title: Immature cell populations and an erythropoiesis gene-expression signature in systemic juvenile idiopathic arthritis: implications for pathogenesis.
abstract: BACKGROUND
  Previous observations suggest that active systemic juvenile idiopathic arthritis (sJIA) is associated with a prominent erythropoiesis gene-expression signature. The aim of this study was to determine the association of this signature with peripheral blood mononuclear cell (PBMC) subpopulations and its specificity for sJIA as compared with related conditions.
  
  
  METHODS
  The 199 patients with JIA (23 sJIA and 176 non-sJIA) and 38 controls were studied. PBMCs were isolated and analyzed for multiple surface antigens with flow cytometry and for gene-expression profiles. The proportions of different PBMC subpopulations were compared among sJIA, non-sJIA patients, and controls and subsequently correlated with the strength of the erythropoiesis signature. Additional gene-expression data from patients with familial hemophagocytic lymphohistiocytosis (FHLH) and from a published sJIA cohort were analyzed to determine whether the erythropoiesis signature was present.
  
  
  RESULTS
  Patients with sJIA had significantly increased proportions of immature cell populations, including CD34+ cells, correlating highly with the strength of the erythropoiesis signature. The erythropoiesis signature strongly overlapped with the gene-expression pattern in purified immature erythroid precursors. The expansion of immature cells was most prominently seen in patients with sJIA and anemia, even in the absence of reticulocytosis. Patients with non-sJIA and anemia did not exhibit the erythropoiesis signature. The erythropoiesis signature was found to be prominent in patients with FHLH and in a published cohort of patients with active sJIA, but not in patients with inactive sJIA.
  
  
  CONCLUSIONS
  An erythropoiesis signature in active sJIA is associated with the expansion of CD34+ cells, also is seen in some patients with FHLH and infection, and may be an indicator of ineffective erythropoiesis and hemophagocytosis due to hypercytokinemia.
authors.affiliation: Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. claas.hinze@gmail.com
authors.forename: Claas H
authors.initials: CH
authors.lastname: Hinze
authors.forename: Ndate
authors.initials: N
authors.lastname: Fall
authors.forename: Sherry
authors.initials: S
authors.lastname: Thornton
authors.forename: Jun Q
authors.initials: JQ
authors.lastname: Mo
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Aronow
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Layh-Schmitt
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Griffin
authors.forename: Susan D
authors.initials: SD
authors.lastname: Thompson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Colbert
authors.forename: David N
authors.initials: DN
authors.lastname: Glass
authors.forename: Michael G
authors.initials: MG
authors.lastname: Barnes
authors.forename: Alexei A
authors.initials: AA
authors.lastname: Grom
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000235:genetics / Q000378:metabolism; D015703:Antigens, CD / Q000378:metabolism; D018952:Antigens, CD34 / Q000378:metabolism; D001171:Arthritis, Juvenile / Q000235:genetics* / Q000378:metabolism / Q000473:pathology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood; D004920:Erythropoiesis / Q000235:genetics*; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000276:immunology / Q000473:pathology*; D008180:Lupus Erythematosus, Systemic / Q000235:genetics / Q000378:metabolism; D051359:Lymphohistiocytosis, Hemophagocytic / Q000235:genetics / Q000378:metabolism; D008297:Male; D011446:Prospective Studies; D011990:Receptors, Transferrin / Q000378:metabolism
chemical_list: D015703:Antigens, CD; D018952:Antigens, CD34; C068126:CD71 antigen; D016207:Cytokines; D011990:Receptors, Transferrin