Novel trends in monitoring and therapy of ANCA associated vasculitides

Czech version

Authors: Radim Bečvář
Authors‘ workplace: Revmatologický ústav a Revmatologická klinika 1. LF UK, Praha
Published in: Vnitř Lék 2018; 64(2): 164-168
Category: Reviews

Overview

Vasculitides with positivity of autoantibodies to neutrophil leukocytes cytoplasm (ANCA, AAV) belong to primary vasculitides involving small and less commonly medium size blood vessels. Three different clinical types of AAV can be distinguished: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis. Since these autoantibodies seem to be weak activity biomarkers of AAV new molecules and factors start to come up, e.g. neutrophil extracellular traps NET, several T-lymphocyte subpopulations and different immunoglobulins classes of ANCA. In modern biological therapy rituximab is widely used, for refractory cases intravenous immunoglobulins and antithymocyte globulin are recommended. The data from clinical trials with alemtuzumab are controversial, but avacopan selective inhibitor of C5a receptor and inhibitor of B-lymphocyte activation factor belimumab are promise for future.

Key words:
biologicals – biomarkers – eosinophilic granulomatosis with polyangiitis – granulomatosis with polyangiitis – microscopic polyangiitis

Sources

1. Bečvář R, Tesař V, Rychlík I. Vaskulitidy v klinické praxi – diagnostika a terapie. Medprint: Praha 1994: 90–102.

2. Ansell BM (ed), Bacon PA, Lie JT et al. The vasculitides. Science and practice. Springer 1996, 267–269. ISBN-10: 0412641402. ISBN-13: 978–0412641404.

3. Hoffman GS, Kerr GS, Leavitt RY et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med 1992; 116(6): 488–498.

4. Cockwell P, Savage CO. Wegener’s granulomatosis. Pathogenesis. In: Hoffman GS, Weyand CM (eds). Inflammatory diseases of blood vessels. Marcel Dekker: New York 2002: 365–380. ISBN 978–0824702694.

5. Bečvář R. Eozinofilní granulomatóza s polyangiitidou. In: Pavelka K et al (ed) Revmatologie. Maxdorf: Praha 2012: 408–410. ISBN 978–80–7345–295–7.

6. Specks U. Churg-Strauss syndrome. In: Ball GV, Louis Bridges S Jret al (eds) Vasculitis. 2nd ed. New York: Oxford University Press 2008: 429–438. ISBN 978–0198570196.

7. Bečvář R. Mikroskopická polyangiitida. In: Pavelka K et al. Revmatologie. 2nd ed. Galén: Praha 2010: 67–68. ISBN 978–80–7262–688–5.

8. Heeringa P, Jennette JC et al. Microscopic polyangiitis: Pathogenesis. In: Hoffman GS, Weyand CM (eds). Inflammatory diseases of blood vessels. Marcel Dekker: New York 2002: 339–354. ISBN 978–0824702694.

9. Brogan P, Eleftheriou D. Vasculitis update: pathogenesis and biomarkers. Pediatr Nephrol 2018; 33(2): 187–198. Dostupné z DOI: <http://dx.doi.org/10.1007/s00467–017–3597–4>.

10. Panda R, Krieger T, Hopf L al. Neutrophil extracellular traps contain selected antigens of anti-neutrophil cytoplasmic antibodies. Front Immunol 2017; 8: 439. Dostupné z DOI: <http://dx.doi.org/10.3389/fimmu.2017.00439>.

11. Natorska J, Ząbczyk M, Siudut J et al. Neutrophil extracellular traps formation in patients with eosinophilic granulomatosis with polyangiitis: association with eosinophilic inflammation. Clin Exp Rheumatol 2017; 35(1 Suppl 103): S27-S32.

12. Zhou XL, Zheng MJ, Shuai ZW et al. The significances of peripheral neutrophils CD(55) and myeloperoxidase expression in patients with myeloperoxidase-specific anti-neutrophil cytoplasmic antibody associated vasculitis. Zhonghua Nei Ke Za Zhi 2017; 56(6): 427–432. Dostupné z DOI: <http://dx.doi.org/10.3760/cma.j.issn.0578–1426.2017.06.008>.

13. Szczeklik W, Jakieła B, Wawrzycka-Adamczyk K. Skewing toward Treg and Th2 responses is a characteristic feature of sustained remission in ANCA-positive granulomatosis with polyangiitis. Eur J Immunol 2017; 47(4): 724–733. Dostupné z DOI: <http://dx.doi.org/10.1002/eji.201646810>.

14. Clain JM, Hummel AM, Stone JH et al. Immunoglobulin (Ig)M antibodies to proteinase 3 in granulomatosis with polyangiitis and microscopic polyangiitis. Clin Exp Immunol 2017; 188(1): 174–181. Dostupné z DOI: <http://dx.doi.org/10.1111/cei.12925>.

15. Bečvář R. Moderní terapie ANCA pozitivních vaskulitid. Acta medicinae 2013; 2(5): 76–79.

16. Faurschou M, Westman K, Rasmussen N et al. [European Vasculitis Study Group]. Brief report: Long-term outcome of a randomized clinical trial comparing methotrexate to cyclophosphamide for remission induction in early systemic antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum 2012; 64(10): 3472–3477. Dostupné z DOI: <http://dx.doi.org/10.1002/art.34547>.

17. Hu W, Liu C, Xie H et al. Mycophenolate mofetil versus cyclophosphamide for inducing remission of ANCA vasculitis with moderate renal involvement. Nephrol Dial Transplant 2008; 23(4): 1307–1312. Dostupné z DOI: <http://dx.doi.org/10.1093/ndt/gfm780>.

18. Pepper RJ, Chanouzas D, Tarzi, R et al. [European Vasculitis Study (EUVAS) investigators] Intravenous cyclophosphamide and plasmapheresis in dialysis-dependent ANCA-associated vasculitis. Clin J Am Soc Nephrol 2013; 8(2): 219–224. Dostupné z DOI: <http://dx.doi.org/10.2215/CJN.03680412>. Erratum in Clin J Am Soc Nephrol 2013; 8(4): 701. Caisian A.

19. Smith RM, Jones RB, Jayne DR. Progress in treatment of ANCA-associated vasculitis. Arthritis Res Ther 2012; 4(2): 210. Dostupné z DOI: <http://dx.doi.org/10.1186/ar3797>.

20. Stone J, Uhlfelder M, Hellmann D et al. Etanercept with conventional treatment in Wegener’s granulomatosis: A six month open-label trial to evaluate safety. Arthritis Rheum 2001; 44(5): 1149–1154. Dostupné z DOI: <http://dx.doi.org/10.1002/1529–0131(200105)44:5<1149::AID-ANR197>3.0.CO;2-F>.

21. Jones RB, Tervaert JW, Hauser T et al. [European Vasculitis Study Group[. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Eng J Med 2010; 363(3): 211–220. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0909169>.

22. Stone JH, Merkel PA, Spiera R et al. Rituximab versus cyclophosphamide forANCA-associated vasculitis. N Eng J Med 2010; 363(3): 221–232. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0909905>.

23. Luqmani R. Maintenance of remission in ANCA-associate vasculitis. Nat Rev Rheumatol 2013; 9(2): 127–132. Dostupné z DOI: <http://dx.doi.org/10.1038/nrrheum.2012.188>.

24. Walsh M, Chaudhry A, Jayne D. Long-term follow-up of relapsing/refractory anti-neutrophil cytoplasm antibody associated vasculitis treated with the lymphocyte depleting antibody alemtuzumab (CAMPATH-1H). Ann Rheum Dis 2008; 67(9): 1322–1327. Dostupné z DOI: <http://dx.doi.org/10.1136/ard.2007.081661>.

25. Jayne RWD, Bruchfeld AN, Harper L et al. [CLEAR Study Group]. Randomized trial of C5a receptor inhibitor Avacopan in ANCA-associated vasculitis. J Am Soc Nephrol 28(9): 2756–2767. Dostupné z DOI: <https://doi.org/10.1681/ASN.2016111179>.

26. Lenert A, Lenert P. Current and emerging treatment options for ANCA-associated vasculitis: potential role of belimumab and other BAFF/APRIL targeting agents. Drug Des Devel Ther 2015; 9: 333–347. Dostupné z DOI: <http://dx.doi.org/10.2147/DDDT.S67264>.