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Open Access 01-12-2017 | Review Article

Personalized medicine in rheumatology: the paradigm of serum autoantibodies

Authors: Silvia Sirotti, Elena Generali, Angela Ceribelli, Natasa Isailovic, Maria De Santis, Carlo Selmi

Published in: Autoimmunity Highlights | Issue 1/2017

Abstract

The sequencing of the human genome is now well recognized as the starting point of personalized medicine. Nonetheless, everyone is unique and can develop different phenotypes of the same disease, despite identical genotypes, as well illustrated by discordant monozygotic twins. To recognize these differences, one of the easiest and most familiar examples of biomarkers capable of identifying and predicting the outcome of patients is represented by serum autoantibodies. In this review, we will describe the concept of personalized medicine and discuss the predictive, prognostic and preventive role of antinuclear antibodies (ANA), anti-citrullinated peptide antibodies (ACPA), rare autoantibodies and anti-drug antibodies (ADA), to evaluate how these can help to identify different disease immune phenotypes and to choose the best option for treating and monitoring rheumatic patients in everyday practice. The importance of ANA resides in the prediction of clinical manifestations in systemic sclerosis and systemic lupus erythematosus and their association with malignancies. ACPA have a predictive role in rheumatoid arthritis, they are associated with the development of a more aggressive disease, extra-articular manifestations and premature mortality in RA patients; moreover, they are capable of predicting therapeutic response. Rare autoantibodies are associated with different disease manifestations and also with a greater incidence of cancer. The determination of ADA levels may be useful in patients where the clinical efficacy of TNF-α inhibitor has dropped, for the assessment of a right management. The resulting scenario supports serum autoantibodies as the cornerstone of personalized medicine in autoimmune diseases.

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Title: Personalized medicine in rheumatology: the paradigm of serum autoantibodies
Authors: Silvia Sirotti
Elena Generali
Angela Ceribelli
Natasa Isailovic
Maria De Santis
Carlo Selmi
Publication date: 01-12-2017
Publisher: Springer International Publishing
Published in: Autoimmunity Highlights / Issue 1/2017
Print ISSN: 2038-0305
Electronic ISSN: 2038-3274
DOI: https://doi.org/10.1007/s13317-017-0098-1

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