Singapore scientists pave way for better juvenile arthritis diagnosis & treatment outcome prediction

Singapore, 14 July 2017 - A team of scientists and doctors from the SingHealth Duke-NUS Academic Medical Centre (AMC) has uncovered a new group of regulatory T (Treg) cells and DNA features associated with juvenile idiopathic arthritis (JIA), the most common form of arthritis among children under the age of 16. Their findings could potentially enhance diagnosis of the disease and prediction of therapy outcomes for improved treatment successes.

Results of their studies were published in the Annals of Rheumatic Diseases and Proceedings of the National Academy of Sciences of the USA.

JIA is a disease of the immune system that causes inflammation leading to pain, stiffness and swelling in patients' joints. It affects around one in 1,000 children in the world.

Juvenile arthritis has no cure and young patients can only alleviate pain or prevent joint deterioration through use of medication or therapy. In advancing care for JIA, researchers are keen to identify the culprit cells or genetic signatures behind the disease in order to tackle it.

In its first discovery, the SingHealth Duke-NUS AMC research team identified a previously unknown group of Treg cells that is associated with inflammation in JIA. Treg cells are a subset of white blood cells that regulate the body's immune system. When the body has an imbalanced number of Treg cells, its immune tolerance can fail and experience autoimmune disorders such as arthritis.

The team found that the identified Treg cells play a role in JIA progression. During the active disease stage of JIA, these cells expand, grow in number, re-circulate through inflamed areas of patients' body, and migrate to the connective tissue of patients' joints. Additionally, a larger quantity of these cells can be found in JIA patients who cannot control arthritis inflammation and are unresponsive to therapy as compared to those who are.

"Clinicians could potentially use this novel group of cells as a marker to diagnose JIA in patients, as well as to predict or monitor patients' responsiveness to therapy. Importantly, these cells are readily detectable in patients' bloodstream, allowing for any clinical tests to be minimally invasive and pain-free for patients," said Professor Salvatore Albani, Director, SingHealth Translational Immunology and Inflammation Centre (STIIC), Professor, Duke-NUS Medical School and Senior Clinician Scientist, KK Women's and Children's Hospital (KKH), who is the principal investigator of the study.

Currently, only about one-third of JIA patients get better after medication or therapy, while the rest continue to see their condition flare up even after treatment.

To accurately predict treatment outcomes, the research team studied JIA patients' treatment responses and found that epigenetics - or individuals' DNA and the way each body uses its genes - determined one's clinical "fate". In other words, the key is not in individuals' genetic make-up but rather, in how their bodies employ genes. Even patients with identical genetic backgrounds could experience different clinical outcomes based on their DNA features that activate genes differently.

One of the research paper's co-author, Associate Professor Thaschawee Arkachaisri, Head & Senior Consultant, Rheumatology and Immunology Service, KKH and Associate Professor, Duke-NUS, said "These discoveries could enable doctors to predict treatment responses and personalise treatment for patients. This is especially relevant for difficult JIA cases which may require more complex therapies, and is important to help save time and money, prevent treatment complications and ultimately, improve care outcomes."

The team's findings are also relevant for adult rheumatoid arthritis, a similar autoimmune condition that affects one in 100 adults in the world.

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The SingHealth Duke-NUS Academic Medical Centre draws on the collective strengths of SingHealth and Duke-NUS Medical School to drive the transformation of healthcare and provide affordable, accessible, quality healthcare. With 42 clinical specialties, a network of 2 Hospitals, 5 National Specialty Centres, 9 Polyclinics and Bright Vision Community Hospital, it delivers comprehensive, multi-disciplinary and integrated care. In 2018, the Sengkang General Hospital and Sengkang Community Hospital will be completed to serve the community in the north-east of Singapore. To enhance community care, the new Outram Community Hospital on SGH Campus will be completed in 2020.

For more information, please visit: http://www.singhealth.com.sg

Hospitals (Tertiary Specialty Care):

Singapore General Hospital, KK Women's and Children's Hospital, Sengkang General Hospital (expected completion: 2018)

National Specialty Centres (Tertiary Specialty Care):

National Cancer Centre Singapore, National Dental Centre Singapore, National Heart Centre Singapore, National Neuroscience Institute, and Singapore National Eye Centre

SingHealth Polyclinics (Primary Care):

Bedok, Bukit Merah, Geylang, Marine Parade, Outram, Pasir Ris, Queenstown, Sengkang, and Tampines

Community Hospitals (Intermediate and Long-term Care):

Bright Vision Hospital, Sengkang Community Hospital (expected completion: 2018), Outram Community Hospital (expected completion: 2020)

KK Women's and Children's Hospital (KKH) is a recognised leader and Singapore's largest tertiary referral centre for Obstetrics, Gynaecology, Paediatrics and Neonatology. Founded in 1858, the 830-bed academic medical institution leads in patient-centred management of high risk conditions in women and children. More than 500 specialists adopt a compassionate, multi-disciplinary and holistic approach to treatment, and harness medical innovations and technology to deliver the best medical care possible.

Accredited as an Academic Medical Centre, KKH is a major teaching hospital for all three medical schools in Singapore, Duke-NUS Medical School, Yong Loo Lin School of Medicine and Lee Kong Chian School of Medicine. The Hospital also runs the largest specialist training programme for Obstetrics and Gynaecology and Paediatrics in the country. Both programmes are accredited by the Accreditation Council for Graduate Medical Education International (ACGME-I), and are highly rated for the high quality of clinical teaching and the commitment to translational research.

For more information, please visit http://www.kkh.com.sg