Elizabeth Mellins

All Publications

• A general platform for targeting MHC-II antigens via a single loop. bioRxiv : the preprint server for biology Du, H., Liu, J., Jude, K. M., Yang, X., Li, Y., Bell, B., Yang, H., Kassardjian, A., Mobedi, A., Parekh, U., Sperberg, R. A., Julien, J. P., Mellins, E. D., Garcia, K. C., Huang, P. S. 2024

  Abstract

  Class-II major histocompatibility complexes (MHC-IIs) are central to the communications between CD4+ T cells and antigen presenting cells (APCs), but intrinsic structural features associated with MHC-II make it difficult to develop a general targeting system with high affinity and antigen specificity. Here, we introduce a protein platform, Targeted Recognition of Antigen-MHC Complex Reporter for MHC-II (TRACeR-II), to enable the rapid development of peptide-specific MHC-II binders. TRACeR-II has a small helical bundle scaffold and uses an unconventional mechanism to recognize antigens via a single loop. This unique antigen-recognition mechanism renders this platform highly versatile and amenable to direct structural modeling of the interactions with the antigen. We demonstrate that TRACeR-II binders can be rapidly evolved across multiple alleles, while computational protein design can produce specific binding sequences for a SARS-CoV-2 peptide of unknown complex structure. TRACeR-II sheds light on a simple and straightforward approach to address the MHC peptide targeting challenge, without relying on combinatorial selection on complementarity determining region (CDR) loops. It presents a promising basis for further exploration in immune response modulation as well as a broad range of theragnostic applications.

  View details for DOI 10.1101/2024.01.26.577489

  View details for PubMedID 38352315

  View details for PubMedCentralID PMC10862749

• Shortwave-infrared-light-emitting probes for the in vivo tracking of cancer vaccines and the elicited immune responses. Nature biomedical engineering Ren, F., Wang, F., Baghdasaryan, A., Li, Y., Liu, H., Hsu, R., Wang, C., Li, J., Zhong, Y., Salazar, F., Xu, C., Jiang, Y., Ma, Z., Zhu, G., Zhao, X., Wong, K. K., Willis, R., Christopher Garcia, K., Wu, A., Mellins, E., Dai, H. 2023

  Abstract

  Tracking and imaging immune cells in vivo non-invasively would offer insights into the immune responses induced by vaccination. Here we report a cancer vaccine consisting of polymer-coated NaErF4/NaYF4 core-shell down-conversion nanoparticles emitting luminescence in the near-infrared spectral window IIb (1,500-1,700 nm in wavelength) and with surface-conjugated antigen (ovalbumin) and electrostatically complexed adjuvant (class-B cytosine-phosphate-guanine). Whole-body wide-field imaging of the subcutaneously injected vaccine in tumour-bearing mice revealed rapid migration of the nanoparticles to lymph nodes through lymphatic vessels, with two doses of the vaccine leading to the complete eradication of pre-existing tumours and to the prophylactic inhibition of tumour growth. The abundance of antigen-specific CD8+ T lymphocytes in the tumour microenvironment correlated with vaccine efficacy, as we show via continuous-wave imaging and lifetime imaging of two intravenously injected near-infrared-emitting probes (CD8+-T-cell-targeted NaYbF4/NaYF4 nanoparticles and H-2Kb/ovalbumin257-264 tetramer/PbS/CdS quantum dots) excited at different wavelengths, and by volumetrically visualizing the three nanoparticles via light-sheet microscopy with structured illumination. Nanoparticle-based vaccines and imaging probes emitting infrared light may facilitate the design and optimization of immunotherapies.

  View details for DOI 10.1038/s41551-023-01083-5

  View details for PubMedID 37620621

  View details for PubMedCentralID 7157724

• Tmem178 negatively regulates IL-1β production through inhibition of the NLRP3 inflammasome. Arthritis & rheumatology (Hoboken, N.J.) Khanna, K., Yan, H., Mehra, M., Rohatgi, N., Mbalaviele, G., Mellins, E. D., Faccio, R. 2023

  Abstract

  Inflammasomes modulate the release of bioactive IL-1β. Excessive IL-1β levels are detected in patients with systemic juvenile idiopathic arthritis (sJIA) and cytokine storm syndrome (CSS) with mutated and unmutated inflammasome components, raising questions on the mechanisms of IL-1β regulation in these disorders.To investigate how the NLRP3 inflammasome is modulated in sJIA, we focused on Tmem178, a negative regulator of calcium levels in macrophages, and measured IL-1β and caspase-1 activation in wild-type (WT) and Tmem178-/- macrophages following calcium chelators, silencing of Stim1, a component of store-operated calcium entry (SOCE), or by expressing a Tmem178 mutant lacking Stim1 binding site. Mitochondrial function in both genotypes was assessed by measuring oxidative respiration, mitochondrial reactive oxygen species (mtROS), and mitochondrial damage. CSS development was analyzed in Perforin-/- /Tmem178-/- mice infected with LCMV in which inflammasome or IL-1β signaling was pharmacologically inhibited. Human TMEM178 and IL1B transcripts were analyzed in datasets of whole blood and peripheral blood monocytes from healthy controls and active sJIA patients.TMEM178 levels are reduced in whole blood and monocytes from sJIA patients while IL1B levels are increased. Accordingly, Tmem178-/- macrophages produce elevated IL-1β compared to WT cells. The elevated intracellular calcium levels following SOCE activation in Tmem178-/- macrophages induce mitochondrial damage, release mtROS, and ultimately, promote NLRP3 inflammasome activation. In vivo, inhibition of inflammasome or IL-1β neutralization prolongs Tmem178-/- mouse survival to LCMV-induced CSS.Downregulation of TMEM178 levels may represent a marker of disease activity and help identify patients that could benefit from inflammasome targeting.

  View details for DOI 10.1002/art.42666

  View details for PubMedID 37534578

• Extracellular Vesicles in Systemic Juvenile Idiopathic Arthritis. Journal of leukocyte biology Maller, J., Morgan, T., Morita, M., McCarthy, F., Jung, Y., Svensson, K. J., Elias, J. E., Macaubas, C., Mellins, E. 2023

  Abstract

  Systemic juvenile idiopathic arthritis (sJIA) is a chronic pediatric inflammatory disease of unknown etiology, characterized by fever, rash, hepatosplenomegaly, serositis and arthritis. We hypothesized that intercellular communication, mediated by extracellular vesicles (EVs), contributes to sJIA pathogenesis and that the number and cellular sources of EVs would differ between inactive and active states of sJIA and healthy controls.We evaluated plasma from healthy pediatric controls and sJIA patients with active systemic flare or inactive disease. We isolated EVs by size-exclusion chromatography and determined total EV abundance and size distribution using microfluidic resistive pulse sensing. Cell-specific EV subpopulations were measured by nanoscale flow cytometry. Isolated EVs were validated using a variety of ways, including Nanotracking and Cryo-EM. EV protein content was analyzed in pooled samples using mass spectrometry.Total EV concentration did not significantly differ between controls and sJIA patients. EVs with diameters <200 nm were the most abundant, including the majority of cell-specific EV subpopulations. sJIA patients had significantly higher levels of EVs from activated platelets, intermediate monocytes, and chronically activated endothelial cells, with the latter significantly more elevated in active sJIA relative to inactive disease and controls. Protein analysis of isolated EVs from active patients showed a pro-inflammatory profile, uniquely expressing heat shock protein 47 (HP47), a stress-inducible protein.Our findings indicate that multiple cell types contribute to altered EV profiles in sJIA. The EV differences between sJIA disease states and healthy controls implicate EV-mediated cellular crosstalk as a potential driver of sJIA disease activity.

  View details for DOI 10.1093/jleuko/qiad059

  View details for PubMedID 37201912

• Proinflammatory polarization of monocytes by particulate air pollutants is mediated by induction of trained immunity in pediatric asthma. Allergy Movassagh, H., Prunicki, M., Kaushik, A., Zhou, X., Dunham, D., Smith, E. M., He, Z., Aleman Muench, G. R., Shi, M., Weimer, A. K., Cao, S., Andorf, S., Feizi, A., Snyder, M. P., Soroosh, P., Mellins, E. D., Nadeau, K. C. 2023

  Abstract

  The impact of exposure to air pollutants, such as fine particulate matter (PM), on the immune system and its consequences on pediatric asthma, are not well understood. We investigated whether ambient levels of fine PM with aerodynamic diameter ≤2.5 microns (PM2.5 ) are associated with alterations in circulating monocytes in children with or without asthma.Monocyte phenotyping was performed by cytometry time-of-flight (CyTOF). Cytokines were measured using cytomtric bead array and Luminex assay. ChIP-Seq was utilized to address histone modifications in monocytes.Increased exposure to ambient PM2.5 was linked to specific monocyte subtypes, particularly in children with asthma. Mechanistically, we hypothesized that innate trained immunity is evoked by a primary exposure to fine PM and accounts for an enhanced inflammatory response after secondary stimulation in vitro. We determined that the trained immunity was induced in circulating monocytes by fine particulate pollutants, and it was characterized by the upregulation of proinflammatory mediators, such as TNF, IL-6, and IL-8, upon stimulation with house dust mite or lipopolysaccharide. This phenotype was epigenetically controlled by enhanced H3K27ac marks in circulating monocytes.The specific alterations of monocytes after ambient pollution exposure suggest a possible prognostic immune signature for pediatric asthma, and pollution-induced trained immunity may provide a potential therapeutic target for asthmatic children living in areas with increased air pollution.

  View details for DOI 10.1111/all.15692

  View details for PubMedID 36929161

• mTORC1 links pathology in experimental models of Still's disease and macrophage activation syndrome. Nature communications Huang, Z., You, X., Chen, L., Du, Y., Brodeur, K., Jee, H., Wang, Q., Linder, G., Darbousset, R., Cunin, P., Chang, M. H., Wactor, A., Wauford, B. M., Todd, M. J., Wei, K., Li, Y., Levescot, A., Iwakura, Y., Pascual, V., Baldwin, N. E., Quartier, P., Li, T., Gianatasio, M. T., Hasserjian, R. P., Henderson, L. A., Sykes, D. B., Mellins, E. D., Canna, S. W., Charles, J. F., Nigrovic, P. A., Lee, P. Y. 2022; 13 (1): 6915

  Abstract

  Still's disease is a severe inflammatory syndrome characterized by fever, skin rash and arthritis affecting children and adults. Patients with Still's disease may also develop macrophage activation syndrome, a potentially fatal complication of immune dysregulation resulting in cytokine storm. Here we show that mTORC1 (mechanistic target of rapamycin complex 1) underpins the pathology of Still's disease and macrophage activation syndrome. Single-cell RNA sequencing in a murine model of Still's disease shows preferential activation of mTORC1 in monocytes; both mTOR inhibition and monocyte depletion attenuate disease severity. Transcriptomic data from patients with Still's disease suggest decreased expression of the mTORC1 inhibitors TSC1/TSC2 and an mTORC1 gene signature that strongly correlates with disease activity and treatment response. Unrestricted activation of mTORC1 by Tsc2 deletion in mice is sufficient to trigger a Still's disease-like syndrome, including both inflammatory arthritis and macrophage activation syndrome with hemophagocytosis, a cellular manifestation that is reproduced in human monocytes by CRISPR/Cas-mediated deletion of TSC2. Consistent with this observation, hemophagocytic histiocytes from patients with macrophage activation syndrome display prominent mTORC1 activity. Our study suggests a mechanistic link of mTORC1 to inflammation that connects the pathogenesis of Still's disease and macrophage activation syndrome.

  View details for DOI 10.1038/s41467-022-34480-6

  View details for PubMedID 36443301

  View details for PubMedCentralID 2036674

• Harnessing IgG Fc glycosylation for clinical benefit. Current opinion in immunology Archer, E. J., Gonzalez, J. C., Ghosh, D., Mellins, E. D., Wang, T. T. 2022; 77: 102231

  Abstract

  The effector activity of IgG antibodies is regulated at several levels, including IgG subclass, modifications of the Fc glycan, and the distribution of Type I and II Fcgamma receptors (FcgammaR) on effector cells. Here, we explore how Fc glycosylation, particularly sialylation and fucosylation, tunes cellular responses to immune complexes. We review the current understanding of the pathways and mechanisms underlying this biology, address FcgammaR in antigen presentation, and discuss aspects of the clinical understanding of Fc glycans in therapies and disease.

  View details for DOI 10.1016/j.coi.2022.102231

  View details for PubMedID 35797920

• Two distinct "brain-homing" monocyte subsets identified in pediatric acute-onset neuropsychiatric syndrome (PANS) are immunosuppressive and neuroprotective Rahman, S., Khatun, A., Gaertner, F., Macaubas, C., Licona, N., Columbo, L., Farhadian, B., Willett, T., Thienemann, M., Frankovich, J., Mellins, E. SPRINGER/PLENUM PUBLISHERS. 2022: S103-S104

  View details for Web of Science ID 000784584900178

• Serum proteome analysis of systemic JIA and related lung disease identifies distinct inflammatory programs and biomarkers. Arthritis & rheumatology (Hoboken, N.J.) Chen, G., Deutsch, G. H., Schulert, G., Zheng, H., Jang, S., Trapnell, B., Lee, P., Macaubas, C., Ho, K., Schneider, C., Saper, V. E., de Jesus, A. A., Krasnow, M., Grom, A., Goldbach-Mansky, R., Khatri, P., Mellins, E. D., Canna, S. W. 2022

  Abstract

  OBJECTIVES: Recent observations in systemic Juvenile Idiopathic Arthritis (sJIA) suggest an increasing incidence of high-mortality interstitial lung disease (sJIA-LD) often characterized by a variant of pulmonary alveolar proteinosis (PAP). Co-occurrence of macrophage activation syndrome (MAS) and PAP in sJIA suggested a shared pathology, but sJIA-LD patients also commonly experience features of drug reaction such as atypical rashes and eosinophilia. We sought to investigate immunopathology and identify biomarkers in sJIA, MAS, and sJIA-LD.METHODS: We used SOMAscan to measure >1300 analytes in sera from healthy controls and patients with sJIA, MAS, sJIA-LD and other related diseases. We verified selected findings by ELISA and lung immunostaining. Because the proteome of a sample may reflect multiple states (sJIA, MAS, sJIA-LD), we used regression modeling to identify subsets of altered proteins associated with each state. We tested key findings in a validation cohort.RESULTS: Proteome alterations in active sJIA and MAS overlapped substantially, including known sJIA biomarkers like SAA and S100A9, and novel elevations of heat shock proteins and glycolytic enzymes. IL-18 was elevated in all sJIA groups, particularly MAS and sJIA-LD. We also identified an MAS-independent sJIA-LD signature notable for elevated ICAM5, MMP7, and allergic/eosinophilic chemokines, which have been previously associated with lung damage. Immunohistochemistry localized ICAM5 and MMP7 in sJIA-LD lung. ICAM5's ability to distinguish sJIA-LD from sJIA/MAS was independently validated.CONCLUSION: Serum proteins support an sJIA-to-MAS continuum, help distinguish sJIA, sJIA/MAS, and sJIA-LD and suggest etiologic hypotheses. Select biomarkers, such as ICAM5, could aid in early detection and management of sJIA-LD.

  View details for DOI 10.1002/art.42099

  View details for PubMedID 35189047

• Regulation of the BCR signalosome by the class II peptide editor, H2-M, affects the development and repertoire of innate-like B cells. Cell reports Ghosh, D., Pham, T. D., Nanaware, P. P., Sengupta, D., Adler, L. N., Li, C. G., He, X., O'Mara, M. E., Kantor, A. B., Nguyen, K. D., Yang, Y., Eisenlohr, L. C., Jensen, P. E., Herzenberg, L. A., Stern, L. J., Boyd, S. D., Ghosn, E. E., Mellins, E. D. 1800; 38 (4): 110200

  Abstract

  The non-classical Major Histocompatibility Complex class II (MHCII) protein, H2-M, edits peptides bound to conventional MHCII in favor of stable peptide/MHCII (p/MHCII) complexes. Here, we show that H2-M deficiency affects B-1 cell survival, reduces cell renewal capacity, and alters immunoglobulin repertoire, allowing for the selection of cells specific for highly abundant epitopes, but not low-frequency epitopes. H2-M-deficient B-1 cells have shorter CDR3 length, higher content of positively charged amino acids, shorter junctional regions, less mutation frequency, and a skewed clonal distribution. Mechanistically, H2-M loss reduces plasma membrane p/MHCII association with B cell receptors (BCR) on B-1 cells and diminishes integrated BCR signal strength, a key determinant of B-1 cell selection, maturation, and maintenance. Thus, H2-M:MHCII interaction serves as a cell-intrinsic regulator of BCR signaling and influences the selection of the B-1 cell clonal repertoire.

  View details for DOI 10.1016/j.celrep.2021.110200

  View details for PubMedID 35081339

• Tuning DO:DM ratios modulates MHC class II immunopeptidomes. Molecular & cellular proteomics : MCP Olsson, N., Jiang, W., Adler, L. N., Mellins, E. D., Elias, J. E. 1800: 100204

  Abstract

  Major histocompatibility complex class II (MHC-II) antigen presentation underlies a wide range of immune responses in health and disease. However, how MHC-II antigen presentation is regulated by the peptide-loading catalyst HLA-DM (DM), its associated modulator, HLA-DO (DO), is incompletely understood. This is due largely to technical limitations: model antigen presenting cell (APC) systems that express these MHC-II peptidome regulators at physiologically variable levels have not been described. Likewise, computational prediction tools that account for DO and DM activities are not presently available. To address these gaps, we created a panel of single MHC-II allele, HLA-DR4-expressing APC lines that cover a wide range of DO:DM ratio states. Using a combined immunopeptidomic and proteomic discovery strategy, we measured the effects DO:DM ratios have on peptide presentation by surveying over 10,000 unique DR4-presented peptides. The resulting data provide insight into peptide characteristics that influence their presentation with increasing DO:DM ratios. These include DM-sensitivity, peptide abundance, binding affinity and motif, peptide length and choice of binding register along the source protein. These findings have implications for designing improved HLA-II prediction algorithms and research strategies for dissecting the variety of functions that different APCs serve in the body.

  View details for DOI 10.1016/j.mcpro.2022.100204

  View details for PubMedID 35085787

• RIPPA: Identification of MHC-II Binding Peptides from Antigen Using a Yeast Display-Based Approach. Current protocols Liu, R., Jiang, W., Li, Y., Mellins, E. D. 1800; 2 (1): e350

  Abstract

  Mapping MHC-II binding peptides derived from an antigenic protein for potential CD4+ T-cell epitopes has been challenging due to a lack of experimental approaches that are both quantitative and rapid. The rate-limiting steps in current approaches include the construction of single MHC allele expressing cell lines and/or the purification of the MHC-II allelic proteins for peptide elution (i.e., mass spectrometry) or in vitro peptide binding (i.e., ELISA) assays. These labor-intensive steps typically take up to 4 months or more. In this protocol, we describe a system that uses yeast cells to display "empty" (i.e., without covalently linked peptides) MHC-II heterodimers that are capable of binding exogenously added peptides of interest. This yeast-MHC-II system eliminates the time-consuming soluble MHC-II purification steps, allowing rapid identification of peptide ligands from protein antigens (RIPPA). The amount of peptide loading to MHC-II or the extent of competition between indicator and competitor peptides at the surface of yeast cells can be quantitatively determined using flow cytometric analysis. Importantly, the protocol only takes 1 month from the construction of plasmids and the yeast display of "empty" MHC-II to the quantitative determination of MHC-II binding peptides from a given antigen. © 2022 Wiley Periodicals LLC. Basic Protocol 1: Yeast display of "empty" MHC-II Support Protocol: Construction of yeast shuttle vector expressing "empty" MHC-II Basic Protocol 2: Peptide competition on the surface of yeast cells Alternate Protocol: RIPPA in a 96-well format.

  View details for DOI 10.1002/cpz1.350

  View details for PubMedID 35041265

• TCR-like antibodies targeting autoantigen-mhc complexes: a mini-review. Frontiers in immunology Li, Y., Jiang, W., Mellins, E. D. 2022; 13: 968432

  Abstract

  T cell receptors (TCRs) recognize peptide antigens bound to major histocompatibility complex (MHC) molecules (p/MHC) that are expressed on cell surfaces; while B cell-derived antibodies (Abs) recognize soluble or cell surface native antigens of various types (proteins, carbohydrates, etc.). Immune surveillance by T and B cells thus inspects almost all formats of antigens to mount adaptive immune responses against cancer cells, infectious organisms and other foreign insults, while maintaining tolerance to self-tissues. With contributions from environmental triggers, the development of autoimmune disease is thought to be due to the expression of MHC risk alleles by antigen-presenting cells (APCs) presenting self-antigen (autoantigen), breaking through self-tolerance and activating autoreactive T cells, which orchestrate downstream pathologic events. Investigating and treating autoimmune diseases have been challenging, both because of the intrinsic complexity of these diseases and the need for tools targeting T cell epitopes (autoantigen-MHC). Naturally occurring TCRs with relatively low (micromolar) affinities to p/MHC are suboptimal for autoantigen-MHC targeting, whereas the use of engineered TCRs and their derivatives (e.g., TCR multimers and TCR-engineered T cells) are limited by unpredictable cross-reactivity. As Abs generally have nanomolar affinity, recent advances in engineering TCR-like (TCRL) Abs promise advantages over their TCR counterparts for autoantigen-MHC targeting. Here, we compare the p/MHC binding by TCRs and TCRL Abs, review the strategies for generation of TCRL Abs, highlight their application for identification of autoantigen-presenting APCs, and discuss future directions and limitations of TCRL Abs as immunotherapy for autoimmune diseases.

  View details for DOI 10.3389/fimmu.2022.968432

  View details for PubMedID 35967436

• Severe delayed hypersensitivity reactions to IL-1 and IL-6 inhibitors link to common HLA-DRB1*15 alleles. Annals of the rheumatic diseases Saper, V. E., Ombrello, M. J., Tremoulet, A. H., Montero-Martin, G., Prahalad, S., Canna, S., Shimizu, C., Deutsch, G., Tan, S. Y., Remmers, E. F., Monos, D., Hahn, T., Phadke, O. K., Cassidy, E., Ferguson, I., Mallajosyula, V., Xu, J., Rosa Duque, J. S., Chua, G. T., Ghosh, D., Szymanski, A. M., Rubin, D., Burns, J. C., Tian, L., Fernandez-Vina, M. A., Mellins, E. D., Hollenbach, J. A., Drug Hypersensitivity Consortium, INCHARGE Consortium, Aziz, R. A., Berard, R., Bingham, C. A., Bonaparth, A. D., Casey, A., Collins, K. P., Cidon, M., Goodman, S. I., Grom, A. A., Hazen, M., Hoftman, A., Ibarra, M., Jerath, R., Kingsbury, D. J., Klein-Gitelman, M. S., Lai, K., Lapidus, S., Mendoza-Londono, R., Onel, K., Perez, M., Radhakrishna, S. M., Reinhardt, A., Riskalla, M., Roth, J., Rosenwasser, N., Saad, N., Schulert, G. S., Shenoi, S., Smith, J. A., Soep, J., Stingl, C., Stoll, M. L., Tesher, M., Whitehead, B., Zemel, L., Anton, J., Bohnsack, J. F., Cobb, J., Demirkaya, E., Foell, D., Gattorno, M., Grom, A., Hilario, M. O., Ilowite, N. T., Haas, J., Hinks, A., Kastner, D. L., Langfeld, C. D., Martini, A., Mellins, E. D., Minden, K., Oliveira, S., Ombrello, M. J., Ozen, S., Prahalad, S., Rosen-Wolff, A., Rosenberg, A., Russo, R., Signa, S., Tachmazidou, I., Tenbrock, K., Thompson, S., Thomson, W., Wedderburn, L. R., Woo, P., Yeung, R. S., Zeft, A. S., Len, C. 2021

  Abstract

  OBJECTIVES: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, delayed hypersensitivity reaction (DHR). We observed DRESS to inhibitors of interleukin 1 (IL-1) or IL-6 in a small group of patients with Still's disease with atypical lung disease. We sought to characterise features of patients with Still's disease with DRESS compared with drug-tolerant Still's controls. We analysed human leucocyte antigen (HLA) alleles for association to inhibitor-related DHR, including in a small Kawasaki disease (KD) cohort.METHODS: In a case/control study, we collected a multicentre series of patients with Still's disease with features of inhibitor-related DRESS (n=66) and drug-tolerant Still's controls (n=65). We retrospectively analysed clinical data from all Still's subjects and typed 94/131 for HLA. European Still's-DRESS cases were ancestry matched to International Childhood Arthritis Genetics Consortium paediatric Still's cases (n=550) and compared for HLA allele frequencies. HLA association also was analysed using Still's-DRESS cases (n=64) compared with drug-tolerant Still's controls (n=30). KD subjects (n=19) were similarly studied.RESULTS: Still's-DRESS features included eosinophilia (89%), AST-ALT elevation (75%) and non-evanescent rash (95%; 88% involving face). Macrophage activation syndrome during treatment was frequent in Still's-DRESS (64%) versus drug-tolerant Still's (3%; p=1.2*10-14). We found striking enrichment for HLA-DRB1*15 haplotypes in Still's-DRESS cases versus INCHARGE Still's controls (p=7.5*10-13) and versus self-identified, ancestry-matched Still's controls (p=6.3*10-10). In the KD cohort, DRB1*15:01 was present only in those with suspected anakinra reactions.CONCLUSIONS: DRESS-type reactions occur among patients treated with IL-1/IL-6 inhibitors and strongly associate with common HLA-DRB1*15 haplotypes. Consideration of preprescription HLA typing and vigilance for serious reactions to these drugs are warranted.

  View details for DOI 10.1136/annrheumdis-2021-220578

  View details for PubMedID 34789453

• Increased activation product of complement 4 protein in plasma of individuals with schizophrenia. Translational psychiatry Kalinowski, A., Liliental, J., Anker, L. A., Linkovski, O., Culbertson, C., Hall, J. N., Pattni, R., Sabatti, C., Noordsy, D., Hallmayer, J. F., Mellins, E. D., Ballon, J. S., O'Hara, R., Levinson, D. F., Urban, A. E. 2021; 11 (1): 486

  Abstract

  Structural variation in the complement 4 gene (C4) confers genetic risk for schizophrenia. The variation includes numbers of the increased C4A copy number, which predicts increased C4A mRNA expression. C4-anaphylatoxin (C4-ana) is a C4 protein fragment released upon C4 protein activation that has the potential to change the blood-brain barrier (BBB). We hypothesized that elevated plasma levels of C4-ana occur in individuals with schizophrenia (iSCZ). Blood was collected from 15 iSCZ with illness duration < 5 years and from 14 healthy controls (HC). Plasma C4-ana was measured by radioimmunoassay. Other complement activation products C3-ana, C5-ana, and terminal complement complex (TCC) were also measured. Digital-droplet PCR was used to determine C4 gene structural variation state. Recombinant C4-ana was added to primary brain endothelial cells (BEC) and permeability was measured in vitro. C4-ana concentration was elevated in plasma from iSCZ compared to HC (mean=654±16ng/mL, 557±94 respectively, p=0.01). The patients also carried more copies of the C4AL gene and demonstrated a positive correlation between plasma C4-ana concentrations and C4A gene copy number. Furthermore, C4-ana increased the permeability of a monolayer of BEC in vitro. Our findings are consistent with a specific role for C4A protein in schizophrenia and raise the possibility that its activation product, C4-ana, increases BBB permeability. Exploratory analyses suggest the novel hypothesis that the relationship between C4-ana levels and C4A gene copy number could also be altered in iSCZ, suggesting an interaction with unknown genetic and/or environmental risk factors.

  View details for DOI 10.1038/s41398-021-01583-5

  View details for PubMedID 34552056

• Effect of Drug Withdrawal on Interleukin-1 or Interleukin-6 Inhibitor Associated Diffuse Lung Disease Saper, V., Prahalad, S., Canna, S., Abdul-Aziz, R., Alvarez, M., Bingham, C., Bader-Meunier, B., Balboni, I., Berard, R., Bolaria, R., Boneparth, A., Casey, A., Cassidy, E., Chang, J. C., Cidon, M., Collins, K., Dickenson, A. M., Espada, G., Fishman, M., Flanagan, E., Hahn, T., Jindal, A. K., Kasapcopur, O., Klein-Gitelman, M., Klouda, T., Kostik, M., Lake, C., Marques, M., Ombrello, M., Onel, K., Phadke, O., Ravelli, A., Reinhardt, A., Robinson, A. D., Rouster-Stevens, K., Saad, N., Schulert, G., Shenoi, S., Stingl, C., Sura, A., Tesher, M., Tibaldi, J., Torok, K., Tsin, C., Vasquez-Canizares, N., Villacis-Nunez, D., Whitehead, B., Wobma, H., Zemel, L., Mellins, E. WILEY. 2021: 3403-3405

  View details for Web of Science ID 000744545206195

• New insights into B cells as antigen presenting cells. Current opinion in immunology Ghosh, D., Jiang, W., Mukhopadhyay, D., Mellins, E. D. 2021; 70: 129-137

  Abstract

  In addition to their role as antibody producing cells, B cells make a critical contribution to adaptive immune responses by functioning as professional antigen-presenting cells (APC). Distinctive features of B cells as APC include the expression of the B cell receptor (BCR) for antigen and regulated expression of HLA-DO. Here, we discuss recent progress in investigation of B cells as APC. We start with an update on the canonical MHC class II antigen presentation pathway in B cells and alternative pathways, including generation of extracellular vesicles. Turning to APC function, we highlight the roles of B cells as thymic APC, as APC for T follicular helper (TFH), as APC for CD4 memory T cells and as presenters of idiotypic BCR determinants. We also note recent examples that link B cell Ag-presentation to disease. Emerging evidence indicates that, in addition to unique features of B cells compared to other professional APC, there is appreciable heterogeneity among B cells, arising from, for example, B cell activation state or the microenvironment.

  View details for DOI 10.1016/j.coi.2021.06.003

  View details for PubMedID 34242927

• A positive feedback loop reinforces the allergic immune response in human peanut allergy. The Journal of experimental medicine Zhou, X., Yu, W., Lyu, S., Macaubas, C., Bunning, B., He, Z., Mellins, E. D., Nadeau, K. C. 2021; 218 (7)

  Abstract

  Food allergies are a leading cause of anaphylaxis, and cellular mechanisms involving antigen presentation likely play key roles in their pathogenesis. However, little is known about the response of specific antigen-presenting cell (APC) subsets to food allergens in the setting of food allergies. Here, we show that in peanut-allergic humans, peanut allergen drives the differentiation of CD209+ monocyte-derived dendritic cells (DCs) and CD23+ (FcєRII) myeloid dendritic cells through the action of allergen-specific CD4+ T cells. CD209+ DCs act reciprocally on the same peanut-specific CD4+ T cell population to reinforce Th2 cytokine expression in a positive feedback loop, which may explain the persistence of established food allergy. In support of this novel model, we show clinically that the initiation of oral immunotherapy (OIT) in peanut-allergic patients is associated with a decrease in CD209+ DCs, suggesting that breaking the cycle of positive feedback is associated with therapeutic effect.

  View details for DOI 10.1084/jem.20201793

  View details for PubMedID 33944900

• Yeast display of MHC-II enables rapid identification of peptide ligands from protein antigens (RIPPA). Cellular & molecular immunology Liu, R., Jiang, W., Mellins, E. D. 2021

  Abstract

  CD4+ T cells orchestrate adaptive immune responses via binding of antigens to their receptors through specific peptide/MHC-II complexes. To study these responses, it is essential to identify protein-derived MHC-II peptide ligands that constitute epitopes for T cell recognition. However, generating cells expressing single MHC-II alleles and isolating these proteins for use in peptide elution or binding studies is time consuming. Here, we express human MHC alleles (HLA-DR4 and HLA-DQ6) as native, noncovalent alphabeta dimers on yeast cells for direct flow cytometry-based screening of peptide ligands from selected antigens. We demonstrate rapid, accurate identification of DQ6 ligands from pre-pro-hypocretin, a narcolepsy-related immunogenic target. We also identify 20 DR4-binding SARS-CoV-2 spike peptides homologous to SARS-CoV-1 epitopes, and one spike peptide overlapping with the reported SARS-CoV-2 epitope recognized by CD4+ T cells from unexposed individuals carrying DR4 subtypes. Our method is optimized for immediate application upon the emergence of novel pathogens.

  View details for DOI 10.1038/s41423-021-00717-5

  View details for PubMedID 34117370

• High Dimensional Analyses of Circulating Immune Cells in Psoriatic Arthritis Detects Elevated Phosphorylated STAT3. Frontiers in immunology Macaubas, C., Rahman, S. S., Lavi, I., Haddad, A., Elias, M., Sengupta, D., Zisman, D., Mellins, E. D. 1800; 12: 758418

  Abstract

  Psoriatic arthritis (PsA) is a chronic inflammatory arthritis, affecting up to 40% of patients with psoriasis. Constitutive expression by CD4+ T cells of an active form of STAT3, a signal transducer and transcription factor, has been shown to induce many of the major features of PsA in an animal model. We used high dimensional mass cytometry (CyTOF) to probe ex-vivo levels of phosphorylated STAT3 (pSTAT3) in circulating immune cell subpopulations from PsA patients during active and inactive states. We evaluated the frequency of 16 immune cell populations and the levels of the activated forms of STAT3 (pSTAT3) and, for comparison, STAT1 (pSTAT1) and Src (pSrc) in whole blood fixed shortly after collection. In addition to PsA patients, we studied active rheumatoid arthritis (RA) patients. Increased levels of pSTAT3 were found in all the CD4+ T cell subsets analyzed, specifically, Th1, Th2, Th17, T follicular helper (Tfh) and T regulatory (Treg) as well as in CD14+CD16- (classical) monocytes from active PsA patients compared to inactive patients. After correcting for body mass index (BMI), smoking and conventional disease modifying antirheumatic drugs (c-DMARDs), levels of pSTAT3 levels remained increased in Th1 and Tfh CD4+ T cells, and in CD14+CD16- monocytes from active patients compared to inactive patients. No differences between the patient groups were observed for pSTAT1 or pSrc. No differences were found between the active PsA and active RA groups after correction for multiple testing. During active PsA, circulating Th1 and Tfh CD4+ T cells, and CD14+CD16- monocytes expressing high levels of pSTAT3 may play a role in PsA pathophysiology, perhaps by migration to inflamed sites.

  View details for DOI 10.3389/fimmu.2021.758418

  View details for PubMedID 35087513

• Inflammatory Bowel Disease in Children with Systemic Juvenile Idiopathic Arthritis. The Journal of rheumatology Maller, J. n., Fox, E. n., Park, K. T., Paul, S. S., Baszis, K. n., Borocco, C. n., Prahalad, S. n., Quartier, P. n., Reinhardt, A. n., Schonenberg-Meinema, D. n., Shipman, L. n., Terreri, M. T., Simard, J. n., Lavi, I. n., Chalom, E. n., Hsu, J. n., Zisman, D. n., Mellins, E. D. 2020

  Abstract

  The incidence of inflammatory bowel disease (IBD) in juvenile idiopathic arthritis (JIA) is higher than in the general pediatric population. However, reports of IBD in the systemic JIA (sJIA) subtype are limited. We sought to characterize sJIA patients diagnosed with IBD and to identify potential contributing risk factors.Using an internationally distributed survey, we identified 16 sJIA patients who were subsequently diagnosed with IBD (sJIA-IBD cohort). 522 sJIA patients without IBD were identified from the CARRA Legacy Registry and served as the sJIA-only cohort for comparison. Differences in demographic, clinical characteristics and therapy were assessed using chi-square test, Fisher's exact test, t-test, and univariate and multivariate logistic regression as appropriate.75% of sJIA-IBD patients had a persistent sJIA course; 25% had a history of MAS. sJIAIBD subjects were older at sJIA diagnosis, more often non-White, had a higher rate of IBD family history, and were more frequently treated with etanercept or canakinumab compared to sJIA-only subjects. 69% of sJIA-IBD patients successfully discontinued sJIA medications following IBD diagnosis, and sJIA symptoms resolved in 9/12 patients treated with TNF-α inhibitors.IBD in the setting of sJIA is a rare occurrence. The favorable response of sJIA symptoms to therapeutic TNF-α inhibition suggests that the sJIA-IBD cohort may represent a mechanistically distinct sJIA subgroup. Our study highlights the importance of maintaining a high level of suspicion for IBD when gastrointestinal involvement occurs in sJIA patients and the likely broad benefit of TNF-α inhibition in those cases.

  View details for DOI 10.3899/jrheum.200230

  View details for PubMedID 32541073

• In vivo clonal expansion and phenotypes of hypocretin-specific CD4+ T cells in narcolepsy patients and controls. Nature communications Jiang, W., Birtley, J. R., Hung, S., Wang, W., Chiou, S., Macaubas, C., Kornum, B., Tian, L., Huang, H., Adler, L., Weaver, G., Lu, L., Ilstad-Minnihan, A., Somasundaram, S., Ayyangar, S., Davis, M. M., Stern, L. J., Mellins, E. D. 2019; 10 (1): 5247

  Abstract

  Individuals with narcolepsy suffer from abnormal sleep patterns due to loss of neurons that uniquely supply hypocretin (HCRT). Previous studies found associations of narcolepsy with thehuman leukocyte antigen (HLA)-DQ6 allele and T-cell receptor alpha (TRA) J24 gene segment and also suggested that in vitro-stimulated T cells can target HCRT. Here, we present evidence of in vivo expansion of DQ6-HCRT tetramer+/TRAJ24+/CD4+ T cells in DQ6+ individuals with and without narcolepsy. We identify related TRAJ24+ TCRalphabeta clonotypes encoded by identical alpha/beta gene regions from two patients and two controls. TRAJ24-G allele+ clonotypes only expand in the two patients, whereas a TRAJ24-C allele+ clonotype expands in a control. A representative tetramer+/G-allele+ TCR shows signaling reactivity to the epitope HCRT87-97. Clonally expanded G-allele+ T cells exhibit an unconventional effector phenotype. Our analysis of in vivo expansion of HCRT-reactive TRAJ24+ cells opens an avenue for further investigation of the autoimmune contribution to narcolepsy development.

  View details for DOI 10.1038/s41467-019-13234-x

  View details for PubMedID 31748512

• Synergy between B cell receptor/antigen uptake and MHCII peptide editing relies on HLA-DO tuning. Scientific reports Jiang, W., Adler, L. N., Macmillan, H., Mellins, E. D. 2019; 9 (1): 13877

  Abstract

  B cell receptors and surface-displayed peptide/MHCII complexes constitute two key components of the B-cell machinery to sense signals and communicate with other cell types during antigen-triggered activation. However, critical pathways synergizing antigen-BCR interaction and antigenic peptide-MHCII presentation remain elusive. Here, we report the discovery of factors involved in establishing such synergy. We applied a single-cell measure coupled with super-resolution microscopy to investigate the integrated function of two lysosomal regulators for peptide loading, HLA-DM and HLA-DO. In model cell lines and human tonsillar B cells, we found that tunable DM/DO stoichiometry governs DMfree activity for exchange of placeholder CLIP peptides with high affinity MHCII ligands. Compared to their naive counterparts, memory B cells with less DMfree concentrate a higher proportion of CLIP/MHCII in lysosomal compartments. Upon activation mediated by high affinity BCR, DO tuning is synchronized with antigen internalization and rapidly potentiates DMfree activity to optimize antigen presentation for T-cell recruitment.

  View details for DOI 10.1038/s41598-019-50455-y

  View details for PubMedID 31554902

• Human Intestinal Enteroids Model MHC-II in the Gut Epithelium FRONTIERS IN IMMUNOLOGY Wosen, J. E., Ilstad-Minnihan, A., Co, J. Y., Jiang, W., Mukhopadhyay, D., Fernandez-Becker, N. Q., Kuo, C. J., Amieva, M. R., Mellins, E. D. 2019; 10

  View details for DOI 10.3389/fimmu.2019.01970

  View details for Web of Science ID 000481776300001

• Human Intestinal Enteroids Model MHC-II in the Gut Epithelium. Frontiers in immunology Wosen, J. E., Ilstad-Minnihan, A., Co, J. Y., Jiang, W., Mukhopadhyay, D., Fernandez-Becker, N. Q., Kuo, C. J., Amieva, M. R., Mellins, E. D. 2019; 10: 1970

  Abstract

  The role of intestinal epithelial cells (IECs) in mucosal tolerance and immunity remains poorly understood. We present a method for inducing MHC class II (MHC-II) in human enteroids, "mini-guts" derived from small intestinal crypt stem cells, and show that the intracellular MHC-II peptide-pathway is intact and functional in IECs. Our approach enables human enteroids to be used for novel in vitro studies into IEC MHC-II regulation and function during health and disease.

  View details for DOI 10.3389/fimmu.2019.01970

  View details for PubMedID 31481960

  View details for PubMedCentralID PMC6710476

• Severe autoinflammation in four patients with C-terminal variants in CDC42 successfully treated with IL-1beta inhibition. The Journal of allergy and clinical immunology Gernez, Y., de Jesus, A. A., Alsaleem, H., Macaubas, C., Roy, A., Lovell, D., Jagadeesh, K. A., Alehashemi, S., Erdman, L., Grimley, M., Talarico, S., Bacchetta, R., Lewis, D. B., Canna, S. W., Laxer, R. M., Mellins, E. D., Goldbach-Mansky, R., Weinacht, K. G. 2019

  Abstract

  Four patients with novel variants in the C-terminal domain of CDC42, severe autoinflammation, constitutive elevation of serum interleukin 18, and predisposition to macrophage activation syndrome respond to treatment with interleukin-1beta signaling inhibition.

  View details for DOI 10.1016/j.jaci.2019.06.017

  View details for PubMedID 31271789

• Plc gamma 2/Tmem178 dependent pathway in myeloid cells modulates the pathogenesis of cytokine storm syndrome JOURNAL OF AUTOIMMUNITY Mahajan, S., Decker, C. E., Yang, Z., Veis, D., Mellins, E. D., Faccio, R. 2019; 100: 62–74

  View details for DOI 10.1016/j.jaut.2019.02.005

  View details for Web of Science ID 000469907400007

• Epitope Selection for HLA-DQ2 Presentation: Implications for Celiac Disease and Viral Defense JOURNAL OF IMMUNOLOGY Hung, S., Hou, T., Jiang, W., Wang, N., Qiao, S., Chow, I., Liu, X., van der Burg, S. H., Koelle, D. M., Kwok, W. W., Sollid, L. M., Mellins, E. D. 2019; 202 (9): 2558–69

  View details for DOI 10.4049/jimmunol.1801454

  View details for Web of Science ID 000465364300006

• Tmem178 negatively regulates store-operated calcium entry in myeloid cells via association with STIM1. Journal of autoimmunity Yang, Z., Yan, H., Dai, W., Jing, J., Yang, Y., Mahajan, S., Zhou, Y., Li, W., Macaubas, C., Mellins, E. D., Shih, C., Fitzpatrick, J. A., Faccio, R. 2019

  Abstract

  Store-operated calcium entry (SOCE) modulates cytosolic calcium in multiple cells. Endoplasmic reticulum (ER)-localized STIM1 and plasma membrane (PM)-localized ORAI1 are two main components of SOCE. STIM1:ORAI1 association requires STIM1 oligomerization, its re-distribution to ER-PM junctions, and puncta formation. However, little is known about the negative regulation of these steps to prevent calcium overload. Here, we identified Tmem178 as a negative modulator of STIM1 puncta formation in myeloid cells. Using site-directed mutagenesis, co-immunoprecipitation assays and FRET imaging, we determined that Tmem178:STIM1 association occurs via their transmembrane motifs. Mutants that increase Tmem178:STIM1 association reduce STIM1 puncta formation, SOCE activation, impair inflammatory cytokine production in macrophages and osteoclastogenesis. Mutants that reduce Tmem178:STIM1 association reverse these effects. Furthermore, exposure to plasma from arthritic patients decreases Tmem178 expression, enhances SOCE activation and cytoplasmic calcium. In conclusion, Tmem178 modulates the rate-limiting step of STIM1 puncta formation and therefore controls SOCE in inflammatory conditions.

  View details for PubMedID 31018906

• US Adult Rheumatologists' Perspective on the Transition Process for Young Adults with Rheumatic Conditions. Arthritis care & research Zisman, D., Samad, A., Ardoin, S. P., Chira, P., White, P., Lavi, I., von Scheven, E., Lawson, E. F., Hing, M., Mellins, E. D. 2019

  Abstract

  OBJECTIVE: To assess the attitudes and common practices of adult rheumatologists in the United States regarding health care transition (HCT) for young adults with rheumatic diseases.METHODS: An anonymous online survey was sent to U.S. adult rheumatologist members of the American College of Rheumatology to collect demographic data and information on attitudes and common practices regarding the transition process.RESULTS: Of 4,064 contacted rheumatologists, 203 (5%) completed the survey. Almost half of respondents (45.1%) were never trained in transition practices, and 74.7% were not familiar with the AAP/AAFP/ACP Consensus Statement About Transitions for Youth with Special Healthcare Needs. Only 56.2% felt comfortable caring for former pediatric patients. The vast majority (90.7%) did not have a multidisciplinary transition team, and 37% did not have a plan for transitioning pediatric patients into their practice. Most adult rheumatologists were unsatisfied with the current transition process (92.9%), due to insufficient resources, personnel (91.1%) and time in clinic (86.9%). They also were unsatisfied with referral data received concerning: previous treatments (48.9%), hospitalization history (48%), disease activity index (45.1%), medical history summary (43.9%), co-morbidities (36.4%), medication list (34.1%) and disease classification (32.6%). Three major barriers to health care transition were lack of insurance reimbursement (33.7%), knowledge about community resources (30.8%) and lapses in care between primary provider and specialist (27.8%).CONCLUSION: This survey identified substantial gaps in knowledge and resources regarding HCT for young adults with rheumatic diseases. These may be best addressed by further training, research, dedicated resources, adequate payment and practice guidelines. This article is protected by copyright. All rights reserved.

  View details for PubMedID 30740937

• Novel CDC42 Mutation Causes Severe Autoinflammatory Syndrome Responsive to IL-1 Inhibition Gernez, Y., Kirbey, M., Balagas, J. M., Macaubas, C. I., Canna, S., Lewis, D. B., Mellins, E., Bacchetta, R., Weinacht, K. G. SPRINGER/PLENUM PUBLISHERS. 2019: S69

  View details for Web of Science ID 000463709600107

• Pulse-Chase Analysis for Studies of MHC Class II Biosynthesis, Maturation, and Peptide Loading. Methods in molecular biology (Clifton, N.J.) Hou, T. n., Rinderknecht, C. n., Ghosh, D. n., Hadjinicolaou, A. V., Busch, R. n., Mellins, E. D. 2019; 1988: 315–41

  Abstract

  Pulse-chase analysis is a commonly used technique for studying the synthesis, processing, and transport of proteins. Cultured cells expressing proteins of interest are allowed to take up radioactively labeled amino acids for a brief interval ("pulse"), during which all newly synthesized proteins incorporate the label. The cells are then returned to nonradioactive culture medium for various times ("chase"), during which proteins may undergo conformational changes, trafficking, or degradation. Proteins of interest are isolated (usually by immunoprecipitation) and resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and the fate of radiolabeled molecules is examined by autoradiography. This chapter describes a pulse-chase protocol suitable for studies of major histocompatibility complex (MHC) class II biosynthesis and maturation. We discuss how results are affected by the recognition by certain anti-class II antibodies of distinct class II conformations associated with particular biosynthetic states. Our protocol can be adapted to follow the fate of many other endogenously synthesized proteins, including viral or transfected gene products, in cultured cells.

  View details for DOI 10.1007/978-1-4939-9450-2_23

  View details for PubMedID 31147950

• HLA associations in inflammatory arthritis: emerging mechanisms and clinical implications. Nature reviews. Rheumatology Busch, R. n., Kollnberger, S. n., Mellins, E. D. 2019

  Abstract

  Our understanding of the mechanisms underlying HLA associations with inflammatory arthritis continues to evolve. Disease associations have been refined, and interactions of HLA genotype with other genes and environmental risk factors in determining disease risk have been identified. This Review provides basic information on the genetics and molecular function of HLA molecules, as well as general features of HLA associations with disease. Evidence is discussed regarding the various peptide-dependent and peptide-independent mechanisms by which HLA alleles might contribute to the pathogenesis of three types of inflammatory arthritis: rheumatoid arthritis, spondyloarthritis and systemic juvenile idiopathic arthritis. Also discussed are HLA allelic associations that shed light on the genetic heterogeneity of inflammatory arthritides and on the relationships between adult and paediatric forms of arthritis. Clinical implications range from improved diagnosis and outcome prediction to the possibility of using HLA associations in developing personalized strategies for the treatment and prevention of these diseases.

  View details for DOI 10.1038/s41584-019-0219-5

  View details for PubMedID 31092910

• Emergent high fatality lung disease in systemic juvenile arthritis. Annals of the rheumatic diseases Saper, V. E., Chen, G. n., Deutsch, G. H., Guillerman, R. P., Birgmeier, J. n., Jagadeesh, K. n., Canna, S. n., Schulert, G. n., Deterding, R. n., Xu, J. n., Leung, A. N., Bouzoubaa, L. n., Abulaban, K. n., Baszis, K. n., Behrens, E. M., Birmingham, J. n., Casey, A. n., Cidon, M. n., Cron, R. Q., De, A. n., De Benedetti, F. n., Ferguson, I. n., Fishman, M. P., Goodman, S. I., Graham, T. B., Grom, A. A., Haines, K. n., Hazen, M. n., Henderson, L. A., Ho, A. n., Ibarra, M. n., Inman, C. J., Jerath, R. n., Khawaja, K. n., Kingsbury, D. J., Klein-Gitelman, M. n., Lai, K. n., Lapidus, S. n., Lin, C. n., Lin, J. n., Liptzin, D. R., Milojevic, D. n., Mombourquette, J. n., Onel, K. n., Ozen, S. n., Perez, M. n., Phillippi, K. n., Prahalad, S. n., Radhakrishna, S. n., Reinhardt, A. n., Riskalla, M. n., Rosenwasser, N. n., Roth, J. n., Schneider, R. n., Schonenberg-Meinema, D. n., Shenoi, S. n., Smith, J. A., Sönmez, H. E., Stoll, M. L., Towe, C. n., Vargas, S. O., Vehe, R. K., Young, L. R., Yang, J. n., Desai, T. n., Balise, R. n., Lu, Y. n., Tian, L. n., Bejerano, G. n., Davis, M. M., Khatri, P. n., Mellins, E. D. 2019

  Abstract

  To investigate the characteristics and risk factors of a novel parenchymal lung disease (LD), increasingly detected in systemic juvenile idiopathic arthritis (sJIA).In a multicentre retrospective study, 61 cases were investigated using physician-reported clinical information and centralised analyses of radiological, pathological and genetic data.LD was associated with distinctive features, including acute erythematous clubbing and a high frequency of anaphylactic reactions to the interleukin (IL)-6 inhibitor, tocilizumab. Serum ferritin elevation and/or significant lymphopaenia preceded LD detection. The most prevalent chest CT pattern was septal thickening, involving the periphery of multiple lobes ± ground-glass opacities. The predominant pathology (23 of 36) was pulmonary alveolar proteinosis and/or endogenous lipoid pneumonia (PAP/ELP), with atypical features including regional involvement and concomitant vascular changes. Apparent severe delayed drug hypersensitivity occurred in some cases. The 5-year survival was 42%. Whole exome sequencing (20 of 61) did not identify a novel monogenic defect or likely causal PAP-related or macrophage activation syndrome (MAS)-related mutations. Trisomy 21 and young sJIA onset increased LD risk. Exposure to IL-1 and IL-6 inhibitors (46 of 61) was associated with multiple LD features. By several indicators, severity of sJIA was comparable in drug-exposed subjects and published sJIA cohorts. MAS at sJIA onset was increased in the drug-exposed, but was not associated with LD features.A rare, life-threatening lung disease in sJIA is defined by a constellation of unusual clinical characteristics. The pathology, a PAP/ELP variant, suggests macrophage dysfunction. Inhibitor exposure may promote LD, independent of sJIA severity, in a small subset of treated patients. Treatment/prevention strategies are needed.

  View details for DOI 10.1136/annrheumdis-2019-216040

  View details for PubMedID 31562126

• Epithelial MHC Class II Expression and Its Role in Antigen Presentation in the Gastrointestinal and Respiratory Tracts FRONTIERS IN IMMUNOLOGY Wosen, J. E., Mukhopadhyay, D., Macaubas, C., Mellins, E. D. 2018; 9

  View details for DOI 10.3389/fimmu.2018.02144

  View details for Web of Science ID 000445610400001

• Epithelial MHC Class II Expression and Its Role in Antigen Presentation in the Gastrointestinal and Respiratory Tracts. Frontiers in immunology Wosen, J. E., Mukhopadhyay, D., Macaubas, C., Mellins, E. D. 2018; 9: 2144

  Abstract

  As the primary barrier between an organism and its environment, epithelial cells are well-positioned to regulate tolerance while preserving immunity against pathogens. Class II major histocompatibility complex molecules (MHC class II) are highly expressed on the surface of epithelial cells (ECs) in both the lung and intestine, although the functional consequences of this expression are not fully understood. Here, we summarize current information regarding the interactions that regulate the expression of EC MHC class II in health and disease. We then evaluate the potential role of EC as non-professional antigen presenting cells. Finally, we explore future areas of study and the potential contribution of epithelial surfaces to gut-lung crosstalk.

  View details for DOI 10.3389/fimmu.2018.02144

  View details for PubMedID 30319613

  View details for PubMedCentralID PMC6167424

• Genetic architecture distinguishes systemic juvenile idiopathic arthritis from other forms of juvenile idiopathic arthritis: clinical and therapeutic implications ANNALS OF THE RHEUMATIC DISEASES Ombrello, M. J., Arthur, V. L., Remmers, E. F., Hinks, A., Tachmazidou, I., Grom, A. A., Foell, D., Martini, A., Gattorno, M., Ozen, S., Prahalad, S., Zeft, A. S., Bohnsack, J. F., Ilowite, N. T., Mellins, E. D., Russo, R., Len, C., Hilario, M. O., Oliveira, S., Yeung, R. S., Rosenberg, A. M., Wedderburn, L. R., Anton, J., Haas, J., Rosen-Wolff, A., Minden, K., Tenbrock, K., Demirkaya, E., Cobb, J., Baskin, E., Signa, S., Shuldiner, E., Duerr, R. H., Achkar, J., Kamboh, M. I., Kaufman, K. M., Kottyan, L. C., Pinto, D., Scherer, S. W., Alarcon-Riquelme, M. E., Docampo, E., Estivill, X., Gul, A., Langefeld, C. D., Thompson, S., Zeggini, E., Kastner, D. L., Woo, P., Thomson, W. 2017; 76 (5)

  Abstract

  Juvenile idiopathic arthritis (JIA) is a heterogeneous group of conditions unified by the presence of chronic childhood arthritis without an identifiable cause. Systemic JIA (sJIA) is a rare form of JIA characterised by systemic inflammation. sJIA is distinguished from other forms of JIA by unique clinical features and treatment responses that are similar to autoinflammatory diseases. However, approximately half of children with sJIA develop destructive, long-standing arthritis that appears similar to other forms of JIA. Using genomic approaches, we sought to gain novel insights into the pathophysiology of sJIA and its relationship with other forms of JIA.We performed a genome-wide association study of 770 children with sJIA collected in nine countries by the International Childhood Arthritis Genetics Consortium. Single nucleotide polymorphisms were tested for association with sJIA. Weighted genetic risk scores were used to compare the genetic architecture of sJIA with other JIA subtypes.The major histocompatibility complex locus and a locus on chromosome 1 each showed association with sJIA exceeding the threshold for genome-wide significance, while 23 other novel loci were suggestive of association with sJIA. Using a combination of genetic and statistical approaches, we found no evidence of shared genetic architecture between sJIA and other common JIA subtypes.The lack of shared genetic risk factors between sJIA and other JIA subtypes supports the hypothesis that sJIA is a unique disease process and argues for a different classification framework. Research to improve sJIA therapy should target its unique genetics and specific pathophysiological pathways.

  View details for DOI 10.1136/annrheumdis-2016-210324

  View details for Web of Science ID 000398387200021

• The Other Function: Class II-Restricted Antigen Presentation by B Cells FRONTIERS IN IMMUNOLOGY Adler, L. N., Jiang, W., Bhamidipati, K., Millican, M., Macaubas, C., Hung, S., Mellins, E. D. 2017; 8

  Abstract

  Mature B lymphocytes (B cells) recognize antigens using their B cell receptor (BCR) and are activated to become antibody-producing cells. In addition, and integral to the development of a high-affinity antibodies, B cells utilize the specialized major histocompatibility complex class II (MHCII) antigen presentation pathway to process BCR-bound and internalized protein antigens and present selected peptides in complex with MHCII to CD4+ T cells. This interaction influences the fate of both types of lymphocytes and shapes immune outcomes. Specific, effective, and optimally timed antigen presentation by B cells requires well-controlled intracellular machinery, often regulated by the combined effects of several molecular events. Here, we delineate and summarize these events in four steps along the antigen presentation pathway: (1) antigen capture and uptake by B cells; (2) intersection of internalized antigen/BCRs complexes with MHCII in peptide-loading compartments; (3) generation and regulation of MHCII/peptide complexes; and (4) exocytic transport for presentation of MHCII/peptide complexes at the surface of B cells. Finally, we discuss modulation of the MHCII presentation pathway across B cell development and maturation to effector cells, with an emphasis on the shaping of the MHCII/peptide repertoire by two key antigen presentation regulators in B cells: HLA-DM and HLA-DO.

  View details for DOI 10.3389/fimmu.2017.00319

  View details for Web of Science ID 000397144900001

  View details for PubMedID 28386257

• Development of Autoimmune Diseases Among Children With Pediatric Acute-Onset Neuropsychiatric Syndrome JAMA network open Ma, M., Masterson, E. E., Gao, J., Karpel, H., Chan, A., Pooni, R., Sandberg, J., Rubesova, E., Farhadian, B., Willet, T., Xie, Y., Tran, P., Silverman, M., Thienemann, M., Mellins, E., Frankovich, J. 2024; 7 (7)

  View details for DOI 10.1001/jamanetworkopen.2024.21688

• Post-infectious inflammation, autoimmunity, and OCD: Sydenham Chorea, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS), and Pediatric Acute-onset Neuropsychiatric Disorder (PANS) DEVELOPMENTAL NEUROSCIENCE Vreeland, A., Calaprice, D., Or-Geva, N., Frye, R. E., Agalliu, D., Lachman, H. M., Pittenger, C., Pallanti, S., Williams, K., Ma, M., Thienemann, M., Gagliano, A., Mellins, E., Frankovich, J. 2023

  Abstract

  Post-infectious neuroinflammation has been implicated in multiple models of acute onset obsessive-compulsive disorder (OCD) including Sydenham's chorea (SC), pediatric acute-onset neuropsychiatric syndrome (PANS), and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). These conditions are associated with a range of autoantibodies which are thought to be triggered by an infections, most notably group A streptococci (GAS). Based on animal models using huma sera, these autoantibodies are thought to cross-react with neural antigens in the basal ganglia and modulate neuronal activity and behavior. As is true for many childhood neuroinflammatory diseases and rheumatological diseases, SC, PANS, and PANDAS lack clinically available, rigorous diagnostic biomarkers and randomized clinical trials. In this review article, we outline the accumulating evidence supporting the role neuroinflammation plays in these disorders. We describe work with animal models including patient-derived anti-neuronal autoantibodies, and we outline imaging studies that show alterations in the basal ganglia. In addition, we present research on metabolites, which are helpful in deciphering functional phenotypes, and on the implication of sleep in these disorders. Finally, we encourage future researchers to collaborate across medical specialties (e.g., pediatrics, psychiatry, rheumatology, immunology, and infectious disease) in order to further research on clinical syndromes presenting with neuropsychiatric manifestations.

  View details for DOI 10.1159/000534261

  View details for Web of Science ID 001076907900001

  View details for PubMedID 37742615

• Synchrony 2022: The Role of Neuroinflammation in Behavioral Exacerbations in Autism Spectrum Disorder. Journal of personalized medicine Frankovich, J., Nanda, H., Mellins, E. D., Jyonouchi, H., Boles, R. G., Walker, S. J., Gaitanis, J., Frye, R. E. 2023; 13 (7)

  Abstract

  The BRAIN Foundation (Pleasanton, CA) hosted Synchrony 2022, a medical conference focusing on research for treatments to benefit individuals with neurodevelopmental disorders (NDD), including those with autism spectrum disorders (ASD) [...].

  View details for DOI 10.3390/jpm13071133

  View details for PubMedID 37511746

• Evaluation of C4 gene copy number in Pediatric Acute Neuropsychiatric Syndrome DEVELOPMENTAL NEUROSCIENCE Kalinowski, A., Tian, L., Pattni, R., Ollila, H., Khan, M., Manko, C., Silverman, M., Ma, M., Columbo, L., Farhadian, B., Swedo, S., Murphy, T., Johnson, M., Fernell, E., Gillberg, C., Thienemann, M., Mellins, E. D., Levinson, D. F., Urban, A. E., Frankovich, J. 2023

  Abstract

  Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is an abrupt-onset neuropsychiatric disorder. PANS patients have an increased prevalence of co-morbid autoimmune illness, most commonly arthritis. In addition, an estimated one-third of PANS patients present with low serum C4 protein, suggesting decreased production or increased consumption of C4 protein. To test the possibility that copy number (CN) variation contributes to risk of PANS illness, we compared mean total C4A and total C4B CN in ethnically-matched subjects from PANS DNA samples and controls (192 cases and 182 controls). Longitudinal data from the Stanford PANS cohort (n = 121) was used to assess whether the time to Juvenile Idiopathic Arthritis (JIA) or Autoimmune Disease (AI) onset was a function of total C4A or C4B. Lastly, we performed several hypothesis-generating analyses to explore the correlation between individual C4 gene variants, sex, specific genotypes and age of PANS onset. Although the mean total C4A or C4B CN did not differ in PANS compared to controls, PANS patients with low C4B CN were at increased risk for subsequent JIA diagnosis (Hazard Ratio = 27, p-value = 0004). We also observed a possible increase in risk for AI in PANS patients and a possible correlation between lower C4B and PANS age of onset. An association between rheumatoid arthritis and low C4B CN has been reported previously. However, patients with PANS develop different types of JIA: enthesitis-related arthritis, spondyloarthritis and psoriatic arthritis. This suggests that C4B plays a role that spans these arthritis types.

  View details for DOI 10.1159/000531707

  View details for Web of Science ID 001018232500001

  View details for PubMedID 37379808

• Regulatory Haplotype of CXCR4 Is Associated with sJIA and Corelates with Enhanced Neutrophil and CD14+Monocyte Migration Nakano, H., Shuldiner, E., Hinks, A., Sudman, M., Remmers, E., Satorius, C., Schmitz, E., Arthur, V., Woo, P., Grom, A., Foell, D., Bohnsack, J., Gattorno, M., Ozen, S., Prahalad, S., Yeung, R., Mellins, E., Oliveira, S., Anton, J., Len, C., Lake, C., Bergeron, L., Millwood, M., de los Santos, E., Marques, M., Langefeld, C., Thompson, S., Thomson, W., Ombrello, M., Juvenile Arthrit Consortium, Genomic Ascertainment Cohort, INCHARGE Consortium WILEY. 2022: 1714-1716

  View details for Web of Science ID 000877386501383

• Large-Scale Targeted Sequencing Study Links Systemic Juvenile Idiopathic Arthritis with Rare Variants of MEFV, LYST, STXBP2, UNC13D Marques, M., Rubin, D., Shuldiner, E., Schmitz, E., Baskin, E., Patt, A., Grom, A., Foell, D., Gattorno, M., Bohnsack, J., Yeung, R., Prahalad, S., Mellins, E., Anton, J., Foell, D., Gattorno, M., Bohnsack, J., Yeung, R., Prahalad, S., Mellins, E., Anton, J., Len, C., Oliveira, S., Woo, P., Ozen, S., Ombrello, M., INCHARGE Consortium WILEY. 2022: 1139-1140

  View details for Web of Science ID 000877386501078

• Early non-neutralizing, afucosylated antibody responses are associated with COVID-19 severity. Science translational medicine Chakraborty, S., Gonzalez, J. C., Sievers, B. L., Mallajosyula, V., Chakraborty, S., Dubey, M., Ashraf, U., Cheng, B. Y., Kathale, N., Tran, K. Q., Scallan, C., Sinnott, A., Cassidy, A., Chen, S. T., Gelbart, T., Gao, F., Golan, Y., Ji, X., Kim-Schulze, S., Prahl, M., Gaw, S. L., Gnjatic, S., Marron, T. U., Merad, M., Arunachalam, P. S., Boyd, S. D., Davis, M. M., Holubar, M., Khosla, C., Maecker, H. T., Maldonado, Y., Mellins, E. D., Nadeau, K. C., Pulendran, B., Singh, U., Subramanian, A., Utz, P. J., Sherwood, R., Zhang, S., Jagannathan, P., Tan, G. S., Wang, T. T. 1800: eabm7853

  Abstract

  A damaging inflammatory response is implicated in the pathogenesis of severe coronavirus disease 2019 (COVID-19), but mechanisms contributing to this response are unclear. In two prospective cohorts, early non-neutralizing, afucosylated IgG antibodies specific to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were associated with progression from mild to more severe COVID-19. In contrast to the antibody structures that were associated with disease progression, antibodies that were elicited by mRNA SARS-CoV-2 vaccines were instead highly fucosylated and enriched in sialylation, both modifications that reduce the inflammatory potential of IgG. To study the biology afucosylated IgG immune complexes, we developed an in vivo model that revealed that human IgG-Fc gamma receptor (FcgammaR) interactions could regulate inflammation in the lung. Afucosylated IgG immune complexes isolated from COVID-19 patients induced inflammatory cytokine production and robust infiltration of the lung by immune cells. By contrast, vaccine-elicited IgG did not promote an inflammatory lung response. Together, these results show that IgG-FcgammaR interactions are able to regulate inflammation in the lung and may define distinct lung activities associated with the IgG that are associated with severe COVID-19 and protection against infection with SARS-CoV-2.

  View details for DOI 10.1126/scitranslmed.abm7853

  View details for PubMedID 35040666

• Repression of CTSG, ELANE and PRTN3-mediated histone H3 proteolytic cleavage promotes monocyte-to-macrophage differentiation. Nature immunology Cheung, P., Schaffert, S., Chang, S. E., Dvorak, M., Donato, M., Macaubas, C., Foecke, M. H., Li, T., Zhang, L., Coan, J. P., Schulert, G. S., Grom, A. A., Henderson, L. A., Nigrovic, P. A., Elias, J. E., Gozani, O., Mellins, E. D., Khatri, P., Utz, P. J., Kuo, A. J. 2021

  Abstract

  Chromatin undergoes extensive reprogramming during immune cell differentiation. Here we report the repression of controlled histone H3 amino terminus proteolytic cleavage (H3DeltaN) during monocyte-to-macrophage development. This abundant histone mark in human peripheral blood monocytes is catalyzed by neutrophil serine proteases (NSPs) cathepsin G, neutrophil elastase and proteinase 3. NSPs are repressed as monocytes mature into macrophages. Integrative epigenomic analysis reveals widespread H3DeltaN distribution across the genome in a monocytic cell line and primary monocytes, which becomes largely undetectable in fully differentiated macrophages. H3DeltaN is enriched at permissive chromatin and actively transcribed genes. Simultaneous NSP depletion in monocytic cells results in H3DeltaN loss and further increase in chromatin accessibility, which likely primes the chromatin for gene expression reprogramming. Importantly, H3DeltaN is reduced in monocytes from patients with systemic juvenile idiopathic arthritis, an autoinflammatory disease with prominent macrophage involvement. Overall, we uncover an epigenetic mechanism that primes the chromatin to facilitate macrophage development.

  View details for DOI 10.1038/s41590-021-00928-y

  View details for PubMedID 34017121

• Carbon Nanotubes-Potent Carriers for Targeted Drug Delivery in Rheumatoid Arthritis. Pharmaceutics Kofoed Andersen, C., Khatri, S., Hansen, J., Slott, S., Pavan Parvathaneni, R., Mendes, A. C., Chronakis, I. S., Hung, S., Rajasekaran, N., Ma, Z., Zhu, S., Dai, H., Mellins, E. D., Astakhova, K. 2021; 13 (4)

  Abstract

  Two types of single-walled carbon nanotubes (SWCNTs), HiPco- and carboxyl-SWCNT, are evaluated as drug carriers for the traditional anti-inflammatory drug methotrexate (MTX) and a small interfering RNA (siRNA) targeting NOTCH1 gene. The nanotubes are solubilized by PEGylation and covalently loaded with MTX. The coupling efficiency (CE%) of MTX is 77-79% for HiPco-SWCNT and 71-83% for carboxyl-SWCNT. siRNA is noncovalently attached to the nanotubes with efficiency of 90-97% for HiPco-SWCNT and 87-98% for carboxyl-SWCNT. Through whole body imaging in the second near-infrared window (NIR-II window, 1000-1700 nm), SWCNTs were found to be selectively accumulated in inflamed joints in a serum transfer mouse model. We further investigated the interactions of the siRNA/MTX loaded nanotubes with human blood and mice bone marrow cells. In human blood, both types of unloaded SWCNTs were associated with B cells, monocytes and neutrophils. Interestingly, loading with MTX suppressed SWCNTs targeting specificity to immune cells, especially B cells; in contrast, loading siRNA alone enhanced the targeting specificity. Loading both MTX and siRNA to carboxyl-SWCNT enhanced targeting specificity to neutrophils and monocytes but not B cells. The targeting specificity of SWCNTs can potentially be adjusted by altering the ratio of MTX and siRNA loaded. The combined results show that carbon nanotubes have the potential for delivery of cargo drugs specifically to immune cells involved in rheumatoid arthritis.

  View details for DOI 10.3390/pharmaceutics13040453

  View details for PubMedID 33801590

• Recent progress in the treatment of non-systemic juvenile idiopathic arthritis. Faculty reviews Bridges, J. M., Mellins, E. D., Cron, R. Q. 2021; 10: 23

  Abstract

  Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease affecting the joints and other organs that occurs in 1 in 1,000 children in the United States. Given the various categories of JIA, interpretation of the literature can be difficult. In this review, new developments in understanding non-systemic JIA and its treatment will be covered. Recent advances in the journey toward personalized treatment in JIA will be highlighted, including a review of currently available biologic modifiers. Uveitis and the temporomandibular joint will be discussed as particularly challenging treatment issues. Recent guideline updates and literature-guided treatment decisions will be reviewed.

  View details for DOI 10.12703/r/10-23

  View details for PubMedID 33718940

• Multicohort Analysis Identifies Monocyte Gene Signatures to Accurately Monitor Subset-Specific Changes in Human Diseases. Frontiers in immunology Vallania, F., Zisman, L., Macaubas, C., Hung, S., Rajasekaran, N., Mason, S., Graf, J., Nakamura, M., Mellins, E. D., Khatri, P. 2021; 12: 659255

  Abstract

  Monocytes are crucial regulators of inflammation, and are characterized by three distinct subsets in humans, of which classical and non-classical are the most abundant. Different subsets carry out different functions and have been previously associated with multiple inflammatory conditions. Dissecting the contribution of different monocyte subsets to disease is currently limited by samples and cohorts, often resulting in underpowered studies and poor reproducibility. Publicly available transcriptome profiles provide an alternative source of data characterized by high statistical power and real-world heterogeneity. However, most transcriptome datasets profile bulk blood or tissue samples, requiring the use of in silico approaches to quantify changes in cell levels. Here, we integrated 853 publicly available microarray expression profiles of sorted human monocyte subsets from 45 independent studies to identify robust and parsimonious gene expression signatures, consisting of 10 genes specific to each subset. These signatures maintain their accuracy regardless of disease state in an independent cohort profiled by RNA-sequencing and are specific to their respective subset when compared to other immune cells from both myeloid and lymphoid lineages profiled across 6160 transcriptome profiles. Consequently, we show that these signatures can be used to quantify changes in monocyte subsets levels in expression profiles from patients in clinical trials. Finally, we show that proteins encoded by our signature genes can be used in cytometry-based assays to specifically sort monocyte subsets. Our results demonstrate the robustness, versatility, and utility of our computational approach and provide a framework for the discovery of new cellular markers.

  View details for DOI 10.3389/fimmu.2021.659255

  View details for PubMedID 34054824

• Tofacitinib Inhibits Angiogenesis Through Its Opposite Effects on Pro- and Anti-angiogenic Factors Zisman, D., Rahat, M., Simanovich, E., Mellins, E., Haddad, A., Gazitt, T., Feld, J., Rahat, M. WILEY. 2020

  View details for Web of Science ID 000587568505031

• A First in Class Therapeutic Nanoparticle for Specific Targeting of Anti-citrullinated Protein Antibody Ameliorates Serum Transfer and Collagen Induced Arthritis Khatri, S., Hansen, J., Clausen, M., Kragstrup, T., Hung, S., Mellins, E., Astakhova, K. WILEY. 2020

  View details for Web of Science ID 000587568504208

• The Killer Immunoglobulin-like Receptor KIR3DL1 in Combination with HLA-Bw4 Is Associated with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) Frankovich, J., Anderson, K., Montero-Martin, G., Chan, A., Thienemann, M., Farhadian, B., Willett, T., Mellins, E., Madden, A., Murphy, T., Swedo, S., Fernandez-Vina, M., Hollenbach, J. WILEY. 2020: 255–57

  View details for Web of Science ID 000542687800146

• The class II peptide editor, H2-M, affects the development and repertoire of B-1 cells Ghosh, D., Pham, T. D., He, X., O'mara, M. E., Kantor, A. B., Khoa Nguyen, Sengupta, D., Eisenlohr, L. C., Jensen, P. E., Herzenberg, L. A., Boyd, S. D., Ghosn, E. B., Mellins, E. D. AMER ASSOC IMMUNOLOGISTS. 2020

  View details for Web of Science ID 000589972401412

• Hemagglutinin as potential in vivo driver of DQ6-restricted clonal expansion of CD4(+) T cells cross-reactive with hypocretin in narcolepsy Jiang, W., Birtley, J. R., Hung, S., Wang, W., Chiou, S., Davis, M. M., Stern, L. J., Mellins, E. D. AMER ASSOC IMMUNOLOGISTS. 2020

  View details for Web of Science ID 000589972402368

• Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) Is Characterized by a Novel Subset of Monocytes with Markers Associated with Crossing the Blood Brain Barrier (BBB) Rahman, S., Gaertner, F., Houghton, J., Macaubas, C., Chan, A., Columbo, L., Frankovich, J., Mellins, E. WILEY. 2020: 262–63

  View details for Web of Science ID 000542687800151

• Response to: 'Successful treatment of plasma exchange for refractory systemic juvenile idiopathic arthritis complicated with macrophage activation syndrome and severe lung disease' by Sato et al. Annals of the rheumatic diseases Saper, V. E., Chen, G., Guillerman, R. P., Khatri, P., Cron, R. Q., Mellins, E. D. 2020

  View details for DOI 10.1136/annrheumdis-2020-217426

  View details for PubMedID 32317313

• Psoriatic arthritis in childhood: A commentary on the controversy. Clinical immunology (Orlando, Fla.) Stoll, M. L., Mellins, E. D. 2020: 108396

  Abstract

  Approximately 5% of children with juvenile idiopathic arthritis (JIA) are diagnosed with the psoriatic form of the disease. In recent years, there has been substantial scholarship demonstrating both heterogeneity within the disease as well as similarities with other forms of JIA, culminating in a recent proposal for the categorization of JIA that excluded the psoriatic form altogether. The purpose of the review is to summarize the clinical, epidemiologic, and genetic features of psoriatic JIA (PsJIA), comparing it with other categories of JIA including spondyloarthritis. We conclude that there are sufficient unique clinical and genetic features within PsJIA as well as similarities with its adult counterpart that warrant including it within the JIA paradigm.

  View details for DOI 10.1016/j.clim.2020.108396

  View details for PubMedID 32229291

• US Adult Rheumatologists' Perspectives on the Transition Process for Young Adults With Rheumatic Conditions ARTHRITIS CARE & RESEARCH Zisman, D., Samad, A., Ardoin, S. P., Chira, P., White, P., Lavi, I., von Scheven, E., Lawson, E. F., Hing, M., Mellins, E. D. 2020; 72 (3): 432–40

  View details for DOI 10.1002/acr.23845

  View details for Web of Science ID 000516667800016

• Drug Reaction and High Fatality Lung Disease in Systemic Onset Juvenile Idiopathic Arthritis (sJIA) Saper, V., Mellins, E., Kwong, B. MOSBY-ELSEVIER. 2020: AB95

  View details for Web of Science ID 000517092700293

• Response to: 'Effectiveness and safety of ruxolitinib for the treatment of refractory systemic idiopathic juvenile arthritis like associated with interstitial lung disease: case report' by Bader-Meunier et al. Annals of the rheumatic diseases Saper, V. E., Chen, G. n., Khatri, P. n., Mellins, E. D. 2020

  View details for DOI 10.1136/annrheumdis-2020-217000

  View details for PubMedID 32054603

• Combined Assay for Detecting Autoantibodies to Nucleic Acids and Apolipoprotein H in Patients with Systemic Lupus Erythematosus. Methods in molecular biology (Clifton, N.J.) Khatri, S. n., Mellins, E. D., Torok, K. S., Bukhari, S. A., Astakhova, K. n. 2020; 2063: 57–71

  Abstract

  The complicated clinical picture and biomolecular pattern of human autoimmune diseases (ADs) make knowledge on their etiology still fragmentary. The diagnostic approaches for ADs require improvement both for clinical and research effort to progress. Synthetic biomolecular antigens find growing applications for diagnosis and investigation of ADs. The main goal of this work is to detect interaction between synthetic antigens and autoantibodies in systemic lupus erythematosus within a combined, high-throughput assay. A panel of synthetic antigens has been prepared from DNA, RNA, locked nucleic acids and apolipoprotein H. The binding of synthetic antigens to autoantibodies has been confirmed in sera samples from those with active systemic lupus erythematosus (SLE) by indirect enzyme linked immunosorbent assay. Our study provides an efficient methodology for combined autoantibody profiling in SLE.

  View details for DOI 10.1007/978-1-0716-0138-9_6

  View details for PubMedID 31667763

• Retinoic Acid and Lymphotoxin Signaling Promote Differentiation of Human Intestinal M Cells. Gastroenterology Ding, S. n., Song, Y. n., Brulois, K. F., Pan, J. n., Co, J. Y., Ren, L. n., Feng, N. n., Yasukawa, L. L., Sánchez-Tacuba, L. n., Wosen, J. E., Mellins, E. D., Monack, D. M., Amieva, M. R., Kuo, C. J., Butcher, E. C., Greenberg, H. B. 2020

  Abstract

  Intestinal microfold (M) cells are a unique subset of intestinal epithelial cells in the Peyer's patches that regulate mucosal immunity, serving as portals for sampling and uptake of luminal antigens. The inability to efficiently develop human M cells in cell culture has impeded studies of the intestinal immune system. We aimed to identify signaling pathways required for differentiation of human M cells and establish a robust culture system using human ileum enteroids.We analyzed transcriptome data from mouse Peyer's Patches to identify cell populations in close proximity to M cells. We used the human enteroid system to determine which cytokines were required to induce M cell differentiation. We performed transcriptome, immunofluorescence, scanning electron microscope, and transcytosis experiments to validate the development of phenotypic and functional human M cells.A combination of retinoic acid and lymphotoxin induced differentiation of glycoprotein 2-positive human M cells, which lack apical microvilli structure. Upregulated expression of innate immune-related genes within M cells correlated with a lack of viral antigens after rotavirus infection. Human M cells, developed in the enteroid system, internalized and transported enteric viruses, such as rotavirus and reovirus, across the intestinal epithelium barrier in the enteroids.We identified signaling pathways required for differentiation of intestinal M cells, and used this information to create a robust culture method to develop human M cells with capacity for internalization and transport of viruses. Studies of this model might increase our understanding of antigen presentation and the systemic entry of enteric pathogens in the human intestine.

  View details for DOI 10.1053/j.gastro.2020.03.053

  View details for PubMedID 32247021

• Diacylglycerol Kinase zeta Regulates Macrophage Responses in Juvenile Arthritis and Cytokine Storm Syndrome Mouse Models. Journal of immunology (Baltimore, Md. : 1950) Mahajan, S., Mellins, E. D., Faccio, R. 2019

  Abstract

  Dysregulation of monocyte and macrophage responses are often observed in children with systemic juvenile idiopathic arthritis (sJIA) and cytokine storm syndrome (CSS), a potentially fatal complication of chronic rheumatic diseases. Both conditions are associated with activation of TLR signaling in monocyte and macrophage lineage cells, leading to overwhelming inflammatory responses. Despite the importance of TLR engagement in activating proinflammatory macrophages, relatively little is known about activation of intrinsic negative regulatory pathways to attenuate excessive inflammatory responses. In this study, we demonstrate that loss of diacylglycerol (DAG) kinase (Dgk) zeta, an enzyme which converts DAG into phosphatidic acid, limits inflammatory cytokine production in an arthritic mouse model dependent on TLR2 signaling and in a CSS mouse model dependent on TLR9 signaling. In vitro, Dgkzeta deficiency results in reduced production of TNF-alpha, IL-6, and IL-1beta and in limited M1 macrophage polarization. Mechanistically, Dgkzeta deficiency decreases STAT1 and STAT3 phosphorylation. Moreover, Dgkzeta levels are increased in macrophages derived from mice with CSS or exposed to plasma from sJIA patients with active disease. Our data suggest that Dgkzeta induction in arthritic conditions perpetuates systemic inflammatory responses mediated by macrophages and highlight a potential role of Dgkzeta-DAG/phosphatidic acid axis as a modulator of inflammatory cytokine production in sJIA and CSS.

  View details for DOI 10.4049/jimmunol.1900721

  View details for PubMedID 31801815

• Multiplex Serum Analysis Identifies Potential Biomarkers of Systemic Juvenile Idiopathic Arthritis, Macrophage Activation Syndrome, and Associated Pulmonary Alveolar Proteinosis: Evidence for Independently-regulated Hyperinflammatory and Eosinophilic Inflammation Chen, G., Schulert, G., De Jesus, A., Saper, V., Schneider, C., Trapnell, B., Grom, A. A., Goldbach-Mansky, R., Mellins, E., Khatri, P., Canna, S. WILEY. 2019

  View details for Web of Science ID 000507466901341

• Systemic Juvenile Idiopathic Arthritis-Lung Disease: Characterization and Risk Factors Schulert, G., Yasin, S., Carey, B., Chalk, C., Thuy Do, Schapiro, A., Husami, A., Watts, A., Brunner, H., Huggins, J., Mellins, E., Morgan, E., Ting, T., Trapnell, B., Wikenheiser-Brokamp, K., Towe, C., Grom, A. A. WILEY. 2019

  View details for Web of Science ID 000507466901340

• Systemic Juvenile Idiopathic Arthritis-Lung Disease: Characterization and Risk Factors. Arthritis & rheumatology (Hoboken, N.J.) Schulert, G. S., Yasin, S., Carey, B., Chalk, C., Do, T., Schapiro, A. H., Husami, A., Watts, A., Brunner, H. I., Huggins, J., Mellins, E. D., Morgan, E. M., Ting, T., Trapnell, B. C., Wikenheiser-Brokamp, K. A., Towe, C., Grom, A. A. 2019

  Abstract

  OBJECTIVE: Systemic Juvenile Idiopathic Arthritis (SJIA) is associated with a recently recognized albeit poorly defined and characterized lung disease (LD). Our objective is to describe clinical characteristics, risk factors, histopathologic and immunologic features of SJIA-associated LD (SJIA-LD).METHODS: Clinical data was abstracted from medical records, and epidemiologic, cellular, biochemical, genomic analysis, and transcriptional profiling analyses were performed.MAIN RESULTS: Eighteen patients with SJIA-LD have been evaluated since 2010. Radiographic findings included diffuse ground-glass opacities, subpleural reticulation, interlobular septal thickening, and lymphadenopathy. Pathologic findings included patchy but extensive lymphoplasmacytic infiltrates and mixed features of pulmonary alveolar proteinosis (PAP) and endogenous lipoid pneumonia (ELP). Compared to SJIA patients without LD, children with SJIA-LD were younger at SJIA diagnosis (OR=6.5, P=0.007), had prior episodes of macrophage activation syndrome (MAS) (OR=14.5, P<0.001), have had adverse reactions to biologic therapy (OR 13.6, P<0.001), and have higher serum IL-18 (27,612 vs. 5,413 pg/mL, P=0.047). SJIA-LD patients lacked genetic, serologic, or functional evidence of GM-CSF pathway dysfunction typical of familial or autoimmune PAP. Additionally, bronchoalveolar lavage (BAL) rarely demonstrated proteinaceous material and had less lipid-laden macrophages than seen in primary PAP (66.1% vs 10.5%, P<0.001). SJIA-LD BAL fluid contained elevated levels of IL-18 and IFNgamma-induced chemokines CXCL9-10. Transcriptional profiling of SJIA-LD lung tissue identified upregulated type II interferon and T-cell activation networks. This signature was also present in SJIA-LD lung tissue sections lacking substantial histopathological findings, suggesting it may precede and drive lung pathology.CONCLUSIONS: Pulmonary disease is increasingly detected in children with SJIA, particularly in association with MAS. This entity has distinct clinical and immunologic features and represents an uncharacterized inflammatory LD. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/art.41073

  View details for PubMedID 31379071

• Tmem178 negatively regulates store-operated calcium entry in myeloid cells via association with STIM1 JOURNAL OF AUTOIMMUNITY Yang, Z., Yan, H., Dai, W., Jing, J., Yang, Y., Mahajan, S., Zhou, Y., Li, W., Macaubas, C., Mellins, E. D., Shih, C., Fitzpatrick, J. J., Faccio, R. 2019; 101: 94–108

  View details for DOI 10.1016/j.jaut.2019.04.015

  View details for Web of Science ID 000472689600009

• The class II peptide editor, H2-M, affects the development and function of B-1 cells Ghosh, D., He, X., O'Mara, M. E., Kantor, A. B., Sengupta, D., Yang, Y., Eisenlohr, L. C., Jensen, P. E., Herzenberg, L. A., Mellins, E. D. AMER ASSOC IMMUNOLOGISTS. 2019

  View details for Web of Science ID 000524982501485

• Citrullinated Peptide Epitope Targets Therapeutic Nanoparticles to Human Neutrophils. Bioconjugate chemistry Khatri, S. n., Hansen, J. n., Mendes, A. C., Chronakis, I. S., Hung, S. C., Mellins, E. D., Astakhova, K. n. 2019

  Abstract

  Multiple drugs have been proposed for reducing harsh symptoms of human rheumatic diseases. However, a targeted therapy with mild to no side effects is still missing. In this study, we have prepared and tested a series of therapeutic nanoparticles for specific targeting of human neutrophils associated with rheumatoid arthritis. In doing this, a series of citrullinated peptide epitopes derived from human proteins, fibrinogen, vimentin, and histone 3, were screened with regard to specific recognition of neutrophils. The most potent epitope proved to be a mutated fragment of an alpha chain in human fibrinogen. Next, a straightforward synthetic strategy was developed for nanoparticles decorated with this citrullinated peptide epitope and an antisense oligonucleotide targeting disease associated microRNA miR-125b-5p. Our study shows that the nanoparticles specifically recognize neutrophils and knock down miR-125b-5p, with no apparent toxicity to human cells. In contrast to organic dendrimers, chitosan-hyaluronic acid formulations do not activate human innate immune response. Our data proves that the strategy we report herein is effective in developing peptide epitopes for decorating delivery vehicles bearing biological drugs, targeted to a specific cell type.

  View details for DOI 10.1021/acs.bioconjchem.9b00518

  View details for PubMedID 31524379

• Multiparameter Mass Cytometry By Time-of-Flight Spectrometry (CyTOF) Phenotyping in Pediatric Localized Scleroderma Mirizio, E., Mellins, E. D., Macaubas, C., Maecker, H. T., Gartner, F., Konnikova, L., Schollaert-Fitch, K., Torok, K. S. WILEY. 2018

  View details for Web of Science ID 000447268903236

• Interleukin-1 in monocyte activation phenotypes in systemic juvenile idiopathic arthritis: Observations from a clinical trial of rilonacept, an interleukin-1 inhibitor CLINICAL IMMUNOLOGY Zhang, Y., Gupta, S., Ilstad-Minnihan, A., Ayyangar, S., Hay, A. D., Pascual, V., Ilowite, N. T., Macaubas, C., Mellins, E. D. 2018; 194: 9–18

  View details for DOI 10.1016/j.clim.2018.06.005

  View details for Web of Science ID 000442714000002

• IL1RN Variation Influences Both Disease Susceptibility and Response to Recombinant Human Interleukin-1 Receptor Antagonist Therapy in Systemic Juvenile Idiopathic Arthritis ARTHRITIS & RHEUMATOLOGY Arthur, V. L., Shuldiner, E., Remmers, E. F., Hinks, A., Grom, A. A., Foell, D., Martini, A., Gattorno, M., Ozen, S., Prahalad, S., Zeft, A. S., Bohnsack, J. F., Ilowite, N. T., Mellins, E. D., Russo, R., Len, C., Oliveira, S., Yeung, R. M., Rosenberg, A. M., Wedderburn, L. R., Anton, J., Haas, J., Roesen-Wolff, A., Minden, K., Szymanski, A., Thomson, W., Kastner, D. L., Woo, P., Ombrello, M. J., INCHARGE Consortium 2018; 70 (8): 1319–30

  Abstract

  To determine whether systemic juvenile idiopathic arthritis (JIA) susceptibility loci that were identified by candidate gene studies demonstrate association with systemic JIA in the largest study population assembled to date.Single-nucleotide polymorphisms (SNPs) from 11 previously reported systemic JIA risk loci were examined for association in 9 populations, including 770 patients with systemic JIA and 6,947 controls. The effect of systemic JIA-associated SNPs on gene expression was evaluated in silico in paired whole genome and RNA sequencing data from the lymphoblastoid cell lines (LCLs) of 373 European subjects from the 1000 Genomes Project. Responses of systemic JIA-associated SNPs to anakinra treatment were evaluated in 38 US patients for whom treatment response data were available.We found no association between the previously reported 26 SNPs and systemic JIA. Expanded analysis of the regions containing the 26 SNPs revealed only 1 significant association: the promoter region of IL1RN (P < 1 × 10-4 ). Systemic JIA-associated SNPs correlated with IL1RN expression in LCLs, with an inverse correlation between systemic JIA risk and IL1RN expression. The presence of homozygous IL1RN high expression alleles correlated strongly with a lack of response to anakinra therapy (odds ratio 28.7 [95% confidence interval 3.2-255.8]).In our study, IL1RN was the only candidate locus associated with systemic JIA. The implicated SNPs are among the strongest known determinants of IL1RN and interleukin-1 receptor antagonist levels, linking low expression with increased systemic JIA risk. Homozygous high expression alleles predicted nonresponsiveness to anakinra therapy, making them ideal candidate biomarkers to guide systemic JIA treatment. This study is an important first step toward the personalized treatment of systemic JIA.

  View details for PubMedID 29609200

• Interleukin-1 in monocyte activation phenotypes in systemic juvenile idiopathic arthritis: Observations from a clinical trial of rilonacept, an interleukin-1 inhibitor. Clinical immunology (Orlando, Fla.) Zhang, Y., Gupta, S., Ilstad-Minnihan, A., Ayyangar, S., Hay, A. D., Pascual, V., Ilowite, N. T., Macaubas, C., Mellins, E. D. 2018; 194: 9–18

  Abstract

  Systemic juvenile idiopathic arthritis (sJIA) is a childhood rheumatic disease of unknown origin. Dysregulated innate immunity is implicated in disease pathology. We investigated if IL-1 inhibition affects circulating cytokines and monocyte gene expression. CD14+ monocytes from patients in the RAPPORT trial were analyzed by RT-PCR for expression of IL1B and transcription factors associated with monocyte activation. Serum IL-1ra decreased with treatment, and IL-18BP transiently increased. Serum levels of IL-1beta, IL-6, IL-10 and IL-18 were unchanged. IRF5 and STAT6 were decreased, and PPARG was increased, independent of clinical response, and may represent a skew toward a PPARG-driven M2-like phenotype. IL1B expression was decreased in early clinical responders. A transient increase in STAT1, and a decrease in SOCS1 preceded the reduction in IL1B in early clinical responders. Changes in IL1B/STAT1/SOCS1 could be associated with crosstalk between IL-1 and IFN pathways in sJIA. These transcriptional changes might be useful as drug response biomarkers.

  View details for PubMedID 29928998

• Juvenile Psoriatic Arthritis: A Report from the GRAPPA 2017 Annual Meeting. The Journal of rheumatology. Supplement Zisman, D., Stoll, M. L., Butbul Aviel, Y., Mellins, E. D. 2018; 94: 11–16

  Abstract

  Juvenile psoriatic arthritis (JPsA), a subtype of juvenile idiopathic arthritis (JIA), constitutes 5% of JIA. The literature is inconsistent regarding features of JPsA, and physicians debate whether it is a distinct entity within JIA. A biphasic age of onset distribution has been noted. Early-onset disease is characterized by female predominance, small joint involvement, dactylitis, and positive antinuclear antibodies. Late-onset JPsA resembles adult-onset psoriatic arthritis (PsA), with male predominance, psoriasis, enthesitis, and axial disease. Recent studies report improved outcomes, likely due to the widespread use of traditional and biologic disease-modifying antirheumatic drugs. Conflicting HLA associations have been reported in JPsA, but notably both HLA class I and II allele associations are suggested. Similar to PsA cohorts, subjects with JPsA have a lower frequency of a protective interleukin 23R allele than controls or other JIA subtypes. Data in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) patient registry suggest the aggressive characteristics of JPsA: 24.6% of children have joint damage 4.6 years after symptom onset. Pediatric and adult PsA classification criteria define different JPsA cohorts within the registry and support a previous suggestion that the International League of Associations for Rheumatology criteria for JPsA may be overly stringent. Increased collaboration between pediatric and adult physicians and comparative research on these clinically related conditions are warranted.

  View details for PubMedID 29858347

• Juvenile Psoriatic Arthritis: A Report from the GRAPPA 2017 Annual Meeting JOURNAL OF RHEUMATOLOGY Zisman, D., Stoll, M. L., Aviel, Y., Mellins, E. D. 2018; 45 (6): 11–16

  View details for DOI 10.3899/jrheum.180131

  View details for Web of Science ID 000434089700003

• The Genetic Profile of Rheumatoid Factor-Positive Polyarticular Juvenile Idiopathic Arthritis Resembles That of Adult Rheumatoid Arthritis ARTHRITIS & RHEUMATOLOGY Hinks, A., Marion, M. C., Cobb, J., Comeau, M. E., Sudman, M., Ainsworth, H. C., Bowes, J., Becker, M. L., Bohnsack, J. F., Haas, J., Lovell, D. J., Mellins, E. D., Nelson, J., Nordal, E., Punaro, M., Reed, A. M., Rose, C. D., Rosenberg, A. M., Rygg, M., Smith, S. L., Stevens, A. M., Videm, V., Wallace, C. A., Wedderburn, L. R., Yarwood, A., Yeung, R. M., Langefeld, C. D., Thompson, S. D., Thomson, W., Prahalad, S., Juvenile Idiopathic Arthrit 2018; 70 (6): 957–62

  Abstract

  Juvenile idiopathic arthritis (JIA) comprises 7 heterogeneous categories of chronic childhood arthritides. Approximately 5% of children with JIA have rheumatoid factor (RF)-positive arthritis, which phenotypically resembles adult rheumatoid arthritis (RA). Our objective was to compare and contrast the genetics of RF-positive polyarticular JIA with those of RA and selected other JIA categories, to more fully understand the pathophysiologic relationships of inflammatory arthropathies.Patients with RF-positive polyarticular JIA (n = 340) and controls (n = 14,412) were genotyped using the Immunochip array. Single-nucleotide polymorphisms were tested for association using a logistic regression model adjusting for admixture proportions. We calculated weighted genetic risk scores (wGRS) of reported RA and JIA risk loci, and we compared the ability of these wGRS to predict RF-positive polyarticular JIA.As expected, the HLA region was strongly associated with RF-positive polyarticular JIA (P = 5.51 × 10-31 ). Nineteen of 44 RA risk loci and 6 of 27 oligoarticular/RF-negative polyarticular JIA risk loci were associated with RF-positive polyarticular JIA (P < 0.05). The RA wGRS predicted RF-positive polyarticular JIA (area under the curve [AUC] 0.71) better than did the oligoarticular/RF-negative polyarticular JIA wGRS (AUC 0.59). The genetic profile of patients with RF-positive polyarticular JIA was more similar to that of RA patients with age at onset 16-29 years than to that of RA patients with age at onset ≥70 years.RF-positive polyarticular JIA is genetically more similar to adult RA than to the most common JIA categories and thus appears to be a childhood-onset presentation of autoantibody-positive RA. These findings suggest common disease mechanisms, which could lead to novel therapeutic targets and shared treatment strategies.

  View details for PubMedID 29426059

  View details for PubMedCentralID PMC5984672

• Single-walled carbon nanotubes target neutrophils and Ly-6C(hi) monocytes and localize to joints in murine models of arthritis Hung, S., Rajasekaran, N., Zhu, S., Ma, Z., Ghosn, E., Mellins, E. D. AMER ASSOC IMMUNOLOGISTS. 2018

  View details for Web of Science ID 000459977703161

• Macrophage dependent pathways modulate the pathogenesis of cytokine storm syndrome Mahajan, S., Decker, C., Mellins, E., Faccio, R. AMER ASSOC IMMUNOLOGISTS. 2018

  View details for Web of Science ID 000459977700050

• A myeloid population potentially corresponding to myeloid monocytic suppressor cells (MoMDSCs) is increased in the blood of Rheumatoid Arthritis patients and associated with osteoclastogenesis Macaubas, C., Gaertner, F., Yeh, C., Rajasekaran, N., Ilstad-Minnihan, A., Nakamura, M. C., Mellins, E. D. AMER ASSOC IMMUNOLOGISTS. 2018

  View details for Web of Science ID 000459977700149

• DO:DM tunes antigen presentation in a BCR affinity-dependent manner Jiang, W., Adler, L. N., Macmillan, H., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2018

  View details for Web of Science ID 000459977704206

• Detection of autoimmune antibodies in localized scleroderma by synthetic oligonucleotide antigens PLOS ONE Samuelsen, S., Jorgensen, C., Mellins, E. D., Torok, K. S., Astakhova, K. 2018; 13 (4): e0195381

  Abstract

  In this study, we developed a series of synthetic oligonucleotides that allowed us to investigate the details on the antigen recognition by autoimmune antibodies in localized scleroderma subjects. Besides dramatically improved analytical specificity of the assay, our data suggests a potential linking for antibodies to DNA to the biological status of disease state in localized scleroderma. Moreover, introducing chemical modifications into short synthetic deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) molecules completely changed the binding titers of corresponding antibodies and their clinical relevance. The strongest observed effect was registered for the localized scleroderma skin damage index (LoSDI) on the IgG antibodies to TC dinucleotide-rich double-stranded antigen (p < 0.001). In addition to providing valuable tools for diagnosis of clinically relevant biomarkers, we believe that this work opens up new opportunities for research on antibodies to nucleic acids in localized scleroderma and other autoimmune diseases.

  View details for PubMedID 29641558

• Autoantibody Profiling in Lupus Patients using Synthetic Nucleic Acids SCIENTIFIC REPORTS Klecka, M., Thybo, C., Macaubas, C., Solov'yov, I., Simard, J., Balboni, I., Fox, E., Voss, A., Mellins, E. D., Astakhova, K. 2018; 8: 5554

  Abstract

  Autoantibodies to nuclear components of cells (antinuclear antibodies, ANA), including DNA (a-DNA), are widely used in the diagnosis and subtyping of certain autoimmune diseases, including systemic lupus erythematosus (SLE). Despite clinical use over decades, precise, reproducible measurement of a-DNA titers remains difficult, likely due to the substantial sequence and length heterogeneity of DNA purified from natural sources. We designed and tested a panel of synthetic nucleic acid molecules composed of native deoxyribonucleotide units to measure a-DNA. ELISA assays using these antigens show specificity and reproducibility. Applying the ELISA tests to serological studies of pediatric and adult SLE, we identified novel clinical correlations. We also observed preferential recognition of a specific synthetic antigen by antibodies in SLE sera. We determined the probable basis for this finding using computational analyses, providing valuable structural information for future development of DNA antigens. Synthetic nucleic acid molecules offer the opportunity to standardize assays and to dissect antibody-antigen interactions.

  View details for PubMedID 29615791

• Adiposity in Juvenile Psoriatic Arthritis JOURNAL OF RHEUMATOLOGY Samad, A., Stoll, M. L., Lavi, I., Hsu, J. J., Strand, V., Robinson, T. N., Mellins, E. D., Zisman, D., CARRA Legacy Registry In 2018; 45 (3): 411–18

  Abstract

  Adult patients with psoriatic arthritis are at increased risk for obesity and metabolic syndrome, but data regarding adiposity in children with juvenile psoriatic arthritis (JPsA) are limited. Our study assessed adiposity in children with JPsA in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry.Patients with JPsA in the CARRA registry were divided into nonoverweight and overweight groups using recommendations from the US Centers for Disease Control, and differences in demographic and clinical characteristics between groups at baseline and after 1-year followup were assessed using chi-square test, Fisher's exact test, T test, or Mann-Whitney U test, as appropriate. The prevalence of overweight status in the JPsA registry patients was compared to rheumatoid factor-positive and -negative polyarticular juvenile idiopathic arthritis (RF+polyJIA; RF-polyJIA) registry cohorts and the US pediatric population, using a chi-square goodness-of-fit test.Overweight children represented 36.3% of this JPsA cohort (n = 320). Compared to nonoverweight children, they were significantly older at symptom onset and rheumatologist's first assessment, and scored significantly worse on patient/physician outcome measures. At 1-year followup, changes in body mass index were not associated with changes in clinical features or outcome measures. The prevalence of overweight and obesity in patients with JPsA was significantly higher than in RF+polyJIA patients, RF-polyJIA patients, and the US pediatric population.In this registry, almost 1 in 5 patients with JPsA were obese and more than one-third were overweight. This is significantly more than expected compared to the US pediatric population, and appropriate longterm followup of this JPsA subgroup is warranted.

  View details for PubMedID 29247150

• PLC gamma 2 differentially modulates pro-inflammatory macrophages through DAG and Calcium pathways in arthritic complications. Mahajan, S., Decker, C., Mellins, E., Faccio, R. WILEY. 2017: S286

  View details for Web of Science ID 000418869203107

• Interferon Gamma (IFN-gamma) Subpopulations in Skin Homing T Cells of Localized Scleroderma Macaubas, C., Mirizio, E., Schollaert-Fitch, K., Mellins, E. D., Torok, K. S. WILEY. 2017

  View details for Web of Science ID 000411824103252

• The MHC class II antigen presentation pathway in human monocytes differs by subset and is regulated by cytokines PLOS ONE Lee, J., Tam, H., Adler, L., Ilstad-Minnihan, A., Macaubas, C., Mellins, E. D. 2017; 12 (8): e0183594

  Abstract

  Monocytes play a critical role in the innate and adaptive immune systems, performing phagocytosis, presenting antigen, and producing cytokines. They are a heterogeneous population that has been divided in humans into classical, intermediate, and non-classical subsets, but the roles of these subsets are incompletely understood. In this study, we investigated the expression patterns of MHC class II (MHCII) and associated molecules and find that the intermediate monocytes express the highest levels of the MHC molecules, HLA-DR (tested in n = 30 samples), HLA-DP (n = 30), and HLA-DQ (n = 10). HLA-DM (n = 30), which catalyzes the peptide exchange on the MHC molecules, is also expressed at the highest levels in intermediate monocytes. To measure HLA-DM function, we measured levels of MHCII-bound CLIP (class II invariant chain peptide, n = 23), which is exchanged for other peptides by HLA-DM. We calculated CLIP:MHCII ratios to normalize CLIP levels to MHCII levels, and found that intermediate monocytes have the lowest CLIP:MHCII ratio. We isolated the different monocyte subsets (in a total of 7 samples) and analyzed their responses to selected cytokines as model of monocyte activation: two M1-polarizing cytokines (IFNγ, GM-CSF), an M2-polarizing cytokine (IL-4) and IL-10. Classical monocytes exhibit the largest increases in class II pathway expression in response to stimulatory cytokines (IFNγ, GM-CSF, IL-4). All three subsets decrease HLA-DR levels after IL-10 exposure. Our findings argue that intermediate monocytes are the most efficient constitutive antigen presenting subset, that classical monocytes are recruited into an antigen presentation role during inflammatory responses and that IL-10 negatively regulates this function across all subsets.

  View details for PubMedID 28832681

• The Juvenile Psoriatic Arthritis Cohort in the CARRA Registry: Clinical Characteristics, Classification, and Outcomes JOURNAL OF RHEUMATOLOGY Zisman, D., Gladman, D. D., Stoll, M. L., Strand, V., Lavi, I., Hsu, J. J., Mellins, E. D. 2017; 44 (3): 342-351

  Abstract

  Children with clinically diagnosed juvenile psoriatic arthritis (JPsA) who were enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry (CARRA-JPsA) were classified according to pediatric International League of Associations for Rheumatology (ILAR) and adult criteria [Classification criteria for Psoriatic Arthritis (CASPAR)]. Data on demographic and clinical features at baseline and 1-year followup were analyzed and compared.Cross-sectional analysis was performed of CARRA-JPsA patients enrolled between May 2010 and December 2013 and stratified according to age at disease onset (≤ or > 4 yrs). Features of patients fulfilling ILAR and CASPAR criteria were compared at baseline and followup using chi square, Fisher's exact, Mann-Whitney-McNemar, Wilcoxon signed rank, and t tests, as appropriate.Among 361 children enrolled as CARRA-JPsA, 72.02% had symptom onset at > 4 years of age, with a male predominance and high prevalence of enthesitis. At followup, statistically significant improvements were reported in arthritis, dactylitis, enthesitis, psoriasis, sacroiliitis, and nail pitting, but not in health questionnaire (HQ) scores. Of the patients, 80.5% fulfilled ILAR criteria for JPsA. Fifty-two patients, whose disease fulfilled CASPAR criteria but had not been included in the JPsA cohort, manifested more enthesitis, sacroiliitis, inflammatory bowel disease and uveitis and less psoriasis.The data support division of patients with JPsA into 2 clinical subgroups, according to age at disease onset. Improvement in objective findings did not correlate with changes in HQ scores. Pediatric rheumatologists currently do not diagnose JPsA in all children whose disease manifestations meet CASPAR criteria. Unification of adult and pediatric PsA classification criteria warrants consideration.

  View details for DOI 10.3899/jrheum.160717

  View details for Web of Science ID 000396031600013

  View details for PubMedID 28148698

• Paediatric rheumatic diseases: Navigating the transition from paediatric to adult care. Nature reviews. Rheumatology Lawson, E. F., Mellins, E. D. 2017; 13 (3): 138–39

  View details for PubMedID 28202918

• New frontiers in the treatment of systemic juvenile idiopathic arthritis. F1000Research Canny, S. n., Mellins, E. n. 2017; 6: 971

  Abstract

  Systemic juvenile idiopathic arthritis (sJIA) and its most significant complication, macrophage activation syndrome (MAS), have traditionally been treated with steroids and non-steroidal anti-inflammatory medications. However, the introduction of biologic medications that inhibit specific cytokines, such interleukins 1 and 6, has changed the treatment paradigm for sJIA patients. In this review, we discuss the therapies currently used in the treatment of sJIA as well as novel targets and approaches under consideration, including mesenchymal stromal cell therapy and JAK inhibitors. We also discuss targeting cytokines that have been implicated in MAS, such as interferon gamma and interleukin 18.

  View details for PubMedID 28690841

• Genetic architecture distinguishes systemic juvenile idiopathic arthritis from other forms of juvenile idiopathic arthritis: clinical and therapeutic implications. Annals of the rheumatic diseases Ombrello, M. J., Arthur, V. L., Remmers, E. F., Hinks, A., Tachmazidou, I., Grom, A. A., Foell, D., Martini, A., Gattorno, M., Özen, S., Prahalad, S., Zeft, A. S., Bohnsack, J. F., Ilowite, N. T., Mellins, E. D., Russo, R., Len, C., Hilario, M. O., Oliveira, S., Yeung, R. S., Rosenberg, A. M., Wedderburn, L. R., Anton, J., Haas, J., Rosen-Wolff, A., Minden, K., Tenbrock, K., Demirkaya, E., Cobb, J., Baskin, E., Signa, S., Shuldiner, E., Duerr, R. H., Achkar, J., Kamboh, M. I., Kaufman, K. M., Kottyan, L. C., Pinto, D., Scherer, S. W., Alarcón-Riquelme, M. E., Docampo, E., Estivill, X., Gül, A., Langefeld, C. D., Thompson, S., Zeggini, E., Kastner, D. L., Woo, P., Thomson, W. 2016

  Abstract

  Juvenile idiopathic arthritis (JIA) is a heterogeneous group of conditions unified by the presence of chronic childhood arthritis without an identifiable cause. Systemic JIA (sJIA) is a rare form of JIA characterised by systemic inflammation. sJIA is distinguished from other forms of JIA by unique clinical features and treatment responses that are similar to autoinflammatory diseases. However, approximately half of children with sJIA develop destructive, long-standing arthritis that appears similar to other forms of JIA. Using genomic approaches, we sought to gain novel insights into the pathophysiology of sJIA and its relationship with other forms of JIA.We performed a genome-wide association study of 770 children with sJIA collected in nine countries by the International Childhood Arthritis Genetics Consortium. Single nucleotide polymorphisms were tested for association with sJIA. Weighted genetic risk scores were used to compare the genetic architecture of sJIA with other JIA subtypes.The major histocompatibility complex locus and a locus on chromosome 1 each showed association with sJIA exceeding the threshold for genome-wide significance, while 23 other novel loci were suggestive of association with sJIA. Using a combination of genetic and statistical approaches, we found no evidence of shared genetic architecture between sJIA and other common JIA subtypes.The lack of shared genetic risk factors between sJIA and other JIA subtypes supports the hypothesis that sJIA is a unique disease process and argues for a different classification framework. Research to improve sJIA therapy should target its unique genetics and specific pathophysiological pathways.

  View details for DOI 10.1136/annrheumdis-2016-210324

  View details for PubMedID 27927641

• Enhancing translational research in paediatric rheumatology through standardization. Nature reviews. Rheumatology Yeung, R. S., Albani, S., Feldman, B. M., Mellins, E., Prakken, B., Wedderburn, L. R. 2016; 12 (11): 684-690

  Abstract

  The past decade has seen many successes in translational rheumatology, from dramatic improvements in outcomes brought about by novel biologic therapies, to the discovery of new monogenic inflammatory disorders. Advances in molecular medicine, combined with progress towards precision care, provide an excellent opportunity to accelerate the translation of biological understanding to the bedside. However, although the field of rheumatology is a leader in the standardization of data collection and measures of disease activity, it lags behind in standardization of biological sample collection and assay performance. Uniform approaches are necessary for robust collaborative research, particularly in rare diseases. Standardization is also critical to increase reproducibility between centres, a prerequisite for clinical implementation of translational research. This Perspectives article emphasizes the need for standardization and implementation of best practices, presented in the context of lessons learned from international biorepository networks.

  View details for DOI 10.1038/nrrheum.2016.156

  View details for PubMedID 27652504

• Synthetic oligonucleotide antigens modified with locked nucleic acids detect disease specific antibodies SCIENTIFIC REPORTS Samuelsen, S. V., Solov'yov, I. A., Balboni, I. M., Mellins, E., Nielsen, C. T., Heegaard, N. H., Astakhova, K. 2016; 6

  Abstract

  New techniques to detect and quantify antibodies to nucleic acids would provide a significant advance over current methods, which often lack specificity. We investigate the potential of novel antigens containing locked nucleic acids (LNAs) as targets for antibodies. Particularly, employing molecular dynamics we predict optimal nucleotide composition for targeting DNA-binding antibodies. As a proof of concept, we address a problem of detecting anti-DNA antibodies that are characteristic of systemic lupus erythematosus, a chronic autoimmune disease with multiple manifestations. We test the best oligonucleotide binders in surface plasmon resonance studies to analyze binding and kinetic aspects of interactions between antigens and target DNA. These DNA and LNA/DNA sequences showed improved binding in enzyme-linked immunosorbent assay using human samples of pediatric lupus patients. Our results suggest that the novel method is a promising tool to create antigens for research and point-of-care monitoring of anti-DNA antibodies.

  View details for DOI 10.1038/srep35827

  View details for Web of Science ID 000385923800001

  View details for PubMedID 27775006

  View details for PubMedCentralID PMC5075775

• Genetic Architecture of Systemic Juvenile Idiopathic Arthritis Distinguishes It from Oligoarticular and Polyarticular Forms of Juvenile Idiopathic Arthritis Ombrello, M. J., Arthur, V., Remmers, E. F., Hinks, A., Grom, A., Foll, D., Martini, A., Gattorno, M., Ozen, S., Prahalad, S., Zeft, A., Bohnsack, J. F., Ilowite, N., Russo, R., Mellins, E. D., Len, C. A., Hilario, M. E., Oliveira, S., Yeung, R. M., Rosenberg, A., Wedderburn, L. R., Anton, J., Haas, J., Rosen-Wolff, A., Tenbrock, K., Thompson, S. D., Kastner, D. L., Woo, P., Thomson, W., International Childhood Arthritis WILEY. 2016

  View details for Web of Science ID 000417143404040

• Proceedings of the 2016 Childhood Arthritis and Rheumatology Research Alliance (CARRA) Scientific Meeting : Toronto, Canada. 14-17 April 2016. Pediatric rheumatology online journal Fotis, L., Shaikh, N., Baszis, K., French, A., Tarr, P., Grevich, S., Lee, P., Ringold, S., Leroux, B., Leahey, H., Yuasa, M., Foster, J., Sokolove, J., Lahey, L., Robinson, W., Newsom, J., Stevens, A., Karasawa, R., Tamaki, M., Tanaka, M., Sato, T., Yudoh, K., Jarvis, J. N., Moncrieffe, H., Bennett, M. F., Tsoras, M., Luyrink, L., Xu, H., Prahalad, S., Morris, P., Dare, J., Nigrovic, P. A., Rosenkranz, M., Becker, M., O’Neil, K. M., Griffin, T., Lovell, D. J., Grom, A. A., Medvedovic, M., Thompson, S. D., Zhu, L., Jiang, K., Wong, L., Buck, M. J., Chen, Y., Moncrieffe, H., Brungs, L., Liu, T., Wang, T., Jarvis, J. N., Alsaeid, K., Alfailakawi, J., Alenezi, H., Alsaeed, H., Beukelman, T., Natter, M., Ilowite, N., Mieszkalski, K., Burrell, G., Best, B., Bristow, H., Carr, S., Dennos, A., Kaufmann, R., Kimura, Y., Schanberg, L., Blier, P. R., Boneparth, A., Wenderfer, S. E., Moorthy, L. N., Radhakrishna, S. M., Sagcal-Gironella, A. C., von Scheven, E., Gedik, K. C., Siddique, S., Aguiar, C. L., Erkan, D., Cohen, E., Lee, Y., Dossett, M., Mehta, D., Davis, R., Gilbert, M., Goilav, B., Meidan, E., Hsu, J., Boneparth, A., Chua, A., Ardoin, S., Wenderfer, S. E., Von Scheven, E., Ruth, N. M., Hui-Yuen, J., Gedik, K. C., Bermudez, L., Cook, A., Imundo, L., Starr, A., Eichenfield, A., Askanase, A., Janow, G., Schanberg, L. E., Setoguchi, S., Hasselblad, V., Mellins, E. D., Schneider, R., Kimura, Y., Kimura, Y., Grevich, S., Beukelman, T., Morgan, E., Graham, T. B., Ibarra, M., Ruas, Y. S., Klein-Gitelman, M., Onel, K., Prahalad, S., Punaro, M., Ringold, S., Toib, D., Van Mater, H., Weiss, J. E., Weiss, P. F., Mieszkalski, K., Schanberg, L. E., Kwok, T. S., Bisaillon, J., Smith, C., Brosseau, L., Stinson, J., Huber, A. M., Duffy, C. M., April, K. T., Lewandowski, L. B., Scott, C., Li, S. C., Torok, K. S., Rabinovich, C. E., Hong, S. D., Becker, M. L., Dedeoglu, F., Ibarra, M. F., Ferguson, P. J., Fuhbrigge, R. C., Stewart, K. G., Pope, E., Laxer, R. M., Mason, T. G., Higgins, G. C., Li, X., Punaro, M. G., Tomlinson, G., Pullenayegum, E., Matelski, J., Schanberg, L., Feldman, B. M., Manthiram, K., Correa, H., Edwards, K., Oberle, E. J., Bayer, M., Co, D. O., Baris, H. E., Chiu, Y., Huber, A., Kim, S., Oberle, E. J., Beukelman, T., Orandi, A. B., Baszis, K. W., Dharnidharka, V., Hoeltzel, M. F., Reed, A., Huber, A., Tomlinson, G., Pullenayegum, E., Matelski, J., Goh, Y. I., Schanberg, L., Feldman, B. M., Schnabel, A., Range, U., Hahn, G., Siepmann, T., Berner, R., Hedrich, C. M., Stevens, B., Torok, K. S., Li, S., Hershey, N., Curran, M., Higgins, G., Moore, K., Rabinovich, E., Stevens, A. M., Stinson, J., Connelly, M., Huber, A., Luca, N., Spiegel, L., Tsimicalis, A., Luca, S., Tajuddin, N., Berard, R., Barsalou, J., Campillo, S., Dancey, P., Duffy, C., Feldman, B., Johnson, N., McGrath, P., Shiff, N., Tse, S., Tucker, L., Victor, C., Stinson, J., Lalloo, C., Harris, L., Cafazzo, J., Spiegel, L., Feldman, B., Luca, N., Laxer, R., Bullock, D. R., Vehe, R. K., Zhang, L., Correll, C. K., Ganguli, S., Shenberger, M., Korumilli, R., Gottlieb, B., Rodriguez, M., de Ranieri, D., Onel, K., Wagner-Weiner, L., Tesher, M., Wojcicki, E. R., Maletta, K. L., Co, D. O., Malloy, M., Thomson, S., Olson, J. C., Wenderfer, S. E., Gilbert, M., Hsu, J., Sule, S., Rubinstein, T. B., Goilav, B., Okamura, D. M., Chua, A., Greenbaum, L. A., Lane, J. C., von Scheven, E., Ardoin, S. P., Ruth, N. M., Woo, J. M., Malloy, M. M., Jegers, J. A., Hahn, D. J., Hintermeyer, M. K., Martinetti, S. M., Heckel, G. R., Roth-Wojcicki, E. L., Co, D. O. 2016; 14 Suppl 1 (Suppl 1): 41

  Abstract

  P1 Serologic evidence of gut-driven systemic inflammation in juvenile idiopathic arthritis Lampros Fotis, Nur Shaikh, Kevin Baszis, Anthony French, Phillip Tarr P2 Oral health and anti-citrullinated peptide antibodies (ACPA) in juvenile idiopathic arthritis Sriharsha Grevich, Peggy Lee, Sarah Ringold, Brian Leroux, Hannah Leahey, Megan Yuasa, Jessica Foster, Jeremy Sokolove, Lauren Lahey, William Robinson, Joshua Newsom, Anne Stevens P3 Novel autoantigens for endothelial cell antibodies in pediatric rheumatic diseases identified by proteomics Rie Karasawa, Mayumi Tamaki, Megumi Tanaka, Toshiko Sato, Kazuo Yudoh, James N. Jarvis P4 Transcriptional profiling reveals monocyte signature associated with JIA patient poor response to methotrexate Halima Moncrieffe, Mark F. Bennett, Monica Tsoras, Lorie Luyrink, Huan Xu, Sampath Prahalad, Paula Morris, Jason Dare, Peter A. Nigrovic, Margalit Rosenkranz, Mara Becker, Kathleen M. O’Neil, Thomas Griffin, Daniel J. Lovell, Alexei A. Grom, Mario Medvedovic, Susan D. Thompson P5 A multi-dimensional genomic map for polyarticular juvenile idiopathic arthritis Lisha Zhu, Kaiyu Jiang, Laiping Wong, Michael J Buck, Yanmin Chen, Halima Moncrieffe, Laura Brungs, Tao Liu, Ting Wang, James N Jarvis P6 Tocilizumab for treatment of children with refractory JIA Khaled Alsaeid, Jasim Alfailakawi, Hamid Alenezi, Hazim Alsaeed P7 Clinical characteristics of the initial patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry Tim Beukelman, Marc Natter, Norm Ilowite, Kelly Mieszkalski, Grendel Burrell, Brian Best, Helen Bristow, Shannon Carr, Anne Dennos, Rachel Kaufmann, Yukiko Kimura, Laura Schanberg P8 Comparative performance of small and large clinical centers in a comprehensive pediatric rheumatology disease registry Peter R Blier P9 Clinical characteristics of children with membranous lupus nephritis: The Childhood Arthritis and Rheumatology Research Alliance Legacy Registry Alexis Boneparth, Scott E. Wenderfer, L. Nandini Moorthy, Suhas M. Radhakrishna, Anna Carmela P. Sagcal-Gironella, Emily von Scheven P10 Rituximab use in pediatric lupus anticoagulant hypoprothrombinemia syndrome - a two center experience Kader Cetin Gedik, Salma Siddique, Cassyanne L. Aguiar, Doruk Erkan P11 Predictors of complementary and alternative medicine use and response in children with musculoskeletal conditions Ezra Cohen, Yvonne Lee, Michelle Dossett, Darshan Mehta, Roger Davis P12 Comparison of pediatric rheumatology and nephrology survey results for the treatment of refractory proliferative lupus nephritis and renal flare in juvenile SLE Mileka Gilbert, Beatrice Goilav, Esra Meidan, Joyce Hsu, Alexis Boneparth, Anabelle Chua, Stacy Ardoin, Scott E. Wenderfer, Emily Von Scheven, Natasha M. Ruth P13 Transitioning lupus patients from pediatric to adult rheumatology Joyce Hui-Yuen, Kader Cetin Gedik, Liza Bermudez, Ashlea Cook, Lisa Imundo, Amy Starr, Andrew Eichenfield, Anca Askanase P14 The systemic juvenile idiopathic arthritis cohort of the Childhood Arthritis & Rheumatology Research Alliance Registry Ginger Janow, Laura E. Schanberg, Soko Setoguchi, Victor Hasselblad, Elizabeth D. Mellins, Rayfel Schneider, Yukiko Kimura, The CARRA Legacy Registry Investigators P15 Results of the pilot study of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans for new-onset systemic juvenile idiopathic arthritis Yukiko Kimura, Sriharsha Grevich, Timothy Beukelman, Esi Morgan, T Brent Graham, Maria Ibarra, Yonit Sterba Ruas, Marisa Klein-Gitelman, Karen Onel, Sampath Prahalad, Marilynn Punaro, Sarah Ringold, Dana Toib, Heather Van Mater, Jennifer E. Weiss, Pamela F. Weiss, Kelly Mieszkalski, Laura E. Schanberg P16 A systemic review of pain relief modalities in juvenile idiopathic arthritis: First step in developing a novel decision support intervention Timothy S. H. Kwok, Jacinthe Bisaillon, Christine Smith, Lucie Brosseau, Jennifer Stinson, Adam M. Huber, Ciaran M. Duffy, Karine Toupin April P17 Barriers and facilitators to care retention for pediatric systemic lupus erythematous patients in South Africa: A qualitative study Laura B Lewandowski, Christiaan Scott P18 Evaluating the feasibility of conducting comparative effectiveness studies in juvenile Localized Scleroderma (jLS) Suzanne C. Li, Kathryn S. Torok, C. Egla Rabinovich, Sandy D. Hong, Mara L Becker, Fatma Dedeoglu, Maria F. Ibarra, Polly J Ferguson, Rob C. Fuhbrigge, Katie G. Stewart, Elena Pope, Ronald M. Laxer, Thomas G. Mason, Gloria C. Higgins, Xiaohu Li, Marilynn G. Punaro, George Tomlinson, Eleanor Pullenayegum, John Matelski, Laura Schanberg, Brian M. Feldman P19 Tonsillar histology in patients with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome Kalpana Manthiram, Hernan Correa, Kathryn Edwards P20 Clinical course of juvenile dermatomyositis presenting as skin predominant disease Edward J. Oberle, Michelle Bayer, Dominic O. Co, Hatice Ezgi Baris, Yvonne Chiu, Adam Huber, Susan Kim P21 A Survey of musculoskeletal ultrasound practices of pediatric rheumatologists in North America Edward J Oberle, Timothy Beukelman P22 Assessment, classification and treatment of calcinosis as a complication of juvenile dermatomyositis: A survey of pediatric rheumatologists by the Childhood Arthritis and Rheumatology Research Alliance Amir B. Orandi, Kevin W. Baszis, Vikas Dharnidharka, Mark F. Hoeltzel, for the CARRA JDM Committee P23 CARRA dermatomyositis CTP pilot study Ann Reed, Adam Huber, George Tomlinson, Eleanor Pullenayegum, John Matelski, Y. Ingrid Goh, Laura Schanberg, Brian M. Feldman P24 Unexpectedly high incidences and prolonged disease activity in children with chronic non-bacterial osteomyelitis (CNO) as compared to bacterial osteomyelitis Anja Schnabel, Ursula Range, Gabriele Hahn, Timo Siepmann, Reinhard Berner, Christian Michael Hedrich P25 Juvenile systemic sclerosis cohort within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry: Follow up characteristics Brandi Stevens, Kathryn S. Torok, Suzanne Li, Nicole Hershey, Megan Curran, Gloria Higgins, Katharine Moore, Egla Rabinovich, Anne M. Stevens, for the CARRA Registry Investigators P26 Development and usability testing of an iPad and desktop psycho-educational game for children with Juvenile Idiopathic Arthritis and their parents Jennifer Stinson, Mark Connelly, Adam Huber, Nadia Luca, Lynn Spiegel, Argerie Tsimicalis, Stephanie Luca, Naweed Tajuddin, Roberta Berard, Julia Barsalou, Sarah Campillo, Paul Dancey, Ciaran Duffy, Brian Feldman, Nicole Johnson, Patrick McGrath, Natalie Shiff, Shirley Tse, Lori Tucker, Charles Victor P27 iCanCopeTM: User-centred design and development of a smartphone app to support self-management for youth with arthritis pain Jennifer Stinson, Chitra Lalloo, Lauren Harris, Joseph Cafazzo, Lynn Spiegel, Brian Feldman, Nadia Luca, Ronald Laxer P28 Accessing pediatric rheumatology care: Despite barriers, few parents prefer telemedicine Danielle R. Bullock, Richard K. Vehe, Lei Zhang, Colleen K. Correll1 P29 Exploration of factors contributing to time to achieve clinically inactive disease (CID) in juvenile idiopathic arthritis (JIA): A preliminary report Suhas Ganguli, Max Shenberger, Ritesh Korumilli, Beth Gottlieb P30 Pediatric rheumatology referral patterns: Presenting complaints of new patients at a large, urban academic center Martha Rodriguez, Deirdre de Ranieri, Karen Onel, Linda Wagner-Weiner, Melissa Tesher P31 Quality improvement (QI) initiatives in childhood systemic lupus erythematosus (cSLE) Elizabeth Roth Wojcicki, Kristyn L. Maletta, Dominic O. Co, Marsha Malloy, Sarah Thomson, Judyann C. Olson P32 Proliferative lupus nephritis in juvenile SLE: Support from the pediatric nephrology community for the definitions of responsiveness and flare in the 2012 consensus treatment plans Scott E. Wenderfer, Mileka Gilbert, Joyce Hsu, Sangeeta Sule, Tamar B. Rubinstein, Beatrice Goilav, Daryl M. Okamura, Annabelle Chua, Laurence A. Greenbaum, Jerome C. Lane, Emily von Scheven, Stacy P. Ardoin, Natasha M. Ruth P33 The steroid taper app: Making of a mobile app Jennifer M. P. Woo, Marsha M. Malloy, James A. Jegers, Dustin J. Hahn, Mary K. Hintermeyer, Stacey M. Martinetti, Gretchen R. Heckel, Elizabeth L. Roth-Wojcicki, Dominic O. Co

  View details for DOI 10.1186/s12969-016-0098-0

  View details for PubMedID 27409414

  View details for PubMedCentralID PMC4943514

• Altered signaling in systemic juvenile idiopathic arthritis monocytes CLINICAL IMMUNOLOGY Macaubas, C., Wong, E., Zhang, Y., Nguyen, K. D., Lee, J., Milojevic, D., Shenoi, S., Stevens, A. M., Ilowite, N., Saper, V., Lee, T., Mellins, E. D. 2016; 163: 66-74

  Abstract

  Systemic juvenile idiopathic arthritis (sJIA) is characterized by systemic inflammation and arthritis. Monocytes are implicated in sJIA pathogenesis, but their role in disease is unclear. The response of sJIA monocytes to IFN may be dysregulated. We examined intracellular signaling in response to IFN type I (IFNα) and type II (IFNγ) in monocytes during sJIA activity and quiescence, in 2 patient groups. Independent of disease activity, monocytes from Group 1 (collected between 2002 and 2009) showed defective STAT1 phosphorylation downstream of IFNs, and expressed higher transcript levels of SOCS1, an inhibitor of IFN signaling. In the Group 2 (collected between 2011 and 2014), monocytes of patients with recent disease onset were IFNγ hyporesponsive, but in treated, quiescent subjects, monocytes were hyperresponsive to IFNγ. Recent changes in medication in sJIA may alter the IFN hyporesponsiveness. Impaired IFN/pSTAT1 signaling is consistent with skewing of sJIA monocytes away from an M1 phenotype and may contribute to disease pathology.

  View details for DOI 10.1016/j.clim.2015.12.011

  View details for Web of Science ID 000370585600010

  View details for PubMedID 26747737

• Novel Phospholipid-Protein Conjugates Allow Improved Detection of Antibodies in Patients with Autoimmune Diseases. PloS one Samuelsen, S. V., Maity, A., Nybo, M., Macaubas, C., Lønstrup, L., Balboni, I. M., Mellins, E. D., Astakhova, K. 2016; 11 (6)

  Abstract

  Reliable measurement of clinically relevant autoimmune antibodies toward phospholipid-protein conjugates is highly desirable in research and clinical assays. To date, the development in this field has been limited to the use of natural heterogeneous antigens. However, this approach does not take structural features of biologically active antigens into account and leads to low reliability and poor scientific test value. Here we describe novel phospholipid-protein conjugates for specific detection of human autoimmune antibodies. Our synthetic approach includes mild oxidation of synthetic phospholipid cardiolipin, and as the last step, coupling of the product with azide-containing linker and copper-catalyzed click chemistry with β2-glycoprotein I and prothrombin. To prove utility of the product antigens, we used enzyme-linked immunosorbent assay and three cohorts of samples obtained from patients in Denmark (n = 34) and the USA (n = 27 and n = 14). Afterwards we analyzed correlation of the obtained autoantibody titers with clinical parameters for each patient. Our results prove that using novel antigens clinically relevant autoantibodies can be detected with high repeatability, sensitivity and specificity. Unlike previously used antigens the obtained autoantibody titers strongly correlate with high disease activity and in particular, with arthritis, renal involvement, anti-Smith antibodies and high lymphocyte count. Importantly, chemical composition of antigens has a strong influence on the correlation of detected autoantibodies with disease activity and manifestations. This confirms the crucial importance of antigens' composition on research and diagnostic assays, and opens up exciting perspectives for synthetic antigens in future studies of autoimmunity.

  View details for DOI 10.1371/journal.pone.0156125

  View details for PubMedID 27257889

  View details for PubMedCentralID PMC4892602

• Ligand Selection and Trafficking for MHC II ENCYCLOPEDIA OF IMMUNOBIOLOGY, VOL 2: MOLECULAR IMMUNOLOGY Mellins, E. D., Ratcliffe, M. J., Colonna, M., Elliott, T., Mantovani, A., Martin, A. 2016: 247–54

  View details for DOI 10.1016/B978-0-12-374279-7.06012-4

  View details for Web of Science ID 000490118200032

• The Systemic Juvenile Idiopathic Arthritis Cohort of the Childhood Arthritis and Rheumatology Research Alliance Registry: 2010-2013. The Journal of rheumatology Janow, G. n., Schanberg, L. E., Setoguchi, S. n., Hasselblad, V. n., Mellins, E. D., Schneider, R. n., Kimura, Y. n. 2016; 43 (9): 1755–62

  Abstract

  We aimed to identify the (1) demographic/clinical characteristics, (2) medication usage trends, (3) variables associated with worse disease activity, and (4) characteristics of patients with persistent chronic arthritis in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry's systemic juvenile idiopathic arthritis (sJIA) cohort.Demographics, disease activity measures, and medications at enrollment of patients with sJIA in the CARRA Registry were analyzed using descriptive statistics. Multivariate analyses were conducted to identify associations with increased disease activity. Medication usage frequencies were calculated by year.There were 528 patients with sJIA enrolled in the registry (2010-2013). There were 435 patients who had a complete dataset; of these, 372 met the International League of Associations for Rheumatology criteria and were included in the analysis. At enrollment, median disease duration and joint count were 3.7 years and 0, respectively; 16.4% had a rash and 6.7% had a fever. Twenty-six percent were taking interleukin 1 (IL-1) inhibitors and 29% glucocorticoids. Disease-modifying antirheumatic drugs and tumor necrosis factor inhibitors use decreased, while IL-6 inhibitor use increased between 2010 and 2013. African American patients had worse joint counts (p = 0.003), functional status (p = 0.01), and physician's global assessment (p = 0.008). Of the 255 subjects with > 2 years of disease duration, 56% had no arthritis or systemic symptoms, while 32% had persistent arthritis only.Most patients in the largest sJIA cohort reported to date had low disease activity. Practice patterns for choice of biologic agents appeared to change over the study period. Nearly one-third had persistent arthritis without systemic symptoms > 2 years after onset. African Americans were associated with worse disease activity. Strategies are needed to improve outcomes in subgroups with poor prognosis.

  View details for PubMedID 27307527

• HLA-DRB1*11 and variants of the MHC class II locus are strong risk factors for systemic juvenile idiopathic arthritis PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Ombrello, M. J., Remmers, E. F., Tachmazidou, I., Grom, A., Foell, D., Haas, J., Martini, A., Gattorno, M., Ozen, S., Prahalad, S., Zeft, A. S., Bohnsack, J. F., Mellins, E. D., Ilowite, N. T., Russo, R., Len, C., Hilario, M. O., Oliveira, S., Yeung, R. S., Rosenberg, A., Wedderburn, L. R., Anton, J., Schwarz, T., Hinks, A., Bilginer, Y., Park, J., Cobb, J., Satorius, C. L., Han, B., Baskin, E., Signa, S., Duerr, R. H., Achkar, J. P., Kamboh, M. I., Kaufman, K. M., Kottyan, L. C., Pinto, D., Scherer, S. W., Alarcon-Riquelme, M. E., Docampo, E., Estivill, X., Guel, A., de Bakker, P. I., Raychaudhuri, S., Langefeld, C. D., Thompson, S., Zeggini, E., Thomson, W., Kastner, D. L., Woo, P. 2015; 112 (52): 15970-15975

  Abstract

  Systemic juvenile idiopathic arthritis (sJIA) is an often severe, potentially life-threatening childhood inflammatory disease, the pathophysiology of which is poorly understood. To determine whether genetic variation within the MHC locus on chromosome 6 influences sJIA susceptibility, we performed an association study of 982 children with sJIA and 8,010 healthy control subjects from nine countries. Using meta-analysis of directly observed and imputed SNP genotypes and imputed classic HLA types, we identified the MHC locus as a bona fide susceptibility locus with effects on sJIA risk that transcended geographically defined strata. The strongest sJIA-associated SNP, rs151043342 [P = 2.8 × 10(-17), odds ratio (OR) 2.6 (2.1, 3.3)], was part of a cluster of 482 sJIA-associated SNPs that spanned a 400-kb region and included the class II HLA region. Conditional analysis controlling for the effect of rs151043342 found that rs12722051 independently influenced sJIA risk [P = 1.0 × 10(-5), OR 0.7 (0.6, 0.8)]. Meta-analysis of imputed classic HLA-type associations in six study populations of Western European ancestry revealed that HLA-DRB1*11 and its defining amino acid residue, glutamate 58, were strongly associated with sJIA [P = 2.7 × 10(-16), OR 2.3 (1.9, 2.8)], as was the HLA-DRB1*11-HLA-DQA1*05-HLA-DQB1*03 haplotype [6.4 × 10(-17), OR 2.3 (1.9, 2.9)]. By examining the MHC locus in the largest collection of sJIA patients assembled to date, this study solidifies the relationship between the class II HLA region and sJIA, implicating adaptive immune molecules in the pathogenesis of sJIA.

  View details for DOI 10.1073/pnas.1520779112

  View details for PubMedID 26598658

• Tmem178 acts in a novel negative feedback loop targeting NFATc1 to regulate bone mass PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Decker, C. E., Yang, Z., Rimer, R., Park-Min, K., Macaubas, C., Mellins, E. D., Novack, D. V., Faccio, R. 2015; 112 (51): 15654-15659

  Abstract

  Phospholipase C gamma-2 (PLCγ2)-dependent calcium (Ca(2+)) oscillations are indispensable for nuclear factor of activated T-cells, cytoplasmic 1 (NFATc1) activation and downstream gene transcription driving osteoclastogenesis during skeletal remodeling and pathological bone loss. Here we describe, to our knowledge, the first known function of transmembrane protein 178 (Tmem178), a PLCγ2 downstream target gene, as a critical modulator of the NFATc1 axis. In surprising contrast to the osteopetrotic phenotype of PLCγ2(-/-) mice, Tmem178(-/-) mice are osteopenic in basal conditions and are more susceptible to inflammatory bone loss, owing to enhanced osteoclast formation. Mechanistically, Tmem178 localizes to the ER membrane and regulates RANKL-induced Ca(2+) fluxes, thus controlling NFATc1 induction. Importantly, down-regulation of Tmem178 is observed in human CD14(+) monocytes exposed to plasma from systemic juvenile idiopathic arthritis patients. Similar to the mouse model, reduced Tmem178 expression in human cells correlates with excessive osteoclastogenesis. In sum, these findings identify an essential role for Tmem178 to maintain skeletal mass and limit pathological bone loss.

  View details for DOI 10.1073/pnas.1511285112

  View details for Web of Science ID 000366916000047

  View details for PubMedID 26644563

  View details for PubMedCentralID PMC4697402

• HLA-DM and HLA-DO: Bi-directional regulation of function, tuned by pH Jiang, W., Strohman, M., Wang, N., Hou, T., Mellins, E. D. PERGAMON-ELSEVIER SCIENCE LTD. 2015: 148

  View details for Web of Science ID 000366767700063

• Comparison of biomarkers for systemic juvenile idiopathic arthritis PEDIATRIC RESEARCH Shenoi, S., Ou, J., Ni, C., Macaubass, C., Gersuk, V. H., Wallace, C. A., Mellins, E. D., Stevens, A. M. 2015; 78 (5): 554-559

  Abstract

  Differentiation of systemic juvenile idiopathic arthritis (SJIA) fever from other childhood fevers is often delayed due to the lack of reliable, specific biomarkers. We hypothesized that PD-L1 expression is dysregulated in SJIA monocytes and compared it to other candidate SJIA biomarkers.This pilot study enrolled children with fever without source and compared PD-L1 expression on myeloid cells to C-reactive protein, erythrocyte sedimentation rate, leukocyte counts, S100A12, S100A8, S100A9, calprotectin, and procalcitonin. Logistic regression models were fit to test SJIA diagnosis with each marker used as an independent predictor. Receiver operating characteristic curves and area under curve were calculated. Gene expression profiling on a subset of samples was performed.Twenty subjects (10 active SJIA, 10 febrile non-SJIA) were enrolled. S100 proteins were significantly elevated in SJIA with >80% sensitivity and >90% specificity. PD-L1 expression was significantly lower in SJIA. Other markers were not specific for SJIA. On exploratory gene analysis, 106 genes were significant for SJIA association, and several of these are associated with immune response pathways.In this small cohort, S100 proteins were specific diagnostic biomarkers for SJIA in children with fever. Decreased PD-L1 surface expression on circulating myeloid cells in SJIA suggests possible mechanism for loss of peripheral immune regulation.

  View details for DOI 10.1038/pr.2015.144

  View details for Web of Science ID 000363601700012

• Comparison of biomarkers for systemic juvenile idiopathic arthritis. Pediatric research Shenoi, S., Ou, J., Ni, C., Macaubas, C., Gersuk, V. H., Wallace, C. A., Mellins, E. D., Stevens, A. M. 2015; 78 (5): 554-559

  Abstract

  Differentiation of systemic juvenile idiopathic arthritis (SJIA) fever from other childhood fevers is often delayed due to the lack of reliable, specific biomarkers. We hypothesized that PD-L1 expression is dysregulated in SJIA monocytes and compared it to other candidate SJIA biomarkers.This pilot study enrolled children with fever without source and compared PD-L1 expression on myeloid cells to C-reactive protein, erythrocyte sedimentation rate, leukocyte counts, S100A12, S100A8, S100A9, calprotectin, and procalcitonin. Logistic regression models were fit to test SJIA diagnosis with each marker used as an independent predictor. Receiver operating characteristic curves and area under curve were calculated. Gene expression profiling on a subset of samples was performed.Twenty subjects (10 active SJIA, 10 febrile non-SJIA) were enrolled. S100 proteins were significantly elevated in SJIA with >80% sensitivity and >90% specificity. PD-L1 expression was significantly lower in SJIA. Other markers were not specific for SJIA. On exploratory gene analysis, 106 genes were significant for SJIA association, and several of these are associated with immune response pathways.In this small cohort, S100 proteins were specific diagnostic biomarkers for SJIA in children with fever. Decreased PD-L1 surface expression on circulating myeloid cells in SJIA suggests possible mechanism for loss of peripheral immune regulation.

  View details for DOI 10.1038/pr.2015.144

  View details for PubMedID 26267155

• Inflammatory Bowel Disease in Children with Systemic Juvenile Idiopathic Arthritis Fox, E., Hsu, J., Chalom, E., Sertial, S., Park, K. T., Simard, J. F., Quartier, P., Terreri, M., Baszis, K., Borocco, C., Prahalad, S., Reinhardt, A., Schonenberg, D., Mellins, E. D., Zisman, D. WILEY-BLACKWELL. 2015

  View details for Web of Science ID 000370860202722

• US Adult Rheumatologists Perspective on the Transition Process for Young Adults with Rheumatic Conditions Zisman, D., White, P., Chira, P., Ardoin, S. P., Lawson, E. F., von Scheven, E., Lavi, I., Tarter, L., Mellins, E. D. WILEY-BLACKWELL. 2015

  View details for Web of Science ID 000370860202540

• Adiposity in Children with Juvenile Psoriatic Arthritis (JPsA) Samad, A., Stoll, M. L., Lavi, I., Gupta, K., Hsu, J., Strand, V., Mellins, E. D., Zisman, D., CARRA Registry Investigators WILEY-BLACKWELL. 2015

  View details for Web of Science ID 000370860202741

• Juvenile Psoriatic Arthritis Manifestations in a Cohort of 361 Patients from US and Canada Zisman, D., Stoll, M. L., Gladman, D. D., Strand, V., Lavi, I., Hsu, J., Mellins, E. D., CARRA Registry Investigators WILEY-BLACKWELL. 2015

  View details for Web of Science ID 000370860202734

• Viral Vectors Take On HIV Infection NEW ENGLAND JOURNAL OF MEDICINE Mellins, E. D., Kay, M. A. 2015; 373 (8): 770–72

  View details for DOI 10.1056/NEJMcibr1504232

  View details for Web of Science ID 000359709400015

  View details for PubMedID 26287853

• Synthesis of Phospholipid-Protein Conjugates as New Antigens for Autoimmune Antibodies MOLECULES Maity, A., Macaubas, C., Mellins, E., Astakhova, K. 2015; 20 (6): 10253-10263

  Abstract

  Copper(I)-catalyzed azide-alkyne cycloaddition, or CuAAC click chemistry, is an efficient method for bioconjugation aiming at chemical and biological applications. Herein, we demonstrate how the CuAAC method can provide novel phospholipid-protein conjugates with a high potential for the diagnostics and therapy of autoimmune conditions. In doing this, we, for the first time, covalently bind via 1,2,3-triazole linker biologically complementary molecules, namely phosphoethanol amine with human β2-glycoprotein I and prothrombin. The resulting phospholipid-protein conjugates show high binding affinity and specificity for the autoimmune antibodies against autoimmune complexes. Thus, the development of this work might become a milestone in further diagnostics and therapy of autoimmune diseases that involve the production of autoantibodies against the aforementioned phospholipids and proteins, such as antiphospholipid syndrome and systemic lupus erythematosus.

  View details for DOI 10.3390/molecules200610253

  View details for Web of Science ID 000357992700048

• Immunological Basis for Rapid Progression of Diabetes in Older NOD Mouse Recipients Post BM-HSC Transplantation PLOS ONE Wang, N., Rajasekaran, N., Hou, T., Macaubas, C., Mellins, E. D. 2015; 10 (5)

  Abstract

  Type I diabetes (T1D), mediated by autoreactive T cell destruction of insulin-producing islet beta cells, has been treated with bone marrow-derived hematopoietic stem cell (BM-HSC) transplantation. Older non-obese diabetic (NOD) mice recipients (3m, at disease-onset stage) receiving syngeneic BM-HSC progressed more rapidly to end-stage diabetes post-transplantation than younger recipients (4-6w, at disease-initiation stage). FACS analyses showed a higher percentage and absolute number of regulatory T cells (Treg) and lower proportion of proliferating T conventional cells (Tcon) in pancreatic lymph nodes from the resistant mice among the younger recipients compared to the rapid progressors among the older recipients. Treg distribution in spleen, mesenteric lymph nodes (MLN), blood and thymus between the two groups was similar. However, the percentage of thymic Tcon and the proliferation of Tcon in MLN and blood were lower in the young resistants. These results suggest recipient age and associated disease stage as a variable to consider in BM-HSC transplantation for treating T1D.

  View details for DOI 10.1371/journal.pone.0128494

  View details for Web of Science ID 000355187300117

  View details for PubMedID 26020954

  View details for PubMedCentralID PMC4447290

• HLA-DO inhibition of HLA-DM catalytic function is regulated by acid-promoted HLA-DO inactivation Jiang, W., Strohman, M., Somasundaram, S., Ayyangar, S., Wang, N., Hou, T., Macmillan, H., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2015

  View details for Web of Science ID 000379404500140

• pH-susceptibility of HLA-DO tunes DO/DM ratios to regulate HLA-DM catalytic activity. Scientific reports Jiang, W., Strohman, M. J., Somasundaram, S., Ayyangar, S., Hou, T., Wang, N., Mellins, E. D. 2015; 5: 17333-?

  Abstract

  The peptide-exchange catalyst, HLA-DM, and its inhibitor, HLA-DO control endosomal generation of peptide/class II major histocompatibility protein (MHC-II) complexes; these complexes traffic to the cell surface for inspection by CD4+ T cells. Some evidence suggests that pH influences DO regulation of DM function, but pH also affects the stability of polymorphic MHC-II proteins, spontaneous peptide loading, DM/MHC-II interactions and DM catalytic activity, imposing challenges on approaches to determine pH effects on DM-DO function and their mechanistic basis. Using optimized biochemical methods, we dissected pH-dependence of spontaneous and DM-DO-mediated class II peptide exchange and identified an MHC-II allele-independent relationship between pH, DO/DM ratio and efficient peptide exchange. We demonstrate that active, free DM is generated from DM-DO complexes at late endosomal/lysosomal pH due to irreversible, acid-promoted DO destruction rather than DO/DM molecular dissociation. Any soluble DM that remains in complex with DO stays inert. pH-exposure of DM-DO in cell lysates corroborates such a pH-regulated mechanism, suggesting acid-activated generation of functional DM in DO-expressing cells.

  View details for DOI 10.1038/srep17333

  View details for PubMedID 26610428

  View details for PubMedCentralID PMC4661524

• Optimized purification strategies for the elimination of non-specific products in the isolation of GAD65-specific monoclonal autoantibodies. F1000Research Jiang, W. n., Macmillan, H. n., Madec, A. M., Mellins, E. D. 2015; 4: 135

  Abstract

  Autoantibodies against antigens expressed by insulin-producing β cells are circulating in both healthy individuals and patients at risk of developing Type 1 diabetes. Recent studies suggest that another set of antibodies (anti-idiotypic antibodies) exists in this antibody/antigen interacting network to regulate auto-reactive responses. Anti-idiotypic antibodies may block the antigen-binding site of autoantibodies or inhibit autoantibody expression and secretion. The equilibrium between autoantibodies and anti-idiotypic antibodies plays a critical role in mediating or preventing autoimmunity. In order to investigate the molecular mechanisms underlying such a network in autoimmunity and potentially develop neutralizing reagents to prevent or treat Type 1 diabetes, we need to produce autoantibodies and autoantigens with high quality and purity. Herein, using GAD65/anti-GAD65 autoantibodies as a model system, we aimed to establish reliable approaches for the preparation of highly pure autoantibodies suitable for downstream investigation.

  View details for PubMedID 29167731

• Alternative pathways of osteoclastogenesis in inflammatory arthritis. Nature reviews. Rheumatology Adamopoulos, I. E., Mellins, E. D. 2015; 11 (3): 189–94

  Abstract

  Osteoclasts are cells of haematopoietic origin that are uniquely specialized to degrade bone. Under physiological conditions, the osteoclastogenesis pathway depends on macrophage colony-stimulating factor 1 (CSF-1, also known as M-CSF) and receptor activator of nuclear factor κB ligand (RANKL). However, an emerging hypothesis is that alternative pathways of osteoclast generation might be active during inflammatory arthritis. In this Perspectives article, we summarize the physiological pathway of osteoclastogenesis and then focus on experimental findings that support the hypothesis that infiltrating inflammatory cells and the cytokine milieu provide multiple routes to bone destruction. The precise identity of osteoclast precursor(s) is not yet known. We propose that myeloid cell differentiation during inflammation could be an important contributor to the differentiation of osteoclast populations and their associated pathologies. Understanding the dynamics of osteoclast differentiation in inflammatory arthritis is crucial for the development of therapeutic strategies for inflammatory joint disease in children and adults.

  View details for PubMedID 25422000

  View details for PubMedCentralID PMC4346500

• Demographic, Clinical and Treatment Characteristics of the Childhood Arthritis and Rheumatology Research Alliance Registry Systemic JIA Cohort Janow, G. L., Schanberg, L., Setoguchi, S., Mellins, E. D., Schneider, R., Kimura, Y., CARRA Registry Investigators WILEY-BLACKWELL. 2014: S999–S1000

  View details for Web of Science ID 000344384904437

• HLA-DRB1*1101, Regulatory Variants of the MHC, and a Regulatory Region Near an Intergenic Long Noncoding RNA on Chromosome 1 Are Risk Factors for Systemic Juvenile Idiopathic Arthritis. Ombrello, M. J., Remmers, E. F., Tachmazidou, I., Grom, A., Foell, D., Martini, A., Gattorno, M., Ozen, S., Prahalad, S., Zeft, A. S., Bohnsack, J. F., Ilowite, N. T., Park, J. L., Mellins, E. D., Russo, R. G., Len, C. A., de Oliveira, S., Yeung, R. M., Wedderburn, L. R., Anton, J., Schwarz, T., Han, B., Duerr, R. H., Achkar, J., Kamboh, M., Kaufman, K. M., Kottyan, L. C., Pinto, D., Scherer, S., Alarcon-Riquelme, M. E., Martinez, E., Estivill, X., Gul, A., Satorius, C., de Bakker, P. W., Raychaudhuri, S., Langefeld, C. D., Thompson, S. D., Zeggini, E., Thomson, W., Kastner, D. L., Woo, P., Int Childhood Arthrit Genetics WILEY-BLACKWELL. 2014: S836

  View details for Web of Science ID 000344384904050

• The MHC Class II Cofactor HLA-DM Interacts with Ig in B Cells. Journal of immunology Macmillan, H., Strohman, M. J., Ayyangar, S., Jiang, W., Rajasekaran, N., Spura, A., Hessell, A. J., Madec, A., Mellins, E. D. 2014; 193 (6): 2641-2650

  Abstract

  B cells internalize extracellular Ag into endosomes using the Ig component of the BCR. In endosomes, Ag-derived peptides are loaded onto MHC class II proteins. How these pathways intersect remains unclear. We find that HLA-DM (DM), a catalyst for MHC class II peptide loading, coprecipitates with Ig in lysates from human tonsillar B cells and B cell lines. The molecules in the Ig/DM complexes have mature glycans, and the complexes colocalize with endosomal markers in intact cells. A larger fraction of Ig precipitates with DM after BCR crosslinking, implying that complexes can form when DM meets endocytosed Ig. In vitro, in the endosomal pH range, soluble DM directly binds the Ig Fab domain and increases levels of free Ag released from immune complexes. Taken together, these results argue that DM and Ig intersect in the endocytic pathway of B cells with potential functional consequences.

  View details for DOI 10.4049/jimmunol.1400075

  View details for PubMedID 25098292

• Susceptibility to HLA-DM Protein Is Determined by a Dynamic Conformation of Major Histocompatibility Complex Class II Molecule Bound with Peptide. journal of biological chemistry Yin, L., Trenh, P., Guce, A., Wieczorek, M., Lange, S., Sticht, J., Jiang, W., Bylsma, M., Mellins, E. D., Freund, C., Stern, L. J. 2014; 289 (34): 23449-23464

  Abstract

  HLA-DM mediates the exchange of peptides loaded onto MHCII molecules during antigen presentation by a mechanism that remains unclear and controversial. Here, we investigated the sequence and structural determinants of HLA-DM interaction. Peptides interacting nonoptimally in the P1 pocket exhibited low MHCII binding affinity and kinetic instability and were highly susceptible to HLA-DM-mediated peptide exchange. These changes were accompanied by conformational alterations detected by surface plasmon resonance, SDS resistance assay, antibody binding assay, gel filtration, dynamic light scattering, small angle x-ray scattering, and NMR spectroscopy. Surprisingly, all of those changes could be reversed by substitution of the P9 pocket anchor residue. Moreover, MHCII mutations outside the P1 pocket and the HLA-DM interaction site increased HLA-DM susceptibility. These results indicate that a dynamic MHCII conformational determinant rather than P1 pocket occupancy is the key factor determining susceptibility to HLA-DM-mediated peptide exchange and provide a molecular mechanism for HLA-DM to efficiently target unstable MHCII-peptide complexes for editing and exchange those for more stable ones.

  View details for DOI 10.1074/jbc.M114.585539

  View details for PubMedID 25002586

  View details for PubMedCentralID PMC4156084

• Assembly and architecture of the EBV B cell entry triggering complex. PLoS pathogens Sathiyamoorthy, K., Jiang, J., Hu, Y. X., Rowe, C. L., Möhl, B. S., Chen, J., Jiang, W., Mellins, E. D., Longnecker, R., Zhou, Z. H., Jardetzky, T. S. 2014; 10 (8)

  Abstract

  Epstein-Barr Virus (EBV) is an enveloped double-stranded DNA virus of the gammaherpesvirinae sub-family that predominantly infects humans through epithelial cells and B cells. Three EBV glycoproteins, gH, gL and gp42, form a complex that targets EBV infection of B cells. Human leukocyte antigen (HLA) class II molecules expressed on B cells serve as the receptor for gp42, triggering membrane fusion and virus entry. The mechanistic role of gHgL in herpesvirus entry has been largely unresolved, but it is thought to regulate the activation of the virally-encoded gB protein, which acts as the primary fusogen. Here we study the assembly and function of the reconstituted B cell entry complex comprised of gHgL, gp42 and HLA class II. The structure from negative-stain electron microscopy provides a detailed snapshot of an intermediate state in EBV entry and highlights the potential for the triggering complex to bring the two membrane bilayers into proximity. Furthermore, gHgL interacts with a previously identified, functionally important hydrophobic pocket on gp42, defining the overall architecture of the complex and playing a critical role in membrane fusion activation. We propose a macroscopic model of the initiating events in EBV B cell fusion centered on the formation of the triggering complex in the context of both viral and host membranes. This model suggests how the triggering complex may bridge the two membrane bilayers, orienting critical regions of the N- and C- terminal ends of gHgL to promote the activation of gB and efficient membrane fusion.

  View details for DOI 10.1371/journal.ppat.1004309

  View details for PubMedID 25144748

  View details for PubMedCentralID PMC4140853

• Assembly and Architecture of the EBV B Cell Entry Triggering Complex. PLoS pathogens Sathiyamoorthy, K., Jiang, J., Hu, Y. X., Rowe, C. L., Möhl, B. S., Chen, J., Jiang, W., Mellins, E. D., Longnecker, R., Zhou, Z. H., Jardetzky, T. S. 2014; 10 (8): e1004309

  Abstract

  Epstein-Barr Virus (EBV) is an enveloped double-stranded DNA virus of the gammaherpesvirinae sub-family that predominantly infects humans through epithelial cells and B cells. Three EBV glycoproteins, gH, gL and gp42, form a complex that targets EBV infection of B cells. Human leukocyte antigen (HLA) class II molecules expressed on B cells serve as the receptor for gp42, triggering membrane fusion and virus entry. The mechanistic role of gHgL in herpesvirus entry has been largely unresolved, but it is thought to regulate the activation of the virally-encoded gB protein, which acts as the primary fusogen. Here we study the assembly and function of the reconstituted B cell entry complex comprised of gHgL, gp42 and HLA class II. The structure from negative-stain electron microscopy provides a detailed snapshot of an intermediate state in EBV entry and highlights the potential for the triggering complex to bring the two membrane bilayers into proximity. Furthermore, gHgL interacts with a previously identified, functionally important hydrophobic pocket on gp42, defining the overall architecture of the complex and playing a critical role in membrane fusion activation. We propose a macroscopic model of the initiating events in EBV B cell fusion centered on the formation of the triggering complex in the context of both viral and host membranes. This model suggests how the triggering complex may bridge the two membrane bilayers, orienting critical regions of the N- and C- terminal ends of gHgL to promote the activation of gB and efficient membrane fusion.

  View details for DOI 10.1371/journal.ppat.1004309

  View details for PubMedID 25144748

  View details for PubMedCentralID PMC4140853

• Serum amyloid A induces mitogenic signals in regulatory T cells via monocyte activation MOLECULAR IMMUNOLOGY Nguyen, K. D., Macaubas, C., Phi Truong, P., Wang, N., Hou, T., Yoon, T., Mellins, E. D. 2014; 59 (2): 172-179

  Abstract

  Serum amyloid A (SAA) has recently been identified by our group as a mitogen for regulatory T cells (Treg). However, the molecular mechanism by which SAA induces Treg proliferation is unknown. Here we provide evidence that IL-1β and IL-6 are directly involved in the SAA-mediated proliferation of Treg. By engaging its several cognate receptors, SAA induces IL-1β and IL-6 secretion by monocytes and drives them toward an HLA-DR(hi) HVEM(lo) phenotype resembling immature dendritic cells, which have been implicated in tolerance generation. This monocyte-derived cytokine milieu is required for Treg expansion, as inhibition of IL-1β and IL-6 abrogate the ability of SAA to induce Treg proliferation. Furthermore, both IL-1β and IL-6 are required for ERK1/2 and AKT signaling in proliferating Treg. Collectively, these results point to a novel mechanism, by which SAA initiates a monocyte-dependent process that drives mitogenic signals in Treg.

  View details for DOI 10.1016/j.molimm.2014.02.011

  View details for Web of Science ID 000334988800007

• Serum amyloid A induces mitogenic signals in regulatory T cells via monocyte activation. Molecular immunology Nguyen, K. D., Macaubas, C., Truong, P., Wang, N., Hou, T., Yoon, T., Mellins, E. D. 2014; 59 (2): 172-179

  Abstract

  Serum amyloid A (SAA) has recently been identified by our group as a mitogen for regulatory T cells (Treg). However, the molecular mechanism by which SAA induces Treg proliferation is unknown. Here we provide evidence that IL-1β and IL-6 are directly involved in the SAA-mediated proliferation of Treg. By engaging its several cognate receptors, SAA induces IL-1β and IL-6 secretion by monocytes and drives them toward an HLA-DR(hi) HVEM(lo) phenotype resembling immature dendritic cells, which have been implicated in tolerance generation. This monocyte-derived cytokine milieu is required for Treg expansion, as inhibition of IL-1β and IL-6 abrogate the ability of SAA to induce Treg proliferation. Furthermore, both IL-1β and IL-6 are required for ERK1/2 and AKT signaling in proliferating Treg. Collectively, these results point to a novel mechanism, by which SAA initiates a monocyte-dependent process that drives mitogenic signals in Treg.

  View details for DOI 10.1016/j.molimm.2014.02.011

  View details for PubMedID 24632292

• HLA-DM and HLA-DO: bi-directional regulation of function, tuned by pH Jiang, W., Strohman, M., Wang, N., Hou, T., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2014

  View details for Web of Science ID 000209765000006

• Direct functional interaction between HLA-DM and human immunoglobulin. Mellins, E., Strohman, M., Macmillan, H., Rajasekaran, N., Ayyangar, S. AMER ASSOC IMMUNOLOGISTS. 2014

  View details for Web of Science ID 000209765000005

• Circulating CD4+T cells in narcolepsy patients react to hypocretin and cross-react with hemagglutinin from an influenza strain linked to increased narcolepsy incidence Mellins, E., Macaubas, C., Jiang, W., De la Herran-Arita, A., Kornum, B., Mahlios, J., Hou, T., Mignot, E. AMER ASSOC IMMUNOLOGISTS. 2014

  View details for Web of Science ID 000209765001065

• A160: role of interleukin-1 in abnormal monocyte phenotype in systemic onset juvenile idiopathic arthritis. Arthritis & rheumatology Zhang, Y., Macaubas, C., Gupta, S., Klein, C., pascual, V., Hay, A., Thompson, S. D., Sandborg, C. I., Ilowite, N. T., Mellins, E. D. 2014; 66: S207-8

  Abstract

  Monocytes phenotype changes in different microenvironments: the proinflammatory M1, regulatory M2, and M2-like phenotypes are each regulated by specific transcriptional factors (TFs). We have observed altered phenotypes in blood monocytes in systemic onset juvenile idiopathic arthritis (sJIA), including a decreased M1 cells, an increased mixed M1/M2 cells, and reduced secretion of IL-1, despite an increased IL-1b response to LPS (PMID 22281427). Here, we investigate whether these monocyte phenotypes are affected by IL-1 blockade. We analyzed monocytes from RAPPORT (RAndomized Placebo Phase study Of Rilonacept in the Treatment of sJIA) patients to determine levels of TFs involved in monocyte polarization and expression of genes related to IL-1 secretion, before and after treatment with Rilonacept, an IL-1 trap.Subjects on the Rilonacept arm received active drug from week 0 for a total of 24 weeks; subjects on the placebo arm received placebo for 4 weeks, then Rilonacept for 20 weeks. Blood samples were obtained at week 0, 2, 4, 14 and 24. We used real time PCR to measure M1 associated genes: Interferon Regulatory factor (IRF) family IRF5, STAT1; M2 associated genes IRF4, STAT6, Kruppel-Like Factor 4 (KLF4) and peroxisome proliferator-activated receptor-γ (PPAR-γ); IL-1 secretion related genes: RAB39, RAB27A, RAB27B, P2RX7, and IL-1β. All TFs levels were normalized by the average levels of 3 housekeeping genes.30 non-paired RNA samples from 15 subjects were tested. Samples from subjects treated with Rilonacept for ≥10 weeks (Late RAPPORT) showed decreased expression of M2 genes, especially KLF4, compared to those untreated or treated for <10 weeks (Early RAPPORT) (Fig ), except for PPAR-γ. Samples collected when there was clinical improvement also showed reduced KLF4 (Fig .). The expression of TFs following IL-1 inhibition in sJIA patients is distinct from normal controls. Levels of IL-1 secretion related genes, except for RAB27B, also were reduced in "Late RAPPORT" samples (Fig .). [Figure: see text] [Figure: see text] [Figure: see text]IL-1 blockade in sJIA is likely associated with changes in the activation profile and expression of IL-1 secretion related genes in circulating monocytes. Monocytes phenotypes in treated subjects are not "normal" and likely reflect changes associated with compensated inflammation.

  View details for DOI 10.1002/art.38586

  View details for PubMedID 24677915

• The Autoimmune Genetic Architecture of Childhood Onset Rheumatoid Arthritis Prahalad, S., Marion, M. C., Cobb, J., Sudman, M., Hinks, A., Pichavant, M., Ponder, L., Reed, A. M., Wallace, C., Becker, M. L., Yeung, R. M., Rosenberg, A. M., Punaro, M. G., Mellins, E. D., Nelson, J., Videm, V., Rygg, M., Nordal, E., Brown, M. A., Cutler, D., Bohnsack, J. F., Thomson, W., Thompson, S. D., Langefeld, C. D. WILEY-BLACKWELL. 2014: S205–S206

  View details for DOI 10.1002/art.38585

  View details for Web of Science ID 000349950900161

• Reduced locomotor activity correlates with increased severity of arthritis in a mouse model of antibody-induced arthritis. Open journal of rheumatology and autoimmune diseases Rajasekaran, N., Tran, R., Pascual, C., Xie, X., Mellins, E. D. 2014; 4 (1): 62-68

  Abstract

  Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial hyperplasia and progressive cartilage and bone destruction that leads to a substantial loss of general functions and/or a decline in physical activities such as walking speed in humans. The K/BxN serum transfer arthritis in mice shares many immunological and pathological features with human RA. Very few studies are available in mice that investigate the changes in physical activity in relation to arthritis development. In this study we investigate the effect of arthritis on the locomotor activity of mice during K/BxN sera transfer arthritis.Arthritis was induced in Balb/c mice by injecting intraperitoneally with 200ul of K/BxN sera; Balb/c mice injected with phosphate buffered saline (PBS) served as control. Progress of arthritis was estimated by daily measurements of joint thickness. Each mouse's locomotor activity (travel distance and travel time) was assessed every day for duration of 20 minute period using the SmartCage™ platform. Data were analyzed using the SmartCage™ analysis software (CageScore™).Arthritic Balb/c mice showed a reduction in distance covered and travel speed when compared to arthritis-free, control Balb/c mice. Maximum decline in locomotor activity was observed during the peak period of the disease and correlated to the increase in joint thickness in the arthritic mice.This report demonstrates that measuring locomotor activity of mice during progression of K/BxN sera-induced arthritis using the SmartCage™ platform offers a quantitative method to assess physical activity in mice during arthritis.

  View details for PubMedID 25506517

• HLA-DM and HLA-DO, key regulators of MHC-II processing and presentation CURRENT OPINION IN IMMUNOLOGY Mellins, E. D., Stern, L. J. 2014; 26: 115-122

  Abstract

  Peptide loading of class II MHC molecules in endosomal compartments is regulated by HLA-DM. HLA-DO modulates HLA-DM function, with consequences for the spectrum of MHC-bound epitopes presented at the cell surface for interaction with T cells. Here, we summarize and discuss recent progress in investigating the molecular mechanisms of action of HLA-DM and HLA-DO and in understanding their roles in immune responses. Key findings are the long-awaited structures of HLA-DM in complex with its class II substrate and with HLA-DO, and observation of a novel phenotype - autoimmunity combined with immunodeficiency - in mice lacking HLA-DO. We also highlight several areas where gaps persist in our knowledge about this pair of proteins and their molecular biology and immunobiology.

  View details for DOI 10.1016/j.coi.2013.11.005

  View details for Web of Science ID 000333001600016

  View details for PubMedID 24463216

• Transgene expression in various organs post BM-HSC transplantation. Stem cell research Wang, N., Rajasekaran, N., Hou, T., Mellins, E. D. 2014; 12 (1): 209-221

  Abstract

  Gene therapy mediated by bone marrow-derived hematopoietic stem cells (BM-HSC) has been widely used in treating genetic deficiencies in both pre-clinical and clinical settings. Using mitotically inactive cell-targeting lentivirus with separate promoters for our gene of interest (the murine MHC class II (MHCII) chaperone, invariant chain (Ii)) and a GFP reporter, we monitored the expression and function of introduced Ii in various types of professional antigen presenting cells (B cells, macrophages and DC) from different organs (spleen, pancreatic lymph nodes (PLN), BM and blood). Ii and GFP were detected. Ii levels correlated with GFP levels only in macrophages and monocytes from spleen, monocytes from PLN and macrophage precursors from blood. By cell type, Ii levels in PLN cells were more similar to those in spleen cells than to those in blood or BM cells. Functionally, Ii expressed in PLN or spleen had more effect on MHCII abundance than Ii expressed in BM or blood. The results have implications for analysis of the outcomes of gene therapy when both therapeutic and reporter genes are introduced. The findings also have implications for understanding the development of immune molecule function.

  View details for DOI 10.1016/j.scr.2013.10.010

  View details for PubMedID 24270160

  View details for PubMedCentralID PMC3895400

• The IL-23/IL-17 axis in psoriatic arthritis. Autoimmunity reviews Suzuki, E. n., Mellins, E. D., Gershwin, M. E., Nestle, F. O., Adamopoulos, I. E. 2014

  Abstract

  Psoriatic arthritis (PsA) is an immune-mediated chronic inflammatory disease, affecting both the skin and joints. Disease progression is associated with aberrant cytokine expression, and TNF blockade is the most successful therapy to date. However, not all patients are responsive to anti-TNF treatment, highlighting the need to better understand the cellular and molecular mechanisms that govern the disease. PsA associations with single nucleotide polymorphisms in IL23R as well as TRAF3IP2 (Act1), a molecule downstream of the IL-17 receptor (IL-17R), have linked the IL-23/IL-17 axis to disease pathology. Although both cytokines are implicated in PsA, a full picture of their cellular targets and pathogenic mechanisms has not yet emerged. In this review, we focus on the IL-23/IL-17 axis-elicited responses mediated by osteoclasts, keratinocytes and neutrophils. Expanding our understanding of the cellular and molecular mechanisms that dictate pathogenicity in PsA will contribute to developing novel treatment strategies to combat disease.

  View details for PubMedID 24424175

• Comparison of transduction efficiency among various lentiviruses containing GFP reporter in bone marrow hematopoietic stem cell transplantation. Experimental hematology Wang, N., Rajasekaran, N., Hou, T., Lisowski, L., Mellins, E. D. 2013; 41 (11): 934-943

  Abstract

  HIV-derived lentiviral vectors have been used widely to transduce non-dividing cells, such as hematopoietic stem cells (HSCs), in the setting of gene therapy. In this study, we screened lentiviral vectors for their ability to drive expression of the murine MHC class II chaperone, invariant chain (Ii) and a GFP reporter. The vectors included T2A vector with T2A-separated Ii and GFP under the same MSCV promoter, dual-promoter vectors with separate promoters for Ii and GFP (called MSCV or EF1a according to the promoter driving Ii expression), and a vector with EF1a driving a fusion of Ii/GFP (called Fusion vector). T2A and MSCV induced the highest levels of Ii and GFP expression, respectively, after direct transfection of 293T cells. All vectors except the Fusion vector drove expression of functional Ii, based on the enhancement of MHC class II level, which is a known consequence of Ii expression. Comparing the vectors after they were packaged into lentiviruses and used to transduce 293T, we found that MSCV and EF1a vectors mediated higher Ii and GFP expression. In ckit(+) bone marrow (BM) cells, MSCV still induced the highest Ii and GFP expression, whereas EF1a induced only robust Ii expression. Regardless of the vector, both Ii and GFP levels were significantly reduced in BM cells compared to 293T cells. When in vivo expression was assessed in cells derived from MSCV-transduced BM-HSCs, up to 80% of myeloid cells were GFP(+), but no Ii expression was observed. In contrast, transplantation of EF1a-transduced BM-HSCs led to much higher in vivo Ii expression. Thus, among those compared, dual-promoter vector-based lentivirus with the EF1a promoter driving the gene of interest is optimal for murine BM-HSC transduction.

  View details for DOI 10.1016/j.exphem.2013.07.002

  View details for PubMedID 23954710

  View details for PubMedCentralID PMC3833897

• B6.g7 mice reconstituted with BDC2·5 non-obese diabetic (BDC2·5NOD) stem cells do not develop autoimmune diabetes. Clinical and experimental immunology Rajasekaran, N., Wang, N., Hang, Y., Macaubas, C., Rinderknecht, C., Beilhack, G. F., Shizuru, J. A., Mellins, E. D. 2013; 174 (1): 27-37

  Abstract

  In BDC2.5NOD mice, a spontaneous model of Type 1 diabetes, CD4(+) T cells express a transgene-encoded T-cell receptor (TCR) with reactivity against a pancreatic antigen, chromogranin. This leads to massive infiltration and destruction of the pancreatic islets and subsequent diabetes. When we reconstituted lethally irradiated, lymphocyte-deficient B6.g7 (I-A(g7+) ) Rag(-/-) mice with BDC2.5NOD (ckit(+) Lin(-) Sca-1(hi) ) hematopoietic stem and progenitor cells (HSPC), the recipients exhibited hyperglycemia and succumbed to diabetes. Surprisingly, lymphocyte-sufficient B6.g7 mice reconstituted with BDC2.5NOD HSPCs were protected from diabetes. In this study, we investigated the factors responsible for attenuation of diabetes in the B6.g7 recipients. Analysis of chimerism in the B6.g7 recipients showed that, although B cells and myeloid cells were 98% donor-derived, the CD4(+) T cell compartment contained ∼50% host-derived cells. These host-derived CD4(+) T cells were enriched for conventional Tregs (CD25(+) Foxp3(+) ) and also for host-derived CD25(-) Foxp3(-) CD4(+) T cells that express markers of suppressive function, CD73, FR4 and CD39. Though negative selection did not eliminate donor-derived CD4(+) T cells in the B6.g7 recipients, these cells were functionally suppressed. Thus, host-derived CD4(+) T cells that emerge in mice following myeloablation exhibit a regulatory phenoytpe and likely attenuate autoimmune diabetes. These cells may provide new therapeutic strategies to suppress autoimmunity.

  View details for DOI 10.1111/cei.12163

  View details for PubMedID 23795893

• Genome Wide Association Meta-Analysis Implicates HLA-DRB1, The BTNL2/HLA-DRA region, and a Novel Susceptibility Locus On Chromosome 1 In Systemic Juvenile Idiopathic Arthritis Ombrello, M. J., Remmers, E. F., Tachmazidou, I., Grom, A. A., Foell, D., Martini, A., Gattorno, M., Ozen, S., Prahalad, S., Bohnsack, J. F., Ilowite, N. T., Mellins, E. D., Russo, R. G., Len, C. A., Oliveira, S. K., Yeung, R. M., Wedderburn, L. R., Anton, J., Langefeld, C. D., Thompson, S. D., Zeggini, E., Thomson, W., Kastner, D. L., Woo, P., Int Childhood Arthrit Genetics WILEY-BLACKWELL. 2013: S937

  View details for Web of Science ID 000325359205146

• Role of Interleukin-1 in Abnormal Monocyte Phenotype in Systemic Onset Juvenile Idiopathic Arthritis Zhang, Y., Macaubas, C., Klein, C., Pascual, M., Hay, A., Thompson, S. D., Sandborg, C. I., Ilowite, N. T., Mellins, E. D. WILEY-BLACKWELL. 2013: S932–S933

  View details for Web of Science ID 000325359205136

• B6.g7 mice reconstituted with BDC2 center dot 5 non-obese diabetic (BDC2 center dot 5NOD) stem cells do not develop autoimmune diabetes CLINICAL AND EXPERIMENTAL IMMUNOLOGY Rajasekaran, N., Wang, N., Hang, Y., Macaubas, C., Rinderknecht, C., Beilhack, G. F., Shizuru, J. A., Mellins, E. D. 2013; 174 (1): 27-37

  Abstract

  In BDC2.5NOD mice, a spontaneous model of Type 1 diabetes, CD4(+) T cells express a transgene-encoded T-cell receptor (TCR) with reactivity against a pancreatic antigen, chromogranin. This leads to massive infiltration and destruction of the pancreatic islets and subsequent diabetes. When we reconstituted lethally irradiated, lymphocyte-deficient B6.g7 (I-A(g7+) ) Rag(-/-) mice with BDC2.5NOD (ckit(+) Lin(-) Sca-1(hi) ) hematopoietic stem and progenitor cells (HSPC), the recipients exhibited hyperglycemia and succumbed to diabetes. Surprisingly, lymphocyte-sufficient B6.g7 mice reconstituted with BDC2.5NOD HSPCs were protected from diabetes. In this study, we investigated the factors responsible for attenuation of diabetes in the B6.g7 recipients. Analysis of chimerism in the B6.g7 recipients showed that, although B cells and myeloid cells were 98% donor-derived, the CD4(+) T cell compartment contained ∼50% host-derived cells. These host-derived CD4(+) T cells were enriched for conventional Tregs (CD25(+) Foxp3(+) ) and also for host-derived CD25(-) Foxp3(-) CD4(+) T cells that express markers of suppressive function, CD73, FR4 and CD39. Though negative selection did not eliminate donor-derived CD4(+) T cells in the B6.g7 recipients, these cells were functionally suppressed. Thus, host-derived CD4(+) T cells that emerge in mice following myeloablation exhibit a regulatory phenoytpe and likely attenuate autoimmune diabetes. These cells may provide new therapeutic strategies to suppress autoimmunity.

  View details for DOI 10.1111/cei.12163

  View details for Web of Science ID 000324045900004

• Susceptibility to Childhood-Onset Rheumatoid Arthritis: Investigation of a Weighted Genetic Risk Score That Integrates Cumulative Effects of Variants at Five Genetic Loci ARTHRITIS AND RHEUMATISM Prahalad, S., Conneely, K. N., Jiang, Y., Sudman, M., Wallace, C. A., Brown, M. R., Ponder, L. A., Rohani-Pichavant, M., Zwick, M. E., Cutler, D. J., Angeles-Han, S. T., Vogler, L. B., Kennedy, C., Rouster-Stevens, K., Wise, C. A., Punaro, M., Reed, A. M., Mellins, E. D., Bohnsack, J. F., Glass, D. N., Thompson, S. D. 2013; 65 (6): 1663-1667

  Abstract

  Children with childhood-onset rheumatoid arthritis (RA) include those with rheumatoid factor or anti-citrullinated protein antibody-positive juvenile idiopathic arthritis. To test the hypothesis that adult-onset RA-associated variants are also associated with childhood-onset RA, we investigated RA-associated variants at 5 loci in a cohort of patients with childhood-onset RA. We also assessed the cumulative association of these variants in susceptibility to childhood-onset RA using a weighted genetic risk score (wGRS).A total of 155 children with childhood-onset RA and 684 healthy controls were genotyped for 5 variants in the PTPN22, TRAF1/C5, STAT4, and TNFAIP3 loci. High-resolution HLA-DRB1 genotypes were available for 149 cases and 373 controls. We tested each locus for association with childhood-onset RA via logistic regression. We also computed a wGRS for each subject, with weights based on the natural log of the published odds ratios (ORs) for the alleles investigated, and used logistic regression to test the wGRS for association with childhood-onset RA.Childhood-onset RA was associated with TNFAIP3 rs10499194 (OR 0.60 [95% confidence interval 0.44-0.83]), PTPN22 rs2476601 (OR 1.61 [95% confidence interval 1.11-2.31]), and STAT4 rs7574865 (OR 1.41 [95% confidence interval 1.06-1.87]) variants. The wGRS was significantly different between cases and controls (P < 2 × 10(-16) ). Individuals in the third to fifth quintiles of wGRS had a significantly increased disease risk compared to baseline (individuals in the first quintile). Higher wGRS was associated with increased risk of childhood-onset RA, especially among males.The magnitude and direction of the association between TNFAIP3, STAT4, and PTPN22 variants and childhood-onset RA are similar to those observed in RA, suggesting that adult-onset RA and childhood-onset RA share common genetic risk factors. Using a wGRS, we have demonstrated the cumulative association of RA-associated variants with susceptibility to childhood-onset RA.

  View details for DOI 10.1002/art.37913

  View details for Web of Science ID 000319740600029

  View details for PubMedID 23450725

  View details for PubMedCentralID PMC3683854

• B6.g7 mice reconstituted with BDC2.5NOD stem cells are protected against autoimmune diabetes. Rajasekaran, N., Wang, N., Hang, Y., Macaubas, C., Rinderknecht, C., Beilhack, G., Shizuru, J., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2013

  View details for Web of Science ID 000322987101141

• A potential role for HLA-DM in linking the antigen uptake and antigen presentation pathways in B cells. Macmillan, H., Strohman, M., Ayyangar, S., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2013

  View details for Web of Science ID 000322987106120

• CD4+T regulatory cells mitogenic signaling is activated by IL-1 and IL-6 produced by serum amyloid A-stimulated monocytes (P1037) Macaubas, C., Khoa Nguyen, Phi Truong, Wang, N., Hou, T., Yoon, T., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2013

  View details for Web of Science ID 000322987100037

• Host-derived CD4+T cells attenuate stem cellmediated transfer of autoimmune arthritis in lethally irradiated C57BL/6.g7 mice ARTHRITIS AND RHEUMATISM Rajasekaran, N., Wang, N., Phi Truong, P., Rinderknecht, C., Macaubas, C., Beilhack, G. F., Shizuru, J. A., Mellins, E. D. 2013; 65 (3): 681-692

  Abstract

  In the K/BxN mouse model of inflammatory arthritis, T cells carrying a transgenic T cell receptor initiate disease by helping B cells to produce arthritogenic anti-glucose-6-phosphate isomerase (anti-GPI) autoantibodies. We found that lethally- irradiated lymphocyte-deficient C57BL/6 (B6).g7 (I-A(g7) +) recombinase-activating gene-deficient (Rag(-/-)) mice reconstituted with K/BxN hematopoietic stem and progenitor cells exhibit arthritis by week 4. In contrast, healthy B6.g7 recipients of K/BxN hematopoietic stem and progenitor cells show only mild arthritis, with limited extent and duration. The objective of this study was to investigate the factors responsible for the attenuation of arthritis in B6.g7 recipients.Antibody responses were measured by enzyme-linked immunosorbent assay. Fluorescence-activated cell sorting analyses were performed for testing chimerism, expression of markers of activation and suppression, tetramer binding, and intracellular cytokines in CD4+ T cells. Suppressive activity of CD4+ T cells was studied by adoptive transfer.Titers of anti-GPI antibodies in reconstituted B6.g7 mice were ∼60-fold lower than in reconstituted B6.g7 Rag(-/-) mice. Examination of chimerism in the reconstituted B6.g7 mice showed that B cells and myeloid cells in these mice were donor derived, but CD4+ T cells were primarily host derived and enriched for cells expressing the conventional regulatory markers CD25 and FoxP3. Notably, CD4+CD25-FoxP3- T cells expressed markers of suppressive function (CD73 and folate receptor 4), and delayed disease after adoptive transfer. Activation of donor-derived CD4+ T cells was reduced, and thymic deletion of these cells appeared increased.Despite myeloablation, host CD4+ T cells having a regulatory phenotype emerge in these mice and attenuate autoimmunity.

  View details for DOI 10.1002/art.37800

  View details for Web of Science ID 000315452400017

  View details for PubMedID 23233229

• HLA-DO acts as a substrate mimic to inhibit HLA-DM by a competitive mechanism NATURE STRUCTURAL & MOLECULAR BIOLOGY Guce, A. I., Mortimer, S. E., Yoon, T., Painter, C. A., Jiang, W., Mellins, E. D., Stern, L. J. 2013; 20 (1): 90-U118

  Abstract

  Mammalian class II major histocompatibility (MHCII) proteins bind peptide antigens in endosomal compartments of antigen-presenting cells. The nonclassical MHCII protein HLA-DM chaperones peptide-free MHCII, protecting it against inactivation, and catalyzes peptide exchange on loaded MHCII. Another nonclassical MHCII protein, HLA-DO, binds HLA-DM and influences the repertoire of peptides presented by MHCII proteins. However, the mechanism by which HLA-DO functions is unclear. Here we have used X-ray crystallography, enzyme kinetics and mutagenesis approaches to investigate human HLA-DO structure and function. In complex with HLA-DM, HLA-DO adopts a classical MHCII structure, with alterations near the α subunit's 3₁₀ helix. HLA-DO binds to HLA-DM at the same sites implicated in MHCII interaction, and kinetic analysis showed that HLA-DO acts as a competitive inhibitor. These results show that HLA-DO inhibits HLA-DM function by acting as a substrate mimic, and the findings also limit the possible functional roles for HLA-DO in antigen presentation.

  View details for DOI 10.1038/nsmb.2460

  View details for Web of Science ID 000313072400015

  View details for PubMedID 23222639

  View details for PubMedCentralID PMC3537886

• Pulse-chase analysis for studies of MHC class II biosynthesis, maturation, and peptide loading. Methods in molecular biology (Clifton, N.J.) Hou, T., Rinderknecht, C. H., Hadjinicolaou, A. V., Busch, R., Mellins, E. 2013; 960: 411-432

  Abstract

  Pulse-chase analysis is a commonly used technique for studying the synthesis, processing and transport of proteins. Cultured cells expressing proteins of interest are allowed to take up radioactively labeled amino acids for a brief interval ("pulse"), during which all newly synthesized proteins incorporate the label. The cells are then returned to nonradioactive culture medium for various times ("chase"), during which proteins may undergo conformational changes, trafficking, or degradation. Proteins of interest are isolated (usually by immunoprecipitation) and resolved by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), and the fate of radiolabeled molecules is examined by autoradiography. This chapter describes a pulse-chase protocol suitable for studies of major histocompatibility complex (MHC) class II biosynthesis and maturation. We discuss how results are affected by the recognition by certain anti-class II antibodies of distinct class II conformations associated with particular biosynthetic states. Our protocol can be adapted to follow the fate of many other endogenously synthesized proteins, including viral or transfected gene products, in cultured cells.

  View details for DOI 10.1007/978-1-62703-218-6_31

  View details for PubMedID 23329504

• A New Era in the Treatment of Systemic Juvenile Idiopathic Arthritis NEW ENGLAND JOURNAL OF MEDICINE Sandborg, C., Mellins, E. D. 2012; 367 (25): 2439-2440

  View details for DOI 10.1056/NEJMe1212640

  View details for Web of Science ID 000312531600015

  View details for PubMedID 23252530

• Self-antigen recognition by follicular lymphoma B-cell receptors BLOOD Sachen, K. L., Strohman, M. J., Singletary, J., Alizadeh, A. A., Kattah, N. H., Lossos, C., Mellins, E. D., Levy, S., Levy, R. 2012; 120 (20): 4182-4190

  Abstract

  Follicular lymphoma is a monoclonal B-cell malignancy with each patient's tumor expressing a unique cell surface immunoglobulin (Ig), or B-cell receptor (BCR), that can potentially recognize antigens and/or transduce signals into the tumor cell. Here we evaluated the reactivity of tumor derived Igs for human tissue antigens. Self-reactivity was observed in 26% of tumor Igs (25 of 98). For one follicular lymphoma patient, the recognized self-antigen was identified as myoferlin. This patient's tumor cells bound recombinant myoferlin in proportion to their level of BCR expression, and the binding to myoferlin was preserved despite ongoing somatic hypermutation of Ig variable regions. Furthermore, BCR-mediated signaling was induced after culture of tumor cells with myoferlin. These results suggest that antigen stimulation may provide survival signals to tumor cells and that there is a selective pressure to preserve antigen recognition as the tumor evolves.

  View details for DOI 10.1182/blood-2012-05-427534

  View details for Web of Science ID 000311637400013

  View details for PubMedID 23024238

  View details for PubMedCentralID PMC3501716

• Genome-Wide Association Meta-Analysis of Eight Independent Systemic Juvenile Idiopathic Arthritis Collections Reveals Regional Association Spanning the Major Histocompatibility Complex Class II and III Gene Cluster Annual Scientific Meeting of the American-College-of-Rheumatology (ACR) and Association-of-Rheumatology-Health-Professionals (ARHP) Ombrello, M. J., Remmers, E., Grom, A. A., Thomson, W., Martini, A., Gattorno, M., Ozen, S., Prahalad, S., Bohnsack, J. F., Zeft, A., Ilowite, N. T., Mellins, E. D., Russo, R. A., Len, C., Oliveira, S. K., Yeung, R. S., Wedderburn, L. R., Lopez, J. A., Sato-Rius, C., Tachmazidou, I., Langefeld, C. D., Zeggini, E., Thompson, S. D., Woo, P., Kastner, D. L. WILEY-BLACKWELL. 2012: S1126–S1126

  View details for Web of Science ID 000309748306167

• Mapping the HLA-DO/HLA-DM complex by FRET and mutagenesis PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Yoon, T., Macmillan, H., Mortimer, S. E., Jiang, W., Rinderknecht, C. H., Stern, L. J., Mellins, E. D. 2012; 109 (28): 11276-11281

  Abstract

  HLA-DO (DO) is a nonclassic class II heterodimer that inhibits the action of the class II peptide exchange catalyst, HLA-DM (DM), and influences DM localization within late endosomes and exosomes. In addition, DM acts as a chaperone for DO and is required for its egress from the endoplasmic reticulum (ER). These reciprocal functions are based on direct DO/DM binding, but the topology of DO/DM complexes is not known, in part, because of technical limitations stemming from DO instability. We generated two variants of recombinant soluble DO with increased stability [zippered DOαP11A (szDOv) and chimeric sDO-Fc] and confirmed their conformational integrity and ability to inhibit DM. Notably, we found that our constructs, as well as wild-type sDO, are inhibitory in the full pH range where DM is active (4.7 to ∼6.0). To probe the nature of DO/DM complexes, we used intermolecular fluorescence resonance energy transfer (FRET) and mutagenesis and identified a lateral surface spanning the α1 and α2 domains of szDO as the apparent binding site for sDM. We also analyzed several sDM mutants for binding to szDOv and susceptibility to DO inhibition. Results of these assays identified a region of DM important for interaction with DO. Collectively, our data define a putative binding surface and an overall orientation of the szDOv/sDM complex and have implications for the mechanism of DO inhibition of DM.

  View details for DOI 10.1073/pnas.1113966109

  View details for Web of Science ID 000306642100053

  View details for PubMedID 22733780

  View details for PubMedCentralID PMC3396517

• On the perils of poor editing: regulation of peptide loading by HLA-DQ and H2-A molecules associated with celiac disease and type 1 diabetes EXPERT REVIEWS IN MOLECULAR MEDICINE Busch, R., De Riva, A., Hadjinicolaou, A. V., Jiang, W., Hou, T., Mellins, E. D. 2012; 14

  Abstract

  This review discusses mechanisms that link allelic variants of major histocompatibility complex (MHC) class II molecules (MHCII) to immune pathology. We focus on HLA (human leukocyte antigen)-DQ (DQ) alleles associated with celiac disease (CD) and type 1 diabetes (T1D) and the role of the murine DQ-like allele, H2-Ag7 (I-Ag7 or Ag7), in murine T1D. MHCII molecules bind peptides, and alleles vary in their peptide-binding specificity. Disease-associated alleles permit binding of disease-inducing peptides, such as gluten-derived, Glu-/Pro-rich gliadin peptides in CD and peptides from islet autoantigens, including insulin, in T1D. In addition, the CD-associated DQ2.5 and DQ8 alleles are unusual in their interactions with factors that regulate their peptide loading, invariant chain (Ii) and HLA-DM (DM). The same alleles, as well as other T1D DQ risk alleles (and Ag7), share nonpolar residues in place of Asp at β57 and prefer peptides that place acidic side chains in a pocket in the MHCII groove (P9). Antigen-presenting cells from T1D-susceptible mice and humans retain CLIP because of poor DM editing, although underlying mechanisms differ between species. We propose that these effects on peptide presentation make key contributions to CD and T1D pathogenesis.

  View details for DOI 10.1017/erm.2012.9

  View details for Web of Science ID 000307169300001

  View details for PubMedID 22805744

• Comparison of protein expression by different lentiviral vectors 99th Annual Meeting of the American-Association-of-Immunologists Wang, N., Rajasekaran, N., Hou, T., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2012

  View details for Web of Science ID 000304659700277

• Cryptic Fate of Gliadin Epitopes: Implication for Celiac Disease 99th Annual Meeting of the American-Association-of-Immunologists Hou, T., Qiao, S., Jin, X., Sidney, J., Sollid, L., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2012

  View details for Web of Science ID 000304659700626

• Crystal structure of the HLA-DM/DO complex and insight into the mechanism of DM-catalyzed peptide exchange 99th Annual Meeting of the American-Association-of-Immunologists Stern, L., Guce, A., Mortimer, S., Yoon, T., Painter, C., Jiang, W., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2012

  View details for Web of Science ID 000304659700628

• Crystal structure of the peptide-exchange inhibitor HLA-DO bound to HLA-DM and insight into the mechanism of DM-facilitated peptide exchange 7th Biannual Workshop on Antigen Presentation Stern, L., Guce, A., Mortimer, S., Yoon, T., Painter, C., Jiang, W., Mellins, E. PERGAMON-ELSEVIER SCIENCE LTD. 2012: 32–32

  View details for DOI 10.1016/j.molimm.2012.02.089

  View details for Web of Science ID 000303429800083

• Interaction of HLA-DM and HLA-DQ2 in antigen presentation: Implications for celiac disease association 7th Biannual Workshop on Antigen Presentation Hou, T., Qiao, S., Jin, X., Sidney, J., Sollid, L., Macmillan, H., Strohman, M., Yoon, T., Mellins, E. D. PERGAMON-ELSEVIER SCIENCE LTD. 2012: 40–40

  View details for DOI 10.1016/j.molimm.2012.03.005

  View details for Web of Science ID 000303429800109

• Alternative activation in systemic juvenile idiopathic arthritis monocytes CLINICAL IMMUNOLOGY Macaubas, C., Nguyen, K. D., Peck, A., Buckingham, J., Deshpande, C., Wong, E., Alexander, H. C., Chang, S., Begovich, A., Sun, Y., Park, J. L., Pan, K., Lin, R., Lih, C., Augustine, E. M., Phillips, C., Hadjinicolaou, A. V., Lee, T., Mellins, E. D. 2012; 142 (3): 362-372

  Abstract

  Systemic juvenile idiopathic arthritis (SJIA) is a chronic autoinflammatory condition. The association with macrophage activation syndrome, and the therapeutic efficacy of inhibiting monocyte-derived cytokines, has implicated these cells in SJIA pathogenesis. To characterize the activation state (classical/M1 vs. alternative/M2) of SJIA monocytes, we immunophenotyped monocytes using several approaches. Monocyte transcripts were analyzed by microarray and quantitative PCR. Surface proteins were measured at the single cell level using flow cytometry. Cytokine production was evaluated by intracellular staining and ELISA. CD14(++)CD16(-) and CD14(+)CD16(+) monocyte subsets are activated in SJIA. A mixed M1/M2 activation phenotype is apparent at the single cell level, especially during flare. Consistent with an M2 phenotype, SJIA monocytes produce IL-1β after LPS exposure, but do not secrete it. Despite the inflammatory nature of active SJIA, circulating monocytes demonstrate significant anti-inflammatory features. The persistence of some of these phenotypes during clinically inactive disease argues that this state reflects compensated inflammation.

  View details for DOI 10.1016/j.clim.2011.12.008

  View details for PubMedID 22281427

• Hierarchy of risk of childhood-onset rheumatoid arthritis conferred by HLA-DRB1 alleles encoding the shared epitope ARTHRITIS AND RHEUMATISM Prahalad, S., Thompson, S. D., Conneely, K. N., Jiang, Y., Leong, T., Prozonic, J., Brown, M. R., Ponder, L. A., Angeles-Han, S. T., Vogler, L. B., Kennedy, C., Wallace, C. A., Wise, C. A., Punaro, M., Reed, A., Park, J. L., Mellins, E. D., Zeft, A. S., Bohnsack, J. F., Glass, D. N. 2012; 64 (3): 925-930

  Abstract

  Associations between shared epitope (SE)-encoding HLA-DRB1 alleles and rheumatoid arthritis (RA) are well established. However, only a limited number of studies have investigated these alleles in patients with childhood-onset RA, which is defined as rheumatoid factor- and/or anti-citrullinated protein antibody-positive juvenile idiopathic arthritis. The aims of this study were to investigate the largest cohort of patients with childhood-onset RA for association with SE alleles and to determine whether there is a hierarchy of risk based on the amino acid sequence of the SE.High-resolution HLA-DRB1 genotypes were obtained for 204 patients with childhood-onset RA and 373 healthy control subjects. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for different SE-encoding HLA-DRB1 alleles. In addition, genotype ORs were calculated for combinations of SE alleles classified into S(2) , S(3P) , or L alleles, based on amino acid sequences in position 70-74 of the DRβ1 chain, as proposed by Tezenas du Montcel et al.We confirmed associations between HLA-DRB1 SE alleles and childhood-onset RA (76% of patients carried 1 or 2 SE alleles compared with 46% of control subjects; OR 3.81, 95% CI 2.4-6.0, P < 1 × 10(-7) ). We also observed associations between individual SE alleles (HLA-DRB1*0101, *0401, *0404, *0405, *0408, and *1001) and childhood-onset RA. Genotype-specific risk estimates suggested a hierarchy of risk, with the highest risk among individuals heterozygous for S(2) /S(3P) (OR 22.3, 95% CI 9.9-50.5, P < 0.0001).We confirm the association between SE-encoding HLA-DRB1 alleles and susceptibility to childhood-onset RA. The excess risk conferred by carriage of the combination of S(2) and S(3P) risk alleles suggests that children with DRβ1 chains containing the KRAA and QRRAA or RRRAA sequences are especially susceptible to RA.

  View details for DOI 10.1002/art.33376

  View details for Web of Science ID 000300835900037

  View details for PubMedID 21953520

  View details for PubMedCentralID PMC3276774

• Major Histocompatibility Complex Class II Gene Cluster Harbors Systemic Juvenile Idiopathic Arthritis Susceptibility Locus 75th Annual Scientific Meeting of the American-College-of-Rheumatology/46th Annual Scientific Meeting of the Association-of-Rheumatology-Health-Professionals (ARHP) Ombrello, M. J., Remmers, E., Grom, A. A., Thomson, W., Martini, A., Gattorno, M., Ozen, S., Gul, A., Bohnsack, J. F., Prahalad, S., Zeft, A. S., Mellins, E. D., Satorius, C., Park, J. L., Langefeld, C. D., Zeggini, E., Glass, D. N., Thompson, S. D., Kastner, D. L., Woo, P. WILEY-BLACKWELL. 2011: S659–S660

  View details for Web of Science ID 000297621502072

• PD-L1 in Systemic Juvenile Idiopathic Arthritis 75th Annual Scientific Meeting of the American-College-of-Rheumatology/46th Annual Scientific Meeting of the Association-of-Rheumatology-Health-Professionals (ARHP) Shenoi, S., Ou, J., Macaubas, C., Mellins, E. D., Wallace, C., Stevens, A. M. WILEY-BLACKWELL. 2011: S98–S98

  View details for Web of Science ID 000297621500263

• An Insertion Mutant in DQA1*0501 Restores Susceptibility to HLA-DM: Implications for Disease Associations JOURNAL OF IMMUNOLOGY Hou, T., Macmillan, H., Chen, Z., Keech, C. L., Jin, X., Sidney, J., Strohman, M., Yoon, T., Mellins, E. D. 2011; 187 (5): 2442-2452

  Abstract

  HLA-DM (DM) catalyzes CLIP release, stabilizes MHC class II molecules, and edits the peptide repertoire presented by class II. Impaired DM function may have profound effects on Ag presentation events in the thymus and periphery that are critical for maintenance of self-tolerance. The associations of the HLA-DQ2 (DQ2) allele with celiac disease and type 1 diabetes mellitus have been appreciated for a long time. The explanation for these associations, however, remains unknown. We previously found that DQ2 is a poor substrate for DM. In this study, to further characterize DQ2-DM interaction, we introduced point mutations into DQ2 on the proposed DQ2-DM interface to restore the sensitivity of DQ2 to DM. The effects of mutations were investigated by measuring the peptide dissociation and exchange rate in vitro, CLIP and DQ2 expression on the cell surface, and the presentation of α-II-gliadin epitope (residues 62-70) to murine, DQ2-restricted T cell hybridomas. We found that the three α-chain mutations (α+53G, α+53R, or αY22F) decreased the intrinsic stability of peptide-class II complex. More interestingly, the α+53G mutant restored DQ2 sensitivity to DM, likely due to improved interaction with DM. Our data also suggest that α-II-gliadin 62-70 is a DM-suppressed epitope. The DQ2 resistance to DM changes the fate of this peptide from a cryptic to an immunodominant epitope. Our findings elucidate the structural basis for reduced DQ2-DM interaction and have implications for mechanisms underlying disease associations of DQ2.

  View details for DOI 10.4049/jimmunol.1100255

  View details for Web of Science ID 000294059500048

  View details for PubMedID 21775680

  View details for PubMedCentralID PMC3159820

• Pathogenesis of systemic juvenile idiopathic arthritis: some answers, more questions NATURE REVIEWS RHEUMATOLOGY Mellins, E. D., Macaubas, C., Grom, A. A. 2011; 7 (7): 416-426

  Abstract

  Systemic juvenile idiopathic arthritis (sJIA) has long been recognized as unique among childhood arthritides, because of its distinctive clinical and epidemiological features, including an association with macrophage activation syndrome. Here, we summarize research into sJIA pathogenesis. The triggers of disease are unknown, although infections are suspects. Once initiated, sJIA seems to be driven by innate proinflammatory cytokines. Endogenous Toll-like receptor ligands, including S100 proteins, probably synergize with cytokines to perpetuate inflammation. These and other findings support the hypothesis that sJIA is an autoinflammatory condition. Indeed, IL-1 is implicated as a pivotal cytokine, but the source of excess IL-1 activity remains obscure and the role of IL-1 in chronic arthritis is less clear. Another hypothesis is that a form of hemophagocytic lymphohistiocytosis underlies sJIA, with varying degrees of its expression across the spectrum of disease. Alternatively, sJIA with MAS might be a genetically distinct subtype. Yet another hypothesis proposes that inadequate downregulation of immune activation is central to sJIA, supporting evidence for which includes 'alternative activation' of monocyte and macrophages and possible deficiencies in IL-10 and T regulatory cells. Some altered immune phenotypes persist during clinically inactive disease, which suggests that this stage might represent compensated inflammation. Despite much progress being made, many questions remain, providing fertile ground for future research.

  View details for DOI 10.1038/nrrheum.2011.68

  View details for Web of Science ID 000292303900007

  View details for PubMedID 21647204

• Human cytomegalovirus decreases constitutive transcription of MHC class II genes in mature Langerhans cells by reducing CIITA transcript levels MOLECULAR IMMUNOLOGY Lee, A. W., Wang, N., Hornell, T. M., Harding, J. J., Deshpande, C., Hertel, L., Lacaille, V., Pashine, A., Macaubas, C., Mocarski, E. S., Mellins, E. D. 2011; 48 (9-10): 1160-1167

  Abstract

  Human cytomegalovirus (HCMV) productively infects CD34(+) progenitor-derived, mature Langerhans-type dendritic cells (matLC) and reduces surface expression of MHC class II complexes (MHC II) by increasing intracellular retention of these molecules. To determine whether HCMV also inhibits MHC II expression by other mechanisms, we assessed mRNA levels of the class II transcriptional regulator, CIITA, and several of its target genes in infected matLC. Levels of CIITA, HLA-DRA (DRA) and DRB transcripts, and new DR protein synthesis were compared in mock-infected and HCMV-infected cells by quantitative PCR and pulse-chase immunoprecipitation analyses, respectively. CIITA mRNA levels were significantly lower in HCMV-infected matLC as compared to mock-infected cells. When assessed in the presence of Actinomycin D, the stability of CIITA transcripts was not diminished by HCMV. Analysis of promoter-specific CIITA isoforms revealed that types I, III and IV all were decreased by HCMV, a result that differs from changes after incubation of these cells with lipopolysaccharide (LPS). Exposure to UV-inactivated virus failed to reduce CIITA mRNA levels, implicating de novo viral gene expression in this effect. HCMV-infected matLC also expressed lower levels of DR transcripts and reduced DR protein synthesis rates compared to mock-infected matLC. In summary, we demonstrate that HCMV infection of a human dendritic cell subset inhibits constitutive CIITA expression, most likely at the transcriptional level, resulting in reduced MHC II biosynthesis. We suggest this represents a new mechanism of modulation of mature LC by HCMV.

  View details for DOI 10.1016/j.molimm.2011.02.010

  View details for Web of Science ID 000290929400010

  View details for PubMedID 21458073

  View details for PubMedCentralID PMC3086682

• Serum amyloid A overrides T-reg anergy via monocyte-dependent and T-reg-intrinsic, SOCS3-associated pathways BLOOD Nguyen, K. D., Macaubas, C., Nadeau, K. C., Phi Truong, T., Yoon, T., Lee, T., Park, J. L., Mellins, E. D. 2011; 117 (14): 3793-3798

  Abstract

  The acute phase protein serum amyloid A (SAA) has been well characterized as an indicator of inflammation. Nevertheless, its functions in pro versus anti-inflammatory processes remain obscure. Here we provide unexpected evidences that SAA induces the proliferation of the tolerogenic subset of regulatory T cells (T(reg)). Intriguingly, SAA reverses T(reg) anergy via its interaction with monocytes to activate distinct mitogenic pathways in T(reg) but not effector T cells. This selective responsiveness of T(reg) correlates with their diminished expression of SOCS3 and is antagonized by T(reg)-specific induction of this regulator of cytokine signaling. Collectively, these evidences suggest a novel anti-inflammatory role of SAA in the induction of a micro-environment that supports T(reg) expansion at sites of infection or tissue injury, likely to curb (auto)-inflammatory responses.

  View details for DOI 10.1182/blood-2010-11-318832

  View details for Web of Science ID 000289265500014

  View details for PubMedID 21325601

  View details for PubMedCentralID PMC3296631

• Chaperone Activity of alpha B-Crystallin Is Responsible for Its Incorrect Assignment as an Autoantigen in Multiple Sclerosis JOURNAL OF IMMUNOLOGY Rothbard, J. B., Zhao, X., Sharpe, O., Strohman, M. J., Kurnellas, M., Mellins, E. D., Robinson, W. H., Steinman, L. 2011; 186 (7): 4263-4268

  Abstract

  For 15 y, α B-crystallin (heat shock protein [Hsp] B5) has been labeled an autoantigen in multiple sclerosis (MS) based on humoral and cellular responses found in humans and animal models. However, there have been several scientific inconsistencies with this assignment, ranging from studies demonstrating small differences in anticrystallin responses between patients and healthy individuals to the inability of crystallin-specific T cells to induce symptoms of experimental allergic encephalomyelitis in animal models. Experiments in this article demonstrate that the putative anti-HspB5 Abs from 23 MS patients cross-react with 7 other members of the human small Hsp family and were equally present in normal plasma. Biolayer interferometry demonstrates that the binding was temperature dependent, and that the calculated K(a) increased as the concentration of the sHsp decreased. These two patterns are characteristic of multiple binding sites with varying affinities, the composition of which changes with temperature, supporting the hypothesis that HspB5 bound the Ab and not the reverse. HspB5 also precipitated Ig heavy and L chains from sera from patients with MS. These results establish that small Hsps bind Igs with high affinity and refute much of the serological data used to assign α B-crystallin as an autoantigen.

  View details for DOI 10.4049/jimmunol.1003934

  View details for PubMedID 21357544

• An insertion mutant in DQA*0501 restores susceptibility to DM: implications for disease associations Hou, T., Macmillan, H., Strohman, M., Yoon, T., Jin, X., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2011

  View details for Web of Science ID 000209751703059

• Structural basis of HLA-DO inhibition of HLA-DM catalyzed peptide exchange on MHC class II Guce, A., Mortimer, S., Mellins, E., Karlsson, L., Stern, L. AMER ASSOC IMMUNOLOGISTS. 2011

  View details for Web of Science ID 000209751703037

• Transmembrane domain interaction regulates HLA-DO inhibition of HLA-DM Yoon, T., Macmillan, H., Roh, S., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2011

  View details for Web of Science ID 000209751703077

• Monocyte phenotypes in systemic juvenile idiopathic arthritis Macaubas, C., Khoa Nguyen, Peck, A., Wong, E., Buckingham, J., Goertz, Y., Deshpande, C., Alexander, H., Chang, S., Sun, Y., Park, J., Lee, T., Begovich, A., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2011

  View details for Web of Science ID 000209751700034

• Human cytomegalovirus decreases constitutive transcription of MHC class II genes in mature Langerhans cells by reducing CIITA transcript levels Lee, A., Hornell, T., Wang, N., Harding, J., Deshpande, C., Hertel, L., Lacaille, V., Pashine, A., Macaubas, C., Mocarsk, E., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2011

  View details for Web of Science ID 000209751706160

• Host-derived CD4+T cells protect lethally irradiated B6.g7 mice from stem cell mediated transfer of autoimmunity. Rajasekaran, N., Wang, N., Phi Truong, Rinderknecht, C., Beilhack, G., Shizuru, J., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2011

  View details for Web of Science ID 000209751705067

• Urine Peptidomic and Targeted Plasma Protein Analyses in the Diagnosis and Monitoring of Systemic Juvenile Idiopathic Arthritis. Clinical proteomics Ling, X. B., Lau, K., Deshpande, C., Park, J. L., Milojevic, D., Macaubas, C., Xiao, C., Lopez-Avila, V., Kanegaye, J., Burns, J. C., Cohen, H., Schilling, J., Mellins, E. D. 2010; 6 (4): 175-193

  Abstract

  PURPOSE: Systemic juvenile idiopathic arthritis is a chronic pediatric disease. The initial clinical presentation can mimic other pediatric inflammatory conditions, which often leads to significant delays in diagnosis and appropriate therapy. SJIA biomarker development is an unmet diagnostic/prognostic need to prevent disease complications. EXPERIMENTAL DESIGN: We profiled the urine peptidome to analyze a set of 102 urine samples, from patients with SJIA, Kawasaki disease (KD), febrile illnesses (FI), and healthy controls. A set of 91 plasma samples, from SJIA flare and quiescent patients, were profiled using a customized antibody array against 43 proteins known to be involved in inflammatory and protein catabolic processes. RESULTS: We identified a 17-urine-peptide biomarker panel that could effectively discriminate SJIA patients at active, quiescent, and remission disease states, and patients with active SJIA from confounding conditions including KD and FI. Targeted sequencing of these peptides revealed that they fall into several tight clusters from seven different proteins, suggesting disease-specific proteolytic activities. The antibody array plasma profiling identified an SJIA plasma flare signature consisting of tissue inhibitor of metalloproteinase-1 (TIMP1), interleukin (IL)-18, regulated upon activation, normal T cell expressed and secreted (RANTES), P-Selectin, MMP9, and L-Selectin. CONCLUSIONS AND CLINICAL RELEVANCE: The urine peptidomic and plasma protein analyses have the potential to improve SJIA care and suggest that SJIA urine peptide biomarkers may be an outcome of inflammation-driven effects on catabolic pathways operating at multiple sites. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12014-010-9058-8) contains supplementary material, which is available to authorized users.

  View details for DOI 10.1007/s12014-010-9058-8

  View details for PubMedID 21124648

  View details for PubMedCentralID PMC2970804

• Plasma profiles in active systemic juvenile idiopathic arthritis: Biomarkers and biological implications PROTEOMICS Ling, X. B., Park, J. L., Carroll, T., Nguyen, K. D., Lau, K., Macaubas, C., Chen, E., Lee, T., Sandborg, C., Milojevic, D., Kanegaye, J. T., Gao, S., Burns, J., Schilling, J., Mellins, E. D. 2010; 10 (24): 4415-4430

  Abstract

  Systemic juvenile idiopathic arthritis (SJIA) is a chronic arthritis of children characterized by a combination of arthritis and systemic inflammation. There is usually non-specific laboratory evidence of inflammation at diagnosis but no diagnostic test. Normalized volumes from 89/889 2-D protein spots representing 26 proteins revealed a plasma pattern that distinguishes SJIA flare from quiescence. Highly discriminating spots derived from 15 proteins constitute a robust SJIA flare signature and show specificity for SJIA flare in comparison to active polyarticular juvenile idiopathic arthritis or acute febrile illness. We used 7 available ELISA assays, including one to the complex of S100A8/S100A9, to measure levels of 8 of the15 proteins. Validating our DIGE results, this ELISA panel correctly classified independent SJIA flare samples, and distinguished them from acute febrile illness. Notably, data using the panel suggest its ability to improve on erythrocyte sedimentation rate or C-reactive protein or S100A8/S100A9, either alone or in combination in SJIA F/Q discriminations. Our results also support the panel's potential clinical utility as a predictor of incipient flare (within 9 wk) in SJIA subjects with clinically inactive disease. Pathway analyses of the 15 proteins in the SJIA flare versus quiescence signature corroborate growing evidence for a key role for IL-1 at disease flare.

  View details for DOI 10.1002/pmic.201000298

  View details for PubMedID 21136595

• Laboratory markers of cardiovascular risk in pediatric SLE: the APPLE baseline cohort LUPUS Ardoin, S. P., Schanberg, L. E., Sandborg, C., Yow, E., Barnhart, H. X., Mieszkalski, K. L., Ilowite, N. T., von Scheven, E., Eberhard, A., Levy, D. M., Kimura, Y., Silverman, E., Bowyer, S. L., Punaro, L., Singer, N. G., Sherry, D. D., McCurdy, D., Klein-Gitelman, M., Wallace, C., Silver, R., Wagner-Weiner, L., Higgins, G. C., Brunner, H. I., Jung, L. K., Imundo, L., Soep, J. B., Reed, A. M. 2010; 19 (11): 1315-1325

  Abstract

  As part of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) Trial, a prospective multicenter cohort of 221 children and adolescents with systemic lupus erythematosus (SLE) (mean age 15.7 years, 83% female) underwent baseline measurement of markers of cardiovascular risk, including fasting levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), lipoprotein A (Lpa), homocysteine and high-sensitivity C-reactive protein (hs-CRP). A cross-sectional analysis of the baseline laboratory values and clinical characteristics of this cohort was performed. Univariable relationships between the cardiovascular markers of interest and clinical variables were assessed, followed by multivariable linear regression modeling. Mean levels of LDL, HDL, Lpa, TG, hs-CRP and homocysteine were in the normal or borderline ranges. In multivariable analysis, increased Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), prednisone dose, and hypertension (HTN) were independently associated with higher LDL levels. Higher hs-CRP and creatinine clearance were independently related to lower HDL levels. Higher body mass index (BMI), prednisone dose, and homocysteine levels were independently associated with higher TG levels. Only Hispanic or non-White status predicted higher Lpa levels. Proteinuria, higher TG and lower creatinine clearance were independently associated with higher homocysteine levels, while use of multivitamin with folate predicted lower homocysteine levels. Higher BMI, lower HDL, and longer SLE disease duration, but not SLEDAI, were independently associated with higher hs-CRP levels. The R(2) for these models ranged from 7% to 23%. SLE disease activity as measured by the SLEDAI was associated only with higher LDL levels and not with hs-CRP. Markers of renal injury (HTN, proteinuria, and creatinine clearance) were independently associated with levels of LDL, HDL, and homocysteine, highlighting the importance of renal status in the cardiovascular health of children and adolescents with SLE. Future longitudinal analysis of the APPLE cohort is needed to further examine these relationships.

  View details for DOI 10.1177/0961203310373937

  View details for Web of Science ID 000282090700007

  View details for PubMedID 20861207

• DM influences the abundance of major histocompatibility complex class II alleles with low affinity for class II-associated invariant chain peptides via multiple mechanisms IMMUNOLOGY Rinderknecht, C. H., Roh, S., Pashine, A., Belmares, M. P., Patil, N. S., Lu, N., Truong, P., Hou, T., Macaubas, C., Yoon, T., Wang, N., Busch, R., Mellins, E. D. 2010; 131 (1): 18-32

  Abstract

  DM catalyses class II-associated invariant chain peptide (CLIP) release, edits the repertoire of peptides bound to major histocompatibility complex (MHC) class II molecules, affects class II structure, and thereby modulates binding of conformation-sensitive anti-class II antibodies. Here, we investigate the ability of DM to enhance the cell surface binding of monomorphic antibodies. We show that this enhancement reflects increases in cell surface class II expression and total cellular abundance, but notably these effects are selective for particular alleles. Evidence from analysis of cellular class II levels after cycloheximide treatment and from pulse-chase experiments indicates that DM increases the half-life of affected alleles. Unexpectedly, the pulse-chase experiments also revealed an early effect of DM on assembly of these alleles. The allelically variant feature that correlates with susceptibility to these DM effects is low affinity for CLIP; DM-dependent changes in abundance are reduced by invariant chain (CLIP) mutants that enhance CLIP binding to class II. We found evidence that DM mediates rescue of peptide-receptive DR0404 molecules from inactive forms in vitro and evidence suggesting that a similar process occurs in cells. Thus, multiple mechanisms, operating along the biosynthetic pathway of class II molecules, contribute to DM-mediated increases in the abundance of low-CLIP-affinity alleles.

  View details for DOI 10.1111/j.1365-2567.2010.03282.x

  View details for Web of Science ID 000280660800003

  View details for PubMedID 20408893

  View details for PubMedCentralID PMC2966754

• Macrophage activation syndrome: advances towards understanding pathogenesis CURRENT OPINION IN RHEUMATOLOGY Grom, A. A., Mellins, E. D. 2010; 22 (5): 561-566

  Abstract

  Macrophage activation syndrome (MAS), a major cause of morbidity and mortality in pediatric rheumatology, is most strongly associated with systemic juvenile idiopathic arthritis (SJIA). There are no validated diagnostic criteria and early diagnosis is difficult. This review summarizes the progress in understanding of MAS pathophysiology that may help define specific diagnostic biomarkers.MAS is similar to the autosomal recessive disorders collectively known as familial hemophagocytic lymphohistiocytosis (FHLH), all associated with various genetic defects affecting the cytolytic pathway. Cytolytic function is profoundly depressed in SJIA with MAS as well. This immunologic abnormality distinguishes SJIA from other rheumatic diseases and is caused by both genetic and acquired factors. Phenotypic characterization of hemophagocytic macrophages has been another focus of research. These macrophages express CD163, a scavenger receptor that binds hemoglobin-haptoglobin complexes, and initiate pathways important for adaptation to oxidative stress induced by free iron. Expansion of these macrophages is seen in more than 30% of SJIA patients perhaps representing early stages of MAS. Recent gene expression studies linked expansion of these macrophages to distinct signatures.Recent advances in understanding of pathophysiologic conditions that favor expansion of hemophagocytic macrophages provide a source of new MAS biomarkers with applicability to clinical practice.

  View details for DOI 10.1097/01.bor.0000381996.69261.71

  View details for Web of Science ID 000280457800015

  View details for PubMedID 20517154

• Monocytes are resistant to apoptosis in systemic juvenile idiopathic arthritis CLINICAL IMMUNOLOGY Srivastava, S., Macaubas, C., Deshpande, C., Alexander, H. C., Chang, S., Sun, Y., Park, J. L., Lee, T., Begovich, A., Mellins, E. D. 2010; 136 (2): 257-268

  Abstract

  We investigated whether circulating monocytes from patients with systemic juvenile idiopathic arthritis (SJIA) are resistant to apoptosis and which apoptotic pathway(s) may mediate this resistance. A microarray analysis of peripheral blood mononuclear cells (PBMC) of SJIA samples and RT-PCR analysis of isolated monocytes showed that monocytes from active SJIA patients express transcripts that imply resistance to apoptosis. SJIA monocytes incubated in low serum show reduced annexin binding and diminished FasL up-regulation compared to controls. SJIA monocytes are less susceptible to anti-Fas-induced apoptosis and, upon activation of the mitochondrial pathway with staurosporine, show diminished Bid cleavage and Bcl-w down-regulation compared to controls. Exposure to SJIA plasma reduces responses to apoptotic triggers in normal monocytes. Thus, SJIA monocytes are resistant to apoptosis due to alterations in both the extrinsic and intrinsic apoptosis pathways, and circulating factors associated with active SJIA may confer this phenotype.

  View details for DOI 10.1016/j.clim.2010.04.003

  View details for PubMedID 20462799

• I-A(g7) is subject to post-translational chaperoning by CLIP INTERNATIONAL IMMUNOLOGY Rinderknecht, C. H., Lu, N., Crespo, O., Truong, P., Hou, T., Wang, N., Rajasekaran, N., Mellins, E. D. 2010; 22 (8): 705-716

  Abstract

  Several MHC class II alleles linked with autoimmune diseases form unusually low-stability complexes with class II-associated invariant chain peptides (CLIP), leading us to hypothesize that this is an important feature contributing to autoimmune pathogenesis. We recently demonstrated a novel post-endoplasmic reticulum (ER) chaperoning role of the CLIP peptides for the murine class II allele I-E(d). In the current study, we tested the generality of this CLIP chaperone function using a series of invariant chain (Ii) mutants designed to have varying CLIP affinity for I-A(g7). In cells expressing these Ii CLIP mutants, I-A(g7) abundance, turnover and antigen presentation are all subject to regulation by CLIP affinity, similar to I-E(d). However, I-A(g7) undergoes much greater quantitative changes than observed for I-E(d). In addition, we find that Ii with a CLIP region optimized for I-A(g7) binding may be preferentially assembled with I-A(g7) even in the presence of higher levels of wild-type Ii. This finding indicates that, although other regions of Ii interact with class II, CLIP binding to the groove is likely to be a dominant event in assembly of nascent class II molecules with Ii in the ER.

  View details for DOI 10.1093/intimm/dxq056

  View details for Web of Science ID 000280281000009

  View details for PubMedID 20547545

  View details for PubMedCentralID PMC2908477

• Masking of a cathepsin G cleavage site in vivo contributes to the proteolytic resistance of major histocompatibility complex class II molecules IMMUNOLOGY Burster, T., Macmillan, H., Hou, T., Schilling, J., Truong, P., Boehm, B. O., Zou, F., Lau, K., Strohman, M., Schaffert, S., Busch, R., Mellins, E. D. 2010; 130 (3): 436-446

  Abstract

  The expression of major histocompatibility complex class II (MHC II) molecules is post-translationally regulated by endocytic protein turnover. Here, we identified the serine protease cathepsin G (CatG) as an MHC II-degrading protease by in vitro screening and examined its role in MHC II turnover in vivo. CatG, uniquely among endocytic proteases tested, initiated cleavage of detergent-solubilized native and recombinant soluble MHC II molecules. CatG cleaved human leukocyte antigen (HLA)-DR isolated from both HLA-DM-expressing and DM-null cells. Even following CatG cleavage, peptide binding was retained by pre-loaded, soluble recombinant HLA-DR. MHC II cleavage occurred on the loop between fx1 and fx2 of the membrane-proximal beta2 domain. All allelic variants of HLA-DR tested and murine I-A(g7) class II molecules were susceptible, whereas murine I-E(k) and HLA-DM were not, consistent with their altered sequence at the P1' position of the CatG cleavage site. CatG effects were reduced on HLA-DR molecules with DRB mutations in the region implicated in interaction with HLA-DM. In contrast, addition of CatG to intact B-lymphoblastoid cell lines (B-LCLs) did not cause degradation of membrane-bound MHC II. Moreover, inhibition or genetic ablation of CatG in primary antigen-presenting cells did not cause accumulation of MHC II molecules. Thus, in vivo, the CatG cleavage site is sterically inaccessible or masked by associated molecules. A combination of intrinsic and context-dependent proteolytic resistance may allow peptide capture by MHC II molecules in harshly proteolytic endocytic compartments, as well as persistent antigen presentation in acute inflammatory settings with extracellular proteolysis.

  View details for DOI 10.1111/j.1365-2567.2010.03247.x

  View details for Web of Science ID 000278619800014

  View details for PubMedID 20331476

  View details for PubMedCentralID PMC2913223

• Distribution of circulating cells in systemic juvenile idiopathic arthritis across disease activity states CLINICAL IMMUNOLOGY Macaubas, C., Nguyen, K., Deshpande, C., Phillips, C., Peck, A., Lee, T., Park, J. L., Sandborg, C., Mellins, E. D. 2010; 134 (2): 206-216

  Abstract

  Juvenile idiopathic arthritis (JIA) encompasses a group of chronic childhood arthritides of unknown etiology. One subtype, systemic JIA (SJIA), is characterized by a combination of arthritis and systemic inflammation. Its systemic nature suggests that clues to SJIA pathogenesis may be found in examination of peripheral blood cells. To determine the immunophenotypic profiles of circulating mononuclear cells in SJIA patients with different degrees of disease activity, we studied PBMC from 31 SJIA patients, 20 polyarticular JIA patients (similar to adult rheumatoid arthritis), and 31 age-matched controls. During SJIA disease flare, blood monocyte numbers were increased, whereas levels of myeloid dendritic cells (DC) and gammadelta T cells were reduced. At both flare and quiescence, increased levels of CD14 and CD16 were found on SJIA monocytes. Levels of CD16-DC were elevated at SJIA quiescence compared both to healthy controls and to SJIA subjects with active disease. Overall, our findings suggest dysregulation of innate immunity in SJIA and raise the possibility that quiescence represents a state of compensated inflammation.

  View details for DOI 10.1016/j.clim.2009.09.010

  View details for PubMedID 19879195

• Plasticity of T-cell phenotype and function: the T helper type 17 example IMMUNOLOGY Peck, A., Mellins, E. D. 2010; 129 (2): 147-153

  Abstract

  Mature T helper type 1 (Th1) and Th2 cells antagonize the development of the opposing subset to sustain lineage-specific responses. However, the recent identification of a third distinct subset of helper T cells - the Th17 lineage - collapses the established Th1/Th2 dichotomy and raises intriguing questions about T-cell fate. In this review, we discuss the Th17 subset in the context of the effector and regulatory T-cell lineages. Initial studies suggested reciprocal developmental pathways between Th17/Th1 subsets and between Th17/regulatory T-cell subsets, and identified multiple mechanisms by which Th1 and Th2 cells antagonize the generation of Th17 cells. However, recent observations reveal the susceptibility of differentiated Th17 cells to Th1 polarization and the enhancement of Th17 memory cells by the Th1 factors interferon-gamma and T-bet. In addition, new data indicate late-stage plasticity of a subpopulation of regulatory T cells, which can be selectively induced to adopt a Th17 phenotype. Elucidating the mechanisms that undermine cross-lineage suppression and facilitate these phenotype shifts will not only clarify the flexibility of T-cell differentiation, but may also shed insight into the pathogenesis of autoimmunity and cancer. Furthermore, understanding these phenomena will be critical for the design of immunotherapy that seeks to disrupt lineage-specific T-cell responses and may suggest ways to manipulate the balance between pathogenic and regulatory lymphocytes for the restoration of homeostasis.

  View details for DOI 10.1111/j.1365-2567.2009.03189.x

  View details for Web of Science ID 000273458000001

  View details for PubMedID 19922424

  View details for PubMedCentralID PMC2814457

• URINE PEPTIDOMICS FOR CLINICAL BIOMARKER DISCOVERY ADVANCES IN CLINICAL CHEMISTRY, VOL 51 Ling, X. B., Mellins, E. D., Sylvester, K. G., Cohen, H. J. 2010; 51: 181-213

  Abstract

  Urine-based proteomic profiling is a novel approach that may result in the discovery of noninvasive biomarkers for diagnosing patients with different diseases, with the aim to ultimately improve clinical outcomes. Given new and emerging analytical technologies and data mining algorithms, the urine peptidome has become a rich resource to uncover naturally occurring peptide biomarkers for both systemic and renal diseases. However, significant analytical hurdles remain in sample collection and storage, experimental design, data analysis, and statistical inference. This study summarizes, focusing on our experiences and perspectives, the progress in addressing these challenges to enable high-throughput urine peptidomics-based biomarker discovery.

  View details for DOI 10.1016/S0065-2423(10)51007-2

  View details for Web of Science ID 000281865700007

  View details for PubMedID 20857622

• Cathepsin G: Roles in antigen presentation and beyond MOLECULAR IMMUNOLOGY Burster, T., Macmillan, H., Hou, T., Boehm, B. O., Mellins, E. D. 2010; 47 (4): 658-665

  Abstract

  Contributions from multiple cathepsins within endosomal antigen processing compartments are necessary to process antigenic proteins into antigenic peptides. Cysteine and aspartyl cathepsins have been known to digest antigenic proteins. A role for the serine protease, cathepsin G (CatG), in this process has been described only recently, although CatG has long been known to be a granule-associated proteolytic enzyme of neutrophils. In line with a role for this enzyme in antigen presentation, CatG is found in endocytic compartments of a variety of antigen presenting cells. CatG is found in primary human monocytes, B cells, myeloid dendritic cells 1 (mDC1), mDC2, plasmacytoid DC (pDC), and murine microglia, but is not expressed in B cell lines or monocyte-derived DC. Purified CatG can be internalized into endocytic compartments in CatG non-expressing cells, widening the range of cells where this enzyme may play a role in antigen processing. Functional assays have implicated CatG as a critical enzyme in processing of several antigens and autoantigens. In this review, historical and recent data on CatG expression, distribution, function and involvement in disease will be summarized and discussed, with a focus on its role in antigen presentation and immune-related events.

  View details for DOI 10.1016/j.molimm.2009.10.003

  View details for Web of Science ID 000274507400004

  View details for PubMedID 19910052

• Precarious Balance: Th17 Cells in Host Defense INFECTION AND IMMUNITY Peck, A., Mellins, E. D. 2010; 78 (1): 32-38

  Abstract

  Lineage-specific responses from the effector T-cell repertoire form a critical component of adaptive immunity. The recent identification of Th17 cells-a third, distinct lineage of helper T cells-collapses the long-accepted paradigm in which Th1 and Th2 cells distinctly mediate cellular and humoral immunity, respectively. In this minireview, we discuss the involvement of the Th17 lineage during infection by extracellular bacteria, intracellular bacteria, and fungi. Emerging trends suggest that the Th17 population bridges innate and adaptive immunity to produce a robust antimicrobial inflammatory response. However, because Th17 cells mediate both host defense and pathological inflammation, elucidation of mechanisms that attenuate but do not completely abolish the Th17 response may have powerful implications for therapy.

  View details for DOI 10.1128/IAI.00929-09

  View details for Web of Science ID 000272984300002

  View details for PubMedID 19901061

  View details for PubMedCentralID PMC2798221

• Oligoarticular and polyarticular JIA: epidemiology and pathogenesis NATURE REVIEWS RHEUMATOLOGY Macaubas, C., Nguyen, K., Milojevic, D., Park, J. L., Mellins, E. D. 2009; 5 (11): 616-626

  Abstract

  Juvenile idiopathic arthritis (JIA) refers to a group of chronic childhood arthropathies of unknown etiology, currently classified into subtypes primarily on the basis of clinical features. Research has focused on the hypothesis that these subtypes arise through distinct etiologic pathways. In this Review, we discuss four subtypes of JIA: persistent oligoarticular, extended oligoarticular, rheumatoid-factor-positive polyarticular and rheumatoid-factor-negative polyarticular. These subtypes differ in prevalence between ethnic groups and are associated with different HLA alleles. Non-HLA genetic risk factors have also been identified, some of which reveal further molecular differences between these subtypes, while others suggest mechanistic overlap. Investigations of immunophenotypes also provide insights into subtype differences: adaptive immunity seems to have a prominent role in both polyarticular and oligoarticular JIA, and the more-limited arthritis observed in persistent oligoarticular JIA as compared with extended oligoarticular JIA may reflect more-potent immunoregulatory T-cell activity in the former. Tumor necrosis factor seems to be a key mediator of both polyarticular and oligoarticular JIA, especially in the extended oligoarticular subtype, although elevated levels of other cytokines are also observed. Limited data on monocytes, dendritic cells, B cells, natural killer T cells and neutrophils suggest that the contributions of these cells differ across subtypes of JIA. Within each subtype, however, common pathways seem to drive joint damage.

  View details for DOI 10.1038/nrrheum.2009.209

  View details for Web of Science ID 000271246900007

  View details for PubMedID 19806151

• Breaking old paradigms: Th17 cells in autoimmune arthritis CLINICAL IMMUNOLOGY Peck, A., Mellins, E. D. 2009; 132 (3): 295-304

  Abstract

  Aberrant helper T cell activation has been implicated in the pathogenesis of an array of autoimmune diseases. In this review, we summarize evidence that suggests the involvement of a novel T cell subset, the Th17 lineage, in rheumatoid arthritis. In particular, we focus on the role of Th17 cells in inducing and perpetuating the chronic inflammation, cartilage damage, and bone erosion that are hallmark phases of joint destruction and consider current and emerging therapies that seek to disrupt the inflammatory Th17 network and shift the immune system back towards homeostasis.

  View details for DOI 10.1016/j.clim.2009.03.522

  View details for Web of Science ID 000268783900001

  View details for PubMedID 19403336

  View details for PubMedCentralID PMC2720426

• Complexes of two cohorts of CLIP peptides and HLA-DQ2 of the autoimmune DR3-DQ2 haplotype are poor substrates for HLA-DM JOURNAL OF IMMUNOLOGY Fallang, L., Roh, S., Holm, A., Bergseng, E., Yoon, T., Fleckenstein, B., Bandyopadhyay, A., Mellins, E. D., Sollid, L. M. 2008; 181 (8): 5451-5461

  Abstract

  Atypical invariant chain (Ii) CLIP fragments (CLIP2) have been found in association with HLA-DQ2 (DQ2) purified from cell lysates. We mapped the binding register of CLIP2 (Ii 96-104) to DQ2 and found proline at the P1 position, in contrast to the canonical CLIP1 (Ii 83-101) register with methionine at P1. CLIP1/2 peptides are the predominant peptide species, even for DQ2 from HLA-DM (DM)-expressing cells. We hypothesized that DQ2-CLIP1/2 might be poor substrates for DM. We measured DM-mediated exchange of CLIP and other peptides for high-affinity indicator peptides and found it is inefficient for DQ2. DM-DQ-binding and DM chaperone effects on conformation and levels of DQ are also reduced for DQ2, compared with DQ1. We suggest that the unusual interaction of DQ2 with Ii and DM may provide a basis for the known disease associations of DQ2.

  View details for Web of Science ID 000260025300037

  View details for PubMedID 18832702

• Modulation of Peripheral B Cell Tolerance by CD72 in a Murine Model ARTHRITIS AND RHEUMATISM Li, D. H., Winslow, M. M., Cao, T. M., Chen, A. H., Davis, C. R., Mellins, E. D., Utz, P. J., Crabtree, G. R., Parnes, J. R. 2008; 58 (10): 3192-3204

  Abstract

  B cells play a dominant role in the pathogenesis of several autoimmune diseases, including systemic lupus erythematosus. It is not well understood how B cell signaling contributes to autoantibody production. The goal of this study was to elucidate the role of CD72 in modulating B cell receptor (BCR)-mediated tolerogenic signaling and peripheral B cell tolerance.A mouse model utilizing hen egg lysozyme (HEL) "anergic" B cells was studied. CD72-deficient mice carrying the BCR-specific IgHEL and/or soluble HEL (sHEL) transgenes were generated by breeding IgHEL-transgenic MD4 mice and/or sHEL-transgenic ML5 mice with congenic, CD72-deficient C57BL/6J mice. Normal and anergic B cells were isolated for analyses of B cell signaling. Aged wild-type and CD72-deficient mice were also examined for autoimmune phenomena.In the absence of CD72, anergic B cells inappropriately proliferated and survived in response to stimulation with self antigen. Biochemical analyses indicated that in anergic B cells, CD72 dominantly down-regulated BCR signaling to limit the antigen-induced elevation in [Ca2+]i and the activation of NFATc1, NF-kappaB, MAPK, and Akt. Mechanistically, CD72 was associated with, and regulated, the molecular adaptor Cbl-b in anergic B cells, suggesting that Cbl-b may play a role in mediating the negative effects of CD72 on BCR signaling. Moreover, in aged CD72-deficient mice, spontaneous production of antinuclear and anti-double-stranded DNA autoantibodies and features of lupus-like autoimmune disease were observed.CD72 is required to maintain B cell anergy and functions as a regulator of peripheral B cell tolerance. Thus, altered CD72 expression may play a role during the development of systemic lupus erythematosus.

  View details for DOI 10.1002/art.23812

  View details for Web of Science ID 000260024400029

  View details for PubMedID 18821699

  View details for PubMedCentralID PMC2790383

• Reduced levels of FasL and apoptosis resistance in SJIA monocytes 8th Annual Meeting of the Federation-of-Clinical-Immunology-Societies Srivastava, S., Macaubas, C., Lee, T., Sandborg, C., Mellins, E. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2008: S93–S93

  View details for DOI 10.1016/j.clim.2008.03.260

  View details for Web of Science ID 000255533200265

• Posttranslational regulation of I-E-d by affinity for CLIP JOURNAL OF IMMUNOLOGY Rinderknecht, C. H., Belmares, M. P., Catanzarite, T. L., Bankovich, A. J., Holmes, T. H., Garcia, K. C., Nanda, N. K., Busch, R., Kovats, S., Mellins, E. D. 2007; 179 (9): 5907-5915

  Abstract

  Several MHC class II alleles linked with autoimmune diseases form unusually low stability complexes with CLIP, leading us to hypothesize that this is an important feature contributing to autoimmune pathogenesis. To investigate cellular consequences of altering class II/CLIP affinity, we evaluated invariant chain (Ii) mutants with varying CLIP affinity for a mouse class II allele, I-E(d), which has low affinity for wild-type CLIP and is associated with a mouse model of spontaneous, autoimmune joint inflammation. Increasing CLIP affinity for I-E(d) resulted in increased cell surface and total cellular abundance and half-life of I-E(d). This reveals a post-endoplasmic reticulum chaperoning capacity of Ii via its CLIP peptides. Quantitative effects on I-E(d) were less pronounced in DM-expressing cells, suggesting complementary chaperoning effects mediated by Ii and DM, and implying that the impact of allelic variation in CLIP affinity on immune responses will be highest in cells with limited DM activity. Differences in the ability of cell lines expressing wild-type or high-CLIP-affinity mutant Ii to present Ag to T cells suggest a model in which increased CLIP affinity for class II serves to restrict peptide loading to DM-containing compartments, ensuring proper editing of antigenic peptides.

  View details for Web of Science ID 000250388000035

  View details for PubMedID 17947664

• Abnormal interaction of autoimmune associated HLA-DQ2 molecule with invariant chain and HLA-DM Fallang, L., Roh, S., Holm, A., Bandyopadhyay, A., Bergseng, E., Fleckenstein, B., Mellins, E. D., Sollid, L. M. BLACKWELL PUBLISHING. 2007: 595

  View details for Web of Science ID 000246713700030

• Influenza A virus elevates active cathepsin B in primary murine DC INTERNATIONAL IMMUNOLOGY Burster, T., Giffon, T., Dahl, M. E., Bjorck, P., Bogy, M., Weber, E., Mahmood, K., Lewis, D. B., Mellins, E. D. 2007; 19 (5): 645-655

  Abstract

  Dendritic cells (DCs) act as a first-line recognition system for invading pathogens, such as influenza A. The interaction of DC with influenza A virus results in DC activation via endosomal Toll-like receptors and also leads to presentation of viral peptides on MHC class II molecules. Prior work demonstrated that influenza A virus (A/HKx31; H3N2) infection of BALB/c mice activates lung DCs for antigen presentation, and that the enhanced function of these cells persists long after viral clearance and resolution of the virus-induced inflammatory response. Whether influenza A virus has acute or longer-lasting effects on the endo/lysosomal antigen-processing machinery of DCs has not been studied. Here, we show that antigen presentation from intact protein antigen, but not peptide presentation, results in increased T cell stimulation by influenza-exposed lung DCs, suggesting increased antigen processing/loading in these DCs. We find that cathepsin (Cat) B levels and activity are substantially up-regulated in murine lung DCs, harvested 30 days after A/HKx31 infection. CatB levels and activity are also increased in murine splenic and bone marrow-derived DCs, following short-term in vitro exposure to UV-inactivated influenza A virus. Modest effects on CatX are also seen during in vivo and in vitro exposure to influenza A virus. Using a cell permeable Cat inhibitor, we show Cats in influenza-exposed DCs to be functional and required for generation of a T cell epitope from intact ovalbumin. Our findings indicate that influenza A virus affects the MHC class II antigen-processing pathway, an essential pathway for CD4(+) T cell activation.

  View details for DOI 10.1093/intimm/dxm030

  View details for Web of Science ID 000246964500007

  View details for PubMedID 17446210

• Clinical research networks: a step towards evidence-based practice in pediatric rheumatology NATURE CLINICAL PRACTICE RHEUMATOLOGY Mellins, E. D., Rider, L. G. 2007; 3 (2): 59-59

  View details for DOI 10.1038/ncprheum0405

  View details for Web of Science ID 000243966500001

  View details for PubMedID 17299440

• Distinct molecular and cellular aspects of systemic juvenile idiopathic arthritis (SJIA) and polyarticular (PolyJIA) 7th Annual Meeting of the Federation-of-Clinical-Immunology-Societies Macaubas, C., Nguyen, K., Pan, K., Lee, T., Deshpande, C., Sandborg, C., Cohen, S., Mellins, E. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2007: S94–S95

  View details for DOI 10.1016/j.clim.2007.03.450

  View details for Web of Science ID 000247137200246

• Effects of class II/CLIP affinity on the class II antigen presentation pathway in the context of autoimmunity Rinderknecht, C., Catanzarite, T., Belmares, M., Mellins, E., Kovats, S. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2007: S119–S120

  View details for DOI 10.1016/j.clim.2007.03.519

  View details for Web of Science ID 000247137200312

• Candidate early predictors for progression to joint damage in systemic juvenile idiopathic arthritis JOURNAL OF RHEUMATOLOGY Sandborg, C., Holmes, T. H., Lee, T., Biederman, K., Bloch, D. A., Emery, H., McCurdy, D., Mellins, E. D. 2006; 33 (11): 2322-2329

  Abstract

  To assess if joint damage at 2 years after diagnosis in patients with systemic juvenile idiopathic arthritis (SJIA) can be predicted by clinical or laboratory features assessed up to 3 or 6 months after diagnosis.Medical records from 70 children were retrospectively reviewed. The primary outcome measure was presence of joint damage at 2 years after diagnosis (JD2) as defined by presence of erosions or fusion in one or more joints. Potential predictor variables for JD2 in the first 3 and 6 months after diagnosis consisted of the highest observed white blood cell count, platelet count, erythrocyte sedimentation rate, active joint count, and presence of symptomatic pulmonary or cardiac disease or macrophage activation syndrome, and treatment data.The outcome of interest, JD2, was identified in 15/70 patients. Classification-tree analysis identified a pair of variables (highest observed platelet count and number of active joints) measured within the first 3 months after diagnosis that together predicted progression to JD2 with an estimated sensitivity of 87%, specificity of 82%, and positive predictive value of 57%. Multivariate logistic regression analyses at 3 months found that higher quantities of joints with active arthritis and early use of methotrexate (MTX) were factors significantly associated with increased odds of progression to JD2 (active joints odds ratio = 1.08, 95% CI 1.00-1.16, p = 0.04; MTX OR = 11.85, 95% CI 1.89-74.26, p = 0.01). Unsupervised cluster analysis identified 2 major phenotypes of patients at 3 months characterized by different ages at onset, acute phase markers, active joint counts, and presence of serositis. These phenotypes differed 3-fold in proportion of subjects progressing to JD2 (p < 0.05).By 3 months after diagnosis, a clinical phenotype based on active joint count and platelet count may be prognostic of an increased risk of progression to JD2. Use of corticosteroids did not appear to change the risk of joint damage. In contrast, the presence of serositis appeared to be associated with decreased risk of joint damage.

  View details for PubMedID 16960920

• Human cytomegalovirus alters localization of MHC class II and dendrite morphology in mature Langerhans cells JOURNAL OF IMMUNOLOGY Lee, A. W., Hertel, L., Louie, R. K., Burster, T., Lacaille, V., Pashine, A., Abate, D. A., Mocarski, E. S., Mellins, E. D. 2006; 177 (6): 3960-3971

  Abstract

  Hemopoietic stem cell-derived mature Langerhans-type dendritic cells (LC) are susceptible to productive infection by human CMV (HCMV). To investigate the impact of infection on this cell type, we examined HLA-DR biosynthesis and trafficking in mature LC cultures exposed to HCMV. We found decreased surface HLA-DR levels in viral Ag-positive as well as in Ag-negative mature LC. Inhibition of HLA-DR was independent of expression of unique short US2-US11 region gene products by HCMV. Indeed, exposure to UV-inactivated virus, but not to conditioned medium from infected cells, was sufficient to reduce HLA-DR on mature LC, implicating particle binding/penetration in this effect. Reduced surface levels reflected an altered distribution of HLA-DR because total cellular HLA-DR was not diminished. Accumulation of HLA-DR was not explained by altered cathepsin S activity. Mature, peptide-loaded HLA-DR molecules were retained within cells, as assessed by the proportion of SDS-stable HLA-DR dimers. A block in egress was implicated, as endocytosis of surface HLA-DR was not increased. Immunofluorescence microscopy corroborated the intracellular retention of HLA-DR and revealed markedly fewer HLA-DR-positive dendritic projections in infected mature LC. Unexpectedly, light microscopic analyses showed a dramatic loss of the dendrites themselves and immunofluorescence revealed that cytoskeletal elements crucial for the formation and maintenance of dendrites are disrupted in viral Ag-positive cells. Consistent with these dendrite effects, HCMV-infected mature LC exhibit markedly reduced chemotaxis in response to lymphoid chemokines. Thus, HCMV impedes MHC class II molecule trafficking, dendritic projections, and migration of mature LC. These changes likely contribute to the reduced activation of CD4+ T cells by HCMV-infected mature LC.

  View details for Web of Science ID 000240475300052

  View details for PubMedID 16951359

• Medicine on a need-to-know basis NATURE IMMUNOLOGY Busch, R., Byrne, B., Gandrud, L., Sears, D., Meyer, E., Kattah, M., Kurihara, C., Haertel, E., Parnes, J. R., Mellins, E. D. 2006; 7 (6): 543-547

  Abstract

  Disease-oriented, introductory medical curricula can help overcome educational and institutional barriers that separate aspiring translational scientists in PhD programs from the world of medicine.

  View details for Web of Science ID 000237751200004

  View details for PubMedID 16715061

• Human dendritic cell expression of HLA-DO is subset-specific and regulated by maturation Annual Meeting of the American-Association-of-Immunologists Hornell, T. M., Burster, T., Jahnsen, F. L., Pashine, A., Ochoa, M. T., Harding, J. J., Macaubas, C., Lee, A., Modlin, R. L., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2006: S49–S49

  View details for Web of Science ID 000238837100226

• HLA-DM influences abundance of a subset of HLA class II alleles Roh, S., Rinderknecht, C., Pashine, A., Patil, N., Belmares, M., Busch, R., McConnell, H., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2006: S53–S54

  View details for Web of Science ID 000238837100247

• Effects of class II/CLIP affinity on the class II antigen presentation pathway Rinderknecht, C., Catanzarite, T., Belmares, M., Mellins, E. AMER ASSOC IMMUNOLOGISTS. 2006: S54

  View details for Web of Science ID 000238837100248

• Human dendritic cell expression of HLA-DO is subset specific and regulated by maturation JOURNAL OF IMMUNOLOGY Hornell, T. M., Burster, T., Jahnsen, F. L., Pashine, A., Ochoa, M. T., Harding, J. J., Macaubas, C., Lee, A. W., Modlin, R. L., Mellins, E. D. 2006; 176 (6): 3536-3547

  Abstract

  Expression of HLA-DO (DO) in cells that express HLA-DM (DM) results in an altered repertoire of MHC class II/peptide complexes, indicating that DO modulates DM function. Human and murine B cells and thymic epithelial cells express DO, while monocytes/macrophages do not. Monocyte-derived dendritic cells (DC) also have been found to be DO-negative, leading to the assumption that DC do not express DO. In this study, we report that, in fact, certain types of human primary DC express DO. These include Langerhans cells (LC) and some subtypes of circulating blood DC. Specifically, the majority of BDCA-3(+) DC, a small subset of uncertain function, are DO(+), while smaller proportions of CD11c(+), BDCA-1(+) (myeloid) DC, at most a minority of CD123(+)/BDCA-2(+) (plasmacytoid) DC, and no detectable CD16(+) (myeloid) DC, express DO. Immunohistochemistry of human tonsil sections demonstrates that tonsillar interdigitating DC are also DO(+). In a subset of immature LC with higher DO expression, an increased fraction of surface DR molecules carry CLIP peptides, indicating that DO functions as a DM inhibitor in these cells. LC expression of DO is down-regulated by maturation stimuli. DM levels also decrease under these conditions, but the DM:DO ratio generally increases. In the myeloid cell types tested, DO expression correlates with levels of DObeta, but not DOalpha, implying that modulation of DObeta regulates DO dimer abundance in these cells. The range of APC types shown to express DO suggests a broader role for DO in immune function than previously appreciated.

  View details for PubMedID 16517722

• Human cytomegalovirus alters localization of MHC class II and dendrite morphology in mature Langerhans cells. 6th Annual Meeting of the Federation-of-Clinical-Immunology-Societies Lee, A., Hertel, L., Louie, R., Burster, T., Lacaille, V., Pashine, A., Abate, D., Mocarski, E., Mellins, E. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2006: S22–S23

  View details for DOI 10.1016/j.clim.2006.04.206

  View details for Web of Science ID 000237924300051

• Gene expression profiling of peripheral blood mononuclear cells (PBMC) from SJIA patients. 6th Annual Meeting of the Federation-of-Clinical-Immunology-Societies Deshpande, C., Sun, Y., Mocaubas, C., Alexander, H., Pan, K., Lee, T., Chang, S., Lih, C., Lin, R., Sandborg, C., Tibshirani, R., Begovich, A. B., Cohen, S., Mellins, E. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2006: S68–S68

  View details for DOI 10.1016/j.clim.2006.04.090

  View details for Web of Science ID 000237924300172

• Diagnostic and prognostic biomarkers in systemic juvenile idiopathic arthritis. 6th Annual Meeting of the Federation-of-Clinical-Immunology-Societies Park, J., Carroll, T., Lau, K., Lee, T., Sandborg, C., Schilling, J., Mellins, E. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2006: S71–S71

  View details for DOI 10.1016/j.clim.2006.04.099

  View details for Web of Science ID 000237924300181

• Differential expression of immune parameters in systemic juvenile idiopathic arthritis (SJIA) flare and quiescence. 6th Annual Meeting of the Federation-of-Clinical-Immunology-Societies Nguyen, K., Macaubas, C., Deshpande, C., Lee, T., Sandborg, C., Mellins, E. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2006: S72–S72

  View details for DOI 10.1016/j.clim.2006.04.100

  View details for Web of Science ID 000237924300182

• Achieving stability through editing and chaperoning: regulation of MHC class II peptide binding and expression IMMUNOLOGICAL REVIEWS Busch, R., Rinderknecht, C. H., Roh, S., Lee, A. W., Harding, J. J., Burster, T., Hornell, T. M., Mellins, E. D. 2005; 207: 242-260

  Abstract

  In antigen-presenting cells (APCs), loading of major histocompatibility complex class II (MHC II) molecules with peptides is regulated by invariant chain (Ii), which blocks MHC II antigen-binding sites in pre-endosomal compartments. Several molecules then act upon MHC II molecules in endosomes to facilitate peptide loading: Ii-degrading proteases, the peptide exchange factor, human leukocyte antigen-DM (HLA-DM), and its modulator, HLA-DO (DO). Here, we review our findings arguing that DM stabilizes a globally altered conformation of the antigen-binding groove by binding to a lateral surface of the MHC II molecule. Our data imply changes in the interactions between specificity pockets and peptide side chains, complementing data from others that suggest DM affects hydrogen bonds. Selective weakening of peptide/MHC interactions allows DM to alter the peptide repertoire. We also review our studies in cells that highlight the ability of several factors to modulate surface expression of MHC II molecules via post-Golgi mechanisms; these factors include MHC class II-associated Ii peptides (CLIP), DM, and microbial products that modulate MHC II traffic from endosomes to the plasma membrane. In this context, we discuss possible mechanisms by which the association of some MHC II alleles with autoimmune diseases may be linked to their low CLIP affinity.

  View details for PubMedID 16181341

• Selective developmental defects of cord blood antigen-presenting cell subsets HUMAN IMMUNOLOGY Drohan, L., Harding, J. J., Holm, B., Cordoba-Tongson, E., Dekker, C. L., Holmes, T., Maecker, H., Mellins, E. D. 2004; 65 (11): 1356-1369

  Abstract

  Defective antigen-presenting cell (APC) function has been hypothesized to contribute to increased infection susceptibility in newborns. We used multiparameter flow cytometry to characterize APC subsets in adult peripheral blood (APB) and cord blood (CB). APB had a higher proportion of CD11c+ dendritic cells (DC), whereas CB mainly contained CD123+ DC. APB was enriched in CD16+CD11c+ DC subset, whereas CD34+CD11c-CD123lo cells were prominent in CB. Lipopolysaccharide (LPS)-induced tumor necrosis factor (TNF)-alpha production was dampened in myeloid DC and monocytes from CB, whereas IL-1alpha production was not different. The reduction in TNF-alpha response did not appear to result from reduced surface detection of LPS, because CD14, toll-like receptor (TLR)-4 and TLR-2 levels were not reduced in CB APC compared with APB cells. Also, there was no correlation between TLR-2 or TLR-4 levels and TNF-alpha production in myeloid DC and monocytes. CB monocytes had lower surface HLA-DR immediately ex vivo. Both APB and CB monocytes upregulated HLA-DR after incubation, but an additional LPS-induced increase in HLA-DR was suggested only in APB monocytes. APB monocytes also showed a greater LPS-induced increase in CD40 expression. Together, our data show significant, selective differences in circulating APC between neonates and adults.

  View details for DOI 10.1016/j.humimm.2004.09.011

  View details for Web of Science ID 000225728800010

  View details for PubMedID 15556686

• Cord blood antigen presenting cells show selective deficits in inflammatory responses Annual Meeting of the Pediatric-Academic-Societies Drohan, L., Holm, B., Holmes, T., Tongson, E. C., Dekker, C., Maecker, H., Mellins, E. NATURE PUBLISHING GROUP. 2004: 390A–390A

  View details for Web of Science ID 000220591102285

• Defective TNF response to LPS stimulation by neonatal monocytes and dendritic cells does not correlate with toll-like receptor 2 and 4 surface expression Harding, J. J., Drohan, L., Mellins, E. D. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2004: 390A

  View details for Web of Science ID 000220591102286

• Bordetella pertussis infection of primary human monocytes alters HLA-DR expression INFECTION AND IMMUNITY Shumilla, J. A., Lacaille, V., Hornell, T. M., Huang, J., Narasimhan, S., Relman, D. A., Mellins, E. D. 2004; 72 (3): 1450-1462

  Abstract

  Bordetella pertussis is the causative agent of whooping cough, a potentially lethal respiratory disease in children. In immunocompetent individuals, B. pertussis infection elicits an effective adaptive immune response driven by activated CD4(+) T cells. However, live B. pertussis persists in the host for 3 to 4 weeks prior to clearance. Thus, B. pertussis appears to have evolved short-term mechanisms for immune system evasion. We investigated the effects of B. pertussis wild-type strain BP338 on antigen presentation in primary human monocytes. BP338 infection reduced cell surface expression of HLA-DR and CD86 but not that of major histocompatibility complex class I proteins. This change in cell surface HLA-DR expression reflected intracellular redistribution of HLA-DR. The proportion of peptide-loaded molecules was unchanged in infected cells, suggesting that intracellular retention occurred after peptide loading. Although B. pertussis infection of monocytes induced rapid and robust expression of interleukin-10 (IL-10), HLA-DR redistribution did not appear to be explained by increased IL-10 levels. BP338-infected monocytes exhibited reduced synthesis of HLA-DR dimers. Interestingly, those HLA-DR proteins that were generated appeared to be longer-lived than HLA-DR in uninfected monocytes. BP338 infection also prevented gamma interferon (IFN-gamma) induction of HLA-DR protein synthesis. Using mutant strains of B. pertussis, we found that reduction in HLA-DR surface expression was due in part to the presence of pertussis toxin whereas the inhibition of IFN-gamma induction of HLA-DR could not be linked to any of the virulence factors tested. These data demonstrate that B. pertussis utilizes several mechanisms to modulate HLA-DR expression.

  View details for DOI 10.1128/IAI.72.3.145-1462.2004

  View details for Web of Science ID 000189270800029

  View details for PubMedID 14977950

  View details for PubMedCentralID PMC356037

• Regulation of the class II MHC pathway in primary human monocytes by granulocyte-macrophage colony-stimulating factor JOURNAL OF IMMUNOLOGY Hornell, T. M., Beresford, G. W., Bushey, A., Boss, J. M., Mellins, E. D. 2003; 171 (5): 2374-2383

  Abstract

  GM-CSF stimulates the growth and differentiation of hematopoietic progenitors and also affects mature cell function. These effects have led to the use of GM-CSF as a vaccine adjuvant with promising results; however, the mechanisms underlying GM-CSF-mediated immune potentiation are incompletely understood. In this study, we investigated the hypothesis that the immune stimulatory role of GM-CSF is in part due to effects on class II MHC Ag presentation. We find that, in primary human monocytes treated for 24-48 h, GM-CSF increases surface class II MHC expression and decreases the relative level of the invariant chain-derived peptide, CLIP, bound to surface class II molecules. GM-CSF also increases expression of the costimulatory molecules CD86 and CD40, but not the differentiation marker CD1a or CD16. Furthermore, GM-CSF-treated monocytes are better stimulators in a mixed leukocyte reaction. Additional analyses of the class II pathway revealed that GM-CSF increases total protein and RNA levels of HLA-DR, DM, and DOalpha. Expression of class II transactivator (CIITA) types I and III, but not IV, transcripts increases in response to GM-CSF. Furthermore, GM-CSF increases the amount of CIITA associated with the DR promoter. Thus, our data argue that the proinflammatory role of GM-CSF is mediated in part through increased expression of key molecules involved in the class II MHC pathway via induction of CIITA.

  View details for Web of Science ID 000184970900025

  View details for PubMedID 12928384

• Interaction of HLA-DR with an acidic face of HLA-DM disrupts sequence-dependent interactions with peptides IMMUNITY Pashine, A., Busch, R., Belmares, M. P., Munning, J. N., Doebele, R. C., Buckingham, M., Nolan, G. P., Mellins, E. D. 2003; 19 (2): 183-192

  Abstract

  HLA-DM (DM) edits major histocompatibility complex class II (MHCII)-bound peptides in endocytic compartments and stabilizes empty MHCII molecules. Crystal structures of DM have revealed similarity to MHCII but not how DM and MHCII interact. We used mutagenesis to map a MHCII-interacting surface on DM. Mutations on this surface impair DM action on HLA-DR and -DP in cells and DM-dependent peptide loading in vitro. The orientation of DM and MHCII predicted by these studies guided design of soluble DM and DR molecules fused to leucine zippers via their beta chains, resulting in stable DM/DR complexes. Peptide release from the complexes was fast and only weakly sequence dependent, arguing that DM diminishes the selectivity of the MHCII groove. Analysis of soluble DM action on soluble DR/peptide complexes corroborates this conclusion.

  View details for Web of Science ID 000184929000006

  View details for PubMedID 12932352

• Cytokines elicited by synovial T cell epitopes from a autoantigen - Altered peptide ligands can reduce interferon-gamma and interleukin-10 production ARTHRITIS AND RHEUMATISM Hall, F. C., Visconti, K. C., Ahmad, R. C., Parry, S. L., Miltenburg, A. M., McConnell, H. M., Mellins, E. D., Sonderstrup, G. 2003; 48 (8): 2375-2385

  Abstract

  To explore the cytokine responses associated with T cell epitopes from human cartilage glycoprotein 39 (HC gp-39) and the potential for modifying cytokine secretion using altered peptide ligands (APLs).Draining lymph node cells were harvested from HLA-DR*0401 transgenic mice that had been immunized with HC gp-39. Cytokine responses to 5 previously identified HLA-DR*0401-restricted HC gp-39 T cell epitopes were studied in vitro. The anchor and T cell receptor (TCR) contact residues of peptide 322-337 were identified, and this information was used to design alanine-substituted APLs. T cells were primed in vivo with wild-type peptide 322-337, restimulated with wild-type peptide or APLs, and the cytokine profiles were compared.Restimulation with individual peptides elicited distinct cytokine profiles. HC gp-39 (peptide 322-337) elicited a dominant interferon-gamma (IFNgamma) response. Residues within the core (positions P1-P9) 322-337 peptide sequence were critical for T cell recognition. Surprisingly, the N-terminal flanking region was also important for recognition by 6 of 10 specific T cell hybridomas. Substitutions of charged TCR contact residues in the 322-337 core epitope (E332A and K335A) were associated with a significant reduction in the IFNgamma and interleukin-10 (IL-10) stimulation indices. Restimulation with peptides W325A and V326A was also associated with a trend toward reduced IFNgamma and IL-10 secretion. In contrast, restimulation with peptide D330N elicited cytokine profiles more comparable with those resulting from restimulation with wild-type peptide.This study indicates that APLs of a proinflammatory HC gp-39 T cell epitope may be used to alter the cytokine response from a memory T cell population.

  View details for DOI 10.1002/art.11132

  View details for Web of Science ID 000184585000035

• Cytokines elicited by T cell epitopes from a synovial autoantigen: altered peptide ligands can reduce interferon-gamma and interleukin-10 production. Arthritis and rheumatism Hall, F. C., Visconti, K. C., Ahmad, R., Parry, S. L., Miltenburg, A. M., McConnell, H. M., Mellins, E. D., Sønderstrup, G. 2003; 48 (8): 2375-2385

  Abstract

  To explore the cytokine responses associated with T cell epitopes from human cartilage glycoprotein 39 (HC gp-39) and the potential for modifying cytokine secretion using altered peptide ligands (APLs).Draining lymph node cells were harvested from HLA-DR*0401 transgenic mice that had been immunized with HC gp-39. Cytokine responses to 5 previously identified HLA-DR*0401-restricted HC gp-39 T cell epitopes were studied in vitro. The anchor and T cell receptor (TCR) contact residues of peptide 322-337 were identified, and this information was used to design alanine-substituted APLs. T cells were primed in vivo with wild-type peptide 322-337, restimulated with wild-type peptide or APLs, and the cytokine profiles were compared.Restimulation with individual peptides elicited distinct cytokine profiles. HC gp-39 (peptide 322-337) elicited a dominant interferon-gamma (IFNgamma) response. Residues within the core (positions P1-P9) 322-337 peptide sequence were critical for T cell recognition. Surprisingly, the N-terminal flanking region was also important for recognition by 6 of 10 specific T cell hybridomas. Substitutions of charged TCR contact residues in the 322-337 core epitope (E332A and K335A) were associated with a significant reduction in the IFNgamma and interleukin-10 (IL-10) stimulation indices. Restimulation with peptides W325A and V326A was also associated with a trend toward reduced IFNgamma and IL-10 secretion. In contrast, restimulation with peptide D330N elicited cytokine profiles more comparable with those resulting from restimulation with wild-type peptide.This study indicates that APLs of a proinflammatory HC gp-39 T cell epitope may be used to alter the cytokine response from a memory T cell population.

  View details for PubMedID 12905493

• Susceptibility of immature and mature Langerhans cell-type dendritic cells to infection and immunomodulation by human cytomegalovirus JOURNAL OF VIROLOGY Hertel, L., Lacaille, V. G., Strobl, H., Mellins, E. D., Mocarski, E. S. 2003; 77 (13): 7563-7574

  Abstract

  Human cytomegalovirus (CMV) infection initiates in mucosal epithelia and disseminates via leukocytes throughout the body. Langerhans cells (LCs), the immature dendritic cells (DCs) that reside in epithelial tissues, are among the first cells to encounter virus and may play important roles in the immune response, as well as in pathogenesis as hosts for viral replication and as vehicles for dissemination. Here, we demonstrate that CD34(+) progenitor cell-derived LC-type DCs exhibit a differentiation state-dependent susceptibility to CMV infection. In contrast to the small percentage (3 to 4%) of the immature LCs that supported infection, a high percentage (48 to 74%) of mature, LC-derived DCs were susceptible to infection with endotheliotropic strains (TB40/E or VHL/E) of CMV. These cells were much less susceptible to viral strains AD169varATCC, TownevarRIT(3), and Toledo. When exposed to endotheliotropic strains, viral gene expression (IE1/IE2 and other viral gene products) and viral replication proceeded efficiently in LC-derived mature DCs (mDCs). Productive infection was associated with downmodulation of cell surface CD83, CD1a, CD80, CD86, ICAM-1, major histocompatibility complex (MHC) class I, and MHC class II on these cells. In addition, the T-cell proliferative response to allogeneic LC-derived mDCs was attenuated when CMV-infected cultures were used as stimulators. This investigation revealed important characteristics of the interaction between CMV and the LC lineage of DCs, suggesting that LC-derived mDCs are important to viral pathogenesis and immunity through their increased susceptibility to virus replication and virus-mediated immune escape.

  View details for DOI 10.1128/JVI.77.13.7563-7574.2003

  View details for Web of Science ID 000183598600043

  View details for PubMedID 12805456

  View details for PubMedCentralID PMC164783

• Point mutations in or near the antigen-binding groove of HLA-DR3 implicate class II-associated invariant chain peptide affinity as a constraint on MHC class II polymorphism JOURNAL OF IMMUNOLOGY Doebele, R. C., Pashine, A., Liu, W., Zaller, D. M., Belmares, M., Busch, R., Mellins, E. D. 2003; 170 (9): 4683-4692

  Abstract

  During maturation of MHC II molecules, newly synthesized and assembled complexes of MHC II alphabeta dimers with invariant chain (Ii) are targeted to endosomes, where Ii is proteolyzed, leaving remnant class II-associated Ii peptides (CLIP) in the MHC II peptide binding groove. CLIP must be released, usually with assistance from the endosomal MHC II peptide exchange factor, HLA-DM, before MHC II molecules can bind endosomal peptides. Structural factors that control rates of CLIP release remain poorly understood, although peptide side chain-MHC II specificity pocket interactions and MHC II polymorphism are important. Here we report that mutations betaS11F, betaS13Y, betaQ70R, betaK71E, betaK71N, and betaR74Q, which map to the P4 and P6 pockets of the groove of HLA-DR3 molecules, as well as alphaG20E adjacent to the groove, are associated with elevated CLIP in cells. Most of these mutations increase the resistance of CLIP-DR3 complexes to dissociation by SDS. In vitro, the groove mutations increase the stability of CLIP-DR3 complexes to dissociation. Dissociation rates in the presence of DM, as well as coimmunoprecipitation of some mutant DR3 molecules with DM, are also diminished. The profound phenotypes associated with some of these point mutations suggest that the need to maintain efficient CLIP release represents a constraint on naturally occurring MHC II polymorphism.

  View details for Web of Science ID 000182528100034

  View details for PubMedID 12707347

• Formation of two peptide/MHC II isomers is catalyzed differentially by HLA-DM BIOCHEMISTRY Belmares, M. P., Busch, R., Mellins, E. D., McConnell, H. M. 2003; 42 (3): 838-847

  Abstract

  Major histocompatability class II proteins are transmembrane alphabeta-heterodimers that present peptides to T-cells. MHC II may bind exogenous peptides directly at the cell surface. Alternatively, peptides derived from processing of endosomal protein may bind to MHC II in endosomal compartments. There, HLA-DM catalyzes the formation of peptide/MHC complexes, which are then transported to the cell surface. Here we report evidence that the peptide Ii CLIP 81-104 binds to DR*0404 in two alternate registries, whose dissociation rates, while kinetically indistinguishable at pH 5.3 and 37 degrees C, are kinetically resolved in the presence of HLA-DM. In one registry isomer, CLIP Met 91 is placed in the N-terminal P1 pocket of DR*0404, and peptide dissociation is readily catalyzed by HLA-DM. In a second proposed registry, likely with CLIP Leu 97 in the P1 pocket, the complex is substantially less sensitive to HLA-DM catalysis. Without HLA-DM, or at pH 7, the fraction of each isomer formed in solution is relatively insensitive to the duration of incubation with peptide. However, with HLA-DM, the fraction of the DM-insensitive isomer is dramatically influenced by peptide incubation time. The mechanism of isomer formation appears to be determined by the HLA-DM-modified relative association to the two registries, followed by HLA-DM-catalyzed dissociation of each isomer and rebinding, leading to a final isomer composition determined by these kinetic constants. Intramolecular isomer interconversion does not appear to be involved. The behavior of these complexes may provide a model for peptide editing by DM in endosomes.

  View details for DOI 10.1021/bi020466p

  View details for Web of Science ID 000180568900027

  View details for PubMedID 12534297

• Growth delay in systemic JRA: Interplay between steroid usage and disease severity 66th Annual Meeting of the American-College-of-Rheumatology Lee, T., Sandborg, C., Biederman, K., Mellins, E. WILEY-LISS. 2002: 3405–

  View details for Web of Science ID 000179754000053

• Structural factors contributing to DM susceptibility of MHC class II/Peptide complexes JOURNAL OF IMMUNOLOGY Belmares, M. P., Busch, R., Wucherpfennig, K. W., McConnell, H. M., Mellins, E. D. 2002; 169 (9): 5109-5117

  Abstract

  Peptide loading of MHC class II (MHCII) molecules is assisted by HLA-DM, which releases invariant chain peptides from newly synthesized MHCII and edits the peptide repertoire. Determinants of susceptibility of peptide/MHCII complexes to DM remain controversial, however. Here we have measured peptide dissociation in the presence and the absence of DM for 36 different complexes of varying intrinsic stability. We found large variations in DM susceptibility for different complexes using either soluble or full-length HLA-DM. The DM effect was significantly less for unstable complexes than for stable ones, although this correlation was modest. Peptide sequence- and allele-dependent interactions along the entire length of the Ag binding groove influenced DM susceptibility. We also observed differences in DM susceptibility during peptide association. Thus, the peptide repertoire displayed to CD4(+) T cells is the result of a mechanistically complicated editing process and cannot be simply predicted from the intrinsic stability of the complexes in the absence of DM.

  View details for Web of Science ID 000178777400053

  View details for PubMedID 12391227

• Determinants of joint damage in systemic onset JRA (SOJRA). 66th Annual Scientific Meeting of the American-College-of-Rheumatology/37th Annual Scientific Meeting of the Association-of-Rheumatology-Health-Professionals Sandberg, C., Lee, T. L., Biederman, K., Chira, P., Saper, V., Emery, H., Kennedy, J., Zehran, S., McCurdy, D., Mellins, E. WILEY-BLACKWELL. 2002: S478–S478

  View details for Web of Science ID 000178421801297

• Stabilization of soluble, low-affinity HLA-DM/HLA-DR1 complexes by leucine zippers JOURNAL OF IMMUNOLOGICAL METHODS Busch, R., Paschine, A., Garcia, K. C., Mellins, E. D. 2002; 263 (1-2): 111-121

  Abstract

  The ectodomains of interacting membrane-bound proteins, when expressed as recombinant soluble molecules, often have low affinities for each other, hampering studies of their interaction. We reasoned that stabilization of unstable protein-protein complexes should aid our understanding of the structural and functional consequences of complex formation. Here, we have used fusion with leucine zipper (LZ) domains to stabilize a complex formed between the class II major histocompatibility complex (MHC-II) protein, HLA-DR1 (which binds peptides for presentation to CD4+ T cells) and HLA-DM (which catalyzes peptide exchange of MHC-II molecules). To this end, the DM beta chain ectodomains were fused to acidic LZ domains (AcidP1 or Fos); similarly, the DR1 beta chain ectodomains were fused to basic LZ domains (BaseP1 or Jun). We expressed LZ-modified soluble DM or DR1 alphabeta dimers, or both, in insect cells and purified the secreted sDM-AcidP1 and sDR1-BaseP1 molecules as well as the complex. LZ modification greatly enhanced DM-catalyzed peptide binding to DR1 compared to unmodified soluble DM and DR1. We readily detected LZ-modified DM/DR complexes on native PAGE gels and by coimmunoprecipitation. Thus, fusion with artificial LZ domains can stabilize unstable protein-protein complexes for biochemical and structural studies of interactions within the complex.

  View details for Web of Science ID 000176076300010

  View details for PubMedID 12009208

• Dendritic cells and monocytes from adult peripheral blood show a more robust response to stimulation in vitro than those found in cord blood Drohan, L. A., Holm, B., Maecker, H., Mellins, E. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2002: 324A

  View details for Web of Science ID 000174714601882

• Modulation of MHC class II by human cytomegalovirus in dendritic cells Lacaille, V. G., Hertel, L., Strobl, H., Mocarski, E. S., Mellins, E. D. FEDERATION AMER SOC EXP BIOL. 2002: A1037

  View details for Web of Science ID 000174593901719

• GM-CSF mediated upregulation of the class II MHC pathway in human monocytes Hornell, T. M., Bushey, A., Boss, J., Mellins, E. D. FEDERATION AMER SOC EXP BIOL. 2002: A1232

  View details for Web of Science ID 000174593902806

• Kinetic properties of soluble HLA-DM/HLA-DR1 complexes stabilized by leucine zippers Busch, R., Pashine, A., Garcia, C., Mellins, E. D. FEDERATION AMER SOC EXP BIOL. 2002: A1234–A1235

  View details for Web of Science ID 000174593902818

• Relationship between kinetic stability and immunogenicity of HLA-DR4/peptide complexes EUROPEAN JOURNAL OF IMMUNOLOGY Hall, F. C., Rabinowitz, J. D., Busch, R., Visconti, K. C., Balmares, M., Patil, N. S., Cope, A. O., Patel, S., McConnell, H. M., Mellins, E. D., Sonderstrup, G. 2002; 32 (3): 662-670

  Abstract

  Immunodominant T cell epitopes from the autoantigen human cartilage glycoprotein 39 have previously been mapped in the context of HLA-DR*0401 and *0402, using mice expressing HLA-DR4 transgenes. We measured the dissociation rates of these epitopes from soluble recombinant DR*0401 and DR*0402 to assess the relationship between peptide/HLA-DR4 kinetic stability and immunogenicity. Experiments were performed at endosomal pH (5.5) and at cell surface pH (7), in the absence and presence of soluble recombinant HLA-DM (sDM). All (4/4) immunodominant peptide/HLA-DR complexes exhibit dissociation half-times of 1h to several days. In contrast, most (3/4) non-immunodominant complexes dissociate with half-times <30 min under at least one of these conditions. Interestingly, a complex which is stable except in the presence of HLA-DM at pH 5.5 is immunogenic only following peptide immunization, while a complex which is stable at acidic but not at neutral pH, is non-immunogenic following either whole protein or peptide immunization. These data indicate that kinetic stability of peptide/MHC complexes in vivo is a key determinant of immunogenicity.

  View details for Web of Science ID 000174439000008

  View details for PubMedID 11857340

• Role of HLA-DM in the peptide binding mechanism of class II MHC proteins. Zavala-Ruiz, Z., Zarutskie, J., Busch, R., Mellins, E. D., Stern, L. J. BIOPHYSICAL SOCIETY. 2002: 331A

  View details for Web of Science ID 000173252701622

• Rheumatoid arthritis (RA)-associated HLA-DR alleles form less stable complexes with class II-associated invariant chain peptide than non-RA-associated HLA-DR alleles JOURNAL OF IMMUNOLOGY Patil, N. S., Pashine, A., Belmares, M. P., Liu, W., Kaneshiro, B., Rabinowitz, J., McConnell, H., Mellins, E. D. 2001; 167 (12): 7157-7168

  Abstract

  Certain HLA-DR alleles confer strong susceptibility to the autoimmune disease rheumatoid arthritis (RA). We compared RA-associated alleles, HLA-DR*0401, HLA-DR*0404, and HLA-DR*0405, with closely related, non-RA-associated alleles, HLA-DR*0402 and HLA-DR*0403, to determine whether they differ in their interactions with the class II chaperone, invariant chain (Ii). Ii binds to class II molecules in the endoplasmic reticulum, inhibits binding of other ligands, and directs class II-Ii complexes to endosomes, where Ii is degraded to class II-associated Ii peptide (CLIP). To evaluate the interaction of Ii and CLIP with these DR4 alleles, we introduced HLA-DR*0401, *0402, and *0404 alleles into a human B cell line that lacked endogenous HLA-DR or HLA-DM molecules. In a similar experiment, we introduced HLA-DR*0403 and *0405 into an HLA-DM-expressing B cell line, 8.1.6, and its DM-negative derivative, 9.5.3. Surface abundance of DR4-CLIP peptide complexes and their susceptibility to SDS-induced denaturation suggested that the different DR4-CLIP complexes had different stabilities. Pulse-chase experiments showed CLIP dissociated more rapidly from RA-associated DR molecules in B cell lines. In vitro assays using soluble rDR4 molecules showed that DR-CLIP complexes of DR*0401 and DR*0404 were less stable than complexes of DR*0402. Using CLIP peptide variants, we mapped the reduced CLIP interaction of RA-associated alleles to the shared epitope region. The reduced interaction of RA-associated HLA-DR4 molecules with CLIP may contribute to the pathophysiology of autoimmunity in RA.

  View details for Web of Science ID 000172613400058

  View details for PubMedID 11739539

• Determination of HLA-DR interaction site on HLA-DM molecule Pashine, A., Munning, J., Busch, R., Doebele, R. C., Mellins, E. D. FEDERATION AMER SOC EXP BIOL. 2001: A676

  View details for Web of Science ID 000167438103882

• The mechanistic basis of HLA-DM function Zarutskie, J. A., Busch, R., Mellins, E. D., Stern, L. J. FEDERATION AMER SOC EXP BIOL. 2001: A675

  View details for Web of Science ID 000167438103878

• Autoantigenic HCgp39 epitopes are presented by the HLA-DM-dependent presentation pathway in human B cells JOURNAL OF IMMUNOLOGY Patil, N. S., Hall, F. C., Drover, S., Spurrell, D. R., BOS, E., Cope, A. P., Sonderstrup, G., Mellins, E. D. 2001; 166 (1): 33-41

  Abstract

  It is hypothesized that autoimmune diseases manifest when tolerance to self-Ags fails. One possible mechanism to break tolerance is presentation of self-Ag in an altered form. Most Ags are presented by APCs via the traditional presentation pathway that includes "epitope editing" by intracellular HLA-DM, a molecule that selects for stable MHC-peptide complexes. We were interested in testing the hypothesis that autoreactive MHC-peptide complexes may reach the cell surface by an alternate pathway without being edited by HLA-DM. We selected a cartilage autoantigen human cartilage glycoprotein 39 to which T cell responses are observed in rheumatoid arthritis (RA) patients and some DR(*)04 healthy subjects. RA is genetically associated with certain DRB1 alleles, including DRB1(*)0401 but closely related allele DRB1(*)0402 is either neutral or mildly protective with respect to RA. We generated human B lymphoblastoid cell line cells expressing DR(*)0401 or DR(*)0402 in the presence or absence of intracellular HLA-DM and assessed their ability to present a candidate autoantigen, human cartilage glycoprotein 39. Our results show that the presence of intracellular HLA-DM is critical for presentation of this autoantigen to CD4(+) T cell hybridomas generated from DR(*)04-transgenic mice. Presentation of an autoantigen by the traditional HLA-DM-dependent pathway has implications for Ag presentation events in RA.

  View details for Web of Science ID 000166012400007

  View details for PubMedID 11123274

• pH stability of HLA-DR4 complexes with antigenic peptides BIOCHEMISTRY Belmares, M. P., Rabinowitz, J. D., Liu, W., Mellins, E. D., McConnell, H. M. 2000; 39 (47): 14558-14566

  Abstract

  Complexes between antigenic peptides and class II proteins of the major histocompatibility complex (MHC) trigger cellular immune responses. These complexes usually dissociate more rapidly at mildly acidic pH, where they are formed intracellularly, as compared to neutral pH, where they function at the cell surface. This paper describes the pH dependence of the dissociation kinetics of complexes between MHC proteins and antigenic peptides containing aspartic and glutamic acid residues. Some of these complexes show an unusual pH dependence, dissociating much more rapidly at pH 7 than at pH 5.3. This occurs when the carboxylate group of the aspartic or glutamic acid residue is located in a neutral pocket of the protein. In contrast, solvent-exposed carboxylate groups or carboxylate groups buried in pockets where they form salt bridges with the protein do not show this unusual pH dependence. The kinetic data having the unusual pH dependence conform closely to a model in which there is a rapid reversible equilibration between a less stable deprotonated complex and a more stable protonated complex. In this model, the pK(a) of the protonation reaction for the partially buried peptide carboxylate group ranges from 7.7 to 8.3, reflecting the strongly basic conditions required for deprotonation. One of the few peptide/MHC complexes demonstrated to play a role in autoimmunity in humans contains a buried peptide carboxylate and shows this unusual pH dependence. The relevance of this finding to understanding the chemical basis of autoimmunity is briefly discussed.

  View details for Web of Science ID 000165602400024

  View details for PubMedID 11087411

• Determination of the HLA-DM interaction site on HLA-DR molecules IMMUNITY Doebele, R. C., Busch, R., Scott, H. M., Pashine, A., Mellins, E. D. 2000; 13 (4): 517-527

  Abstract

  HLA-DM removes CLIP and other loosely bound peptides from MHC class II molecules. The crystal structures of class II molecules and of HLA-DM have not permitted identification of their interaction sites. Here, we describe mutations in class II that impair interactions with DM. Libraries of randomly mutagenized DR3 alpha and beta chains were screened for their ability to cause cell surface accumulation of CLIP/DR3 complexes in EBV-B cells. Seven mutations were associated with impaired peptide loading in vivo, as detected by SDS stability assays. In vitro, these mutant DR3 molecules were resistant to DM-catalyzed CLIP release and showed reduced binding to DM. All mutations localize to a single lateral face of HLA-DR, which we propose interacts with DM during peptide exchange.

  View details for Web of Science ID 000090079100011

  View details for PubMedID 11070170

• Accessory molecules for MHC class II peptide loading CURRENT OPINION IN IMMUNOLOGY Busch, R., Doebele, R. C., Patil, N. S., Pashine, A., Mellins, E. D. 2000; 12 (1): 99-106

  Abstract

  Accessory molecules, such as HLA-DM and invariant chain, modulate the ligands bound to MHC class II molecules in antigen-presenting cells. Recent investigations, including gene targeting experiments, have shed light on the functions of these molecules, their mechanisms of action, interactions with class II molecules, and the relationships with associated molecules such as tetraspanins and HLA-DO.

  View details for Web of Science ID 000085306900014

  View details for PubMedID 10679402

• Secondary structure composition and pH-dependent conformational changes of soluble recombinant HLA-DM JOURNAL OF BIOLOGICAL CHEMISTRY Busch, R., Reich, Z., Zaller, D. M., Sloan, V., Mellins, E. D. 1998; 273 (42): 27557-27564

  Abstract

  HLA-DM catalyzes the release of invariant chain fragments from newly synthesized major histocompatibility complex (MHC) class II molecules, stabilizes empty class II molecules, and edits class II-associated peptides by preferentially releasing those that are loosely bound. The ability of HLA-DM to carry out these functions in vitro is pH dependent, with an optimum at pH 4.5-5.5 and poor activity at pH 7. The structural basis for these properties of HLA-DM is unknown. Sequence homology suggests that HLA-DM resembles classical, peptide-binding MHC class II molecules. In this study, we examined whether HLA-DM has a secondary structure composition consistent with an MHC fold and whether HLA-DM changes conformation between pH 5 and pH 7. Far-UV circular dichroism (CD) spectra of recombinant soluble HLA-DM (sDM) indicate that HLA-DM belongs to the alpha/beta class of proteins and structurally resembles both MHC class I and class II molecules. The CD peak around 198 nm increases upon going from neutral to endosomal pH and drops sharply upon denaturation below pH 3.5, distinguishing at least three states of sDM: the denatured state and two highly similar folded states. Fluorescence emission spectra show a slight blue-shift and a approximately 20% drop in intensity at pH 5 compared with pH 7. Unfolding experiments using guanidinium chloride show that the stability of sDM is somewhat reduced but not lost at pH 5. These results indicate that sDM undergoes a pH-dependent conformational change between neutral and endosomal pH. The change seems to involve both hydrogen bonding patterns and the hydrophobic core of sDM and may contribute to the pH dependence of DM activity.

  View details for Web of Science ID 000076448000075

  View details for PubMedID 9765288

• Aberrant intermolecular disulfide bonding in a mutant HLA-DM molecule: Implications for assembly, maturation, and function JOURNAL OF IMMUNOLOGY Busch, R., Doebele, R. C., von Scheven, E., Fahrni, J., Mellins, E. D. 1998; 160 (2): 734-743

  Abstract

  HLA-DM (abbreviated DM) is an MHC-encoded glycoprotein that catalyzes the selective release of peptides, including class II-associated invariant chain peptides, from MHC class II molecules. To perform its function, DM must assemble in the endoplasmic reticulum (ER), travel to endosomes, and interact productively with class II molecules. We have described previously an EBV-transformed B cell line, 7.12.6, which displays a partial Ag presentation defect and expresses a mutated DM beta-chain with Cys79 replaced by Tyr. In this study, we show that HLA-DR molecules in 7.12.6 have a defect in peptide loading and accumulate class II-associated invariant chain peptides (CLIP). Peptide loading is restored by transfection of wild-type DMB. The mutant DM molecules exit the ER slowly and are degraded rapidly, resulting in greatly reduced levels of mutant DM in post-Golgi compartments. Whereas wild-type DM forms noncovalent alphabeta dimers, such dimers form inefficiently in 7.12.6; many mutant DM beta-chains instead form a disulfide-bonded dimer with DM alpha. Homodimers of DM beta are also detected in 7.12.6 and in the alpha-chain defective mutant, 2.2.93. We conclude that during folding of wild-type DM, the native conformation is stabilized by a conserved disulfide bond involving Cys79beta and by noncovalent contacts with DM alpha. Without these interactions, DM beta can form malfolded structures containing interchain disulfide bonds; malfolding is correlated with ER retention and accelerated degradation.

  View details for Web of Science ID 000071915200027

  View details for PubMedID 9551909

• MEDIATION BY HLA-DM OF DISSOCIATION OF PEPTIDES FROM HLA-DR NATURE Sloan, V. S., Cameron, P., Porter, G., Gammon, M., Amaya, M., Mellins, E., Zaller, D. M. 1995; 375 (6534): 802-806

  Abstract

  Human leukocyte antigen (HLA)-DM is an unconventional major histocompatibility complex (MHC) class II heterodimer that is important for B-cell-mediated antigen processing and presentation to MHC class II-restricted T cells. HLA-DM is encoded by two genes, DMA and DMB, which map to the MHC class II region, and shares some homology with MHC class I and class II proteins. Here we define the biochemical role of HLA-DM. Recombinant soluble HLA-DM heterodimers have been purified from culture supernatants of insect cell transformants. At pH 5.0, they induce the dissociation of a subset of peptides bound to HLA-DR, including a nested set of class-II-associated invariant chain peptides (CLIP). This process liberates HLA-DR and leads to the enhanced binding of exogenous peptides.

  View details for Web of Science ID A1995RF98900082

  View details for PubMedID 7596415

• AN ESSENTIAL ROLE FOR HLA-DM IN ANTIGEN PRESENTATION BY CLASS-II MAJOR HISTOCOMPATIBILITY MOLECULES NATURE Morris, P., Shaman, J., ATTAYA, M., Amaya, M., Goodman, S., Bergman, C., Monaco, J. J., Mellins, E. 1994; 368 (6471): 551-554

  Abstract

  In antigen-presenting cells, class II molecules of the major histocompatibility complex (MHC) bind peptides derived from endocytosed proteins. In certain B-lymphoblastoid cell mutants, MHC class II molecule-peptide complex formation is impaired, resulting in deficient antigen-presenting function. MHC deletion mutants with this defect map the responsible gene(s) to the class II region of the MHC. Here we report that multiple independent mutants with the class II presentation defect harbour lesions in HLA-DMB, an MHC-linked gene encoding a class II-like beta-chain. Expression of DMB complementary DNA in mutants lacking DMB messenger RNA restores the wild-type phenotype. These results establish HLA-DM as a critical regulatory molecule in class II-restricted antigen presentation and suggest that it functions at an intracellular site to promote class II molecule-peptide association.

  View details for Web of Science ID A1994NE33500056

  View details for PubMedID 8139689