ABSTRACT
Anti-Tumor Necrosis Factor (anti-TNF) drugs are biologic agents commonly used to treat rheumatoid arthritis (RA). However, anti-TNFs are not effective in approximately one out of four treated patients. We conducted a Genome-Wide Association Study (GWAS) to identify the genetic variation associated with the response to anti-TNF therapy in RA. In the discovery stage, 372 RA patients treated with an anti-TNF agent (infliximab, adalimumab or etanercept) were analyzed and treatment response was defined at 12 weeks of therapy. We found a genome-wide significant association in the MED15 gene with the response to etanercept (P<1.5e-8). Using an independent cohort of 245 RA patients, we performed a replication study of the most significant GWAS associations. We replicated the association at the MED15 locus and found suggestive evidence of association in the previously associated MAFB locus. The results of this study suggest novel mechanisms associated with the response to anti-TNF therapies.
Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Genetic Loci , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab/therapeutic use , Adult , Arthritis, Rheumatoid/genetics , Etanercept/therapeutic use , Female , Genetic Markers , Genome-Wide Association Study , Humans , Infliximab/therapeutic use , MafB Transcription Factor/genetics , Male , Mediator Complex/genetics , Middle Aged , Polymorphism, Single NucleotideABSTRACT
OBJECTIVES: Several recent studies have shown that the MHC class III region, located telomeric to HLA-DRB1, contains an additional genetic factor that predisposes to rheumatoid arthritis (RA). In this study, we investigate whether inhibitor of kappaB-like (IkappaBL), MICB or MICA located in the MHC class III region are the second susceptibility gene associated with RA. METHODS: A total of 154 healthy controls and 140 RA patients were genotyped for HLA-DRB1, MICA, MICB and the polymorphism -62 of the IkappaBL gene. RESULTS: A significant increase of HLA-DRB1 shared epitope (SE) alleles was detected in RA patients (61.4 vs 43.5%, P(c) = 0.01, OR = 2.1, 95% CI = 1.3-3.3). Among SE alleles, the HLA-DRB1*0401 (13.5 vs 5.1%, P(c) = 0.04, OR = 3.2, 95% CI = 1.3-8.1) and HLA-DRB1*0404 (6.4 vs 1.2%, P = 0.02, P(c) = NS) showed the most significantly association with RA. No increase of risk was associated with HLA-DRB1*01. Remarkably, the allele MICB*004 was also significantly associated with RA susceptibility (40.7 vs 23.3%, P(c) = 0.01, OR = 2.2, 95% CI = 1.3-3.7). MICB*004 was in linkage disequilibrium with HLA-DRB1*0404 (lambda(s) = 0.33) and HLA-DRB1*0405 (lambda(s) = 0.34). However, MICB*004 was also increased in HLA-DRB1 SE negative patients (37 vs 21.5%, P = 0.04). No significant association between IkappaBL and MICA with RA was found. CONCLUSIONS: MICB*004 allele was associated with RA susceptibility. This allele was in linkage disequilibrium with HLA-DRB1*0404 and DRB1*0405. The association of MICB with RA susceptibility and the functional role of MIC genes in the pathogenesis of RA converts MICB into a candidate to be an additional MHC gene associated with RA susceptibility.
Subject(s)
Arthritis, Rheumatoid/genetics , Genetic Predisposition to Disease , Histocompatibility Antigens Class I/genetics , Adaptor Proteins, Signal Transducing , Adolescent , Adult , Aged , Aged, 80 and over , Female , HLA-DR Antigens/genetics , HLA-DRB1 Chains , Histocompatibility Antigens Class II/genetics , Histocompatibility Testing/methods , Humans , Linkage Disequilibrium , Male , Middle AgedABSTRACT
La artritis séptica por Salmonella no typhi representa menos del 2 por ciento del total de las artritis sépticas1. El serotipo etiológico más frecuente es Salmonella enteritidis. Su clínica, precedida o no de una gastroenteritis, no difiere de otras artritis sépticas, y se presenta con fiebre y sinovitis monoarticular, habitualmente en rodilla, cadera y hombro. La inmunosupresión (terapéutica, virus de la inmunodeficiencia humana [VIH], lupus eritematoso sistémico [LES], etc.) es el principal factor de riesgo en su desarrollo. La drepanocitosis, la hemofilia, las neoplasias y las edades extremas de la vida también predisponen a su aparición. El diagnóstico se realiza por cultivo de líquido sinovial. El tratamiento está condicionado por las resistencias descritas a múltiples antibióticos, incluso a los más actuales, como son las fluoroquinolonas. Las complicaciones locales más frecuentes son la limitación residual funcional y la osteomielitis. El pronóstico, marcado por la enfermedad de base, presenta una elevada mortalidad (AU)
