RESUMO
BACKGROUND: Biopharmaceutical products (BPs) are widely used to treat autoimmune diseases, but immunogenicity limits their efficacy for an important proportion of patients. Our knowledge of patient-related factors influencing the occurrence of antidrug antibodies (ADAs) is still limited. METHODS AND FINDINGS: The European consortium ABIRISK (Anti-Biopharmaceutical Immunization: prediction and analysis of clinical relevance to minimize the RISK) conducted a clinical and genomic multicohort prospective study of 560 patients with multiple sclerosis (MS, n = 147), rheumatoid arthritis (RA, n = 229), Crohn's disease (n = 148), or ulcerative colitis (n = 36) treated with 8 different biopharmaceuticals (etanercept, n = 84; infliximab, n = 101; adalimumab, n = 153; interferon [IFN]-beta-1a intramuscularly [IM], n = 38; IFN-beta-1a subcutaneously [SC], n = 68; IFN-beta-1b SC, n = 41; rituximab, n = 31; tocilizumab, n = 44) and followed during the first 12 months of therapy for time to ADA development. From the bioclinical data collected, we explored the relationships between patient-related factors and the occurrence of ADAs. Both baseline and time-dependent factors such as concomitant medications were analyzed using Cox proportional hazard regression models. Mean age and disease duration were 35.1 and 0.85 years, respectively, for MS; 54.2 and 3.17 years for RA; and 36.9 and 3.69 years for inflammatory bowel diseases (IBDs). In a multivariate Cox regression model including each of the clinical and genetic factors mentioned hereafter, among the clinical factors, immunosuppressants (adjusted hazard ratio [aHR] = 0.408 [95% confidence interval (CI) 0.253-0.657], p < 0.001) and antibiotics (aHR = 0.121 [0.0437-0.333], p < 0.0001) were independently negatively associated with time to ADA development, whereas infections during the study (aHR = 2.757 [1.616-4.704], p < 0.001) and tobacco smoking (aHR = 2.150 [1.319-3.503], p < 0.01) were positively associated. 351,824 Single-Nucleotide Polymorphisms (SNPs) and 38 imputed Human Leukocyte Antigen (HLA) alleles were analyzed through a genome-wide association study. We found that the HLA-DQA1*05 allele significantly increased the rate of immunogenicity (aHR = 3.9 [1.923-5.976], p < 0.0001 for the homozygotes). Among the 6 genetic variants selected at a 20% false discovery rate (FDR) threshold, the minor allele of rs10508884, which is situated in an intron of the CXCL12 gene, increased the rate of immunogenicity (aHR = 3.804 [2.139-6.764], p < 1 × 10-5 for patients homozygous for the minor allele) and was chosen for validation through a CXCL12 protein enzyme-linked immunosorbent assay (ELISA) on patient serum at baseline before therapy start. CXCL12 protein levels were higher for patients homozygous for the minor allele carrying higher ADA risk (mean: 2,693 pg/ml) than for the other genotypes (mean: 2,317 pg/ml; p = 0.014), and patients with CXCL12 levels above the median in serum were more prone to develop ADAs (aHR = 2.329 [1.106-4.90], p = 0.026). A limitation of the study is the lack of replication; therefore, other studies are required to confirm our findings. CONCLUSION: In our study, we found that immunosuppressants and antibiotics were associated with decreased risk of ADA development, whereas tobacco smoking and infections during the study were associated with increased risk. We found that the HLA-DQA1*05 allele was associated with an increased rate of immunogenicity. Moreover, our results suggest a relationship between CXCL12 production and ADA development independent of the disease, which is consistent with its known function in affinity maturation of antibodies and plasma cell survival. Our findings may help physicians in the management of patients receiving biotherapies.
Assuntos
Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/genética , Produtos Biológicos/imunologia , Adalimumab/uso terapêutico , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/genética , Produtos Biológicos/uso terapêutico , Terapia Biológica/métodos , Estudos de Coortes , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/genética , Doença de Crohn/tratamento farmacológico , Doença de Crohn/genética , Feminino , Estudo de Associação Genômica Ampla/métodos , Cadeias alfa de HLA-DQ/genética , Humanos , Imunossupressores/uso terapêutico , Infliximab/uso terapêutico , Interferon beta-1a/uso terapêutico , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/genética , Estudos Prospectivos , Rituximab/uso terapêuticoRESUMO
BACKGROUND: Upon treatment with biopharmaceuticals, the immune system may produce anti-drug antibodies (ADA) that inhibit the therapy. Up to 40% of multiple sclerosis patients treated with interferon ß (IFNß) develop ADA, for which a genetic predisposition exists. Here, we present a genome-wide association study on ADA and predict the occurrence of antibodies in multiple sclerosis patients treated with different interferon ß preparations. METHODS: We analyzed a large sample of 2757 genotyped and imputed patients from two cohorts (Sweden and Germany), split between a discovery and a replication dataset. Binding ADA (bADA) levels were measured by capture-ELISA, neutralizing ADA (nADA) titers using a bioassay. Genome-wide association analyses were conducted stratified by cohort and treatment preparation, followed by fixed-effects meta-analysis. RESULTS: Binding ADA levels and nADA titers were correlated and showed a significant heritability (47% and 50%, respectively). The risk factors differed strongly by treatment preparation: The top-associated and replicated variants for nADA presence were the HLA-associated variants rs77278603 in IFNß-1a s.c.- (odds ratio (OR) = 3.55 (95% confidence interval = 2.81-4.48), p = 2.1 × 10-26) and rs28366299 in IFNß-1b s.c.-treated patients (OR = 3.56 (2.69-4.72), p = 6.6 × 10-19). The rs77278603-correlated HLA haplotype DR15-DQ6 conferred risk specifically for IFNß-1a s.c. (OR = 2.88 (2.29-3.61), p = 7.4 × 10-20) while DR3-DQ2 was protective (OR = 0.37 (0.27-0.52), p = 3.7 × 10-09). The haplotype DR4-DQ3 was the major risk haplotype for IFNß-1b s.c. (OR = 7.35 (4.33-12.47), p = 1.5 × 10-13). These haplotypes exhibit large population-specific frequency differences. The best prediction models were achieved for ADA in IFNß-1a s.c.-treated patients. Here, the prediction in the Swedish cohort showed AUC = 0.91 (0.85-0.95), sensitivity = 0.78, and specificity = 0.90; patients with the top 30% of genetic risk had, compared to patients in the bottom 30%, an OR = 73.9 (11.8-463.6, p = 4.4 × 10-6) of developing nADA. In the German cohort, the AUC of the same model was 0.83 (0.71-0.92), sensitivity = 0.80, specificity = 0.76, with an OR = 13.8 (3.0-63.3, p = 7.5 × 10-4). CONCLUSIONS: We identified several HLA-associated genetic risk factors for ADA against interferon ß, which were specific for treatment preparations and population backgrounds. Genetic prediction models could robustly identify patients at risk for developing ADA and might be used for personalized therapy recommendations and stratified ADA screening in clinical practice. These analyses serve as a roadmap for genetic characterizations of ADA against other biopharmaceutical compounds.
Assuntos
Estudo de Associação Genômica Ampla/métodos , Interferon beta/imunologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Accumulating evidence suggests that microRNAs (miRNAs) are a contributing factor to neurodegenerative diseases. Although altered miRNA profiles in serum or plasma have been reported for several neurodegenerative diseases, little is known about the interaction between dysregulated miRNAs and their protein binding partners. We found significant alterations of the miRNA abundance pattern in serum and in isolated serum-derived extracellular vesicles of Parkinson's disease (PD) patients. The differential expression of miRNA in PD patients was more robust in serum than in isolated extracellular vesicles and could separate PD patients from healthy controls in an unsupervised approach to a high degree. We identified a novel protein interaction partner for the strongly dysregulated hsa-mir-4745-5p. Our study provides further evidence for the involvement of miRNAs and HNF4a in PD. The demonstration that miRNA-protein binding might mediate the pathologic effects of HNF4a both by direct binding to it and by binding to proteins regulated by it suggests a complex role for miRNAs in pathology beyond the dysregulation of transcription.
Assuntos
MicroRNAs/sangue , Doença de Parkinson/sangue , Doença de Parkinson/genética , Proteínas/metabolismo , Idoso , Estudos de Casos e Controles , Exossomos/genética , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Humanos , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Análise de Componente Principal , Ligação ProteicaRESUMO
While the development of self-recognition in a mirror by toddlers is well documented, less is known about how the presence of a mirror affects young children's behaviour. Here, we explored how the presence of a mirror affected 2.5- to 3.5-year-olds' behaviour in a gift-delay task. Behaviour was assessed for a five-minute test period during which children sat in front of a gift bag that was not to be touched until an experimenter returned. Transgressive behaviour by adults is reduced in the presence of a mirror, so we hypothesized that children faced with a mirror would be less likely to touch the gift than children tested without a mirror. We found that the mirror reduced transgressions in children starting from around 3 years of age. We conclude that the presence of a mirror facilitated self-monitoring in 3-year-old children, such that deviations from a behavioural standard are noticed and corrected immediately. Statement of contribution What is already known on the subject? Children's self-recognition in a mirror has been well documented. Adults' behaviour can be affected by the presence of a mirror. There is a lack of research investigating how the presence of a mirror affects young children's behaviour. What does this study add? We show that the presence of a mirror decreases young children's likelihood to transgress in a gift-delay task. This effect appears to emerge at around three years of age. These findings raise interesting questions regarding the development of self-awareness and how it relates to other mechanisms.
Assuntos
Conscientização/fisiologia , Comportamento Infantil/fisiologia , Desenvolvimento Infantil/fisiologia , Desvalorização pelo Atraso/fisiologia , Função Executiva/fisiologia , Inibição Psicológica , Autocontrole , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
Young children help others in a range of situations, relatively indiscriminate of the characteristics of those they help. Recent results have suggested that young children's helping behavior extends even to humanoid robots. However, it has been unclear how characteristics of robots would influence children's helping behavior. Considering previous findings suggesting that certain robot features influence adults' perception of and their behavior toward robots, the question arises of whether young children's behavior and perception would follow the same principles. The current study investigated whether two key characteristics of a humanoid robot (animate autonomy and friendly expressiveness) would affect children's instrumental helping behavior and their perception of the robot as an animate being. Eighty-two 3-year-old children participated in one of four experimental conditions manipulating a robot's ostensible animate autonomy (high/low) and friendly expressiveness (friendly/neutral). Helping was assessed in an out-of-reach task and animacy ratings were assessed in a post-test interview. Results suggested that both children's helping behavior, as well as their perception of the robot as animate, were unaffected by the robot's characteristics. The findings indicate that young children's helping behavior extends largely indiscriminately across two important characteristics. These results increase our understanding of the development of children's altruistic behavior and animate-inanimate distinctions. Our findings also raise important ethical questions for the field of child-robot interaction.