M694V gene polymorphism may not contribute to the pathogenesis of reactive arthritis in the North Indian population

Introduction: Reactive arthritis (ReA) is a postinfectious, nonseptic arthritis that is characterized by an acute lower limb predominant oligoarthritis. Inflammasome activation and its contribution to autoinflammatory loop are described in spondyloarthritis (SpA). ReA may present a forme fruste of diseases with autoinflammation as in familial Mediterranean fever. Therefore, we investigated the presence of gene polymorphisms of the Mediterranean fever (MEFV) gene in patients with ReA. Methods: Patients of ReA presenting to a Tertiary Hospital in North India were enrolled and evaluated for MEFV gene polymorphism by restriction fragment length polymorphism analysis. Results: Forty-nine patients (male:female - 37:12), including five juvenile ReA were included during the study. The median age was 25 (±11) years and disease duration was 0.76 (±1.33) months. Twenty-six cases were triggered by preceding enteritis and 23 by urethritis. Ten healthy controls of age 27 (male:female - 7:3, interquartile range ± 1.5) were included for comparison. All 49 patients of adult and juvenile ReA were negative for the M694V mutation. Conclusions: This is the first study assessing the prevalence of MEFV gene mutation in SpA in India. It is difficult to ascertain if the lack of association is limited to the Indian subcontinent.</p

High serum myostatin level suggests accelerated muscle senescence in active idiopathic inflammatory myositis

Introduction: Inflammation is the forerunner to fibrosis and premature aging in various systemic diseases. Hence, we hypothesized that idiopathic inflammatory myopathies (IIM) may exhibit accelerated senescence, and the serum myostatin (MSTN):follistatin system may be a reflection of early senescence events in the muscle. Methods: Patients with IIM (ACR/EULAR criteria) were recruited (2017-2019) for comparison with healthy and disease controls (DCs). Those with active infection, pregnancy, renal dysfunction, or chronic kidney disease were excluded from the study. MSTN and follistatin were estimated in sera using ELISA (R&amp;D systems, USA). Juvenile myositis and young adults (18-40 years) were subsequently analyzed separately. Nonparametric tests were used for paired and unpaired analysis. Results expressed as median and interquartile range. Results: A total of 84 myositis (3 juvenile myositis, 40 DM, 30 PM, 11 overlap) patients (68 females) with median age 38 (27-47.0) years and median disease duration of 0.9 (2.3-5.1) years were included. Serum MSTN was lower in IIM than in healthy control (149.3 vs. 243.6 P &lt; 0.0001) but higher in IIM as compared with DCs (149.3 vs. 85.11, P = 0.0174). MSTN levels were higher in active as compared with inactive myositis in young adults (189.6 vs. 115.8, P = 0.0349). Serum MSTN correlated with height (r = 0.3, P = 0.003) and weight (r = 0.2, P = 0.047) but not MMT8 or muscle enzymes. On follow-up, the serial MSTN estimation paralleled change in disease activity. Conclusion: Elevated serum MSTN levels in active myositis raise the possibility of accelerated senescence in the inflamed muscle tissues which need further investigation.</p

Humoral Immune Response of SARS-CoV-2 Infection and Anti-SARS-CoV-2 Vaccination in Renal Transplant Recipients

Vaccination-induced SARS-CoV-2 neutralizing antibodies are required for herd immunity. Vaccine availability and poor vaccine response in renal transplant recipients (RTRs) remain a concern. There is no report on the efficacy of Covaxin and Covishield vaccines in RTRs. We recruited 222 live donors RTRs and analyzed the serum titer of anti-SARS-CoV-2 spike protein antibody by chemiluminescent magnetic microparticle immunoassay. Patients were categorized into three groups: group1 with SARS-CoV-2 infection and no vaccination (n = 161); group 2 with only vaccination and no SARS-CoV-2 infection (n = 41); and group 3 with both vaccination and SARS-CoV-2 infection (n = 20). Overall seroconversion rate was 193/222 (86.9%) with a median titer 1095.20 AU/mL. The median IgG titer value in group 1 was 647.0 AU/mL; group 2 was 1409.0 AU/mL; and group 3 was 1831.30 AU/mL. Covaxin associated seroconversion was observed in 16/19 (84.21%), with a median titer of 1373.90 AU/mL compared to that of Covishield 32/42 (76.19%), whose median titer was 1831.10 AU/mL. The seroconversion rate due to SARS-CoV-2 infection was 145 (90.06%), it was lowest with the vaccination-only group (70.7%), and with both vaccination and SARS-CoV-2 infection group it was highest (95%). In RTRs, SARS-CoV-2 infection and both Covaxin and Covishield vaccination effectively induce a humoral immune response against the SARS-CoV-2 spike protein; however, seroconversion rate was lower and the antibody titer was higher with vaccine than infection