Revisiting the criteria for remission in rheumatoid arthritis

The first provisional criteria for defining remission in RA were drawn up by EULAR and the ACR in 2011. Two types of remission definition were agreed on. The first was the so-called Boolean definition, which required that that a person must have a score of 1 or less in each of four core variables: tender joint count, swollen joint count, patient global assessment (PtGA), and C-reactive protein (CRP) – a measure of inflammation. Conversely, the index-based definition used the remission cut-off point of the Simplified Disease Activity Index (SDAI).

Since then, critics argued that the threshold of 1 or less for the PtGA was too strict, with some patients not achieving it despite meeting the other cut-offs. This is important, because PtGA is an important measure of disease activity, and one of the most sensitive ones used in clinical trials. Recently, new data have suggested that a higher threshold for the PtGA element could improve agreement between the two sets of remission criteria.

With this in mind, patient data were retrieved from four clinical trials testing the efficacy of various biological disease-modifying antirheumatic drugs (bDMARDs) against placebo or methotrexate. The authors increased the threshold of the PtGA in 0.5 cm increments, from 1.0 up to 2.5. The group also looked at a Boolean definition that did not include the PtGA criterion at all.

As expected, using PtGA 2 cm yielded higher remission rates compared with 1 cm, and omitting PtGA entirely increased rates even further. Of note, there were no differences in radiographic progression seen in people with people established RA achieving remission according to the different definitions. Importantly, although these revised definition allow more people to be classed as in remission, EULAR note that the definition of remission should remain strict – both to ensure beneficial long-term outcomes and prevent unnecessary treatment escalation.

The full paper is published in October 2022 issue of the Annals of the Rheumatic Diseases, and provides validation of the previously proposed modification of the Boolean ACR/EULAR

remission criteria, to include a threshold of 2 cm rather than 1 cm for the PtGA criterion. It is proposed that this change be adopted both for future clinical trials and as a target in clinical

practice.

World’s largest autism whole genome sequencing study reveals 134 autism-linked genes

Genetics and autism
Genetics and autism


Researchers from The Hospital for Sick Children (SickKids) have uncovered new genes and genetic changes associated with autism in the largest autism whole genome sequencing analysis to date, providing better understanding into the ‘genomic architecture’ that underlies this disorder.

The study, published today in Cell, used whole genome sequencing (WGS) to examine the entire genomes of over 7,000 individuals with autism as well as an additional 13,000 siblings and family members. The team found 134 genes linked with autism and discovered a range of genetic changes, most notably gene copy number variations (CNVs), likely to be associated with autism, including autism-associated rare variants in about 14 per cent of participants with autism.

“By sequencing the entire genome of all participants, and with deep involvement from the participating families in MSSNG on forming our research priorities, we maximize the potential for discovery and allow analysis that encompasses all types of variants, from the smallest DNA changes to those that affect entire chromosomes,” says Dr. Stephen Scherer, Senior Scientist, Genetics & Genome Biology and Chief of Research at SickKids and Director of the McLaughlin Centre at the University of Toronto.

Dr. Brett Trost, lead author of the paper and a Research Associate in the Genetics & Genome Biology program at SickKids, notes the use of WGS allowed researchers to uncover variant types that would not have otherwise been detectable. These variant types include complex rearrangements of DNA, as well as tandem repeat expansions, a finding supported by recent SickKids research on the link between autism and DNA segments that are repeated many times. The role of the maternally inherited mitochondrial DNA was also examined in the study and found to account for two per cent of autism.

The paper also points to important nuances in autism genetics in families with only one individual with autism compared with families that have multiple individuals with autism, known as multiplex families. Surprising to the team was that the “polygenic score” – an estimation of the likelihood of an individual having autism, calculated by aggregating the effects of thousands of common variants throughout the genome – was not higher among multiplex families.

“This suggests that autism in multiplex families may be more likely to be linked to rare, highly impactful variants inherited from a parent. Because both the genetics and clinical traits associated with autism are so complex and varied, large data sets like the ones we used are critical to providing researchers with a clearer understanding of the genetic architecture of autism,” says Trost.

The research team says the study data can help expand inquiries into the range of variants that might be linked to autism, as well as efforts to better understand contributors to the 85 per cent of autistic individuals for which the genetic cause remains unresolved. In a linked study of 325 families with autism from Newfoundland published this same month in Nature Communications, Dr. Scherer’s team found that combinations of spontaneous, rare-inherited, and polygenic genetic factors coming together in the same individual can potentially lead to different sub-types of autism.

Dr. Suzanne Lewis, a geneticist and investigator at the BC Children’s Hospital Research Institute who diagnosed many of the families enrolled in the study said, “Collectively, these latest findings represent a massive step forward in better understanding the complex genetic and biological circuitry linked with autism . This rich data set also offers an opportunity to dive deeper into examining other factors that may determine an individual’s chance of developing this complex condition to help individualize future treatment approaches.”

A promising drug candidate discovered for the prevention of type 1 diabetes


According to a study, type 1 diabetes could be prevented by inhibiting a gene associated with the onset of the disease. A drug based on the same mechanism has already been approved for the treatment of another autoimmune disease psoriasis in the United States, which may boost the development of drug therapies for diabetes.

The incidence of type 1 diabetes is higher in Finland than in any other country. While hundreds of genes underlying the disease have been identified, the mechanisms of action of most of them remain unclear. In other words, individuals at high risk of developing the disease can be identified, but so far no effective means of preventing the progression of the disease without the risk of significant adverse effects have been found.

Under the direction of Professor Timo Otonkoski, researchers at the University of Helsinki have investigated the mechanisms of action of the risk genes associated with type 1 diabetes with the aim of finding novel methods for the prevention of the disease. The results have been published in the Nature Communications journal.

“We focused on a gene known as TYK2, as its mutations are known to protect against type 1 diabetes,” Otonkoski says.

Making white blood cells harmless

The researchers assumed that inhibiting the expression of the TYK2 gene could reduce the destruction of pancreatic beta cells that causes the onset of type 1 diabetes. Pancreatic beta cells produce vital insulin for the body, which patients with diabetes must substitute with insulin injections.

The assumption was confirmed in the study, and the destruction of beta cells was effectively stopped by inhibiting TYK2 expression.

“The destruction of beta cells is the result of an autoimmune reaction where white blood cells activated by the body’s immune system attack their own tissues. Using the TYK2 inhibitor, the havoc wreaked by the white blood cells was markedly reduced,” Otonkoski confirms.

Another finding in the study, which came as a surprise, was that eliminating the effect of the TYK2 gene resulted in a reduction of the differentiation of pancreatic islet cells, or a reduction in beta cell production.

“However, this adverse effect was only observed in the earlier stages of beta-cell development. Inhibiting TYK2 expression did not affect the functioning of mature beta cells,” says Dr. Vikash Chandra, the first author of the paper.

Previously, Otonkoski’s research group successfully developed from stem cells fully functional pancreatic beta cells that can be used to restore the body’s insulin production.

Further research will provide data for drug development

In light of the findings, a TYK2 inhibitor is a promising drug candidate for the prevention of type 1 diabetes.

“We utilised not only cells from which the TYK2 gene had been removed but also a chemical TYK2 inhibitor. This drug molecule has already been approved in the United States for the treatment of psoriasis,” Otonkoski notes.

According to Otonkoski, the effect of TYK2 inhibitors in the prevention of diabetes must next be carefully investigated in animal models. If the results are positive, the next step to clinical trials can be taken.

The study was carried out at Professor Timo Otonkoski’s laboratory under the INNODIA project.

Read more about stem cell research in the University of Helsinki’s Stem Cell Portal

More about autism and the diversity of autism

Research in human and animal models points to potential biological and genetic mechanisms contributing to the diversity of behaviours seen in autism. The findings were presented at Neuroscience 2022, the annual meeting of the Society for Neuroscience and the world’s largest source of emerging news about brain science and health.




Autism constitutes a diverse group of conditions related to brain development. According to the Centers for Disease Control and Prevention, approximately 1 in 44 children in the U.S. is diagnosed with an autism spectrum disorder, with the diagnosis being four times more common in boys than girls. New research is offering a better understanding of how natural genetic variation impacts brain development and gives rise to the spectrum of behaviours associated with autism, and may contribute to more individualized approaches for supporting people with autism.




Today’s new findings show that:

  • A group of genes that have altered activity in autism are also regulated differently in developing male and female brains, potentially contributing to sex differences in autism symptoms and diagnosis. (Donna Werling, University of Wisconsin-Madison)
  • Analyses focused on behavioural and genomic differences between sibling pairs reveal genetic locations that could prove relevant to autism-related social difficulties. (Nathaniel Stockham, Stanford University)
  • In humans with autism and mouse models of autism, brain imaging reveals two dominant subtypes characterized by altered communication between brain regions. (Marco Pagani, Istituto Italiano Di Tecnologia)



“Studies like those presented today confirm that autism is driven by sources of genetic variation that naturally exist in the human population,” says Nicola Grissom, an assistant professor of psychology at the University of Minnesota who studies individual and sex differences in motivated behaviour and executive function in mouse models. “A better understanding of the genetic components of autism, and appreciation of the neurodiversity occurring naturally among people, may help combat the stigma that still exists around autism.”

“Why eye contact is rare among people with autism” – Do you think this is correct?

Eye strain


A hallmark of autism is the reluctance to make eye contact with others in natural conditions. Although eye contact is a critically important part of everyday interactions, scientists have been limited in studying the neurological basis of live social interaction with eye contact in autism because of the inability to imagine two people’s brains simultaneously.

However, using an innovative technology that enables imaging of two individuals during live and natural conditions, Yale researchers have identified specific brain areas in the dorsal parietal region of the brain associated with the social symptomatology of autism. The study, published Nov. 9 in the journal PLOS ONE, finds that these neural responses to live face and eye contact may provide a biomarker for the diagnosis of autism as well as provide a test of the efficacy of treatments for autism.

“Our brains are hungry for information about other people, and we need to understand how these social mechanisms operate in the context of a real and interactive world in both typically developed individuals as well as individuals with autism,” said co-corresponding author Joy Hirsch, Elizabeth Mears and House Jameson Professor of Psychiatry, Comparative Medicine, and of Neuroscience at Yale.

The Yale team, led by Hirsch and James McPartland, Harris Professor at the Yale Child Study Center, analyzed brain activity during brief social interactions between pairs of adults — each including a typical participant and one with autism — using functional near-infrared spectroscopy, a non-invasive optical neuroimaging method. Both participants were fitted with caps with many sensors that emitted light into the brain and also recorded changes in light signals with information about brain activity during face gaze and eye-to-eye contact.

The investigators found that during eye contact, participants with autism had significantly reduced activity in a brain region called the dorsal parietal cortex compared to those without autism.  Further, the more severe the overall social symptoms of autism as measured by ADOS (Autism Diagnostic Observation Schedule, 2nd Edition) scores, the less activity was observed in this brain region. Neural activity in these regions was synchronous between typical participants during real eye-to-eye contact but not during gaze at a video face. This typical increase in neural coupling was not observed in autism and is consistent with the difficulties in social interactions.

“We now not only have a better understanding of the neurobiology of autism and social differences but also of the underlying neural mechanisms that drive typical social connections,” Hirsch said.