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Open Access Highly Accessed Research article

Immune response profiling in early rheumatoid arthritis: discovery of a novel interaction of treatment response with viral immunity

John M Davis1*, Keith L Knutson2, Michael A Strausbauch3, Abigail B Green4, Cynthia S Crowson4, Terry M Therneau4, Eric L Matteson15 and Sherine E Gabriel15

Author Affiliations

1 Division of Rheumatology, Department of Medicine, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA

2 Cancer Vaccine and Immune Therapies Program, Vaccine & Gene Therapy Institute of Florida, 9801 S.W. Discovery Way, Port Saint Lucie, FL 34987, USA

3 Department of Surgical Research, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA

4 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA

5 Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA

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Arthritis Research & Therapy 2013, 15:R199  doi:10.1186/ar4389

Published: 25 November 2013

Abstract

Introduction

It remains challenging to predict the outcomes of therapy in patients with rheumatoid arthritis (RA). The objective of this study was to identify immune response signatures that correlate with clinical treatment outcomes in patients with RA.

Methods

A cohort of 71 consecutive patients with early RA starting treatment with disease-modifying antirheumatic drugs (DMARDs) was recruited. Disease activity at baseline and after 21 to 24 weeks of follow-up was measured using the Disease Activity Score in 28 joints (DAS28). Immune response profiling was performed by analyzing multi-cytokine production from peripheral blood cells following incubation with a panel of stimuli, including a mixture of human cytomegalovirus (CMV) and Epstein-Barr virus (EBV) lysates. Profiles identified via principal components analysis (PCA) for each stimulus were then correlated with the ΔDAS28 from baseline to follow-up. A clinically meaningful improvement in the DAS28 was defined as a decrease of ≥1.2.

Results

A profile of T-cell cytokines (IL-13, IL-4, IL-5, IL-2, IL-12, and IFN-γ) produced in response to CMV/EBV was found to correlate with the ΔDAS28 from baseline to follow-up. At baseline, a higher magnitude of the CMV/EBV immune response profile predicted inadequate DAS28 improvement (mean PCA-1 scores: 65.6 versus 50.2; P = 0.029). The baseline CMV/EBV response was particularly driven by IFN-γ (P = 0.039) and IL-4 (P = 0.027). Among patients who attained clinically meaningful DAS28 improvement, the CMV/EBV PCA-1 score increased from baseline to follow-up (mean +11.6, SD 25.5), whereas among patients who responded inadequately to DMARD therapy, the CMV/EBV PCA-1 score decreased (mean -12.8, SD 25.4; P = 0.002). Irrespective of the ΔDAS28, methotrexate use was associated with up-regulation of the CMV/EBV response. The CMV/EBV profile was associated with positive CMV IgG (P <0.001), but not EBV IgG (P = 0.32), suggesting this response was related to CMV exposure.

Conclusions

A profile of T-cell immunity associated with CMV exposure influences the clinical response to DMARD therapy in patients with early RA. Because CMV latency is associated with greater joint destruction, our findings suggest that changes in T-cell immunity mediated by viral persistence may affect treatment response and possibly long-term outcomes of RA.