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Zhou X, Cai F, Li S, Li G, Zhang C, Xie J, Yang Y. Machine learning techniques for prediction in pregnancy complicated by autoimmune rheumatic diseases: Applications and challenges. Int Immunopharmacol 2024; 134:112238. [PMID: 38735259 DOI: 10.1016/j.intimp.2024.112238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024]
Abstract
Autoimmune rheumatic diseases are chronic conditions affecting multiple systems and often occurring in young women of childbearing age. The diseases and the physiological characteristics of pregnancy significantly impact maternal-fetal health and pregnancy outcomes. Currently, the integration of big data with healthcare has led to the increasing popularity of using machine learning (ML) to mine clinical data for studying pregnancy complications. In this review, we introduce the basics of ML and the recent advances and trends of ML in different prediction applications for common pregnancy complications by autoimmune rheumatic diseases. Finally, the challenges and future for enhancing the accuracy, reliability, and clinical applicability of ML in prediction have been discussed. This review will provide insights into the utilization of ML in identifying and assisting clinical decision-making for pregnancy complications, while also establishing a foundation for exploring comprehensive management strategies for pregnancy and enhancing maternal and child health.
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Affiliation(s)
- Xiaoshi Zhou
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Feifei Cai
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shiran Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guolin Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Changji Zhang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jingxian Xie
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; College of Pharmacy, Southwest Medical University, Luzhou, China
| | - Yong Yang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Lin HC, Chang HM, Hung YM, Chang R, Chen HH, Wei JCC. Hashimoto's thyroiditis increases the risk of new-onset systemic lupus erythematosus: a nationwide population-based cohort study. Arthritis Res Ther 2023; 25:20. [PMID: 36759862 PMCID: PMC9909872 DOI: 10.1186/s13075-023-02999-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Previous studies have shown systemic lupus erythematosus (SLE) patients had a significantly higher prevalence of thyroid diseases and hypothyroidism than matched controls, and some case reports showed SLE may occur after Hashimoto's thyroiditis (HT). OBJECTIVE This study aimed to investigate the subsequent risk of SLE in patients with HT. METHODS In this retrospective cohort study done by the Taiwan National Health Insurance Research Database, the HT group (exposure group) and the non-HT group (comparator group) were propensity score matched at a ratio of 1:2 by demographic data, comorbidities, medications, and the index date. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Several sensitivity analyses were done for cross-validation of our findings. RESULTS We identified 15,512 HT patients and matched 31,024 individuals. The incidence rate ratio of SLE was 3.58 (95% CI, 2.43-5.28; p < 0.01). Several sensitivity analyses show adjusted hazard ratio (aHR) (CIs) of 4.35 (3.28-5.76), 4.39 (3.31-5.82), 5.11 (3.75-6.98), and 4.70 (3.46-6.38), consistent with the results of the main model. CONCLUSION Our study showed an increased risk of SLE in the HT group after adjustment for baseline characteristics, comorbidities, and medical confounders compared with the reference group.
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Affiliation(s)
- Hong-Ci Lin
- grid.411641.70000 0004 0532 2041School of Medicine, Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsu-Min Chang
- grid.415011.00000 0004 0572 9992Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Min Hung
- grid.415007.70000 0004 0477 6869Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan ,grid.419674.90000 0004 0572 7196College of Health and Nursing, Meiho University, Pingtung, Taiwan
| | - Renin Chang
- grid.415011.00000 0004 0572 9992Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan. .,Institute of Biomedical Science and Rong Hsing Research Centre for Translational Medicine, Chung Hsing University, Taichung, Taiwan. .,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan. .,Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. .,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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Williams EM, Nelson J, Francis D, Corbin K, Link G, Caldwell T, Gilkeson G. Formative research to promote lupus awareness and early screening at Historically Black College and University (HBCU) communities in South Carolina. BMC Rheumatol 2022; 6:92. [PMID: 36585733 PMCID: PMC9805239 DOI: 10.1186/s41927-022-00323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/01/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus or lupus is a severe chronic autoimmune disorder that disproportionately impacts young African Americans. Increasing lupus awareness in this high-risk group may be an effective approach to ultimately improving lupus outcomes. To begin to address this disparity, this report describes qualitative data to be utilized in the development of a campaign to enhance awareness of lupus on Historically Black Colleges and University (HBCU) campuses. METHODS Two focus groups (N = 14) were held with African American students in the network of HBCU's in South Carolina to examine perspectives of focus group participants on knowledge, awareness, and experiences with lupus. RESULTS Five key emergent themes included: (1) Lupus Knowledge and Awareness, (2) Barriers for Not Seeking Healthcare, (3) Fatalism for Disease Burden, (4) Lifestyle Debilitation, and (5) Elevation of Education and Advocacy for Lupus. Additionally, five key recommendations emerged to improve lupus awareness and support, including: (1) remaining positive, (2) developing a supportive network, (3) the importance of increasing advocacy efficacy, and (4) messaging strategies around lupus, and (5) providing education to foster knowledge around the clinical impacts of lupus. CONCLUSION Participants in our study stressed the necessity of lupus education and awareness among African American youth and expressed the desire for resources that would enable them to advocate for themselves and their families. Given the early age of onset for lupus, it is therefore vital to include African American youth in increasing education and awareness about lupus.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, CU 420708, Rochester, NY 14642 USA
| | - Joni Nelson
- James B. Edwards College of Dental Medicine, Medical University of South Carolina, 73 Ashley Ave, BSB 127, Charleston, SC 29425 USA
| | - Diane Francis
- Department of Communication, University of Kentucky, 343 S. Martin Luther King Blvd, Lexington, KY 40506 USA
| | - Keesha Corbin
- James B. Edwards College of Dental Medicine, Medical University of South Carolina, 73 Ashley Ave, BSB 127, Charleston, SC 29425 USA
| | - Gary Link
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425 USA
| | - Tomika Caldwell
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, CU 420708, Rochester, NY 14642 USA
| | - Gary Gilkeson
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425 USA
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Woo JMP, Parks CG, Jacobsen S, Costenbader KH, Bernatsky S. The role of environmental exposures and gene-environment interactions in the etiology of systemic lupus erythematous. J Intern Med 2022; 291:755-778. [PMID: 35143075 DOI: 10.1111/joim.13448] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex, chronic autoimmune disease, whose etiology includes both genetic and environmental factors. Individual genetic risk factors likely only account for about one-third of observed heritability among individuals with a family history of SLE. A large portion of the remaining risk may be attributable to environmental exposures and gene-environment interactions. This review focuses on SLE risk associated with environmental factors, ranging from chemical and physical environmental exposures to lifestyle behaviors, with the weight of evidence supporting positive associations between SLE and occupational exposure to crystalline silica, current smoking, and exogenous estrogens (e.g., oral contraceptives and postmenopausal hormones). Other risk factors may include lifestyle behaviors (e.g., dietary intake and sleep) and other exposures (e.g., ultraviolet [UV] radiation, air pollution, solvents, pesticides, vaccines and medications, and infections). Alcohol use may be associated with decreased SLE risk. We also describe the more limited body of knowledge on gene-environment interactions and SLE risk, including IL-10, ESR1, IL-33, ITGAM, and NAT2 and observed interactions with smoking, UV exposure, and alcohol. Understanding genetic and environmental risk factors for SLE, and how they may interact, can help to elucidate SLE pathogenesis and its clinical heterogeneity. Ultimately, this knowledge may facilitate the development of preventive interventions that address modifiable risk factors in susceptible individuals and vulnerable populations.
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Affiliation(s)
- Jennifer M P Woo
- Epidemiology Branch, National Institutes of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Christine G Parks
- Epidemiology Branch, National Institutes of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sasha Bernatsky
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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5
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Environmental factors associated with juvenile idiopathic inflammatory myopathy clinical and serologic phenotypes. Pediatr Rheumatol Online J 2022; 20:28. [PMID: 35414090 PMCID: PMC9004071 DOI: 10.1186/s12969-022-00684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Environmental exposures have been associated with the juvenile idiopathic inflammatory myopathies (JIIM). We undertook a questionnaire-based study to evaluate patient-reported exposures as possible risk factors for JIIM. FINDINGS One-hundred-seven patients with JIIM were enrolled in a myositis natural history protocol and completed environmental questionnaires. Frequencies of exposures in clinical and myositis-specific autoantibody (MSA) groups were examined. Patients with juvenile dermatomyositis (JDM) and juvenile connective tissue myositis (JCTM) more frequently received an immunization within 1 year of diagnosis compared to juvenile polymyositis (57.5 and 71.4% vs 0.0%, p ≤ 0.017). JCTM patients were more often underweight at diagnosis relative to JDM patients (42.9% vs 7.0%, p = 0.002). MSA-negative patients more frequently had gastroenteritis within a year of diagnosis compared to patients with anti-MDA5 autoantibodies (28.6% vs 0.0%, p = 0.032). Heavy exercise was more frequent in MSA-negative and anti-MDA5 groups compared to the anti-TIF-1 autoantibody group (42.9 and 35.3% vs. 9.0%, p ≤ 0.047). Medications received within 1 year of diagnosis were more frequent in MSA-negative patients relative to those with anti-MDA5 autoantibodies (92.9% vs. 52.8% p = 0.045). Being breastfed > 6 months was more frequent in MSA-negative patients (88.9%) compared to anti-TIF-1 and anti-MDA5 autoantibody groups (41.2 and 28.6%, p ≤ 0.036). CONCLUSIONS Certain environmental exposures prior to diagnosis differed among clinical and serologic subgroups of JIIM, suggesting additional exposures to be explored as possible risk factors for JIIM phenotypes.
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Younes ST, Showmaker K, Johnson AC, Garrett MR, Ryan MJ. Single cell RNA sequencing reveals ferritin as a key mediator of autoimmune pre-disposition in a mouse model of systemic lupus erythematosus. Sci Rep 2021; 11:24245. [PMID: 34930978 PMCID: PMC8688484 DOI: 10.1038/s41598-021-03649-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/13/2021] [Indexed: 11/09/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a devastating autoimmune disorder characterized by failure of self-tolerance with resultant production of autoreactive antibodies. The etiology of this syndrome is complex, involving perturbations in immune cell signaling and development. The NZBWF1 mouse spontaneously develops a lupus-like syndrome and has been widely used as a model of SLE for over 60 years. The NZBWF1 model represents the F1 generation of a cross between New Zealand Black (NZB) and New Zealand White (NZW) mice. In order to better understand the factors that contribute to the development of autoimmunity, single cell RNA sequencing was conducted using the bone marrow from female NZBWF1 mice prior to the development of overt disease. The results were contrasted with single cell RNA sequencing results from the two parental strains. The expected findings of B cell abundance and upregulation, and evidence of interferon signaling were validated in this model. In addition, several novel areas of inquiry were identified. Most notably, the data showed a marked upregulation of the ferritin light chain across all cell types in the NZBWF1 mice compared to parental controls. This data can serve as a gene expression atlas of all hematopoietic cells in the NZBWF1 bone marrow prior to the development of autoimmunity.
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Affiliation(s)
| | - Kurt Showmaker
- Department of Pharmacology and Experimental Therapeutics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ashley C Johnson
- Department of Pharmacology and Experimental Therapeutics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael R Garrett
- Department of Pharmacology and Experimental Therapeutics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael J Ryan
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, 6439 Garners Ferry Road, Columbia, SC, 29209, USA.
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El-Reshaid K, Al-Bader S, Sallam HT. A Self-Limited Facial Rash in a Lupus Patient: The Case of Primary Facial Raynaud's Phenomenon. Case Rep Dermatol 2021; 13:366-371. [PMID: 34413734 PMCID: PMC8339507 DOI: 10.1159/000517553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
Skin is involved in 80% of systemic lupus erythematosus (SLE) and the second most affected after joint disease. Lupus-specific lesions include (a) acute ones viz. malar rash (80%), (b) subacute ones viz. photosensitive maculopapular dermatitis (50%), and (c) chronic ones viz. discoid rash. The lupus nonspecific lesions include; (a) nonscarring alopecia (86.67%), oral ulcers (56.67%), vasculitic lesions (33.34%), bullous lesions (10%), and Raynaud's phenomenon (6.67%). In this case report, we describe a patient with SLE and antiphospholipid antibodies that had developed a transient facial form of Raynaud's phenomenon that was not associated with disease activity and digital changes. Its association with SLE is discussed.
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Affiliation(s)
- Kamel El-Reshaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Shaikha Al-Bader
- Department of Medicine, Nephrology Unit, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
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Palma Dos Reis CR, Cardoso G, Carvalho C, Nogueira I, Borges A, Serrano F. Prediction of Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus. Clin Rev Allergy Immunol 2021; 59:287-294. [PMID: 31444781 DOI: 10.1007/s12016-019-08762-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease associated with major obstetrical complications such as gestational loss, preterm delivery, fetal growth restriction (FGR) and preeclampsia. Published literature is not consensual regarding the main risk factors for each of these outcomes. Our goal with this study was to determine the most important predictors for each of the main adverse pregnancy outcomes in this population. We conducted a retrospective cohort study of unifetal pregnancies of women with the diagnosis of SLE followed in our unit between January 1994 and December 2016. We excluded elective terminations of pregnancy and cases lost to follow-up and we analyzed 157 pregnancies (128 women). Multiple logistic regression models for the outcomes gestational loss, preterm delivery, fetal growth restriction, and preeclampsia were built. Two-sided p-values of < 0.05 were used to determine statistical significance, and two-sided confidence intervals of 95% are reported. In our cohort, the main risk factors for gestational loss were maternal age and the presence of antiphospholipid antibodies. Lupic nephritis was predictive of a preterm delivery and preeclampsia. Renal involvement and lupus flares during pregnancy were risk factors for FGR. Overall, the main risk factor for an adverse pregnancy outcome were lupus flares during pregnancy. Despite optimal pregnancy monitoring, women with SLE are still at risk for adverse pregnancy outcomes. Risk stratification for each of these outcomes is crucial for an effective counselling and tailored monitoring.
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Affiliation(s)
- Catarina R Palma Dos Reis
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal. .,Department of Obstetrics and Gynecology, Nova Medical School
- Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal.
| | - Gonçalo Cardoso
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal
| | - Carolina Carvalho
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal
| | - Isabel Nogueira
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal
| | - Augusta Borges
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal
| | - Fátima Serrano
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal.,Department of Obstetrics and Gynecology, Nova Medical School
- Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
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Strong association of common variants in the miRNA-binding site of NOD2 gene with clinicopathological characteristics and disease activity of systemic lupus erythematosus. Clin Rheumatol 2021; 40:4559-4567. [PMID: 34173079 DOI: 10.1007/s10067-021-05812-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION/OBJECTIVES Systemic lupus erythematosus (SLE) is a multifactorial systemic autoimmune disease, in which genetic susceptibility plays a pivotal role. The nucleotide oligomerization domain 2 (NOD2) gene is one of the main regulators of chronic inflammatory conditions and could be involved in SLE pathogenesis. Single nucleotide polymorphisms (SNPs) in miRNA binding sites which are located in 3'UTR of the NOD2 gene could be associated with SLE risk by dysregulation of NOD2 expression. In the present study, we assessed the possible association between SNPs rs3135500 and rs3135499 in the NOD2 gene with SLE risk in the Iranian population. METHODS A case-control study using 110 SLE patients and 120 control subjects was undertaken to estimate rs3135500 (G > A) and rs3135499 (A > C) genotypes via real-time PCR high-resolution melting method (HRM). RESULTS No significant association was observed between allele and genotype frequencies of rs3135500 and rs3135499 polymorphisms and SLE risk in this population (P > 0.05). However, there was an obvious association between rs3135500 (A allele) with laboratory factors that are associated with disease activity (P < 0.05) and some clinical manifestations that are associated with disease severity such as neurological symptoms, skin manifestations, renal involvements, and higher serum concentration of creatinine (P < 0.05). Besides, rs3135499 (C allele) was correlated with renal involvement and also the concentration of creatinine (P < 0.05). Moreover, in the patients group, the risk alleles in these polymorphisms were associated with lower age of onset (P < 0.05). CONCLUSIONS Our results suggest a substantial association between NOD2 polymorphisms with clinicopathological characteristics and SLE disease activity. Key Points • Single nucleotide polymorphisms (SNPs) in miRNA binding sites which are located in 3'UTR of the NOD2 gene could be associated with SLE risk by dysregulation of NOD2 expression. • Our results suggested that two miRSNPs (rs3135500 and rs3135499) in the NOD2 gene were meaningfully correlated with clinicopathological characteristics and disease activity of SLE.
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Vascular Endothelial Growth Factor Biology and Its Potential as a Therapeutic Target in Rheumatic Diseases. Int J Mol Sci 2021; 22:ijms22105387. [PMID: 34065409 PMCID: PMC8161097 DOI: 10.3390/ijms22105387] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/11/2022] Open
Abstract
Rheumatic diseases constitute a diversified group of diseases distinguished by arthritis and often involve other organs. The affected individual has low quality of life, productivity even life-threatening in some severe conditions. Moreover, they impose significant economic and social burdens. In recent years, the patient outcome has been improved significantly due to clearer comprehension of the pathology of rheumatic diseases and the effectiveness of "treat to target" therapies. However, the high cost and the adverse effects are the concerns and full remissions are not often observed. One of the main processes that contributes to the pathogenesis of rheumatic diseases is angiogenesis. Vascular endothelial growth factor (VEGF), a central mediator that regulates angiogenesis, has different isoforms and functions in various physiological processes. Increasing evidence suggests an association between the VEGF system and rheumatic diseases. Anti-VEGF and VEGF receptor (VEGFR) therapies have been used to treat several cancers and eye diseases. This review summarizes the current understanding of VEGF biology and its role in the context of rheumatic diseases, the contribution of VEGF bioavailability in the pathogenesis of rheumatic diseases, and the potential implications of therapeutic approaches targeting VEGF for these diseases.
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Said D, Rashad NM, Abdelrahmanc NS, Dawaa GA. Antineutrophil Cytoplasmic Antibody in Lupus Nephritis: Correlation with Clinicopathological Characteristics and Disease Activity. Curr Rheumatol Rev 2021; 17:213-221. [PMID: 33292154 DOI: 10.2174/1573397116999201208213422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lupus nephritis (LN) represents 40%-50% of all systemic lupus erythematosus (SLE) patients, and rapidly progressive glomerulonephritis is associated with significant morbidity and mortality. Antineutrophil cytoplasmic antibody (ANCA) might be involved in the pathogenesis of LN. OBJECTIVE We evaluated the role of myeloperoxidase (MPO)-ANCA, proteinase 3 (PR3)-ANCA, and anti-glomerular basement membrane autoantibodies (anti-GBM autoAb) for the diagnosis of LN. METHODS In this cross-sectional study, 95 SLE patients were divided into 2 subgroups: LN group (n = 60) and non-LN group (n = 35). For further analysis, we subclassified the LN group into ANCA- positive (n = 16) and ANCA-negative (n = 44) LN patients. The entire Non-LN group was ANCA- negative. The SLE disease activity index (SLEDAI) was reported for each patient. Determination of MPO-ANCA, PR3-ANCA, and anti-GBM autoAb was performed using a novel multiplex bead-based technology in all patients. Data analyses were done using SPSS, version 20. Approval was obtained from the institutional review board of Zagazig University (ZU-IRB#6000). RESULTS Of 95 patients with SLE, 16 patients (16.84%) had ANCA-positive LN, all of which were MPO-ANCA. There was a positive correlation between MPO-ANCA and SLEDAI, as well as with class IV LN. Receiver operating characteristic analyses revealed that the sensitivity and specificity of MPO-ANCA were 81.3% and 99.8%, respectively, in discriminating LN from systemic lupus without nephritis. CONCLUSION MPO-ANCA level was significantly correlated with SLEDAI, inflammatory markers, kidney function tests, and LN class IV.
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Affiliation(s)
- Dina Said
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Egypt
| | | | | | - Ghada Aboelsaud Dawaa
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Kedves M, Kósa F, Kunovszki P, Takács P, Szabó MZ, Karyekar C, Lofland JH, Nagy G. Large-scale mortality gap between SLE and control population is associated with increased infection-related mortality in lupus. Rheumatology (Oxford) 2021; 59:3443-3451. [PMID: 32357240 PMCID: PMC7590419 DOI: 10.1093/rheumatology/keaa188] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/19/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of the present study was to analyse the incidence, prevalence, mortality and cause of death data of adult SLE patients and matched controls in a full-populational, nationwide, retrospective study. METHODS This non-interventional study was based on database research of the National Health Insurance Fund of Hungary. A total of 7888 patients were included in the analyses, within which two subgroups of incident patients were created: the 'All incident SLE patients' group consisted of all incident SLE patients (4503 patients), while the 'Treated SLE patients' group contained those who received relevant therapy in the first 6 months after diagnosis (2582 patients). RESULTS The median age of the SLE population was found to be 46.5 years (women 85%). The incidence rate was 4.86 and 2.78 per 100 000 inhabitants in the 'All incident SLE patients' and 'Treated SLE patients' groups, respectively. The standardized mortality ratio was 1.63 and 2.09 in the 'All incident SLE patients' and 'Treated SLE patients' groups, respectively. Overall survival was significantly lower (P < 0.001) in both groups than in the general population, with hazard ratio = 2.17 in the 'All incident SLE patients' group and hazard ratio = 2.75 in the 'Treated SLE patients' group. There was no significant difference between SLE and control deaths regarding cerebrovascular conditions as the cause of death. Generally, cancer-related deaths were less common, while haematological cancer and infection-related deaths were more common in SLE patients. CONCLUSION Infections, especially sepsis, had the largest positive effect on top of the extra mortality of SLE. This highlights that SLE patients are at increased risk of infection-related death.
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Affiliation(s)
- Melinda Kedves
- Department of Rheumatology, Hospital of Bács-Kiskun County, Kecskemét
| | - Fruzsina Kósa
- Janssen Global Commercial Strategy Organization, Budapest
| | | | - Péter Takács
- Janssen Global Commercial Strategy Organization, Budapest
| | | | - Chetan Karyekar
- Janssen R&D Services, Janssen Global Commercial Organization, Horsham, PA, USA
| | - Jennifer H Lofland
- Janssen R&D Services, Janssen Global Commercial Organization, Horsham, PA, USA
| | - György Nagy
- Department of Rheumatology, 3rd Department of Internal Medicine, Semmelweis University, Budapest.,Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest.,Department of Rheumatology, Buda Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
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Patel J. Medical problems dental students could identify part 3: Lupus. BDJ STUDENT 2021. [PMCID: PMC7829639 DOI: 10.1038/s41406-020-0178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yung S, Yap DYH, Chan TM. A review of advances in the understanding of lupus nephritis pathogenesis as a basis for emerging therapies. F1000Res 2020; 9:F1000 Faculty Rev-905. [PMID: 32789005 PMCID: PMC7405261 DOI: 10.12688/f1000research.22438.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 01/30/2023] Open
Abstract
Lupus nephritis is an important cause of both acute kidney injury and chronic kidney disease that can result in end-stage renal disease. Its pathogenic mechanisms are characterized by aberrant activation of both innate and adaptive immune responses, dysregulation of inflammatory signaling pathways, and increased cytokine production. Treatment of lupus nephritis remains a challenging issue in the management of systemic lupus erythematosus since the clinical presentation, response to treatment, and prognosis all vary considerably between patients and are influenced by ethnicity, gender, the degree of chronic kidney damage, pharmacogenomics, and non-immunological modulating factors. Elucidation of the various immunopathogenic pathways in lupus nephritis has resulted in the development of novel therapies, including biologics that target specific antigens on B lymphocytes to achieve B cell depletion, agents that modulate B cell proliferation and development, drugs that block co-stimulatory pathways, drugs that target T lymphocytes primarily, and therapies that target complement activation, signaling pathways, pro-inflammatory cytokines, and neutrophil extracellular traps. This review will discuss recent advances in the understanding of disease pathogenesis in lupus nephritis in the context of potential emerging therapies.
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Affiliation(s)
- Susan Yung
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Desmond YH Yap
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tak Mao Chan
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Abdel-Aal NM, Ali KM, Eladl HM. Efficacy of high-intensity laser therapy on arthropathy of the hands in patients with systemic lupus erythematosus: a double-blinded, randomized controlled trial. Clin Rehabil 2020; 34:1303-1312. [PMID: 32638614 DOI: 10.1177/0269215520941059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the efficacy of high-intensity laser therapy (HILT) on arthropathy of the hands in patients with systemic lupus erythematosus. DESIGN A double-blinded randomized, controlled study. SETTING Outpatient setting. PARTICIPANTS Fifty patients, 30-50-years-old, suffering from arthropathy of the hands were randomly assigned either into the experimental group, received HILT plus the routine physical therapy program or the control group, received sham HILT plus the same routine physical therapy program. INTERVENTION All treatment interventions were applied at a frequency of three sessions per week for eight weeks. OUTCOME MEASURES Handgrip strength, joints swelling counts, joints tenderness counts, visual analog scale (VAS) were measured before and after eight-weeks of interventions. RESULTS There were statistically significant differences in handgrip strength, joint swelling count, joint tenderness count and VAS in favor of the study group (P < 0.05). After eight-weeks of intervention, the mean (SD) for handgrip strength, joint swelling counts, joint tenderness count, and pain score was 28.34 ± 8.3 kg, 4.4 ± 2.18, 5 ± 2.1, and 35.6 ± 13.87 mm in the study group, and 22.96 ± 8.76 kg, 7.36 ± 2.14, 9.08 ± 1.63, and 58.8 ± 10.54 mm in the control group, respectively. The MD (95%CI) for handgrip strength, joint swelling counts, joint tenderness count, and pain score was 5.38(0.53,10.23) kg, -2.96(-4.19, -1.73), -4.08(-5.15, -3.01), and -23.2(-30.2, -16.2) mm between groups, respectively. CONCLUSIONS Adding HILT to the routine physical therapy program might be more effective than routine physical therapy program alone in improving handgrip strength, decreasing joint swelling counts, joint tenderness counts, and pain in patients with arthropathy of the hands.
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Affiliation(s)
- Nabil Mahmoud Abdel-Aal
- Department of physical therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Khadra Mohamed Ali
- Department of physical therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hadaya Mosaad Eladl
- Department of physical therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Correlations of Expression Levels of a Panel of Genes ( IRF5, STAT4, TNFSF4, MECP2, and TLR7) and Cytokine Levels (IL-2, IL-6, IL-10, IL-12, IFN- γ, and TNF- α) with Systemic Lupus Erythematosus Outcomes in Jordanian Patients. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1703842. [PMID: 31871930 PMCID: PMC6907047 DOI: 10.1155/2019/1703842] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/14/2019] [Accepted: 11/12/2019] [Indexed: 12/15/2022]
Abstract
Systemic lupus erythematosus (SLE) is characterized by systemic end-organ damage. We investigated the involvement of IRF5, TLR-7, MECP2, STAT4, and TNFSF4 genes and TNF-α, IFN-γ, IL-2, IL-12, IL-6, and IL-10 cytokines in SLE pathogenesis and in organ damage in Jordanian patients. Blood was collected from 51 patients and 50 controls. Expression levels of SLE genes in PBMCs and cytokine levels were determined using RT-PCR and ELISA, respectively. Expression levels of all genes and levels of TNF-α, IL-12, IL-6, and IL-10 were higher in SLE patients than those in controls (p < 0.05), whereas IL-2 level was lower. High STAT4 (α), TNFSF4, and IL-10 levels correlated with cardiovascular damage, and high MECP2 (α) and TNF-α correlated with renal damage. Pulmonary and musculoskeletal damages correlated with high levels of TNFSF4. We concluded that STAT4 and TNFSF4 genes with TNF-α and IL-10 cytokines could be used as biomarkers to assess SLE activity and manage treatment.
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Kwon YC, Chun S, Kim K, Mak A. Update on the Genetics of Systemic Lupus Erythematosus: Genome-Wide Association Studies and Beyond. Cells 2019; 8:cells8101180. [PMID: 31575058 PMCID: PMC6829439 DOI: 10.3390/cells8101180] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/20/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of complex etiology that primarily affects women of childbearing age. The development of SLE is attributed to the breach of immunological tolerance and the interaction between SLE-susceptibility genes and various environmental factors, resulting in the production of pathogenic autoantibodies. Working in concert with the innate and adaptive arms of the immune system, lupus-related autoantibodies mediate immune-complex deposition in various tissues and organs, leading to acute and chronic inflammation and consequent end-organ damage. Over the past two decades or so, the impact of genetic susceptibility on the development of SLE has been well demonstrated in a number of large-scale genetic association studies which have uncovered a large fraction of genetic heritability of SLE by recognizing about a hundred SLE-susceptibility loci. Integration of genetic variant data with various omics data such as transcriptomic and epigenomic data potentially provides a unique opportunity to further understand the roles of SLE risk variants in regulating the molecular phenotypes by various disease-relevant cell types and in shaping the immune systems with high inter-individual variances in disease susceptibility. In this review, the catalogue of SLE susceptibility loci will be updated, and biological signatures implicated by the SLE-risk variants will be critically discussed. It is optimistically hoped that identification of SLE risk variants will enable the prognostic and therapeutic biomarker armamentarium of SLE to be strengthened, a major leap towards precision medicine in the management of the condition.
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Affiliation(s)
- Young-Chang Kwon
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222–1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea;
| | - Sehwan Chun
- Department of Biology, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea;
| | - Kwangwoo Kim
- Department of Biology, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea;
- Correspondence: (K.K.); (A.M.); Tel.: +82-29610604 (K.K.); +65-82338216 (A.M.)
| | - Anselm Mak
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Correspondence: (K.K.); (A.M.); Tel.: +82-29610604 (K.K.); +65-82338216 (A.M.)
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CRISPR/Cas9 guided genome and epigenome engineering and its therapeutic applications in immune mediated diseases. Semin Cell Dev Biol 2019; 96:32-43. [PMID: 31112800 DOI: 10.1016/j.semcdb.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 12/21/2022]
Abstract
Recent developments in the nucleic acid editing technologies have provided a powerful tool to precisely engineer the genome and epigenome for studying many aspects of immune cell differentiation and development as well as several immune mediated diseases (IMDs) including autoimmunity and cancer. Here, we discuss the recent technological achievements of the CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats)-based RNA-guided genome and epigenome editing toolkit and provide an insight into how CRISPR/Cas9 (CRISPR Associated Protein 9) toolbox could be used to examine genetic and epigenetic mechanisms underlying IMDs. In addition, we will review the progress in CRISPR/Cas9-based genome-wide genome and epigenome screens in various cell types including immune cells. Finally, we will discuss the potential of CRISPR/Cas9 in defining the molecular function of disease associated SNPs overlapping gene regulatory elements.
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Alshamrani HM, Alsolami MA, Alshehri AM, Salman AK, Alharbi MW, Alzuhayri AJ, Mleeh NT. Pattern of skin diseases in a university hospital in Jeddah, Saudi Arabia: age and sex distribution. Ann Saudi Med 2019; 39:22-28. [PMID: 30712047 PMCID: PMC6464678 DOI: 10.5144/0256-4947.2019.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Previous studies have investigated the pattern of dermatological diseases in some regions of Saudi Arabia, but studies on the prevalence of skin diseases in Jeddah are lacking. OBJECTIVES Assess the pattern of skin diseases in Jeddah based on age and sex differences and compare the results with those of previous studies conducted in other regions of Saudi Arabia and the Middle East. DESIGN A cross-sectional prevalence study, retrospective. SETTING Dermatology clinic of King Abdulaziz University hospital. PATIENTS AND METHODS Data obtained from electronic medical records were summarized and analyzed. We only included new patients, who first visited the clinic in 2017. MAIN OUTCOME MEASURES Descriptive epidemiological data and statistical comparisons. SAMPLE SIZE 1244. RESULTS Among 3458 patients who attended the dermatology clinic, 1244 were new patients. There were 365 (29.3%) men and 879 (70.7%) women for a male-to-female ratio of 1:2.4. The mean (SD) age of the total population was 35 (3.8) years. The most common dermatological disease was dermatitis (n=266, 21.4%), followed by acne (n=195, 15.7%) and fungal infection (n=136, 10.9%). Atopic dermatitis was the most prevalent dermatome in children (41.7%), while acne was the most prevalent disease in adults (19.5%). The chi-square test indicated a significant difference between acne and sex (P=.007), with adult women being more commonly affected (79%) and for alopecia and sex (P less than .001), with women being more commonly affected (91.2%). CONCLUSIONS There are slight differences in the prevalence of dermatological diseases in Jeddah, as shown in this study and other studies from other regions in Saudi Arabia and the Middle East. We recommend initiating awareness campaigns to increase knowledge about skin diseases, particularly in men, and improving dermatology-related training programs for primary health care physicians. A population-based study is warranted to clarify the prevalence of skin diseases in Saudi Arabia. LIMITATIONS The inclusion of patients who visited the dermatology clinic only in 2017 and data collection from only registration records. CONFLICT OF INTEREST None.
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Affiliation(s)
- Hussein M Alshamrani
- Dr. Hussein M. Alshamrani, Faculty of Medicine, King Abdulaziz University Hospital,, Jeddah 21333, Saudi Arabia, T: +966530204524, , ORCID: http://orcid. org/0000-0001-9893-7528
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20
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Xie QM, Hu HQ, Li SS, Wang F, Zhang M, Jiang SQ, Pan FM, Su H, Zou YF. Association of oestrogen receptor alpha gene polymorphisms with systemic lupus erythematosus risk: An updated meta-analysis. Microb Pathog 2018; 127:352-358. [PMID: 30572014 DOI: 10.1016/j.micpath.2018.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 12/13/2018] [Accepted: 12/15/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a complex, chronic autoimmune disease, and oestrogen is considered to be a predisposing factor for SLE. Although some studies are conducted to explore the association between oestrogen receptor alpha (ERα) gene polymorphisms and SLE susceptibility, their results are inconsistent. METHODS Meta-analysis was conducted to confirm whether ERα gene polymorphisms were associated with SLE susceptibility, and the strength of association was anticipated by pooled ORs with 95% CIs. Stata software package version 12.0 was used to calculate all the statistical analyses. RESULTS Twelve studies included 2494 cases and 4176 controls were incorporated in our meta-analysis. A significant association was found for ERα PvuII polymorphism in the overall population (CC+CT vs TT: OR = 1.334, 95% CI = 1.195-1.490, P < 0.001; CC vs TT: OR = 1.401, 95% CI = 1.096-1.791, P = 0.007; CT vs TT: OR = 1.284, 95% CI = 1.141-1.444, P < 0.001; C vs T: OR = 1.221, 95% CI = 1.084-1.375, P = 0.001), while there was no significant association for ERα XbaI polymorphism. Besides, in stratification analyses by ethnicity, the PvuII polymorphism was associated with an increased risk of SLE in Asians (CC+CT vs TT: OR = 1.379, 95% CI = 1.203-1.581, P < 0.001; CT vs TT: OR = 1.308, 95% CI = 1.130-1.515, P < 0.001; C vs T: OR = 1.240, 95% CI = 1.052-1.462, P = 0.010), while for ESR1 XbaI polymorphism, a significantly increased risk of SLE susceptibility was found in Asians (GA vs AA: OR = 1.271, 95% CI = 1.101-1.467, P = 0.001). CONCLUSION Our meta-analysis indicated that the ERα PvuII polymorphism was significantly associated with SLE susceptibility in the overall and Asian populations, while the ERα XbaI GA genotype only played a key role in SLE susceptibility in Asian populations.
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Affiliation(s)
- Qiao-Mei Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China; The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Hua-Qing Hu
- Department of Health Examination Center, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Su-Su Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China; The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Fang Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Man Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China; The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Shan-Qun Jiang
- School of Life Sciences, Anhui University, 111 Jiulong Road, Hefei, 230601, China
| | - Fa-Ming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China; The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Hong Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China; The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China
| | - Yan-Feng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China; The Key Laboratory of Anhui Medical Autoimmune Diseases, Hefei, 230032, Anhui, China.
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Williams JN, Chang SC, Sinnette C, Malspeis S, Parks CG, Karlson EW, Fraser P, Costenbader K. Pesticide exposure and risk of systemic lupus erythematosus in an urban population of predominantly African-American women. Lupus 2018; 27:2129-2134. [PMID: 30309287 DOI: 10.1177/0961203318805844] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Past studies have reported associations between pesticide exposure and the risk of systemic lupus erythematosus (SLE). Residential pesticide exposure has been less well studied than agricultural exposure. The purpose of this study was to assess SLE risk associated with residential pesticide exposure in an urban population of predominantly African-American women. METHODS Adult women with SLE were identified from six hospital databases and community screening in three neighborhoods in Boston, Massachusetts, USA. Controls were adult women volunteers from the same neighborhoods who were screened for the absence of connective tissue disease and anti-nuclear antibodies. Subjects were considered exposed to pesticides if they had ever had an exterminator for an ant, cockroach, or termite problem prior to SLE diagnosis or corresponding reference age in controls. Risks associated with pesticide exposure were analyzed using multivariable logistic regression models, adjusted for sociodemographic factors. RESULTS We identified 93 SLE subjects and 170 controls with similar baseline characteristics. Eighty-three per cent were African-American. Pesticide exposure was associated with SLE, after controlling for potential confounders (odds ratio 2.24, 95% confidence interval 1.28-3.93). CONCLUSION Residential exposure to pesticides in an urban population of predominantly African-American women was associated with increased SLE risk. Additional studies are needed to corroborate these findings.
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Affiliation(s)
- J N Williams
- 1 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, USA
| | - S-C Chang
- 1 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, USA
| | - C Sinnette
- 1 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, USA
| | - S Malspeis
- 1 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, USA
| | - C G Parks
- 2 Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, USA
| | - E W Karlson
- 1 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, USA
| | - P Fraser
- 1 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, USA
| | - K Costenbader
- 1 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, USA
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Glomerulonephritis Pattern at a Jordanian Tertiary Care Center. Int J Nephrol 2018; 2018:2751372. [PMID: 30405912 PMCID: PMC6201331 DOI: 10.1155/2018/2751372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/04/2018] [Accepted: 09/30/2018] [Indexed: 01/17/2023] Open
Abstract
Aim To determine the prevalence and frequency of different pathological patterns of glomerulonephritis (GN) in adolescent (age ≥ 11 years) and adult Jordanian patients. Materials and Methods A retrospective analysis of all clinical and pathological reports of Jordanian patients who had native renal biopsies at the University of Jordan hospital between January 2007 and March 2018 to assess the prevalence and pathological pattern of GN. The data were analyzed statistically using descriptive statistics, the chi-squared test, and Fisher's exact tests. The level of significance was set at P < 0.05. Results Two hundred and nine patients (88 males and 121 females) had native kidney biopsies diagnosed as having GN; the mean age at the time of biopsy was 36.0 ± 14.9 years. Primary GN (51.2%) was more common than secondary GN (48.8%). The most common GN was lupus nephritis (LN) (33.5%), followed by membranous nephropathy (MGN) (15.3%), and diabetic nephropathy (DN) (11.0%). Furthermore, IgA nephropathy was noted in 8.1% of cases. LN was the most common among the secondary GN and occurred in 49.6% of females; MGN was the most common primary GN and occurred in 22.7% of males. There was a statistically significant difference between males and females in the prevalence of LN and MGN (P < .001 and P = .011, respectively). LN was also dominant in all age groups expect for the ≥60 years group, which tended to exhibit DN (40%). Conclusion LN is the most common GN type in Jordan, followed by MGN and DN. MGN is the predominant primary GN with a higher prevalence among males; LN is the predominant secondary GN and tends to occur in Jordanian females. The GN patterns in this study shifted from membranoproliferative GN to MGN in Jordan, which revealed a shift towards similar patterns exhibited in developed countries. Furthermore, DN is the most frequent GN in the elderly.
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Pham GS, Mathis KW. Lipopolysaccharide Challenge Reveals Hypothalamic-Pituitary-Adrenal Axis Dysfunction in Murine Systemic Lupus Erythematosus. Brain Sci 2018; 8:E184. [PMID: 30287776 PMCID: PMC6211064 DOI: 10.3390/brainsci8100184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 01/04/2023] Open
Abstract
Crosstalk between the brain and innate immune system may be dysregulated in systemic lupus erythematosus (SLE), a chronic autoimmune disease that presents with dysautonomia and aberrant inflammation. The hypothalamic-pituitary-adrenal (HPA) axis is an endogenous neuro-endocrine-immune pathway that can regulate inflammation following activation of vagal afferents. We hypothesized that chronic inflammatory processes in SLE are in part due to HPA axis dysfunction, at the level of either the afferent vagal-paraventricular nuclei (PVN) interface, the anterior pituitary, and/or at the adrenal glands. To study this, we challenged female control and SLE mice with lipopolysaccharide (LPS) and measured c-Fos expression as an index of neuronal activation, plasma adrenocorticotrophic hormone (ACTH) as an index of anterior pituitary function, and plasma corticosterone as an index of adrenal function. We found that c-Fos expression in the PVN, and plasma ACTH and corticosterone were comparable between unchallenged SLE and control mice. PVN c-Fos was increased similarly in control and SLE mice three hours after LPS challenge; however, there were no changes in plasma ACTH amongst any experimental groups post inflammatory challenge. Plasma corticosterone was markedly increased in LPS-challenged SLE mice compared to their vehicle-treated counterparts, but not in controls. Paradoxically, following LPS challenge, brain and spleen TNF-α were elevated in LPS-challenged SLE mice despite heightened plasma corticosterone. This suggests that, despite normal c-Fos expression in the PVN and activation of the HPA axis following LPS challenge, this cumulative response may not adequately defend SLE mice against inflammatory stimuli, leading to abnormally heightened innate immune responses and peripheral inflammation.
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Affiliation(s)
- Grace S Pham
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
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Immunological and Clinical Characteristics of Systemic Lupus Erythematosus: A Series from Morocco. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3139404. [PMID: 30363993 PMCID: PMC6186365 DOI: 10.1155/2018/3139404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/14/2018] [Accepted: 07/09/2018] [Indexed: 01/15/2023]
Abstract
Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with a high female predominance. To date, studies about SLE in Morocco are few. This retrospective study describes the clinical and immunological features in a series of 50 SLE Moroccan patients in University Hospital Center of Rabat, Morocco, between December 2011 and December 2013. All patients were screened for antinuclear antibodies (ANA) and anti-DNA antibodies by indirect immunofluorescence, followed by identification of anti-extractable nuclear antigen antibodies by ELISA. The female to male ratio was 6.1:1. Mean age was 31.72 years. The main clinical manifestations were arthritis (82%), mucocutaneous manifestations (80%), renal manifestations (50%), and hematological features (46%). Of the mucocutaneous features, the highest frequencies were observed in the malar rash (68%) and photosensitivity (60%). Of the hematological features, lymphopenia was most frequently observed in 30% of patients, followed by hemolytic anemia in 16% and leucopenia and thrombocytopenia in 8%. Central nervous system was involved in 10%. ANA were found in 88%, anti-DNA antibodies in 56%, and anti-Sm antibodies in 50%. Anti-SSA, anti-SSB, anti-Sm/RNP, and anti-Scl70 antibodies were detected in 38%, 10%, 48%, and 8%, respectively. Our data show that, in our patients, the main clinical and immunological features of SLE remain comparable to patients from other Arab countries.
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Grygiel-Górniak B, Rogacka N, Puszczewicz M. Antinuclear antibodies in healthy people and non-rheumatic diseases - diagnostic and clinical implications. Reumatologia 2018; 56:243-248. [PMID: 30237629 PMCID: PMC6142026 DOI: 10.5114/reum.2018.77976] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023] Open
Abstract
The presence of antinuclear antibodies (ANA) is mainly associated with connective tissue diseases (CTD). In addition, their presence is found in healthy people. These antibodies are more common in women and the elderly. Some drugs and xenobiotics are also important for the development of autoimmunity and ANA synthesis. Moreover, the deficiency of vitamin D in the body of patients correlates with occurrence of these antibodies. Unlike the healthy group, a positive ANA count was observed in patients with atopic dermatitis (AD) and in people with immune disorders. Antinuclear antibodies in low counts are also found in the course of chronic bacterial or viral infection and in patients with hematological malignancies. Also the possibility of false positive results, which may be caused by the choice of method used to determine antibodies, should be borne in mind. Taking into account all these factors, it is concluded that the ANA result itself has no diagnostic value.
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Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology and Internal Medicine, Poznań University of Medical Sciences, Poland
| | - Natalia Rogacka
- Department of Rheumatology and Internal Medicine, Poznań University of Medical Sciences, Poland
| | - Mariusz Puszczewicz
- Department of Rheumatology and Internal Medicine, Poznań University of Medical Sciences, Poland
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Geraldino-Pardilla L, Kapoor T, Canto I, Perez-Recio T, Then J, Tineo C, Loyo E, Askanase A. Damage accrual in systemic lupus erythematosus in Dominicans in New York City and the Dominican Republic. Lupus 2018; 27:1989-1995. [PMID: 30092732 DOI: 10.1177/0961203318791764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Hispanics with systemic lupus erythematosus (SLE) in the United States have more severe disease and damage accrual compared with whites. Data on Hispanics of similar ancestry in geographically different locations is limited but essential in defining genetic and environmental factors for SLE. This study evaluates SLE disease burden in two Dominican communities, Washington Heights in New York City (NYC) and Santiago in the Dominican Republic (DR). Methods Disease activity (SLE Disease Activity Index 2000 (SLEDAI-2K)) and damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)) were cross-sectionally measured in 76 Dominican SLE patients from the Columbia University Lupus Cohort in NYC and compared with 75 Dominican SLE patients living in Santiago in the DR. Results Mean (±SD) age was 40 (±14) and 36 (±11) years for NYC and DR patients, respectively. Median disease duration was 8 years. Disease activity was mild in both groups (SLEDAI-2K of 3 in NYC versus 4 in the DR). NYC Dominicans had more discoid lesions, positive anti-dsDNA, and anti-SSB antibodies. Dominicans in the DR used more corticosteroids, had less medical insurance, lower educational level, and were more likely to be unemployed, whereas more Dominicans in NYC smoked. NYC patients had a higher SDI compared with SLE patients in the DR (0.96 versus 0.24, p < 0.0001). Statistical significance was maintained in adjusted analysis (1.26 versus 0.57, p < 0.0001). Conclusion SLE Dominican patients in NYC had a higher SDI than those in the DR. Longitudinal studies are needed to ascertain whether this difference is due to biological, environmental factors, immigration patterns or a survival bias.
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Affiliation(s)
| | - T Kapoor
- 1 Columbia University College of Physicians and Surgeons, New York, USA
| | - I Canto
- 2 Hospital Regional Universitario Jose Maria Cabral y Baez, Santiago, Dominican Republic
| | - T Perez-Recio
- 1 Columbia University College of Physicians and Surgeons, New York, USA
| | - J Then
- 2 Hospital Regional Universitario Jose Maria Cabral y Baez, Santiago, Dominican Republic
| | - C Tineo
- 2 Hospital Regional Universitario Jose Maria Cabral y Baez, Santiago, Dominican Republic
| | - E Loyo
- 2 Hospital Regional Universitario Jose Maria Cabral y Baez, Santiago, Dominican Republic
| | - A Askanase
- 1 Columbia University College of Physicians and Surgeons, New York, USA
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Stewart S, Brenton-Rule A, Dalbeth N, Aiyer A, Frampton C, Rome K. Foot and ankle characteristics in systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:847-859. [PMID: 30093237 DOI: 10.1016/j.semarthrit.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/14/2018] [Accepted: 07/06/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine characteristics of the foot and ankle in people with systemic lupus erythematosus (SLE). METHODS Medline, CINAHL, Sports-Discus, Scopus and Cochrane Library databases were searched up to January 2018. Studies reporting foot- and ankle-related outcomes in the following domains were included: vascular, neurological, musculoskeletal, cutaneous (skin and nail) or pain/function. The Quality Index tool was used to assess methodological quality. Where appropriate, odds ratio (OR) and mean difference meta-analyses were conducted for case-control studies; and pooled mean prevalence meta-analyses for studies assessing characteristics in SLE. RESULTS Forty-nine studies were included with mean (range) quality scores of 75% (38-100%). Twenty-three studies assessed vascular characteristics, followed by musculoskeletal (n = 16), neurological (n = 11), cutaneous (n = 5) and pain/function (n = 4). Foot and ankle characteristics in people with SLE included impaired vascular supply, abnormal nerve function, musculoskeletal pathology, skin and nail pathology, and pain and functional disability. Twenty-four studies were included in meta-analyses. Pooled OR for abnormal ankle brachial index was 3.08 for SLE compared with controls. Pooled mean difference in brachial-ankle pulse-wave velocity between SLE and controls was significant (161.39 cm/s, P = 0.004). Pooled prevalence was 0.54 for intermittent claudication, 0.50 for Raynaud's phenomenon, 0.28 for chilblains, 0.00 for gangrene, 0.30 for hallux valgus, 0.15 for onychomycosis, 0.76 for history of foot pain, and 0.36 for current foot pain. CONCLUSION People with SLE experience a wide range of foot and ankle manifestations. Published research highlights the impact of peripheral arterial disease, peripheral neuropathy, musculoskeletal deformity, skin and nail pathology and patient-reported foot pain and disability.
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Affiliation(s)
- Sarah Stewart
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Angela Brenton-Rule
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Department of Rheumatology, Auckland District Health Board, New Zealand
| | - Ashok Aiyer
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Christopher Frampton
- Biostatistics Department, University of Otago, PO Box 7343, Wellington South, New Zealand
| | - Keith Rome
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
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Zhou A, Liu X, Xia T, Li F, Wang J, Li J. Estrogen receptor alpha gene (ESR1) polymorphism and its interaction with smoking and drinking contribute to susceptibility of systemic lupus erythematosus. Immunol Res 2018; 65:951-956. [PMID: 28707126 DOI: 10.1007/s12026-017-8935-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study is to investigate the association of estrogen receptor alpha gene (ESR1) polymorphisms, additional gene-gene, and gene-environment interaction with systemic lupus erythematosus (SLE) risk. SNPStats (available online at http://bioinfo.iconcologia.net/SNPstats ) was used to investigate the Hardy-Weinberg equilibrium (HWE) in controls and association between SNP and SLE risk. Generalized multifactor dimensionality reduction (GMDR) was used to screen the interactions among SNPs and environmental risk factors; SLE risk was significantly higher in carriers of rs2234693 C allele than those with TT (TC + CC versus TT), adjusted OR (95%CI) = 1.57 (1.21-2.06), and was also higher in carriers of rs9340799 G allele than those with AA (AG + GG versus AA), adjusted OR (95%CI) = 1.68 (1.24-2.13). However, we also find no association between rs2228480 and SLE risk after covariates adjustment. We found a significant two-locus model (p = 0.0010) involving rs2234693 and smoking; the cross-validation consistency of this model was 10/10, and the testing accuracy was 62.70%. Smokers with TC or CC of rs2234693 genotype have the highest SLE risk, compared to never-smokers with TT of rs2234693 genotype, OR (95%CI) was 2.50 (1.65-3.42), after covariates adjustment for gender, age, alcohol drinking, and BMI. We found that C allele of rs2234693 and G allele of rs9340799 within ESR1 gene, their interaction between rs2234693 and current smoking were all associated with increased SLE risk.
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Affiliation(s)
- Aihong Zhou
- Department of Rheumatology, Affiliated Hospital of Qingdao University, No 16 of Jiangsu road, Qingdao, 266003, China.,Department of Rheumatology, Tai'an Central Hospital, No 29 of Long' tan road, Shandong Province, 271000, China
| | - Xin Liu
- Department of Ultrasound Branch, Tai'an Central Hospital, Shandong Province, 271000, China
| | - Tao Xia
- Department of Vascular Surgery, Tai'an Central Hospital, Shandong Province, 271000, China
| | - Fang Li
- Department of Rheumatology, Tai'an Central Hospital, No 29 of Long' tan road, Shandong Province, 271000, China
| | - Jibo Wang
- Department of Rheumatology, Affiliated Hospital of Qingdao University, No 16 of Jiangsu road, Qingdao, 266003, China.
| | - Jun Li
- Department of Rheumatology, Tai'an Central Hospital, No 29 of Long' tan road, Shandong Province, 271000, China.
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Mohammadian R, Tarighatnia A, Naghibi M, Koleini E, Nader ND. Vertebrobasilar Artery Stroke as the Heralding Sign of Systemic Lupus Erythematosus. J Stroke Cerebrovasc Dis 2018; 27:e80-e85. [PMID: 29306594 DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/31/2017] [Accepted: 12/03/2017] [Indexed: 12/21/2022] Open
Abstract
Cerebral ischemia because of vertebrobasilar insufficiency (VBI) rarely presents as an initial sign within the systemic lupus erythematosus (SLE) population, and there are very few case reports supporting this manifestation. This report details 3 different patients with SLE who experienced VBI as an initial manifestation. Patient 1 was a 24-year-old female who developed a bilateral pontine lesion as a consequence of basilar artery stenosis. Patient 2 was a 34-year-old male with an acute ischemic lesion on the right side of his cerebellum and pons because of significant stenosis in the distal segment of the right vertebral artery. Patient 3 was a 37-year-old female, previously diagnosed with multiple sclerosis, with multiple lesions in her cerebellum and pons bilaterally. Further investigations within this case revealed severe stenosis of the left vertebral artery. The diagnosis of SLE was based on clinical presentations such as myalgia, skin rashes, ulcers, and fatigue along with relevant laboratory findings including positive anti ds-DNA antibody and depressed levels of complement C3 and C4 proteins. In young patients with multifocal ischemic lesions or infarcts in the posterior cerebral circulation system, physicians should investigate for less common etiologies such as SLE.
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Affiliation(s)
- Reza Mohammadian
- Neuroscience Research Center (NSRC), Tabriz University of Medical sciences, Tabriz, Iran
| | - Ali Tarighatnia
- Neuroscience Research Center (NSRC), Tabriz University of Medical sciences, Tabriz, Iran
| | - Mehran Naghibi
- Neuroscience Research Center (NSRC), Tabriz University of Medical sciences, Tabriz, Iran
| | - Evin Koleini
- Department of Anesthesiology, VA Western NY Healthcare System, New York
| | - Nader D Nader
- Department of Anesthesiology, SUNY-Buffalo, Buffalo, New York.
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Momen S, Kirkham B, Barker J, Smith C. Tumour necrosis factor antagonist-induced lupus: a Critically Appraised Topic. Br J Dermatol 2017; 177:1519-1526. [DOI: 10.1111/bjd.15866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- S.E. Momen
- St John's Institute of Dermatology; Guy's and St Thomas’ NHS Foundation Trust; London U.K
| | - B. Kirkham
- Department of Rheumatology; Guy's and St Thomas’ NHS Foundation Trust; London U.K
| | - J.N. Barker
- St John's Institute of Dermatology; Guy's and St Thomas’ NHS Foundation Trust; London U.K
| | - C.H. Smith
- St John's Institute of Dermatology; Guy's and St Thomas’ NHS Foundation Trust; London U.K
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Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W. The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology (Oxford) 2017; 56:1945-1961. [PMID: 28968809 DOI: 10.1093/rheumatology/kex260] [Citation(s) in RCA: 401] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Indexed: 01/26/2023] Open
Abstract
Objectives The aim was to review the worldwide incidence and prevalence of SLE and variation with age, sex, ethnicity and time. Methods A systematic search of MEDLINE and EMBASE search engines was carried out using Medical Subject Headings and keyword search terms for Systemic Lupus Erythematosus combined with incidence, prevalence and epidemiology in August 2013 and updated in September 2016. Author, journal, year of publication, country, region, case-finding method, study period, number of incident or prevalent cases, incidence (per 100 000 person-years) or prevalence (per 100 000 persons) and age, sex or ethnic group-specific incidence or prevalence were collected. Results The highest estimates of incidence and prevalence of SLE were in North America [23.2/100 000 person-years (95% CI: 23.4, 24.0) and 241/100 000 people (95% CI: 130, 352), respectively]. The lowest incidences of SLE were reported in Africa and Ukraine (0.3/100 000 person-years), and the lowest prevalence was in Northern Australia (0 cases in a sample of 847 people). Women were more frequently affected than men for every age and ethnic group. Incidence peaked in middle adulthood and occurred later for men. People of Black ethnicity had the highest incidence and prevalence of SLE, whereas those with White ethnicity had the lowest incidence and prevalence. There appeared to be an increasing trend of SLE prevalence with time. Conclusion There are worldwide differences in the incidence and prevalence of SLE that vary with sex, age, ethnicity and time. Further study of genetic and environmental risk factors may explain the reasons for these differences. More epidemiological studies in Africa are warranted.
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Affiliation(s)
- Frances Rees
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham.,Rheumatology Department, Nottingham University Hospitals NHS Trust
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Peter Lanyon
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham.,Rheumatology Department, Nottingham University Hospitals NHS Trust
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham
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Fatemi A, Shamsaee S, Raeisi A, Sayedbonakdar Z, Smiley A. Prognostic factors of mortality in Iranian patients with systemic lupus erythematosus admitted to intensive care unit. Clin Rheumatol 2017; 36:2471-2477. [PMID: 28879449 DOI: 10.1007/s10067-017-3808-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/21/2017] [Accepted: 08/28/2017] [Indexed: 12/29/2022]
Abstract
The aim was to determine the course, outcome, and determinants of mortality in patients with systemic lupus erythematosus (SLE) in intensive care unit (ICU). SLE patients admitted to ICU from 2004 to 2015 were recruited retrospectively. Demographic data, disease characteristics, causes of admission, baseline SLE disease activity index-2K (SLEDAI-2K) and Acute Physiologic and Chronic Health Evaluation II (APACHE) score, the outcome, and the causes of death were recorded. Predictors of mortality were compared between alive and dead patients by Cox regression analysis. Ninety-four patients with SLE were enrolled. Mean age at the time of ICU admission was 29.6 years. Average scores of SLEDAI and APACHE II were 11.3 and 19.8, respectively. The most common causes of ICU admission were pneumonia, diffuse alveolar hemorrhage (DAH), and seizure. Forty-seven patients (50%) died in ICU. The principal causes of death were septic shock (25.5%), multi-organ failure (12.5%), DAH (10.6%), and pneumonia (10.6%). After multivariate analysis, high APACHE II, septic shock, and duration of mechanical ventilation were indicators of survival outcome. Mean (95% CI) survival days in ICU in patients with and without respiratory failure were 14.6 (10.4-18.9) and 28.7 (17.9-39.5) days, respectively (P = 0.001). This figure for those with and without septic shock was 13.5 (4.9-11.1) and 22.3 (9.3-24.7) days, respectively (P = 0.016). High APACHE II, septic shock, and duration of mechanical ventilation were the main predictors of death in patients with SLE in ICU. Multicenter studies are needed to draw a fine picture of SLE behavior in ICU.
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Affiliation(s)
- Alimohammad Fatemi
- Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Somayeh Shamsaee
- Department of Internal Medicine, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Raeisi
- Department of Internal Medicine, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Sayedbonakdar
- Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Smiley
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
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Abstract
PURPOSE OF REVIEW This review examines evidence relating environmental factors to the development of systemic lupus erythematosus (SLE). RECENT FINDINGS The strongest epidemiologic evidence exists for the associations of silica, cigarette smoking, oral contraceptives, postmenopausal hormone therapy and endometriosis, with SLE incidence. Recent studies have also provided robust evidence of the association between alcohol consumption and decreased SLE risk. There are preliminary, conflicting or unsubstantiated data that other factors, including air pollution, ultraviolet light, infections, vaccinations, solvents, pesticides and heavy metals such as mercury, are related to SLE risk. Biologic mechanisms linking environmental exposures and SLE risk include increased oxidative stress, systemic inflammation and inflammatory cytokine upregulation, and hormonal triggers, as well as epigenetic modifications resulting from exposure that could lead to SLE. SUMMARY Identifying the environmental risk factors related to risk of SLE is essential as it will lead to increased understanding of pathogenesis of this complex disease and will also make risk factor modification possible for those at increased risk.
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Ahmed N, Shigidi M, Al Agib AN, Abdelrahman H, Taha E. Clinical features and antinuclear antibodies profile among adults with systemic lupus erythematosus and lupus nephritis: a cross-sectional study. Pan Afr Med J 2017; 27:114. [PMID: 28819535 PMCID: PMC5554640 DOI: 10.11604/pamj.2017.27.114.5981] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 06/07/2017] [Indexed: 01/26/2023] Open
Abstract
Introduction Limited data is available regarding the clinical manifestations and pattern of Systemic Lupus Erythematosus (SLE) in Sudan. This study aimed to determine the clinical manifestations and Antinuclear Antibodies (ANA) profile among Sudanese adults with SLE and lupus nephritis (LN). Methods A descriptive study was conducted in Omdurman Military Hospital, Sudan. It included all adults with SLE and on regular follow-up during the study period (December 2012 to May 2013). These were investigated regarding their demographic details, clinical features, and immunological profile (ANA, anti-double stranded DNA, and ANA profile 3 levels). Patients with LN had their pattern of renal involvement described; furthermore, associations between the various SLE reactive antibodies and the histological diagnosis of lupus were studied. Results Sixty-two Sudanese adults with SLE were included, their mean age was 31 ± 10.9 year. Females made 93.5% of patients. A clear predominance of those of Arab ancestry was seen, with most patients being from the Ja'alin and Shaigiya ethnic groups accounting for 29% and 12.9%, respectively. Arthritis was the dominant clinical manifestation seen in 85.5%, whereas renal involvement was seen in 66.1% of patients. Lupus nephritis class III was the dominant histological lesion, seen in 39% of patients. On correlating the ANA profile to the histopathological diagnosis of LN, anti-Nucleosomes and anti-AMA-M2 autoantibodies were found to be significantly associated with LN class IV and class VI, respectively (P values < 0.05). Conclusion Further epidemiological studies regarding SLE and its ANA profile remain essential as they might help predicting the clinical patterns of the disease and its prognosis.
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Affiliation(s)
- Nashwa Ahmed
- Sudan Medical Specialization Board, Ministry of Health, Khartoum, Sudan
| | - Mazin Shigidi
- Salma Centre for Kidney Diseases, Faculty of Medicine, University of Khartoum, Sudan
| | | | - Hassan Abdelrahman
- Faculty of Medicine, University of Medical Sciences and Technology, Sudan
| | - Elshafie Taha
- Cardiology Department, Al Ain Hospital, United Arab Emirates
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Parks CG, de Souza Espindola Santos A, Barbhaiya M, Costenbader KH. Understanding the role of environmental factors in the development of systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2017; 31:306-320. [PMID: 29224673 PMCID: PMC5729939 DOI: 10.1016/j.berh.2017.09.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/16/2017] [Accepted: 09/03/2017] [Indexed: 12/20/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem disease with a complex etiology. Its risk is higher among women, racial and ethnic minorities, and individuals with a family history of SLE or related autoimmune diseases. It is believed that genetic factors interact with environmental exposures throughout the lifespan to influence susceptibility to developing SLE. The strongest epidemiologic evidence exists for increased risk of SLE associated with exposure to crystalline silica, current cigarette smoking, use of oral contraceptives, and postmenopausal hormone replacement therapy, while there is an inverse association with alcohol use. Emerging research results suggest possible associations of SLE risk with exposure to solvents, residential and agricultural pesticides, heavy metals, and air pollution. Ultraviolet light, certain infections, and vaccinations have also been hypothesized to be related to SLE risk. Mechanisms linking environmental exposures and SLE include epigenetic modifications resulting from exposures, increased oxidative stress, systemic inflammation and inflammatory cytokine upregulation, and hormonal effects. Research needs to include new studies of environmental risk factors for SLE in general, with a focus on lifetime exposure assessment. In addition, studies in susceptible subgroups, such as family members, studies based on genetic risk profiles, and studies in individuals with evidence of pre-clinical autoimmunity based on the detection of specific auto-antibodies are also required. Understanding the role of environmental exposures in the development of SLE may help identify modifiable risk factors and potential etiological mechanisms.
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Affiliation(s)
- Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Durham, NC, USA
| | - Aline de Souza Espindola Santos
- Occupational and Environmental Health Branch, Public Health Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Medha Barbhaiya
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, Weill-Cornell Medical School, New York, NY, USA
| | - Karen H Costenbader
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Harley JB, Harley ITW, Guthridge JM, James JA. The curiously suspicious: a role for Epstein-Barr virus in lupus. Lupus 2016; 15:768-77. [PMID: 17153849 DOI: 10.1177/0961203306070009] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While the events initiating the development of autoantibodies in systemic lupus erythematosus (SLE) have not yet been convincingly established, newly developed tools for molecular investigation make such an undertaking increasingly practical. Applied to the earliest events in the sequence culminating in lupus autoimmunity, we present a critical potential role for Epstein-Barr virus (EBV) in the development and perhaps perpetuation of SLE. The expected properties for an environmental risk factor for SLE are found in this virus and the human host response against it. Existing data show the molecular progression to autoimmunity observed in SLE patient sera, the discovery of the first autoimmune epitopes in the Sm and Ro autoantigen systems, and the possible emergence of these autoantibodies from the heterologous antibodies against Epstein-Barr nuclear antigen-1 (EBNA-1). Further, existing data demonstrate association of SLE with EBV infection, even preceding the development of autoimmunity. Finally, the data are consistent with a proposed model of lupus pathogenesis that begins with antibodies to EBNA-1, predisposing to immune responses that develop crossreactive autoantibodies that culminate in the development of SLE autoimmunity.
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Affiliation(s)
- J B Harley
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma 73104, USA
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Abstract
Systemic lupus erythematosus (SLE) is a systemic non-organ specific autoimmune disease associated with multiple autoantibodies targeting autoantigens from the nucleus. Given the complex pathophysiology of SLE and the role of TNF alpha in that disease, modulation of TNF alpha (in SLE or non-SLE patients) using TNF blockers could either be detrimental or beneficial in some patients. In this review we will focus on lupus autoantibodies and clinical manifestations after TNF blockade in SLE patients and conversely on drug-induced-SLE in non-SLE patients. Some hypotheses regarding the mechanism of induction of autoantibodies in RA patients treated with TNF blockers are proposed.
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Affiliation(s)
- M De Bandt
- Rheumatology Department, Hôpital Robert Ballanger, Aulnay sous Bois, France.
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Tincani A, Nuzzo M, Lojacono A, Cattalini M, Meini A. Review: Contraception in adolescents with systemic lupus erythematosus. Lupus 2016; 16:600-5. [PMID: 17711895 DOI: 10.1177/0961203307078074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In the management of adolescents with systemic lupus erythematosus (SLE), sexual activity and prevention of unwanted pregnancies are important topics. Many contraceptive methods are available nowadays. Oral contraceptives (OCs) are the preferred choice among adolescents in general. However, the use of these medications in adolescents with SLE raises serious concerns, particularly the risk of thrombotic events from estrogen exposure and the impact of these medications on lupus activity. In this article, different contraceptive methods available are reviewed and their application in adolescents with SLE is discussed. In conclusion, OCs are the methods of choice in adolescents with stable disease and no antiphospholipid antibodies (aPL) detected. In patients with aPL, fewer options are available, and the selection of the preferred form of contraception should be made on an individual basis. Lupus (2007) 16, 600—605.
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Affiliation(s)
- A Tincani
- Department of Rheumatology and Clinical Immunology, Brescia Hospital and University of Brescia, Brescia, Italy.
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Zheng B, Yu X, Greth W, Robbie GJ. Population pharmacokinetic analysis of sifalimumab from a clinical phase IIb trial in systemic lupus erythematosus patients. Br J Clin Pharmacol 2016; 81:918-28. [PMID: 26659791 PMCID: PMC4834601 DOI: 10.1111/bcp.12864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/23/2015] [Accepted: 12/02/2015] [Indexed: 01/05/2023] Open
Abstract
AIMS Sifalimumab, a human immunoglobulin (Ig) G1 monoclonal antibody against INF-alpha, is being studied as a treatment for systemic lupus erythematosus (SLE). This analysis characterized population pharmacokinetics (PK) of sifalimumab following repeat fixed dose and evaluated the utility of fixed dosing vs. body weight normalized dosing in SLE patients. METHODS PK data were collected in a phase IIb study where 298 patients received multiple intravenous doses (200-1200 mg) of sifalimumab every 4 weeks for 52 weeks. A population pharmacokinetic model was developed using 3961 quantifiable serum concentrations and the impact of patient demographics, clinical indices and biomarkers on pharmacokinetic parameters was evaluated. The appropriateness of the final model was evaluated using visual predictive check and bootstrap. RESULTS A two compartment model with first order elimination adequately described sifalimumab serum PK. The estimated typical clearance (CL) and central volume of distribution (V1 ) were 184 ml day(-1) and 2.82 l with 24% and 16% between-subject variability (BSV), respectively. Body weight, dose, 21 INF gene signature baseline and concomitant steroid use were identified as statistically significant covariates for CL and V1 and accounted for <10% of PK variability in the final model. Typical values and BSV of PK parameters from the current analysis with fixed dosing were similar to previous population PK results with body weight normalized dosing. CONCLUSIONS The transition from body weight normalized dosing to fixed dosing did not impact sifalimumab PK. These findings support the use of fixed dosing for sifalimumab in future clinical studies evaluating it as a potential treatment for SLE.
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Affiliation(s)
- Bo Zheng
- Clinical Pharmacology and DMPK (CPD)MedImmune, LLC, One MedImmune WayGaithersburgMaryland20878
| | - Xiang‐Qing Yu
- Clinical Pharmacology and DMPK (CPD)MedImmune, LLC, One MedImmune WayGaithersburgMaryland20878
| | - Warren Greth
- Clinical DevelopmentMedImmune, LLC, One MedImmune WayGaithersburgMaryland20878USA
| | - Gabriel J. Robbie
- Clinical Pharmacology and DMPK (CPD)MedImmune, LLC, One MedImmune WayGaithersburgMaryland20878
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Houldcroft CJ, Underdown SJ. Neanderthal genomics suggests a pleistocene time frame for the first epidemiologic transition. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 160:379-88. [PMID: 27063929 DOI: 10.1002/ajpa.22985] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 02/10/2016] [Accepted: 03/03/2016] [Indexed: 12/13/2022]
Abstract
High quality Altai Neanderthal and Denisovan genomes are revealing which regions of archaic hominin DNA have persisted in the modern human genome. A number of these regions are associated with response to infection and immunity, with a suggestion that derived Neanderthal alleles found in modern Europeans and East Asians may be associated with autoimmunity. As such Neanderthal genomes are an independent line of evidence of which infectious diseases Neanderthals were genetically adapted to. Sympathetically, human genome adaptive introgression is an independent line of evidence of which infectious diseases were important for AMH coming in to Eurasia and interacting with Neanderthals. The Neanderthals and Denisovans present interesting cases of hominin hunter-gatherers adapted to a Eurasian rather than African infectious disease package. Independent sources of DNA-based evidence allow a re-evaluation of the first epidemiologic transition and how infectious disease affected Pleistocene hominins. By combining skeletal, archaeological and genetic evidence from modern humans and extinct Eurasian hominins, we question whether the first epidemiologic transition in Eurasia featured a new package of infectious diseases or a change in the impact of existing pathogens. Coupled with pathogen genomics, this approach supports the view that many infectious diseases are pre-Neolithic, and the list continues to expand. The transfer of pathogens between hominin populations, including the expansion of pathogens from Africa, may also have played a role in the extinction of the Neanderthals and offers an important mechanism to understand hominin-hominin interactions well back beyond the current limits for aDNA extraction from fossils alone. Am J Phys Anthropol 160:379-388, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Charlotte J Houldcroft
- Division of Biological Anthropology, Department of Archaeology & Anthropology, University of Cambridge, Cambridge, CB2 3QG, UK.,Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, WC1N 1EH, UK
| | - Simon J Underdown
- Human Origins and Palaeoenvironmental Research Group (HOPE), Department of Anthropology & Geography, Oxford Brookes University, Oxford, OX3 0BP, UK
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Dinse GE, Jusko TA, Whitt IZ, Co CA, Parks CG, Satoh M, Chan EK, Rose KM, Walker NJ, Birnbaum LS, Zeldin DC, Weinberg CR, Miller FW. Associations Between Selected Xenobiotics and Antinuclear Antibodies in the National Health and Nutrition Examination Survey, 1999-2004. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:426-36. [PMID: 26252071 PMCID: PMC4829978 DOI: 10.1289/ehp.1409345] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 08/04/2015] [Indexed: 05/25/2023]
Abstract
BACKGROUND Potential associations between background environmental chemical exposures and autoimmunity are understudied. OBJECTIVES Our exploratory study investigated exposure to individual environmental chemicals and selected mixtures in relation to the presence of antinuclear antibodies (ANA), a widely used biomarker of autoimmunity, in a representative sample of the U.S. METHODS This cross-sectional analysis used data on 4,340 participants from the National Health and Nutrition Examination Survey (1999-2004), of whom 14% were ANA positive, to explore associations between ANA and concentrations of dioxins, dibenzofurans, polychlorinated biphenyls, organochlorines, organophosphates, phenols, metals, and other environmental exposures and metabolites measured in participants' serum, whole blood, or urine. For dioxin-like compounds with toxic equivalency factors, we developed and applied a new statistical approach to study selected mixtures. Lognormal models and censored-data methods produced estimates of chemical associations with ANA in males, nulliparous females, and parous females; these estimates were adjusted for confounders and accommodated concentrations below detectable levels. RESULTS Several associations between chemical concentration and ANA positivity were observed, but only the association in males exposed to triclosan remained statistically significant after correcting for multiple comparisons (mean concentration ratio = 2.8; 95% CI: 1.8, 4.5; p < 0.00001). CONCLUSIONS These data suggest that background levels of most xenobiotic exposures typical in the U.S. population are not strongly associated with ANA. Future studies should ideally reduce exposure misclassification by including prospective measurement of the chemicals of concern and should track changes in ANA and other autoantibodies over time. CITATION Dinse GE, Jusko TA, Whitt IZ, Co CA, Parks CG, Satoh M, Chan EKL, Rose KM, Walker NJ, Birnbaum LS, Zeldin DC, Weinberg CR, Miller FW. 2016. Associations between selected xenobiotics and antinuclear antibodies in the National Health and Nutrition Examination Survey, 1999-2004. Environ Health Perspect 124:426-436; http://dx.doi.org/10.1289/ehp.1409345.
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Affiliation(s)
- Gregg E. Dinse
- Biostatistics Center, Social & Scientific Systems, Inc., Durham, North Carolina, USA
| | - Todd A. Jusko
- Departments of Public Health Sciences and Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Irene Z. Whitt
- Division of Rheumatology and Immunology, Department of Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Caroll A. Co
- Biostatistics Center, Social & Scientific Systems, Inc., Durham, North Carolina, USA
| | - Christine G. Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Edward K.L. Chan
- Department of Oral Biology, University of Florida, Gainesville, Florida, USA
| | - Kathryn M. Rose
- Biostatistics Center, Social & Scientific Systems, Inc., Durham, North Carolina, USA
| | - Nigel J. Walker
- Division of the National Toxicology Program, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | - Linda S. Birnbaum
- Laboratory of Toxicology and Toxicokinetics, National Cancer Institute, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | | | - Clarice R. Weinberg
- Biostatistics and Computational Biology Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
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Ovarian function and reproductive outcomes of female patients with systemic lupus erythematosus and the strategies to preserve their fertility. Obstet Gynecol Surv 2015; 70:196-210. [PMID: 25769434 DOI: 10.1097/ogx.0000000000000160] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune systemic disease that mainly affects women of reproductive age. Emerging data from recent molecular studies show us that estrogen hormone plays a central role in the development of this disease. By acting via its cognate receptors ERα and ERβ expressed on immune cells, estrogen can modulate immune function in both the innate and adaptive immune responses. Interestingly, estrogen may also evoke autoimmune responses after binding to B lymphocytes leading to the generation of high-affinity autoantibodies and proinflammatory cytokines (so-called estrogen-induced autoimmunity). Unfortunately, reproductive function of young female patients with this disease is commonly compromised by different pathophysiologic processes. First, ovarian reserve is diminished even in the presence of mild disease suggesting a direct impact of the disease itself on ovarian function possibly due to ovarian involvement in the form of autoimmune oophoritis. Second, SLE patients with severe manifestations of the disease are treated with alkylating chemotherapy agent cyclophosphamide. Cyclophosphamide and other drugs of alkylating category have the highest gonadotoxicity. Therefore, SLE patients exposed to cyclophosphamide have a much higher risk of developing infertility and premature ovarian failure than do the counterparts who are treated with other less toxic treatments. Third, the functions of the hypothalamic pituitary ovarian axis are perturbed by chronic inflammatory state. And finally adverse pregnancy outcomes are more commonly observed in SLE patients such as fetal loss, preterm birth, intrauterine fetal growth restriction, preeclampsia-eclampsia, and fetal congenital heart block. We aimed in this review article to provide the readers an update on how estrogen hormone closely interacts with and induces lupus-prone changes in the immune system. We also discuss ovarian function and other reproductive outcomes in SLE patients and the current strategies to preserve their fertility in the light of the most recent evidence-based findings of the clinical trials and molecular studies.
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Evaluating the association of interleukin-10 gene promoter -592 A/C polymorphism with lupus nephritis susceptibility. Kidney Res Clin Pract 2015; 35:29-34. [PMID: 27069855 PMCID: PMC4811976 DOI: 10.1016/j.krcp.2015.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 10/15/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022] Open
Abstract
Background Interleukin-10 (IL-10) is an important immunoregulatory cytokine. There are few studies evaluating the association between IL-10 and lupus nephritis (LN). The aim of this study was to evaluate the association of IL-10 gene promoter -592 A/C with LN susceptibility. Methods The study was conducted on 84 patients with systemic lupus erythematosus (SLE). Patients were divided into LN group (Group I, 48 patients) and non-LN group (Group II, 36 patients). The -592 A/C polymorphisms in IL-10 promoter gene were determined by polymerase chain reaction and restriction fragment length polymorphism in both groups. IL-10 was determined by enzyme-linked immunosorbent assay. Frequencies of the genotypes were compared between LN and non-LN patients and among LN patients with different pathologic classes. Results There was a significant increase in serum level of IL-10 (P = 0.001) in Group I compared with Group II and significant positive correlation between serum IL-10 and SLE disease activity index (r = 0.466, P = 0.001) in Group I. There were no significant differences in the distribution of the IL-10 gene promoter -592 A/C genotypes or the allele frequencies between Groups I and II. There was no significant difference between AC/CC and AA genotypes with SLE disease activity index, proteinuria, hematuria, anti-double-stranded DNA, and IL-10 in Group I. There was no significant difference in the distribution of AC and CC genotypes among different pathologic LN classes. Conclusion IL-10 suggested to play a role in pathogenesis and development of LN. However, the promoter -592 A/C of IL-10 gene suggested to be not associated with serum IL-10 levels or LN susceptibility. In addition, it appears that promoter -592 A/C of IL-10 gene not associated with LN activity or the pathologic classes of LN.
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Heshmat TS, Khalil NM, Elhamid HA, Labib S, Mahfouz M. Assessment of premature coronary atherosclerosis in patients with systemic lupus erythematosus disease. THE EGYPTIAN RHEUMATOLOGIST 2015. [DOI: 10.1016/j.ejr.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Smoking and the risk of systemic lupus erythematosus: an updated systematic review and cumulative meta-analysis. Clin Rheumatol 2015; 34:1885-92. [PMID: 26188616 DOI: 10.1007/s10067-015-3008-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/08/2015] [Accepted: 07/03/2015] [Indexed: 12/13/2022]
Abstract
Published articles reported controversial results about the association of smoking with the risk of systemic lupus erythematosus (SLE). A meta-analysis was performed to assess the aforementioned association and arrive at a more precise estimate of effect. A comprehensive search was performed to identify case-control or cohort studies (from 1990 to 2015) of the aforementioned association. The I (2) statistic was used to examine between-study heterogeneity. Fixed or random effect model was selected based on heterogeneity test among studies. Publication bias was estimated using Egger's regression asymmetry test. A total of 12 published articles with 13 studies were finally included in our meta-analysis. Results showed that the pooled odds ratio (OR) for SLE risk was 1.56 (95% confidence interval (CI) = 1.26-1.95) among current smokers compared with nonsmokers. For ex-smokers versus nonsmokers, the pooled OR for SLE risk was 1.23 (95% CI = 0.93-1.63). Subgroup analysis by geographic location and cumulative meta-analysis were also analyzed. In conclusion, our meta-analysis suggested that smoking increased the risk of SLE. Further studies are needed to confirm this result.
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Washio M, Takahashi H, Kobashi G, Kiyohara C, Tada Y, Asami T, Ide Y, Atsumi T, Horiuchi T. Risk factors for development of systemic lupus erythematosus among Japanese females: medical history and reproductive factors. Int J Rheum Dis 2015; 20:76-83. [DOI: 10.1111/1756-185x.12600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Masakazu Washio
- Department of Community Health and Clinical Epidemiology; St. Mary's College; Kurume Japan
| | - Hiroki Takahashi
- Department of Gastroenterology, Rheumatology and Clinical Immunology; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Gen Kobashi
- Department of Public Health; Dokkyo Medical University School of Medicine; Tochigi Japan
| | - Chikako Kiyohara
- Department of Preventive Medicine; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Yoshifumi Tada
- Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Toyoko Asami
- Rehabilitation Center; Saga University Hospital; Saga Japan
| | - Yuichiro Ide
- Department of Community Health and Clinical Epidemiology; St. Mary's College; Kurume Japan
| | - Tatsuya Atsumi
- Department of Medicine II; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Takahiko Horiuchi
- Department of Internal Medicine; Kyushu University Beppu Hospital; Beppu Japan
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Li WG, Ye ZZ, Yin ZH, Zhang K. Clinical and immunological characteristics in 552 systemic lupus erythematosus patients in a southern province of China. Int J Rheum Dis 2015; 20:68-75. [PMID: 25865002 DOI: 10.1111/1756-185x.12480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The purpose of this study was to gain a better understanding of systemic lupus erythematosus (SLE) in Hakka populations. METHODS We studied the demographic, clinical and laboratory characteristics in a cohort of 552 SLE patients diagnosed at the Rheumatology Department in MeiZhou People's Hospital from January 2008 to December 2012. There were 495 women and 57 men (8.7 : 1) with a mean age of 35.3 years (range 12-78 years). The mean age at disease onset and the mean disease duration were 31.8 ± 14.4 years and 3.3 ± 2.8 years, respectively. RESULTS The most common clinical manifestations were arthritis (61.6%), followed by malar rash (52.7%), photosensitivity (22.8%), mouth ulcers (17.0%) and discoid lupus (14.7%). The prevalence was 46.7% for nephritis (by biopsy), 18.3% for pleuritis, 15.6% for pericarditis and 4.9% for neuropsychiatric manifestations. The most common hematological manifestations were anemia (63.8%), followed by leucopenia (29.0%) and thrombocytopenia (14.9%). Antinuclear antibodies were detected in 99.8% of patients, followed by anti-double-stranded DNA (81.3%), anti-SSA (Sjögren's syndrome antigen A)/Ro (58.7%), anti-ribonucleoprotein (36.8%), anti-Sm (35.7%), and anti-SSB/La (15.0%). Anti-cardiolipin immunoglobulin G (IgG) and IgM were detected in 18.3% and 14.1% of patients, respectively. Active disease and infections were the two major causes of death. CONCLUSION The clinical and immunological characteristics of the SLE patients in our study place our population in the middle of the spectrum between other Asian and Caucasian populations.
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Affiliation(s)
- Wen-Gen Li
- Department of Rheumatology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Zhi-Zhong Ye
- Department of Rheumatology, The Affiliated Futian Hospital of Guangdong Medical College, Shenzhen, Guangdong, China
| | - Zhi-Hua Yin
- Department of Rheumatology, The Affiliated Futian Hospital of Guangdong Medical College, Shenzhen, Guangdong, China
| | - Ke Zhang
- Department of Rheumatology, Meizhou People's Hospital, Meizhou, Guangdong, China
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Epidemiology and classification of systemic lupus erythematosus. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Abstract
Exposure to ultraviolet (UV) radiation is among the environmental factors that have been proposed and studied in association with systemic lupus erythematosus (SLE). While it is known that UV radiation exposure may exacerbate pre-existing lupus, it remains unclear whether UV exposure is a risk factor for the development of SLE. Experimental studies show a significant immunomodulatory role for UV radiation, but strong epidemiologic data regarding its role in triggering SLE onset are lacking. Further studies are needed to assess the role of UV radiation in relation to development of incident SLE, yet they are challenging to design due to difficulties in accurate exposure assessment, the heterogeneous nature of SLE, and the challenge of assessing photosensitivity, a feature of SLE, which often precedes its diagnosis.
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Affiliation(s)
- M Barbhaiya
- Brigham and Women's Hospital, Division of Rheumatology, Immunology, and Allergy, Harvard Medical School, USA
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50
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Devaraju P, Gulati R, Antony PT, Mithun CB, Negi VS. Susceptibility to SLE in South Indian Tamils may be influenced by genetic selection pressure on TLR2 and TLR9 genes. Mol Immunol 2014; 64:123-6. [PMID: 25466615 DOI: 10.1016/j.molimm.2014.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/28/2014] [Accepted: 11/06/2014] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder with complex etiology. Genetics plays an important role in lupus pathogenesis through its influence on clinical and autoantibody phenotype of the disease. Toll like receptors (TLR) recognize molecular patterns of pathogens and activate the innate immune system. Their ability to identify nucleic acids makes them suitable candidates for investigation of their role in lupus pathogenesis. Hence, this study was carried out to analyze the G to A and C to T transitions in TLR2 and TLR9 genes respectively and to test their association with lupus susceptibility, clinical and autoantibody phenotypes in South Indian Tamils. METHOD Three hundred SLE patients fulfilling ACR 2012 criteria for SLE and 460 age, sex similar, ethnicity matched controls were recruited as cases and controls. TLR2 (R753Q) and TLR9 (-1237C/T) polymorphisms were analyzed by real time PCR. RESULTS The TLR2 gene remained monomorphic in patients and controls, the frequency of the homozygous wild type allele being 100% and 99.6% respectively. Hence, it did not confer susceptibility to SLE. The more frequent T allele of TLR9 gene conferred a significant risk to develop SLE (p=0.011, OR 1.69, 95% CI 1.1-2.6). Both the polymorphisms did not influence clinical or autoantibody phenotype of the disease. CONCLUSION Prevailing endemic infections in the Indian subcontinent may have exerted a selection pressure resulting in TLR2 gene remaining monomorphic and the TLR9 adapting to a mutation for its increased expression. These may have an additive effect in the presence of other genetic and environmental risk factors to confer susceptibility to SLE in South Indian Tamils.
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Affiliation(s)
- Panneer Devaraju
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India
| | - Reena Gulati
- Genetic Services Unit, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India
| | - Paul T Antony
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India
| | - C B Mithun
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India
| | - Vir S Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India.
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