Despite this, little is known about neutrophil function at the site of inflammation in JIA and how local neutrophils contribute to disease pathogenesis. This study aimed to characterize the phenotype and function of synovial fluid neutrophils in oligoarticular JIA.MethodsNeutrophils obtained from paired blood and synovial fluid from patients with active oligoarticular JIA were investigated phenotypically (n = 17) and functionally (phagocytosis and oxidative burst, n = 13) by flow cytometry. In a subset of patients (n = 6), blood samples were also obtained during inactive disease at a follow-up visit. The presence of CD206-expressing neutrophils was investigated in synovial biopsies from four patients by immunofluorescence.ResultsNeutrophils in synovial fluid had an activated phenotype, characterized by increased CD66b and CD11b levels, and most neutrophils had a CD16hi CD62Llowaged phenotype. A large proportion of the synovial fluid neutrophils expressed CD206, a mannose receptor not commonly expressed by neutrophils but by monocytes, macrophages, and dendritic cells. CD206-expressing neutrophils were also found in synovial tissue biopsies. The synovial fluid neutrophil phenotype was not dependent on transmigration alone. Functionally, synovial fluid neutrophils had reduced phagocytic capacity and a trend towards impaired oxidative burst compared to blood neutrophils. In addition, the effector functions of the synovial fluid neutrophils correlated negatively with the proportion of CD206+ neutrophils.ConclusionsNeutrophils in the inflamed joint in oligoarticular JIA were altered, both regarding phenotype and function. Neutrophils in the synovial fluid were activated, had an aged phenotype, had gained monocyte-like features, and had impaired phagocytic capacity. The impairment in phagocytosis and oxidative burst was associated with the phenotype shift. We speculate that these neutrophil alterations might play a role in the sustained joint inflammation seen in JIA.

Project description:BACKGROUND:Juvenile idiopathic arthritis (JIA) is an umbrella term of inflammatory joint diseases in children. Oligoarthritis is the most common form in the Western world, representing roughly 60% of all patients. Monocytes and macrophages play an important role in adult arthritides, but their role in oligoarticular JIA is less studied. Polarization highly influences monocytes' and macrophages' effector functions, broadly separated into pro-inflammatory M1 or anti-inflammatory M2 phenotypes. Here, we set out to investigate the polarization pattern and functional aspects of synovial monocytes in oligoarticular juvenile idiopathic arthritis (JIA). METHODS:Paired synovial fluid, blood samples (n?=?13), and synovial biopsies (n?=?3) were collected from patients with untreated oligoarticular JIA. Monocytes were analyzed for polarization markers by flow cytometry and qPCR. Effector function was analyzed by a phagocytosis assay. Polarization of healthy monocytes was investigated by stimulation with synovial fluid in vitro. Monocyte/macrophage distribution, polarization, and mRNA expression were investigated in biopsies by immunohistochemistry, immunofluorescence, and in situ hybridization. RESULTS:Children with oligoarticular JIA have polarized synovial fluid monocytes of a specific M1(IFN?)/M2(IL-4)-like pattern. This was evidenced by increased surface expression of CD40 (p?<?0.001), CD86 (p?<?0.001), and CD206 (p?<?0.001), but not CD163, as compared to paired circulating monocytes. Additionally, polarization was extensively explored at the mRNA level and synovial fluid monocytes differentially expressed classical markers of M1(IFN?)/M2(IL-4) polarization compared to circulating monocytes. Synovial fluid monocytes were functionally affected, as assessed by reduced capacity to phagocytose (p?<?0.01). Synovial fluid induced M2 markers (CD16 and CD206), but not M1 (CD40) or CD86 in healthy monocytes and did not induce cytokine production. Single and co-expression of surface CD40 and CD206, as well as mRNA expression of IL-10 and TNF, was observed in monocytes/macrophages in synovial biopsies. CONCLUSION:Children with untreated oligoarticular JIA have similar and distinct synovial fluid monocyte polarization pattern of mixed pro- and anti-inflammatory features. This pattern was not exclusively a result of the synovial fluid milieu as monocytes/macrophages in the synovial membrane show similar patterns. Our study highlights a distinct polarization pattern in oligoarticular JIA, which could be utilized for future treatment strategies.

Project description:New early low-invasive biomarkers are highly demanded for the management of Oligoarticular Juvenile Idiopathic Arthritis (OJIA), the most common chronic pediatric rheumatic disease in Western countries and a leading cause of disability. Despite recent significant advances in OJIA treatment, a high percentage of patients undergo arthritis recurrence and/or extension to other joints by one-two years after onset. A deeper understanding of the molecular basis of OJIA pathophysiology is essential for the identification of biomarkers for early disease detection and patient stratification and to guide targeted therapeutic intervention to allow the development of diagnostic and therapeutic interventions earlier in disease course. Proteomic profiling of extracellular vesicles (EVs) released in biological fluids has recently emerged as a minimally invasive approach to elucidate adult arthritis pathogenic mechanisms and for new biomarker discovery. However, EV-prot expression and potential as biomarkers in OJIA have not been explored. This study represents the first detailed longitudinal characterization investigation of EV proteome in newly diagnosed OJIA patients. Fourty-five OJIA patients were recruited at disease onset and followed up for 24 months, and protein expression profiling was carried out by liquid chromatography-tandem mass spectrometry in EVs isolated from plasma (PL) and synovial fluid (SF) samples. Because joints are the main targets of clinical manifestations, we first searched for EV-prots potentially implicated in disease development by comparing the EV-proteome of SF (SF_OJIA) vs paired PL (PL_OJIA). We identified a subset of 83 proteins significantly (FDR < 0.01) differentially expressed (31 up- and 52 downregulated) in EVs from SF compared to PL and 33 EV-prots exclusively present in SF samples. Pathway analysis revealed EV-prot enrichment in processes related to cartilage/bone metabolism and inflammation suggesting their role in OJIA joint pathogenesis and potential value as early biomarkers of disease development. Comparative analysis of the SF_OJIA and PL_OJIA EV-proteomic profiles was then carried out respect to the PL of 24 age/gender-matched control children (PL_CTR) to identify early disease-specific proteins. Significant up- and down-regulation of 110 and 92 EV-prots, respectively, were observed in PL_OJIA compared to PL_CTR samples, and 294 EV-prots were found exclusively present, effectively differentiating new-onset OJIA patients from control children. EV-prots were significantly associatd to biological processes related to innate immunity, antigen processing and presentation, and cytoskeleton organization. Importantly, a subset of 76 EV-prots displayed consensual regulation in, and 77 exclusively expressed EV-prots were shared by, PL and SF from patients respect to CTR, potentially representing a disease-associated signature measurable at both the systemic and local levels with diagnostic potential. Finally, we runned WGCNA on the SF- and PL-derived EV-prot datasets to search for EV-prot clusters associated to clinical parameters, such as ANA positivity, disease relapse, polyarticular extension, and iridocyclitis development occurring within the 2 years of follow-up, and we identified 9 and 7 EV-prot modules in SF and PL samples, respectively, able to stratify OJIA patients in distinct subgroups with different disease course. These data provide mechanistic insights into OJIA pathophysiology and an important contribution in the search of new candidate biomarkers for the disease.

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Biologic predictors of extension of oligoarticular juvenile idiopathic arthritis as determined from synovial fluid cellular composition and gene expression.

Publications

Biologic predictors of extension of oligoarticular juvenile idiopathic arthritis as determined from synovial fluid cellular composition and gene expression.

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