ResearchIn-Press Preview Open Access | 10.1172/jci.insight.180750
1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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1Institute of Molecular Medicine, Feinstein Institutes for Medical Research, New York, United States of America
2Department of Microbiology and Immunology, Emory Univerisity School of Medicine, Atlanta, United States of America
3Division of Rheumatology and Immunolgy, Stanford University School of Medicine, Stanford, United States of America
4Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, United States of America
5Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, United States of America
6Donald and Barbara Zucker School of Medicine at Northwell Health, New York, United States of America
7Department of Pathology and Laboratory Medicine, Northwell Health, New York, United States of America
8Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, United States of America
9Division of Rheumatology, Department of Medicine, Emory Univerisity School of Medicine, Atlanta, United States of America
10Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
11Laboratory Medicine and Pathology, University of Pennsylvania, Philadelphia, United States of America
12Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
13Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
14Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center Medical Research Foundation, Oklahoma City, United States of America
15Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
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Published June 4, 2024 - More info
Patients with autoimmune diseases are at higher risk for severe infection due to their underlying disease and immunosuppressive treatments. In this real-world observational study of 463 autoimmune subjects, we examined risk factors for poor B and T cell responses to SARS-CoV-2 vaccination. We show a high frequency of inadequate anti-spike IgG responses to vaccination and boosting in the autoimmune population but minimal suppression of T cell responses. Low IgG responses in B cell–depleted multiple sclerosis (MS) subjects were associated with higher CD8 T cell responses. By contrast, subjects taking mycophenolate mofetil exhibited concordant suppression of B and T cell responses. Treatments with highest risk for low IgG anti-spike response included B cell depletion within the last year, fingolimod, and combination treatment with mycophenolate mofetil (MMF) and belimumab. Our data show that the mRNA-1273 (Moderna) vaccine, is the most effective vaccine in the autoimmune population. There was minimal induction of either disease flares or autoantibodies by vaccination and no significant effect of pre-existing anti-type I interferon antibodies on either vaccine response or breakthrough infections. The low frequency of breakthrough infections and lack of SARS-CoV-2–related deaths suggest that T cell immunity contributes to protection in autoimmune disease.