Impact of Immune Activation on Cardiovascular and Immune Health in RA

未经治疗的类风湿性关节炎(RA)发病率很高，包括肌肉骨骼残疾和 心血管疾病。幸运的是，在过去的15年里，我们已经能够很好地控制类风湿性关节炎 通过单独提供甲氨蝶呤、来氟米特、肿瘤坏死因子阻滞剂治疗、利妥昔单抗或其组合 甲氨蝶呤和一种生物(来自人类基因的基因工程蛋白)疗法。同时 众所周知，生物制剂会增加严重感染、损害宿主的发生率。 对疫苗的反应，以及癌症风险的适度增加。可以肯定的是，这些代理阻止了这两个 致病性自身免疫性疾病的活动途径以及有益的宿主反应和宿主防御 小路。此外，类风湿性关节炎本身与全身免疫活性增强和 患心血管疾病的风险。我们和其他人的数据表明，慢性免疫激活很可能 导致免疫功能障碍，通过宿主对新抗原和召回抗原的反应来衡量 免疫，免疫激活可在慢性感染的情况下预测心血管疾病。 我们建议通过以下方式研究自身免疫性疾病背景下免疫健康的决定因素 测试假设在类风湿性关节炎中慢性免疫激活(升高的sCD14，sCD163， 肿瘤坏死因子受体2、肿瘤坏死因子、自体趋化因子和CD8/DC/单核细胞活化)预测免疫功能障碍，表现为 宿主对疫苗的反应受损，以及心脏病。这种关系因肿瘤坏死因子的阻断而中断。目标 1：确定免疫激活，如sCD14、sCD163、自体趋化蛋白水平升高所反映的， 肿瘤坏死因子受体2，白介素6，C反应蛋白，树突状细胞激活和单核细胞激活，预测免疫健康，AS 在接受治疗的RA中通过宿主对新抗原和召回抗原疫苗的反应来衡量，以及肿瘤坏死因子 阻断治疗改变了这种关系。目标2：确定免疫与免疫之间的关系 类风湿性关节炎患者的激活、内皮功能、冠状动脉粥样硬化以及肿瘤坏死因子阻断是否改善 免疫激活和心血管替代物。

Untreated rheumatoid arthritis (RA) carries high morbidity, including musculoskeletal disability and cardiovascular disease. Fortunately, in the past 15 years we have been able to control rheumatoid arthritis very well by offering methotrexate alone, leflunomide alone, TNF blocker therapy, rituximab, or a combination of methotrexate and a biologic (genetically-engineered proteins derived from human genes) therapy. At the same time, it is known that biologic agents contribute to an increased incidence of serious infections, impaired host response to vaccines, and a modest increase in risk for cancer. For certain, these agents block both pathogenic autoimmune disease activity pathways as well as the beneficial host response and host defense pathways. Furthermore, rheumatoid arthritis itself is associated with increased systemic immune activation and risk for cardiovascular disease. Our data, and that of others, indicate that chronic immune activation likely contributes to immune dysfunction, as measured by host response to neo-antigen and recall antigen immunization, and that immune activation predicts cardiovascular disease in the setting of chronic infection. We propose here to investigate determinants of immune health in the setting of auto immune disease by testing the hypothesis that in rheumatoid arthritis chronic immune activation (elevated sCD14, sCD163, TNFR2, TNF, autotaxin, and CD8/DC/monocyte activation) predicts immune dysfunction, as manifest by impaired host response to vaccine, and cardiac disease. This relationship is interrupted by TNF blockade. Aim 1: Determine whether immune activation, as reflected by elevated levels of sCD14, sCD163, autotaxin, TNFR2, IL6, CRP, dendritic cell activation and monocyte activation, predict immune health, as measured by host response to neo-antigen and recall antigen vaccine in treated RA, and whether TNF blocking treatment modifies this relationship. Aim 2: Determine the relation between immune activation, endothelial function, coronary atherosclerosis in RA, and whether TNF blockade improves both immune activation and cardiovascular surrogates.