Elevated circulating levels of interferon-γ and interferon-γ-induced chemokines characterise patients with macrophage activation syndrome complicating systemic juvenile idiopathic arthritis

Claudia Bracaglia, Kathy de Graaf, Denise Pires Marafon, Florence Guilhot, Walter Ferlin, Giusi Prencipe, Ivan Caiello, Sergio Davì, Grant Schulert, Angelo Ravelli, Alexei A Grom, Cristina de Min, Fabrizio De Benedetti

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: Interferon-γ (IFNγ) is the pivotal mediator in murine models of primary haemophagocytic lymphohistiocytosis (pHLH). Given the similarities between primary and secondary HLH (sec-HLH), including macrophage activation syndrome (MAS), we investigate the involvement of the IFNγ pathway in MAS by evaluating levels of IFNγ and of the induced chemokines, and their relation with laboratory parameters of MAS in systemic juvenile idiopathic arthritis (sJIA) patients with MAS and in a murine MAS model.

METHODS: The Luminex multiplexing assay was used to assess serum levels of interleukin (IL)-1β, IL-6, IFNγ and of the IFNγ-induced chemokines CXCL9, CXCL10 and CXCL11 in patients with sec-HLH (n=11) and in patients with sJIA (n=54), of whom 20 had active MAS at sampling. Expression of IFNγ-induced chemokines was assessed in IL-6 transgenic mice in which MAS is induced by TLR4 stimulation with lipopolysaccharide.

RESULTS: Levels of IFNγ and of IFNγ-induced chemokines were markedly elevated during active MAS and sec-HLH and were significantly higher in patients with MAS compared with active sJIA without MAS. Levels in patients with active sJIA without MAS were comparable to those of patients with clinically inactive sJIA. During MAS, ferritin and alanine transferase levels and neutrophil and platelet counts were significantly correlated with serum levels of IFNγ and CXCL9. In murine MAS, serum levels of ferritin were significantly correlated with mRNA levels of Cxcl9 in liver and spleen.

CONCLUSIONS: The high levels of IFNγ and of IFNγ-induced chemokines and their correlation with the severity of laboratory abnormalities of MAS suggest a pivotal role of IFNγ in MAS.

Original languageEnglish
Pages (from-to)166-172
Number of pages7
JournalAnnals of the Rheumatic Diseases
Volume76
Issue number1
DOIs
Publication statusPublished - Jan 2017

Keywords

  • Adolescent
  • Animals
  • Arthritis, Juvenile
  • Biomarkers
  • Chemokines
  • Child
  • Child, Preschool
  • Disease Models, Animal
  • Female
  • Humans
  • Interferon-gamma
  • Interleukin-1beta
  • Interleukin-6
  • Macrophage Activation Syndrome
  • Male
  • Mice, Transgenic
  • Severity of Illness Index
  • Journal Article
  • Multicenter Study

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