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Is a human in vitro enthesitis model relevant to SpA-associated enthesitis? Response to: ‘Beware of wolves in sheep's clothing: immune cell plasticity and instability in health and disease’ by Alunno et al
  1. Abdulla Watad1,2,3,
  2. Hannah Rowe3,
  3. Darren Newton4,
  4. Charlie Bridgewood3,
  5. Dennis G McGonagle3
  1. 1Internal Medicine B', Sheba Medical Center, Tel Hashomer, Israel
  2. 2Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
  3. 3Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
  4. 4Division of Haematology and Immunology, University of Leeds, Leeds, West Yorkshire, UK
  1. Correspondence to Dr Abdulla Watad, Internal Medicine B', Sheba Medical Center at Tel Hashomer, Tel Hashomer 52621, Israel; watad.abdulla{at}

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We thank Alunno et al1 for their comments on our paper reporting on the isolation and preliminary characterisation of normal human enthesis CD4+ and CD8+ conventional T-cells.2 Our work showed that up to 2% of CD4+ T cells were Th17 in nature as demonstrated by intracellular flow cytometry. We were unable to identify FOXP3+ Tregs at the enthesis, but these were readily demonstrable in peripheral blood from the same patients. Alunno and colleagues1 point towards the transdifferentiation between Th17s and Tregs that may occur in vivo and which can be modulated by pivotal spondyloarthritis (SpA) associated cytokines including TNF. Our results were generated in an artificial ‘in vitro enthesitis’ model, and we agree with the comments by Alunno et al1 in regard to the role of TNF and other …

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