Recent advances in understanding spondyloarthritis.

This review is concerned with a number of recent publications that contribute to current thinking on the pathogenesis of spondyloarthritis. The areas covered include the lymphocyte population in the enthesis, which is thought to drive enthesitis, and hence clinical manifestations. The debate on how HLA-B27 is implicated in inflammation is also considered, together with recent and contradictory evidence on the effects of the peptide-trimming enzyme ERAP1 on B27 expression and hence susceptibility to spondylitis. Lastly, a recent report on the role of the gut microbiome in an important model of spondyloarthritis is considered

Relationship of CD146 expression to secretion of interleukin (IL)-17, IL-22 and interferon-γ by CD4(+) T cells in patients with inflammatory arthritis.

Expression of the adhesion molecule, CD146/MCAM/MelCAM, on T cells has been associated with recent activation, memory subsets and T helper type 17 (Th17) effector function, and is elevated in inflammatory arthritis. Th17 cells have been implicated in the pathogenesis of rheumatoid arthritis (RA) and spondyloarthritides (SpA). Here, we compared the expression of CD146 on CD4(+) T cells between healthy donors (HD) and patients with RA and SpA [ankylosing spondylitis (AS) or psoriatic arthritis (PsA)] and examined correlations with surface markers and cytokine secretion. Peripheral blood mononuclear cells (PBMC) were obtained from patients and controls, and synovial fluid mononuclear cells (SFMC) from patients. Cytokine production [elicited by phorbol myristate acetate (PMA)/ionomycin] and surface phenotypes were evaluated by flow cytometry. CD146(+) CD4(+) and interleukin (IL)-17(+) CD4(+) T cell frequencies were increased in PBMC of PsA patients, compared with HD, and in SFMC compared with PBMC. CD146(+) CD4(+) T cells were enriched for secretion of IL-17 [alone or with IL-22 or interferon (IFN)-γ] and for some putative Th17-associated surface markers (CD161 and CCR6), but not others (CD26 and IL-23 receptor). CD4(+) T cells producing IL-22 or IFN-γ without IL-17 were also present in the CD146(+) subset, although their enrichment was less marked. Moreover, a majority of cells secreting these cytokines lacked CD146. Thus, CD146 is not a sensitive or specific marker of Th17 cells, but rather correlates with heterogeneous cytokine secretion by subsets of CD4(+) helper T cells.This is the final version. It was first published by Wiley at http://onlinelibrary.wiley.com/doi/10.1111/cei.12434/abstract

Chlamydia trachomatis Infection and Anti-Hsp60 Immunity: The Two Sides of the Coin

Chlamydia trachomatis (CT) infection is one of the most common causes of reproductive tract diseases and infertility. CT-Hsp60 is synthesized during infection and is released in the bloodstream. As a consequence, immune cells will produce anti-CT-Hsp60 antibodies. Hsp60, a ubiquitous and evolutionarily conserved chaperonin, is normally sequestered inside the cell, particularly into mitochondria. However, upon cell stress, as well as during carcinogenesis, the chaperonin becomes exposed on the cell surface (sf-Hsp60) and/or is secreted from cells into the extracellular space and circulation. Reports in the literature on circulating Hsp and anti-Hsp antibodies are in many cases short on details about Hsp60 concentrations, and about the specificity spectra of the antibodies, their titers, and their true, direct, pathogenetic effects. Thus, more studies are still needed to obtain a definitive picture on these matters. Nevertheless, the information already available indicates that the concurrence of persistent CT infection and appearance of sf-Hsp60 can promote an autoimmune aggression towards stressed cells and the development of diseases such as autoimmune arthritis, multiple sclerosis, atherosclerosis, vasculitis, diabetes, and thyroiditis, among others. At the same time, immunocomplexes composed of anti-CT-Hsp60 antibodies and circulating Hsp60 (both CT and human) may form deposits in several anatomical locations, e.g., at the glomerular basal membrane. The opposite side of the coin is that pre-tumor and tumor cells with sf-Hsp60 can be destroyed with participation of the anti-Hsp60 antibody, thus stopping cancer progression before it is even noticed by the patient or physician

Th17 cell responses in spondyloarthritis.

Targeting IL-17 has become an important option in the current treatment of spondyloarthritis (SpA). To place this therapeutic advancement in context, we review the discovery and properties of this cytokine, noting those which predispose to inflammation and led to it being considered as an attractive target for the treatment of arthritis, especially SpA. The processes that regulate the differentiation of IL-17-producing cells, particularly Th17 CD4+ T cells, have been investigated thoroughly, including the role of IL-23, as these point to additional potential therapies as alternatives to direct IL-17 blockade. IL-17 is a critical cytokine in combatting infection, particularly caused by fungi, but it also has an important role in maintaining epithelial barrier functions, especially in the gut. Both these functions help predict possible adverse effects of IL-17 blockade. Finally, we review the current evidence for the use of IL-17 blockade in various forms of SpA and briefly speculate on future developments