Recherche de nouveaux facteurs génétiques de susceptibilité à la spondyloarthrite grâce à une approche associant études familiales et génomique fonctionnelle

Spondyloarthritis (SpA) is a frequent and disabling chronic rheumatic disease. To date, more than 20 susceptibility loci have been identified, including HLA-B27 in the major histocompatibility complex (MHC). Most of the disease heritability remains to be elucidated. The aim of the study was to identify new genetic factors of susceptibility to SpA using an approach combining genetics and functional genomics. In the first part of this work, we genotyped SpA multiplex families with microarrays of 250,000 SNPs. Non parametric linkage analysis revealed a new locus significantly linked to SpA outside the MHC, in 13q13. Further studies on this locus allowed us to map the disease interval to a 1.3 Mb region, which will be soon sequenced. Moreover, family-based association study identified a significant association between one intronic SNP in MAPK14 and SpA. We also showed that one of the known ankylosing spondylitis-associated SNP in IL23R was indeed associated with sacroiliitis in SpA. We have also compared dendritic cells gene expression between nine SpA patients and ten controls and identified 81 genes differentially expressed. Moreover, we showed that ERAP1 gene expression (and at a less extent protein expression and enzymatic activity) is under the control of several polymorphisms in the gene which has previously been associated with SpA.La spondyloarthrite (SpA) est un rhumatisme inflammatoire chronique fréquent et invalidant. Plus d’une vingtaine de locus de susceptibilité à la maladie ont été identifiés à ce jour, dont HLA-B27 situé dans le complexe majeur d’histocompatibilité (CMH). L’objectif de ce travail était d’identifier de nouveaux facteurs génétiques de susceptibilité à la SpA grâce à une double approche d’études familiales et de génomique fonctionnelle. Dans la première partie, nous avons génotypé des familles multiplex de SpA. L’analyse de liaison non paramétrique a révélé la présence, en plus du CMH, d’un nouveau locus significativement lié à la SpA en 13q13. L’étude de ce locus nous a permis de restreindre la région d’intérêt à un intervalle de 1,3 Mb, dont le séquençage est en cours. Par ailleurs, l’étude d’association intra-familiale a identifié un SNP intronique de MAPK14 significativement associé à la SpA. Enfin, nous avons montré que l’un des SNPs du gène IL23R connu pour être associé à la spondylarthrite ankylosante était en fait associé à la présence d’une sacro-iliite radiologique dans la SpA. Parallèlement aux études familiales, nous avons comparé le transcriptome de cellules dendritiques de neuf patients atteints de SpA à celui de dix témoins sains. Nous avons ainsi identifié 81 gènes différentiellement exprimés. Nous avons aussi montré que l’expression génique d’ERAP1 (et à un moindre degré son expression protéique et son niveau d’activité enzymatique) étaient sous le contrôle de polymorphismes de ce gène associés à la SpA

How to translate genetic findings into clinical applications in spondyloarthritis?

Spondyloarthritis (SpA) is characterized by a strong genetic predisposition evidenced by the identification of up to 50 susceptibility loci, in addition to HLA-B27, the major genetic factor associated with the disease. These loci have not only deepened our understanding of disease pathogenesis but also offer the potential to improve disease management. Diagnostic delay is a major issue in SpA. HLA-B27 testing is widely used as diagnostic biomarker in SpA but its predictive value is limited. Several attempts have been made to develop more sophisticated polygenic risk score (PRS). However, these scores currently offer very little improvement as compared to HLA-B27 and are still difficult to implement in clinical routine. Genetics might also help to predict disease outcome including treatment response. Several genetic variants have been reported to be associated with radiographic damage or with poor response to TNF blockers, unfortunately with lack of coherence across studies. Large-scale studies should be conducted to obtain more robust findings. Genetic and genomic evidence in complex diseases can be further used to support the identification of new drug targets and to repurpose existing drugs. Although not fully driven by genetics, development of IL-17 blockers has been facilitated by the discovery of the association between IL23R variants and SpA. Development of recent approaches combining GWAS findings with functional genomics will help to prioritize new drug targets in the future. Although very promising, translational genetics in SpA remains challenging and will require a multidisciplinary approach that integrates genetics, genomics, immunology, and clinical research

Genetics and Functional Genomics of Spondyloarthritis

Spondyloarthritis (SpA) is a chronic inflammatory disorder with high heritability but with complex genetics. It encompasses several entities that share common clinical features. Most of the genetic studies in SpA have been restricted to ankylosing spondylitis (AS), the prototypical form of SpA. However, there is growing evidence of shared genetic background between all the SpA subtypes and also with some other immune-mediated diseases. The most important part of SpA heritability comes from the HLA-B27 allele in the major histocompatibility complex (MHC) that explains around 25% of the attributable heredity. Several other loci outside of the MHC have been shown to be involved in the disease. However, all these non-MHC loci explain only a small additional fraction of disease predisposition. Thus, a substantial fraction of SpA genetic basis remains poorly understood. Gene expression profiling is a complementary approach to elucidate the underlying mechanisms and pathways that drive the disease. Several expression profiling studies have been undertaken in SpA. However, results have been quite disappointing with little overlap between the studies largely due to the small sample sizes, resulting in limited power to discover small effects. In this review, we summarize current knowledge on genetic findings concerning SpA and we describe strategic approaches for identification of additional variants, with a focus on rare variants in familial forms. We also provide an overview of gene expression studies in SpA and discuss the possibilities offered by high-throughput RNA sequencing technologies, in particular in sorted cells. Finally, issues in establishing molecular mechanisms underlying genetic association hits and potential translational applications will be addressed

Identification of new genetic factors of susceptibility to spondyloarthritis by combining famillial studies and functional genomics

La spondyloarthrite (SpA) est un rhumatisme inflammatoire chronique fréquent et invalidant. Plus d’une vingtaine de locus de susceptibilité à la maladie ont été identifiés à ce jour, dont HLA-B27 situé dans le complexe majeur d’histocompatibilité (CMH). L’objectif de ce travail était d’identifier de nouveaux facteurs génétiques de susceptibilité à la SpA grâce à une double approche d’études familiales et de génomique fonctionnelle. Dans la première partie, nous avons génotypé des familles multiplex de SpA. L’analyse de liaison non paramétrique a révélé la présence, en plus du CMH, d’un nouveau locus significativement lié à la SpA en 13q13. L’étude de ce locus nous a permis de restreindre la région d’intérêt à un intervalle de 1,3 Mb, dont le séquençage est en cours. Par ailleurs, l’étude d’association intra-familiale a identifié un SNP intronique de MAPK14 significativement associé à la SpA. Enfin, nous avons montré que l’un des SNPs du gène IL23R connu pour être associé à la spondylarthrite ankylosante était en fait associé à la présence d’une sacro-iliite radiologique dans la SpA. Parallèlement aux études familiales, nous avons comparé le transcriptome de cellules dendritiques de neuf patients atteints de SpA à celui de dix témoins sains. Nous avons ainsi identifié 81 gènes différentiellement exprimés. Nous avons aussi montré que l’expression génique d’ERAP1 (et à un moindre degré son expression protéique et son niveau d’activité enzymatique) étaient sous le contrôle de polymorphismes de ce gène associés à la SpA.Spondyloarthritis (SpA) is a frequent and disabling chronic rheumatic disease. To date, more than 20 susceptibility loci have been identified, including HLA-B27 in the major histocompatibility complex (MHC). Most of the disease heritability remains to be elucidated. The aim of the study was to identify new genetic factors of susceptibility to SpA using an approach combining genetics and functional genomics. In the first part of this work, we genotyped SpA multiplex families with microarrays of 250,000 SNPs. Non parametric linkage analysis revealed a new locus significantly linked to SpA outside the MHC, in 13q13. Further studies on this locus allowed us to map the disease interval to a 1.3 Mb region, which will be soon sequenced. Moreover, family-based association study identified a significant association between one intronic SNP in MAPK14 and SpA. We also showed that one of the known ankylosing spondylitis-associated SNP in IL23R was indeed associated with sacroiliitis in SpA. We have also compared dendritic cells gene expression between nine SpA patients and ten controls and identified 81 genes differentially expressed. Moreover, we showed that ERAP1 gene expression (and at a less extent protein expression and enzymatic activity) is under the control of several polymorphisms in the gene which has previously been associated with SpA

Diagnostic de tuberculose latente chez des patients atteints de rhumatisme inflammatoire chronique candidats à une biothérapie (facteurs infuençant le résultat d un test de libération d interféron gamma (T-SPOT.TB®))

La recherche de tuberculose latente est nécessaire avant l introduction d un traitement anti-TNF alpha. Cependant il n y a pas de consensus sur ses modalités. Les tests de libération d interféron gamma (IGRA) semblent intéressants mais l immunosuppression liée au rhumatisme et à ses traitements pourraient influencer leurs résultats. L objectif de notre étude a donc été l identification des facteurs pouvant influencer les résultats des IGRA dans ce contexte. Pour ce faire, 590 patients atteints de polyarthrite rhumatoïde (49,8%), de spondylarthrite (45,9%) ou d autres rhumatismes inflammatoires (4,2%) et candidats à une biothérapie ont été recrutés consécutivement. Tous ont bénéficié d une radiographie pulmonaire, d une intradermo-réaction à la tuberculine et d un IGRA (T-SPOT.TB®). 78% des patients étaient vaccinés par le BCG. 21,2% des T-SPOT.TB® étaient positifs, 63% négatifs et 15,8% indéterminés. Les facteurs significativement associés à un test positif sont un âge élevé, un antécédent de tuberculose active et une radiographie thoracique anormale. L activité du rhumatisme influence significativement le taux de résultats indéterminés, positivement pour la polyarthrite rhumatoïde, négativement pour la spondylarthrite. Aucune influence de la vaccination BCG ou des traitements n a été mise en évidence. Le taux de concordance entre le T-SPOT.TB® et l IDR est faible (kappa = 0,17). En conclusion, le T-SPOT.TB® apparaît comme bien corrélé aux principaux facteurs de risque de tuberculose et peu influencé par le rhumatisme inflammatoire et ses traitements. L influence de l activité de la maladie sur la fréquence de résultats indéterminés est toutefois un facteur pouvant limiter son utilisationScreening for latent tuberculosis infection (LTBI) is mandatory before initiating TNF-alpha blocker treatment. Use of interferon gamma release assay (IGRA) for the screening seems interesting but has not been validated. The aim of our study was to identify factors that may influence IGRA results in this situation. 590 patients with rheumatoid arthritis (49,8%), spondyloarthritis (45,9%) or other inflammatory rheumatism (4,2%) and eligible for biologic treatments have been consecutively recruited. A chest X-ray, a tuberculin skin test (TST) and an IGRA (T-SPOT.TB®) were performed for each patient. 78% were vaccinated with BCG. 21,2% of T-SPOT.TB® were positive, 63% negative and 15,8% indeterminate. Factors significantly associated with a positive test are older age, history of active tuberculosis and abnormal chest X-ray. Disease activity significantly influence indeterminate results rate, positively for rheumatoid arthritis, negatively for spondyloarthritis. There is no influence of BCG vaccination or treatment. The concordance rate between T-SPOT.TB® and TST is low (kappa =0,17). In conclusion, T-SPOT.TB® is well correlated with most of the risk factors of tuberculosis and little influenced by chronic inflammatory arthritis or treatment. However, influence of disease activity on indeterminate results rate could be a problem.NANCY1-Bib. numérique (543959902) / SudocSudocFranceF

Genetics and Functional Genomics of Spondyloarthritis

International audienceSpondyloarthritis (SpA) is a chronic inflammatory disorder with high heritability but with complex genetics. It encompasses several entities that share common clinical features. Most of the genetic studies in SpA have been restricted to ankylosing spondylitis (AS), the prototypical form of SpA. However, there is growing evidence of shared genetic background between all the SpA subtypes and also with some other immune-mediated diseases. The most important part of SpA heritability comes from the HLA-B27 allele in the major histocompatibility complex (MHC) that explains around 25% of the attributable heredity. Several other loci outside of the MHC have been shown to be involved in the disease. However, all these non-MHC loci explain only a small additional fraction of disease predisposition. Thus, a substantial fraction of SpA genetic basis remains poorly understood. Gene expression profiling is a complementary approach to elucidate the underlying mechanisms and pathways that drive the disease. Several expression profiling studies have been undertaken in SpA. However, results have been quite disappointing with little overlap between the studies largely due to the small sample sizes, resulting in limited power to discover small effects. In this review, we summarize current knowledge on genetic findings concerning SpA and we describe strategic approaches for identification of additional variants, with a focus on rare variants in familial forms. We also provide an overview of gene expression studies in SpA and discuss the possibilities offered by high-throughput RNA sequencing technologies, in particular in sorted cells. Finally, issues in establishing molecular mechanisms underlying genetic association hits and potential translational applications will be addressed

Correspondence between patient-reported flare and disease activity score variation in axial spondyloarthritis: A 12-months web-based study

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Two Phenotypes Are Identified by Cluster Analysis in Early Inflammatory Back Pain Suggestive of Spondyloarthritis: Results From the DESIR Cohort

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Impact of synovial biopsy procedures and disease-specific aspects on synovial tissue outcome: a systematic literature review informing the EULAR points to consider for the minimal reporting requirements in synovial tissue research in rheumatology

International audienceBACKGROUND: The aim of this work was to summarise the literature evaluating the impact of biopsy procedures, tissue handling, tissue quality and disease-specific aspects including joint biopsied and disease stage, on synovial tissue outcome. METHODS: Two reviewers independently identified eligible studies according to the Patients, Intervention, Comparator and Outcome framework obtained for five research questions formulated during the first EULAR task force meeting to produce points to consider (PtC) for minimal reporting requirements in synovial tissue studies. The databases explored were Medline, Embase, CENTRAL and Cinhal. The risk of bias of each study was evaluated using an adapted version of the Joanna Briggs Institute checklist for analytical cross-sectional studies. RESULTS: Of the 7654 records yielded, 75 full texts were assessed, leading to the inclusion of 26 manuscripts in the systematic literature review (SLR). Two papers assessed the impact of biopsy procedures on the quality and quantity of tissue retrieved alongside patient tolerability; six papers focused on synovial tissue variability. Four papers studied the impact of sample handling or randomisation and 14 assessed the impact of disease stage and state, namely early or established active rheumatoid arthritis and remission on histopathological and transcriptomic results. CONCLUSIONS: This SLR informs the EULAR PtC for minimal reporting requirements in synovial tissue research in rheumatology. Characteristics related to the study design, population, sample handling, randomisation and analysis can affect the final synovial tissue outcome in the studies reviewed. Thus, accurate reporting of these factors is required in order to ensure the scientific validity of manuscripts describing synovial tissue outcomes

Épigénétique de la spondyloarthrite

International audienceLa spondyloarthrite (SpA) est un rhumatisme inflammatoire chronique d’étiologie inconnue dont la survenue résulte de l’interaction de facteurs de prédisposition environnementaux et génétiques. Malgré des avancées récentes, une large fraction de la prédisposition génétique à la SpA demeure inexpliquée. Plusieurs mécanismes ont été proposés pour expliquer cette part d’héritabilité manquante, tels que l’épigénétique, qui peut jouer un rôle à l’interface entre facteurs génétiques et environnementaux de susceptibilité. L’épigénétique se réfère aux variations de l’expression génique qui n’impliquent aucun changement de la séquence d’ADN. Les mécanismes épigénétiques comprennent principalement la méthylation de l’ADN, les modifications des histones et les ARN non codants. La perturbation de l’un de ces systèmes peut conduire à une altération de l’expression génique susceptible de favoriser le développement de la maladie. Grâce aux récents progrès technologiques, on observe un intérêt croissant pour le domaine de l’épigénétique dans le contexte des maladies complexes comme la SpA. Cependant, les études épigénétiques sont confrontées à des obstacles méthodologiques qui limitent l’interprétation de leurs résultats : petite taille des échantillons, absence de confirmation des résultats, choix inapproprié des témoins, choix inadéquat du type cellulaire/tissulaire. Dans le futur, l’association de l’épigénétique aux autres données « -omiques » permettra de mieux comprendre la pathogénie de la SpA. Ces problématiques doivent être résolues avant d’envisager l’utilisation des marques épigénétiques en routine clinique, en tant que biomarqueurs ou cibles médicamenteuses