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Novelli L, Barbati C, Capuano C, Recalchi S, Ceccarelli F, Vomero M, Alessandri C, Morrone S, Conti F. KLRG1 is reduced on NK cells in SLE patients, inversely correlates with disease activity and is modulated by hydroxychloroquine in vitro. Lupus 2023; 32:549-559. [PMID: 36876466 DOI: 10.1177/09612033231160979] [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: 03/07/2023]
Abstract
OBJECTIVES Killer cell lectin-like receptor G 1 (KLRG1), a transmembrane receptor with inhibitory capacity expressed in human immune cells, emerged as a novel susceptibility gene for systemic lupus erythematosus (SLE). The aim of this study was to investigate the expression of KLRG1 in SLE patients compared to healthy controls (HC) on both NK and T cells and to evaluate its possible involvement in SLE pathogenesis. METHODS Eighteen SLE patients and twelve healthy controls were enrolled. Peripheral blood mononuclear cells (PBMCs) from these patients were phenotypically characterized by immunofluorescence and flow cytometry. The effect of the hydroxychloroquine (HCQ) in vitro on KLRG1 expression and its signaling mediated functions in NK cells were analyzed. RESULTS KLRG1 expression was significantly reduced on the analyzed immune cell populations in SLE patients compared to HC, especially on total NK cells. Moreover, expression of KLRG1 on total NK cells inversely correlated with the SLEDAI-2K. A direct association between KLRG1 expression on NK cells and patients' treatment with HCQ was observed. In vitro treatment with HCQ increased KLRG1 expression on NK cells. In HC, KLRG1+ NK cells showed reduced degranulation and IFNγ production, while in SLE patient, this inhibition occurred only for the IFNγ production. CONCLUSION With this study we revealed a reduced expression and an impaired function of KLRG1 on NK cells in SLE patients. These results suggest a possible role of KLRG1 in the pathogenesis of SLE and as a novel biomarker of this disease.
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Affiliation(s)
- Lucia Novelli
- Lupus Clinic, Rheumatology Unit, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Cristiana Barbati
- Lupus Clinic, Rheumatology Unit, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Cristina Capuano
- Department of Experimental Medicine, 9311Sapienza University of Rome, Rome, Italy
| | - Serena Recalchi
- Department of Experimental Medicine, 9311Sapienza University of Rome, Rome, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Rheumatology Unit, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Marta Vomero
- Lupus Clinic, Rheumatology Unit, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Rheumatology Unit, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
| | - Stefania Morrone
- Department of Experimental Medicine, 9311Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Lupus Clinic, Rheumatology Unit, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, 9311Sapienza University of Rome, Rome, Italy
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2
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Chen FY, Chen SW, Chen X, Huang JY, Ye Z, Wei JCC. Hydroxychloroquine might reduce risk of incident endometriosis in patients with systemic lupus erythematosus: A retrospective population-based cohort study. Lupus 2021; 30:1609-1616. [PMID: 34259057 DOI: 10.1177/09612033211031009] [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: 11/15/2022]
Abstract
BACKGROUND SLE, which is common in women, is commonly treated with HCQ, an anti-inflammation medication. Reproductive-age women with SLE are prone to be impacted by endometriosis. This study analyzes the relationship between HCQ and endometriosis patients with SLE in order to determine whether HCQ is effective for treating the latter. METHODS This population-based, retrospective cohort study analyzed the SLE risk in a cohort of newly diagnosed SLE patients with endometriosis during 2000 through 2013. Controls were selected at a 1:2 ratio through age-matching using the greedy algorithm. The Cox proportional hazard model was used to analyze the association between HCQ use and endometriosis incidence. Four different Cox regression models were used. Lastly, sensitivity analysis with PSOW and IPW was implemented to evaluate the hazard ratio (HR) of endometriosis after exposure with HCQ. RESULTS In the cohort where age and sex matched high and low HCQ dosage, the average follow-up time was about 1 year. The cohort's overall incidence rates of endometriosis were 44.54 and 90.03 per 100000 person-month for high and low dosage respectively. The high dose group's conditional hazard ratio (aHR) for incidental endometriosis was 0.482 (CI = 0.191 to 1.213). The incidence rate and Kaplan-Meir curves of endometriosis were consistent with the results for the cohort. CONCLUSION This study demonstrated that SLE patients continuously treated with HCQ have a lower risk of developing endometriosis. Clinically, HCQ can be beneficial for endometriosis patients with SLE.
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Affiliation(s)
- Fang-Yu Chen
- Institute of Medicine, 34899Chung Shan Medical University, Chung Shan Medical University, Taichung, Taiwan
| | - Shuo-Wei Chen
- Institute of Medicine, 34899Chung Shan Medical University, Chung Shan Medical University, Taichung, Taiwan
| | - Xinpeng Chen
- Department of Rheumatology, 74550Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, Guangdong, China
| | - Jing-Yang Huang
- Department of Medical Research, 63276Chung Shan Medical University Hospital, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Zhizhong Ye
- Department of Rheumatology, 74550Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, Guangdong, China
| | - James Cheng-Chung Wei
- Institute of Medicine, 34899Chung Shan Medical University, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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3
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Arakawa H, Tanese K, Tanaka R, Murakami K, Sujino K, Miyamoto J, Amagai M, Tanikawa A. Efficacy of hydroxychloroquine for treating annular erythema associated with Sjögren's syndrome. J Dermatol 2021; 48:1526-1532. [PMID: 34254339 DOI: 10.1111/1346-8138.16045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/06/2021] [Indexed: 11/27/2022]
Abstract
Annular erythema is one of the cutaneous manifestations of Sjögren's syndrome (SS). Topical corticosteroids and tacrolimus, and oral corticosteroids, have been used as treatments for this condition. However, the safety and efficacy of these treatments remains unsatisfactory, and further development of therapies are desired. In this study, we performed a retrospective analysis of 16 annular erythema associated with SS (AESS) patients treated with hydroxychloroquine (HCQ). Disease activity was assessed using a modified version of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), which we termed the modified CLASI (m-CLASI). HCQ treatment improved AESS lesions in all 16 patients. The mean m-CLASI score was reduced by 85.6% at the 12-week follow-up relative to baseline (p < 0.01). Notably, 60% (6/10 cases) of patients with AESS lesions limited to the facial area achieved complete remission within 4 weeks. In the analysis of six patients who had taken oral prednisolone before starting HCQ, all were able to reduce the dose within 52 weeks without relapse. Particularly, 75% (3/4 cases) of patients with prednisolone dose of more than 5 mg/day could reduce their dose to less than 5 mg/day in combination with HCQ. For the safety concerns, two patients experienced grade 1 diarrhea during the 52-week observation period. However, neither serious adverse events nor adverse events requiring discontinuation of treatment occurred. The results of the present study suggest that HCQ may not only be highly effective as a single agent, but may also be useful as a steroid-sparing agent in refractory case requiring long-term steroid administration, making it a good treatment option for AESS.
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Affiliation(s)
- Hiroki Arakawa
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Tanaka
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Murakami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuyo Sujino
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Julia Miyamoto
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Tanikawa
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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4
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Sanghera C, Wong LM, Panahi M, Sintou A, Hasham M, Sattler S. Cardiac phenotype in mouse models of systemic autoimmunity. Dis Model Mech 2019; 12:dmm036947. [PMID: 30858306 PMCID: PMC6451423 DOI: 10.1242/dmm.036947] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients suffering from systemic autoimmune diseases are at significant risk of cardiovascular complications. This can be due to systemically increased levels of inflammation leading to accelerated atherosclerosis, or due to direct damage to the tissues and cells of the heart. Cardiac complications include an increased risk of myocardial infarction, myocarditis and dilated cardiomyopathy, valve disease, endothelial dysfunction, excessive fibrosis, and bona fide autoimmune-mediated tissue damage by autoantibodies or auto-reactive cells. There is, however, still a considerable need to better understand how to diagnose and treat cardiac complications in autoimmune patients. A range of inducible and spontaneous mouse models of systemic autoimmune diseases is available for mechanistic and therapeutic studies. For this Review, we systematically collated information on the cardiac phenotype in the most common inducible, spontaneous and engineered mouse models of systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis. We also highlight selected lesser-known models of interest to provide researchers with a decision framework to choose the most suitable model for their study of heart involvement in systemic autoimmunity.
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Affiliation(s)
- Chandan Sanghera
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Lok Man Wong
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Mona Panahi
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Amalia Sintou
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Muneer Hasham
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Susanne Sattler
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
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5
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Tang KT, Hsieh TY, Chao YH, Li JP, Lan JL, Lin CC, Chen DY. Apoptosis in patients with primary antiphospholipid antibody syndrome. Int J Rheum Dis 2019; 22:677-685. [PMID: 30729698 DOI: 10.1111/1756-185x.13468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/05/2018] [Accepted: 12/19/2018] [Indexed: 01/27/2023]
Abstract
AIM Dysregulated apoptosis has been implicated in autoimmune diseases. In the present study, we investigated the apoptosis-related cytokines and apoptosis in patients with primary antiphospholipid syndrome (pAPS). METHOD We prospectively recruited 12 pAPS patients, 17 antiphospholipid antibody (APA)-positive systemic lupus erythematosus (SLE) patients without APS manifestations (APA+ SLE), 13 SLE patients with secondary APS (APS+ SLE) and 10 healthy controls (HCs). Plasma levels of soluble apoptosis-inducing ligands and cytokines, and the expression levels of apoptosis-inducing ligands in peripheral blood mononuclear cells, were determined. In addition, blood lymphocytes/monocytes apoptosis were determined in six pAPS patients and six HCs, using flow cytometric analysis of caspase 3, 8 and 9 activities. RESULTS There was a trend toward higher plasma levels of soluble tumor necrosis factor (TNF)-related apoptosis-inducing ligand (sTRAIL), interleukin-10 (IL-10) and TNF-α in pAPS patients when compared with HCs. We also observed higher plasma levels of IL-10 and TNF α in APA+ SLE and APS+ SLE patients when compared with HCs. However, there was no significant difference in blood lymphocytes/monocytes apoptosis between pAPS patients and HCs. CONCLUSION There was a trend toward elevated plasma levels of sTRAIL, IL-10 and TNF-α, but no evidence for dysregulated apoptosis in pAPS patients.
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Affiliation(s)
- Kuo-Tung Tang
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ya-Hsuan Chao
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Ju-Pi Li
- Translational Medicine Laboratory, Rheumatic Diseases Research Center, China Medical University Hospital, Taichung, Taiwan.,Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
| | - Joung-Liang Lan
- Translational Medicine Laboratory, Rheumatic Diseases Research Center, China Medical University Hospital, Taichung, Taiwan.,Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Chien Lin
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Der-Yuan Chen
- Translational Medicine Laboratory, Rheumatic Diseases Research Center, China Medical University Hospital, Taichung, Taiwan.,Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
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6
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Davies R, Hammenfors D, Bergum B, Jakobsen K, Solheim M, Vogelsang P, Brun JG, Bryceson Y, Jonsson R, Appel S. Patients with Primary Sjögren's Syndrome Have Alterations in Absolute Quantities of Specific Peripheral Leucocyte Populations. Scand J Immunol 2017; 86:491-502. [PMID: 29072325 DOI: 10.1111/sji.12622] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022]
Abstract
An accurate dissection of peripheral blood enumeration is lacking in primary Sjögren's syndrome (pSS). The purpose of this study was to quantify different leucocyte populations in peripheral blood of patients with pSS. Numbers of specific leucocyte subsets were determined in 86 pSS patients and 74 healthy donors quantifying 21 distinct subtypes by flow cytometry. Subgroups of pSS patients were stratified based on presence of extraglandular manifestations (EGMs) and SSA/SSB autoantibodies. Overall, pSS patients manifested decreased lymphocyte subpopulations compared to healthy donors. Such decreases were more pronounced in SSA/SSB positive patients and patients with EGM. Granulocyte and monocyte subpopulations were increased in pSS patients compared to healthy donors, with the greatest increases in SSA/SSB positive patients. Unsupervised hierarchal clustering based on cell quantities was used to further subgroup the pSS patients into four clusters. One of the clusters characterized by higher concentrations of NKT cells, CD56hi NK cells, CD20+ CD38- B cells and CD8+ CD38- T cells was associated with weaker clinical symptoms than the other clusters, possibly marking a milder disease phenotype. In conclusion, our analyses indicate significant alterations in the cellular profiles of peripheral blood leucocytes in patients with pSS and may help to stratify the patients according to disease severity.
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Affiliation(s)
- R Davies
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - D Hammenfors
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - B Bergum
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - K Jakobsen
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - M Solheim
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Vogelsang
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J G Brun
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Y Bryceson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Centre for Infectious Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - R Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - S Appel
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
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7
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Novel function of hydroxychloroquine: Down regulation of T follicular helper cells in collagen-induced arthritis. Biomed Pharmacother 2017; 97:838-843. [PMID: 29136759 DOI: 10.1016/j.biopha.2017.10.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/11/2017] [Accepted: 10/23/2017] [Indexed: 01/26/2023] Open
Abstract
Hydroxychloroquine (HCQ) is an immunosuppressive agent widely used in rheumatoid arthritis (RA). T follicular helper (Tfh) cells play a vital role in the pathogenesis of RA. However, whether HCQ suppresses arthritis development through interfering with Tfh cells have never been reported. To address this issue, we investigated the percent of Tfh cells in newly diagnosed RA patients and found that they were up-regulated in peripheral blood. Importantly, in ex vivo experiments of peripheral blood mononuclear cells (PBMCs) from healthy volunteers, we proved that the percentage of Tfh cells in PBMCs and purified CD4+ T cells were decreased after HCQ treatment. In in vivo experiments of collagen-induced arthritis (CIA) model, we discovered that HCQ suppressed the incidence and score of arthritis, reduced the secretion of proinflammatory cytokines in serum. Similar to ex vivo study, the ratio of Tfh cells in HCQ treated CIA mice declined to the level of vehicle-treated group. Further research demonstrated that HCQ inhibited the generation of Tfh cells stimulated by IL-12 and IL-21. In conclusion, our study indicates a previously unrecognized mechanism of HCQ in RA, that HCQ directly suppresses the generation of Tfh cells by blocking IL-12 and IL-21 signaling pathways probably.
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8
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Wu SF, Chang CB, Hsu JM, Lu MC, Lai NS, Li C, Tung CH. Hydroxychloroquine inhibits CD154 expression in CD4 + T lymphocytes of systemic lupus erythematosus through NFAT, but not STAT5, signaling. Arthritis Res Ther 2017; 19:183. [PMID: 28793932 PMCID: PMC5550984 DOI: 10.1186/s13075-017-1393-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/18/2017] [Indexed: 12/28/2022] Open
Abstract
Background Overexpression of membranous CD154 in T lymphocytes has been found previously in systemic lupus erythematosus (SLE). Because hydroxychloroquine (HCQ) has been used frequently in the treatment of lupus, we sought to identify the effects of HCQ on CD154 and a possibly regulatory mechanism. Methods CD4+ T cells were isolated from the blood of lupus patients. After stimulation with ionomycin or IL-15 and various concentrations of HCQ, expression of membranous CD154 and NFAT and STAT5 signaling were assessed. Results HCQ treatment had significant dose-dependent suppressive effects on membranous CD154 expression in ionomycin-activated T cells from lupus patients. Furthermore, HCQ inhibited intracellular sustained calcium storage release, and attenuated the nuclear translocation of NFATc2 and the expression of NFATc1. However, CD154 expressed through IL-15-mediated STAT5 signaling was not inhibited by HCQ treatment. Conclusions HCQ inhibited NFAT signaling in activated T cells and blocked the expression of membranous CD154, but not STAT5 signaling. These findings provide a mechanistic insight into SLE in HCQ treatment.
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Affiliation(s)
- Shu-Fen Wu
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan
| | - Chia-Bin Chang
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan
| | - Jui-Mei Hsu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi, Taiwan
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi, Taiwan
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi, Taiwan
| | - Chin Li
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan
| | - Chien-Hsueh Tung
- Department of Life Science, Institute of Molecular Biology, National Chung-Cheng University, No.168, University Rd, Min-Hsiung, Chia-Yi, 62247, Taiwan. .,Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
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9
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Abstract
Systemic lupus erythematosus (lupus, SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which bind to antigens and are deposited within tissues to fix complement, resulting in widespread systemic inflammation. The studies presented herein are consistent with hyperpolarized, adenosine triphosphate (ATP)-deficient mitochondria being central to the disease process. These hyperpolarized mitochondria resist the depolarization required for activation-induced apoptosis. The mitochondrial ATP deficits add to this resistance to apoptosis and also reduce the macrophage energy that is needed to clear apoptotic bodies. In both cases, necrosis, the alternative pathway of cell death, results. Intracellular constituents spill into the blood and tissues, eliciting inflammatory responses directed at their removal. What results is “autoimmunity.” Ultraviolet (UV)-A1 photons have the capacity to remediate this aberrancy. Exogenous exposure to low-dose, full-body, UV-A1 radiation generates singlet oxygen. Singlet oxygen has two major palliative actions in patients with lupus and the UV-A1 photons themselves have several more. Singlet oxygen depolarizes the hyperpolarized mitochondrion, triggering non-ATP-dependent apoptosis that deters necrosis. Next, singlet oxygen activates the gene encoding heme oxygenase (HO-1), a major governor of systemic homeostasis. HO-1 catalyzes the degradation of the oxidant heme into biliverdin (converted to bilirubin), Fe, and carbon monoxide (CO), the first three of these exerting powerful antioxidant effects, and in conjunction with a fourth, CO, protecting against injury to the coronary arteries, the central nervous system, and the lungs. The UV-A1 photons themselves directly attenuate disease in lupus by reducing B cell activity, preventing the suppression of cell-mediated immunity, slowing an epigenetic progression toward SLE, and ameliorating discoid and subacute cutaneous lupus. Finally, a combination of these mechanisms reduces levels of anticardiolipin antibodies and protects during lupus pregnancy. Capping all of this is that UV-A1 irradiation is an essentially innocuous, highly manageable, and comfortable therapeutic agency.
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Affiliation(s)
- H McGrath
- Veterans Administration, New Orleans, LA, USA
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10
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Feller JM. Potential Ebola prophylaxis. J Paediatr Child Health 2015; 51:743. [PMID: 26135157 PMCID: PMC7166650 DOI: 10.1111/jpc.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- John M Feller
- VMO Sydney Children's Hospital, University of New South Wales, Sydney, New South Wales, Australia
- School of Maternal and Child Health, UNSW, Discipline of Paediatrics, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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11
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Gómez-Guzmán M, Jiménez R, Romero M, Sánchez M, Zarzuelo MJ, Gómez-Morales M, O'Valle F, López-Farré AJ, Algieri F, Gálvez J, Pérez-Vizcaino F, Sabio JM, Duarte J. Chronic hydroxychloroquine improves endothelial dysfunction and protects kidney in a mouse model of systemic lupus erythematosus. Hypertension 2014; 64:330-7. [PMID: 24842914 DOI: 10.1161/hypertensionaha.114.03587] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hydroxychloroquine has been shown to be efficacious in the treatment of autoimmune diseases, including systemic lupus erythematosus. Hydroxychloroquine-treated lupus patients showed a lower incidence of thromboembolic disease. Endothelial dysfunction, the earliest indicator of the development of cardiovascular disease, is present in lupus. Whether hydroxychloroquine improves endothelial function in lupus is not clear. The aim of this study was to analyze the effects of hydroxychloroquine on hypertension, endothelial dysfunction, and renal injury in a female mouse model of lupus. NZBWF1 (lupus) and NZW/LacJ (control) mice were treated with hydroxychloroquine 10 mg/kg per day by oral gavage, or with tempol and apocynin in the drinking water, for 5 weeks. Hydroxychloroquine treatment did not alter lupus disease activity (assessed by plasma double-stranded DNA autoantibodies) but prevented hypertension, cardiac and renal hypertrophy, proteinuria, and renal injury in lupus mice. Aortae from lupus mice showed reduced endothelium-dependent vasodilator responses to acetylcholine and enhanced contraction to phenylephrine, which were normalized by hydroxychloroquine or antioxidant treatments. No differences among all experimental groups were found in both the relaxant responses to acetylcholine and the contractile responses to phenylephrine in rings incubated with the nitric oxide synthase inhibitor N(G)-nitro-l-arginine methyl ester. Vascular reactive oxygen species content and mRNA levels of nicotinamide adenine dinucleotide phosphate oxidase subunits NOX-1 and p47(phox) were increased in lupus mice and reduced by hydroxychloroquine or antioxidants. Chronic hydroxychloroquine treatment reduced hypertension, endothelial dysfunction, and organ damage in severe lupus mice, despite the persistent elevation of anti-double-stranded DNA, suggesting the involvement of new additional mechanisms to improve cardiovascular complications.
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Affiliation(s)
- Manuel Gómez-Guzmán
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Rosario Jiménez
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Miguel Romero
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Manuel Sánchez
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - María José Zarzuelo
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Mercedes Gómez-Morales
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Francisco O'Valle
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Antonio José López-Farré
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Francesca Algieri
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Julio Gálvez
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Francisco Pérez-Vizcaino
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - José Mario Sabio
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Juan Duarte
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.).
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Costedoat-Chalumeau N, Dunogué B, Morel N, Le Guern V, Guettrot-Imbert G. Hydroxychloroquine: a multifaceted treatment in lupus. Presse Med 2014; 43:e167-80. [PMID: 24855048 DOI: 10.1016/j.lpm.2014.03.007] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/18/2014] [Indexed: 12/13/2022] Open
Abstract
The efficacy of antimalarials, especially hydroxychloroquine (HCQ), in preventing systemic lupus erythematosus (SLE) flares is well demonstrated. However, many studies show that the percentage of SLE patients treated with HCQ remains low. By blocking the toll-like receptor 7 and 9 in plasmacytoid dendritic cells, HCQ inhibits interferon-alpha production which plays a crucial role in SLE pathogenesis. In addition to reducing damage accrual in SLE patients, HCQ appears to protect against the occurrence of diabetes, thrombotic events, and dyslipidemia. As a consequence, some studies have suggested that HCQ, which is inexpensive, has a protective effect on survival in SLE patients. Thanks to the pharmacokinetic properties of HCQ (long half-life) and to the availability of its blood assay, very low or undetectable blood HCQ concentrations are a valuable marker of non-adherence to treatment, thus adding a new benefit to HCQ prescriptions. The main side effect of HCQ is retinal toxicity. This complication is very rare, but may be potentially severe, thus requiring regular screening. Retinal toxicity remains the only absolute contra-indication of HCQ in adult SLE patients. Other contra-indications are few and rare. During pregnancy and breast-feeding, HCQ continuation is not only allowed but recommended. In conclusion, the risk/benefit ratio of HCQ is excellent. Many now believe that all SLE patients should be offered this treatment.
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Affiliation(s)
- Nathalie Costedoat-Chalumeau
- AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France.
| | - Bertrand Dunogué
- AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France
| | - Nathalie Morel
- AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France
| | - Véronique Le Guern
- AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France
| | - Gaëlle Guettrot-Imbert
- Université de Clermont-Ferrand, CHU de Clermont-Ferrand, hôpital Gabriel-Montpied, service de médecine interne, 63003 Clermont-Ferrand, France
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13
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Abstract
The 4-aminoquinolines are weak bases that are completely absorbed from the gastrointestinal tract, sequestered in peripheral tissues, metabolized in the liver to pharmacologically active by-products, and excreted via the kidneys and the feces. The parent drugs and metabolites are excreted with a half-life of elimination of approximately 40 days. However, slow release from sequestered stores of the drugs means that after discontinuation, they continue to be released into the plasma for years. Correct dosing is based on the ideal body weight of the patient, which depends on height. The 4AQs diminish autoimmunity without compromising immunity to infections.
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Affiliation(s)
- David J. Browning
- grid.490463.cCharlotte Eye Ear Nose & Throat Associates, Charlotte, NC USA
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14
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Jin L, Weiqian C, Lihuan Y. Peripheral CD24hi CD27+ CD19+ B cells subset as a potential biomarker in naïve systemic lupus erythematosus. Int J Rheum Dis 2013; 16:698-708. [PMID: 24286662 DOI: 10.1111/1756-185x.12229] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM B cells are likely to play critical roles in the pathogenesis of systemic lupus erythematosus (SLE). Our aim was to investigate the role of peripheral CD24(hi) CD27(+) CD19(+) B cells in Chinese patients with new-onset SLE. METHOD Peripheral CD24(hi) CD27(+) CD19(+) B cells were analyzed in 55 new-onset lupus and 36 healthy controls by flow cytometry. All SLE cases were treated with prednisolone and hydroxychloroquine during a 1-year follow-up. Thirteen cases were added with cyclophosphamide or mycophenolate mofetil. The CD24(hi) CD27(+) CD19(+) B cells were analyzed at days 0, 7, 14 and months 1, 3, 6, 9 and 12. Interleukin-10 (IL-10)-producing B cell was detected in eight naïve lupus and 10 healthy controls. RESULTS Compared to healthy controls, the frequency and number of primary circulating CD24(hi) CD27(+) CD19(+) B cells was significantly reduced in SLE cases (8.22 ± 3.48% vs. 31.67 ± 5.53%, P < 0.0001; 4.04 ± 2.85 vs. 38.66 ± 10.22 10(3) cells/mL, P = 0.0001) before treatment; IL-10(+) CD19(+) B cells and IL-10(+) CD24(hi) CD27(+) CD19(+) B cells also decreased in SLE. Interestingly, primary CD24(hi) CD27(+) CD19(+) B cells inversely correlated with SLE disease activity index (SLEDAI) score. Patients with arthritis and hematologic disorders had a lower primary CD24(hi) CD27(+) CD19(+) B cells. In 48 SLE cases who finished the 1-year follow-up, the frequency and number of CD24(hi) CD27(+) CD19(+) B cells increased from 8.26 ± 3.61% to 25.51 ± 4.56%; 3.99 ± 2.86 to 28.64 ± 11.81 10(3) cells/mm(3) (P < 0.0001), accompanied by a significantly decreased SLEDAI score. Of note, CD24(hi) CD27(+) CD19(+) B cells decreased in some flare cases with an elevated SLEDAI score. CONCLUSION These results demonstrate that a lower primary CD24(hi) CD27(+) CD19(+) B cells may be an immunologic aspect of new-onset SLE. CD24(hi) CD27(+) CD19(+) B cells may be a useful tool to evaluate lupus activity and monitor the response to therapy.
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Affiliation(s)
- Lin Jin
- Department of Rheumatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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15
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Multifaceted effects of hydroxychloroquine in human disease. Semin Arthritis Rheum 2013; 43:264-72. [PMID: 23481418 DOI: 10.1016/j.semarthrit.2013.01.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Hydroxychloroquine (HCQ) is a widely used medication for the treatment of rheumatoid arthritis and systemic lupus erythematosus. An increasing body of evidence supports actions of this drug that are not directly related to its immunosuppressive or anti-rheumatic properties. The objective of this systematic review is to characterize the spectrum of conditions that might be responsive to treatment with HCQ. METHODS PubMed was searched using the MeSH for HCQ with relevant subheadings and the limits of human topics and English language. Four-hundred and fifty-six abstracts from this search were examined individually to exclude those that were not focused on the objectives of this review. The resulting 76 articles were grouped according to topic areas and reviewed in detail. RESULTS HCQ has been reported to have therapeutic effects in a wide array of conditions, including diabetes mellitus, dyslipidemias, coagulopathies, infectious diseases and malignancies. Mechanisms of action responsible for these effects likely include altered signaling through cellular receptors, post-glycosylation modifications of infectious agents, changes in levels of inflammatory mediators and inhibition of autophagy. Many of the pathways are likely dependent on drug-induced changes in intra-endosomal acidity. CONCLUSIONS The use of, and interest in, HCQ has spread into many areas of medicine. Actions of this drug may be directly beneficial to patients with non-rheumatic conditions such as diabetes mellitus or viral infections. Further understanding of underlying mechanisms has potential to reveal modifiable pathogenic pathways that might elucidate approaches to the design of more effective therapeutics for many chronic diseases.
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16
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Keyßer G. [Conventional basis therapy of rheumatoid arthritis. Effects within and outside cells]. Z Rheumatol 2012; 71:468-72. [PMID: 22802023 DOI: 10.1007/s00393-011-0878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Conventional disease-modifying antirheumatic drugs (DMARDs) were formerly introduced into the treatment of rheumatoid arthritis and other rheumatic disorders on an empirical basis. In many cases their mode of action is only partially understood but as a rule of thumb they act on more than one point within the cellular metabolism. Less often they exert biological effects in the extracellular space or on the cell membrane.
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Affiliation(s)
- G Keyßer
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland.
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Willis R, Seif AM, McGwin G, Martinez-Martinez LA, González EB, Dang N, Papalardo E, Liu J, Vilá LM, Reveille JD, Alarcón GS, Pierangeli SS. Effect of hydroxychloroquine treatment on pro-inflammatory cytokines and disease activity in SLE patients: data from LUMINA (LXXV), a multiethnic US cohort. Lupus 2012; 21:830-5. [PMID: 22343096 DOI: 10.1177/0961203312437270] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We sought to determine the effect of hydroxychloroquine therapy on the levels proinflammatory/prothrombotic markers and disease activity scores in patients with systemic lupus erythematosus (SLE) in a multiethnic, multi-center cohort (LUMINA). METHODS Plasma/serum samples from SLE patients (n = 35) were evaluated at baseline and after hydroxychloroquine treatment. Disease activity was assessed using SLAM-R scores. Interferon (IFN)-α2, interleukin (IL)-1β, IL-6, IL-8, inducible protein (IP)-10, monocyte chemotactic protein-1, tumor necrosis factor (TNF)-α and soluble CD40 ligand (sCD40L) levels were determined by a multiplex immunoassay. Anticardiolipin antibodies were evaluated using ELISA assays. Thirty-two frequency-matched plasma/serum samples from healthy donors were used as controls. RESULTS Levels of IL-6, IP-10, sCD40L, IFN-α and TNF-α were significantly elevated in SLE patients versus controls. There was a positive but moderate correlation between SLAM-R scores at baseline and levels of IFN-α (p = 0.0546). Hydroxychloroquine therapy resulted in a significant decrease in SLAM-R scores (p = 0.0157), and the decrease in SLAM-R after hydroxychloroquine therapy strongly correlated with decreases in IFN-α (p = 0.0087). CONCLUSIONS Hydroxychloroquine therapy resulted in significant clinical improvement in SLE patients, which strongly correlated with reductions in IFN-α levels. This indicates an important role for the inhibition of endogenous TLR activation in the action of hydroxychloroquine in SLE and provides additional evidence for the importance of type I interferons in the pathogenesis of SLE. This study underscores the use of hydroxychloroquine in the treatment of SLE.
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Affiliation(s)
- R Willis
- University of Texas Medical Branch, Galveston, USA
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18
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Ding D, Wei–dong Q, Dong–zhen Y, Hai–yan J, Salvi R. Ototoxic effects of mefloquine in cochlear organotypic cultures. J Otol 2009. [DOI: 10.1016/s1672-2930(09)50018-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Totino PRR, Daniel-Ribeiro CT, Ferreira-da-Cruz MDF. Pro-apoptotic effects of antimalarial drugs do not affect mature human erythrocytes. Acta Trop 2009; 112:236-8. [PMID: 19665984 DOI: 10.1016/j.actatropica.2009.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 07/31/2009] [Accepted: 08/03/2009] [Indexed: 10/20/2022]
Abstract
Malaria is an important public health problem worldwide, representing also an obstacle for the development of the countries, mainly in the African continent. Since no effective vaccine has been developed yet, early diagnosis and prompt treatment are the main strategy to control malaria transmission. Many of the drugs used for malaria treatment have the ability to induce apoptosis in different cell types. In addition, apoptosis has also been identified in enucleated cells. The present work is aimed, therefore, to evaluate the pro-apoptotic aptness of chloroquine, quinine, artemisinin and mefloquine on mature erythrocytes by flow cytometry through the detection of cell shrinkage and phosphatidylserine exposure at the cell surface-hallmarks of apoptosis. Although we observed that known apoptosis inducer, such as ionomycin, had led to erythrocyte apoptosis, we were not able to detect any pro-apoptotic effect of the studied antimalarial drugs on these cells. We conclude that chloroquine, quinine, artemisinin and mefloquine may not be able to induce apoptosis in erythrocytes and, therefore, do not seem to contribute to malaria associated erythrocyte destruction and anemia.
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Oikarinen A. Hydroxychloroquine induces autophagic cell death of human dermal fibroblasts: implications for treating fibrotic skin diseases. J Invest Dermatol 2009; 129:2333-5. [PMID: 19749781 DOI: 10.1038/jid.2009.164] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hydroxychloroquine (HCQ) is widely used to treat rheumatic and inflammatory diseases. It inhibits inflammation by downregulating the effects of inflammatory cells and their mediators. Although HCQ has been used to treat several fibrotic skin diseases, the mechanisms by which it exerts its effects on human dermal fibroblasts (HDFs) have not been studied in detail. In this issue, Ramser et al. show that HCQ inhibits proliferation of HDFs and induces autophagy. These observations are supported by the demonstration that HCQ upregulates Beclin-1, a key regulator of autophagy. Future studies are needed to determine whether HCQ induces autophagy in vivo and whether antimalarials have antifibrotic effects when used in clinically relevant doses.
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Affiliation(s)
- Aarne Oikarinen
- Department of Dermatology, University of Oulu and Oulu University Hospital, Oulu, Finland.
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21
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Hydroxychloroquine modulates metabolic activity and proliferation and induces autophagic cell death of human dermal fibroblasts. J Invest Dermatol 2009; 129:2419-26. [PMID: 19357706 DOI: 10.1038/jid.2009.80] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hydroxychloroquine (HCQ) is a commonly used therapeutic agent in skin disorders. Some reports also suggest that HCQ can be useful in fibroblastic diseases of the skin. Here, we investigated the effects of HCQ in human dermal fibroblasts (HDFs). HCQ significantly reduced the metabolic activity and suppressed cell proliferation (IC(50) = approximately 30 microM) of HDFs. The antiproliferative effect of HCQ was associated with decreased activation of the extracellular signal-regulated kinases 1/2 but not with inhibition of the mammalian target of the rapamycin pathway or with dephosphorylation of Akt. HCQ induced a distinct type of cell death in HDFs, characterized by surface exposure of phosphatidylserine but a lack of morphological signs of apoptosis and absence of DNA fragmentation. The HCQ-treated HDFs instead showed autophagic vacuoles with double membranes and digested organelle content. These vacuoles showed light-chain 3 immunostaining, in accordance with increased protein amounts of this autophagy marker. Induction of autophagic cell death by HCQ was also paralleled by increased expression of Beclin-1, a key regulator of autophagy. Our findings indicate that HDFs are target cells of HCQ and form a rationale on the basis of which the in vivo effects of antimalarials can be studied in patients with aberrant fibroblast function.
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Kim E, Giese A, Deppert W. Wild-type p53 in cancer cells: when a guardian turns into a blackguard. Biochem Pharmacol 2008; 77:11-20. [PMID: 18812169 DOI: 10.1016/j.bcp.2008.08.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 08/25/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022]
Abstract
The tumor suppressor p53 controls a broad range of cellular responses. Induction of a transient (cell cycle arrest) or a permanent (senescence) block of cell proliferation, or the activation of cell death pathways in response to genotoxic stress comprise the major arms of the survival-death axis governed by p53. Due to these biological properties, inactivation of p53 is a crucial step in tumor development and progression, reflected by the high incidence of TP53 mutations in different types of human cancers. The remarkable potency of p53 in suppressing tumorigenic outgrowth has promoted the expectation that tumor cells expressing wild-type p53 (wtp53) should be more prone to elimination by cytotoxic treatments than tumor cells expressing mutant p53 (mutp53) with defunct wtp53 activities. However, recent findings yielded somewhat unexpected insights concerning the preponderance of the survival-promoting effects of wtp53 in cancer cells, a rather undesired property from the therapeutic point of view. In this commentary we will discuss the possibility that the developmentally established distinct patterns of wtp53 mediated responses in different tissues are an important factor in determining the ultimate outcome of cellular responses mediated by wtp53 in different types of tumor cells, with a particular focus on the divergent impact of wtp53 in malignant tumors of the central nervous system. We infer that a selective gain of pro-survival functions of wtp53 in cancer cells will confer a survival advantage that counteracts tumor therapy.
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Affiliation(s)
- Ella Kim
- The Translational Neurooncology Research Group, Department of Neurosurgery, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, 37074 Göttingen, Germany.
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Porter H, Gamette MJ, Cortes-Hernandez DG, Jensen JB. Asexual blood stages of Plasmodium falciparum exhibit signs of secondary necrosis, but not classical apoptosis after exposure to febrile temperature (40 C). J Parasitol 2008; 94:473-80. [PMID: 18564748 DOI: 10.1645/ge-1343.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
It has been shown by others that after cultures of Plasmodium falciparum were exposed to a febrile temperature of 40 C, parasitemia was reduced in the subsequent generation, suggesting a temperature-induced inhibition of trophozoites and schizonts. In the current study, influences unique to cultivation were ruled out, demonstrating that 40 C impacted the parasites directly. Metabolic profiling of DNA synthesis, protein synthesis, and glucose utilization clearly indicated that febrile temperatures had a direct effect on parasite development, beginning 20-24 hr after erythrocyte invasion. The mechanism of parasite death was investigated for evidence of temperature-induced apoptosis. Lack of typical physiological hallmarks, namely, caspase activation, characteristic mitochondrial membrane potential changes, and DNA degradation as indicated by DNA laddering, eliminated 'classical' apoptosis as a mechanism of parasite death. Parasites dying under the influence of heat, staurosporine, and chloroquine initially appeared pyknotic by light and electron microscopy (as in apoptosis), but eventual swelling and lysis of the food vacuole membrane led to secondary necrosis. Chloroquine did induce DNA laddering, but it was later attributed to occult white blood cell contaminants. While not apoptosis, the results do not rule out other forms of temperature-induced programmed cell death.
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Affiliation(s)
- Heidi Porter
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah 84602, USA.
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Abstract
Although chloroquine, hydroxychloroquine and quinacrine were originally developed for the treatment of malaria, these medications have been used to treat skin disease for over 50 years. Recent clinical data have confirmed the usefulness of these medications for the treatment of lupus erythematosus. Current research has further enhanced our understanding of the pharmacologic mechanisms of action of these drugs involving inhibition of endosomal toll-like receptor (TLR) signaling limiting B cell and dendritic cell activation. With this understanding, the use of these medications in dermatology is broadening. This article highlights the different antimalarials used within dermatology through their pharmacologic properties and mechanism of action, as well as indicating their clinical uses. In addition, contraindications, adverse effects, and possible drug interactions of antimalarials are reviewed.
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Affiliation(s)
- Sunil Kalia
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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Ramos-Avila A, Ventura-Gallegos JL, Zentella-Dehesa A, Machuca-Rodríguez C, Moreno-Altamirano MM, Narváez V, Legorreta-Herrera M. Immunomodulatory role of chloroquine and pyrimethamine in Plasmodium yoelii 17XL infected mice. Scand J Immunol 2007; 65:54-62. [PMID: 17212767 DOI: 10.1111/j.1365-3083.2006.01869.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chloroquine (CLQ) and Pyrimethamine (PYR) are used for the treatment of malaria and some autoimmune diseases; although their mechanism of action is only partially understood, their therapeutic effectiveness in the second case has been attributed to their ability to increase apoptosis of T lymphocytes. In view of the potential for immunomodulation during malaria chemotherapy, we investigated the effects of CLQ and PYR treatment on lymphocyte apoptosis and cytokine expression during infection with blood-stage Plasmodium. This work shows that infection of BALB/c mice with Plasmodium yoelii 17XL (Py17XL) reduced apoptosis in spleen cells but when infected mice were treated with CLQ, apoptosis of B and T lymphocytes increased significantly via a Fas-mRNA expression independent mechanism associated with downregulation of Bcl-2 expression, whereas treatment with PYR increased apoptosis to a lesser extent and only in B lymphocytes. CLQ treatment of Py17XL infected mice upregulated tumour necrosis factor-alpha mRNA expression, while PYR treatment increased interferon-gamma mRNA expression. In infected mice, treatment with CLQ downregulated expression of the anti-inflammatory cytokines, interleukin-10 and transforming growth factor-beta (TGF-beta), while PYR treatment upregulated TGF-beta. Thus, in addition to their anti-malarial effects, both drugs modulate the immune response in malaria by increasing apoptosis and modulating the mRNA expression of cytokines involved in parasite elimination and regulation of inflammatory responses.
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Affiliation(s)
- A Ramos-Avila
- Laboratorio de Inmunología Molecular, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, México D.F
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Kim WU, Yoo SA, Min SY, Park SH, Koh HS, Song SW, Cho CS. Hydroxychloroquine potentiates Fas-mediated apoptosis of rheumatoid synoviocytes. Clin Exp Immunol 2006; 144:503-11. [PMID: 16734620 PMCID: PMC1941983 DOI: 10.1111/j.1365-2249.2006.03070.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Inadequate apoptosis may contribute to the synovial hyperplasia associated with rheumatoid arthritis (RA). The Fas-associated death domain protein (FADD)-like interleukin (IL)-1beta-converting enzyme (FLICE)-inhibitory protein (FLIP), which is an apoptotic inhibitor, has been implicated in the resistance to Fas-mediated apoptosis of synoviocytes. This study investigated whether hydroxychloroquine (HCQ), an anti-rheumatic drug, induces the apoptosis of rheumatoid synoviocytes, and modulates the expression of FLIP. Fibroblast-like synoviocytes (FLS) were prepared from the synovial tissues of RA patients, and were cultured with various concentrations of HCQ in the presence or absence of the IgM anti-Fas monoclonal antibodies (mAb) (CH11). Treatment with HCQ, ranging from 1 to 100 microM, induced the apoptosis of FLS in a dose- and time-dependent manner. The increase in synoviocytes apoptosis by HCQ was associated with caspase-3 activation. A combined treatment of HCQ and anti-Fas mAb increased FLS apoptosis and caspase-3 activity synergistically, compared with either anti-Fas mAb or HCQ alone. The Fas expression level in the FLS was not increased by the HCQ treatment, while the FLIP mRNA and protein levels were decreased rapidly by the HCQ treatment. Moreover, time kinetics analysis revealed that the decreased expression of FLIP by HCQ preceded the apoptotic event that was triggered by HCQ plus anti-Fas mAb. Taken together, HCQ increases the apoptosis of rheumatoid synoviocytes by activating caspase-3, and also sensitizes rheumatoid synoviocytes to Fas-mediated apoptosis. Our data suggest that HCQ may exert its anti-rheumatic effect in rheumatoid joints through these mechanisms.
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Affiliation(s)
- W-U Kim
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Catholic University of Korea, Catholic Research Institutes of Medical Sciences, Seoul, Korea
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Affiliation(s)
- Robert J Smith
- RJS Biomedical Communications, 10405 Toston Lane, Glen Allen, VA 23060, USA.
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Abstract
The antimalarials, mainly chloroquine and hydroxychloroquine, derive from the quinoleine core of quinine. Their initial therapeutic indication was the treatment of malaria attacks but, because of anti-inflammatory and immuno-modulatory activities, they have been since used to treat many other pathologies, in particular dermatological ones. For some of these pathologies, lupus or porphyria cutanea tarda for example, the use of these molecules is based on obvious scientific evidence. For other pathologies (cutaneous sarcoidosis, polymyositis, polymorphous light eruption...), the data on the medical literature corroborating the daily clinical practice are extremely poor. Their toxicity is limited. Their most common toxic effects are gastrointestinal (mild nausea or diarrhea) or mucocutaneous (reversible skin or mucosal pigmentation). Their most serious and dreaded side effect, retinopathy, can be largely prevented by using amounts of APS adapted to the weight of the patients. The recommended "safe" daily dose for hydroxychloroquine is 6.5 mg per kilogramme of body weight and for chloroquine 4 mg per kilogramme of body weight. However, at 6- to 12 months intervals, follow-up eye examinations should be performed.
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Affiliation(s)
- L Fardet
- Service de Dermatologie, Hôpital Henri Mondor, 51, avenue Maréchal de Lattre de Tassigny, 94000 Créteil
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Fessler BJ, Alarcón GS, McGwin G, Roseman J, Bastian HM, Friedman AW, Baethge BA, Vilá L, Reveille JD. Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual. ACTA ACUST UNITED AC 2005; 52:1473-80. [PMID: 15880829 DOI: 10.1002/art.21039] [Citation(s) in RCA: 255] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine whether hydroxychloroquine (HCQ) usage is associated with a reduced risk of damage accrual in patients with systemic lupus erythematosus (SLE). METHODS Patients (n = 518) meeting the American College of Rheumatology criteria for diagnosis of SLE and with </=5 years disease duration at study entry were followed up annually. Socioeconomic, demographic, clinical, and serologic manifestations as well as disease activity (by the Systemic Lupus Activity Measure [SLAM]) and damage (by the Systemic Lupus International Collaborating Clinics damage index [SDI]) were measured. Propensity scores were calculated to adjust for confounding factors affecting treatment assignment. A Cox proportional hazards model was used to compare the risk of developing new damage according to HCQ use at enrollment into the study. RESULTS Fifty-six percent of the patients were treated with HCQ at the time of study enrollment. Patients who were not treated with HCQ on enrollment had higher SLAM and SDI scores than patients who were treated. Untreated patients were significantly more likely to have major organ involvement such as renal disease (P < 0.0001) or central nervous system disease (P < 0.0025). Results of unadjusted analysis suggested that treated patients were less likely to accrue damage (hazard ratio [HR] 0.68). With adjustment for differences in treatment assignment, HCQ usage was still associated with a reduced risk of developing new damage, with an HR of 0.68 (95% confidence interval [95% CI] 0.53-0.93) (P = 0.014). With adjustment for differences in treatment assignment, HCQ usage was still associated with a reduced risk of developing new damage (HR 0.73 [95% CI 0.52-1.00]) (P = 0.05). However, patients receiving HCQ who had no damage at study entry had a statistically significant decrease in the risk of damage accrual (HR 0.55 [95% CI 0.34-0.87]) (P = 0.0111), whereas those receiving HCQ who had damage at study entry did not (HR 1.106 [95% CI 0.70-1.74]) (P = 0.6630). CONCLUSION These findings indicate that, after adjustment for propensity to receive HCQ, HCQ usage is independently associated with a reduced risk of damage accrual in SLE patients who had not yet accrued damage at the time of treatment initiation.
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Parris GE. Hypothesis links emergence of chloroquine-resistant malaria and other intracellular pathogens and suggests a new strategy for treatment of diseases caused by intracellular parasites. Med Hypotheses 2004; 62:354-7. [PMID: 14975502 PMCID: PMC7130919 DOI: 10.1016/j.mehy.2003.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 12/09/2003] [Indexed: 01/18/2023]
Abstract
Chloroquine and related anti-malarial drugs appear to promote apoptosis in T-cells by suppressing NF-kappa-B, which enhances the expression of anti-apoptotic proteins (e.g., Bcl-2). Thus, chloroquine has found applications in autoimmune diseases where it apparently facilitates apoptosis of abnormally persistent T-cell clones. The mode of action of chloroquine in prevention of malaria is not known, but it may be to minimize replication of the parasite in the liver cells, which occurs before invasion of the erythrocytes, by facilitating premature apoptosis of the infected host cells. After introduction of chloroquine in the 1950s world-wide for prophylactic use, chloroquine-resistant malaria emerged. Here it is hypothesized that concurrent with emergence of chloroquine-resistant malaria (presumably with enhanced anti-apoptotic capabilities), other intracellular parasites have evolved to enhance their ability to prevent apoptosis in host cells. Two examples of viral diseases that have emerged from areas of high incidence of chloroquine-resistant malaria are AIDS from HIV and SARS from coronavirus. The hypothesis holds that prophylactic exposure to pro-apoptotic chloroquine drugs caused natural selection for strains of viruses and other parasites that have enhanced anti-apoptotic abilities. When transmitted to host organisms that are not under the influence of the pro-apoptotic drug, the new "anti-apoptotic" strains may cause unexpected diseases. In the case of SARS, the coronavirus appears to have accessed a new niche where it proves to be lethal to its host. In the case of AIDS, the HIV (which has had a long-term symbiotic relationship with primates) has run amuck because the infected cells are now substantially more tolerant to the toxins (i.e., resistant to apoptosis) that they secrete than the uninfected bystander cells, which are not unusually resistant to apoptosis. A corollary to the hypothesis is that if the level of resistance to apoptosis in the infected cells were no higher than the level of resistance in the bystander cells, then the infected cells would preferentially kill themselves through apoptosis. It appears that in the case of HIV, the increased resistance to apoptosis is provided by expression of Bcl-2 and suppression of p53. Hence, drugs that suppresses Bcl-2 or restore p53 function might be effective in restoring the parity of resistance to apoptosis between infected and uninfected cells. Currently, an antisense drug targeting Bcl-2 (G3139/Genasense(TM), Genta, Inc.) is in late-stage cancer trials and may be on the market for those indications in months. It would be interesting to try these drugs against various intracellular parasites including HIV. This approach to prevent or eliminate active infections might be particularly attractive against a range of parasites (virus, bacteria, protozoa, fungus) when safe and effective vaccines are not available.
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Nord JE, Shah PK, Rinaldi RZ, Weisman MH. Hydroxychloroquine cardiotoxicity in systemic lupus erythematosus: a report of 2 cases and review of the literature. Semin Arthritis Rheum 2004; 33:336-51. [PMID: 15079764 DOI: 10.1016/j.semarthrit.2003.09.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hydroxychloroquine (HCQ) is extensively used in the long-term treatment of systemic lupus erythematosus (SLE). Although considered by clinicians to be relatively safe, serious side effects have been documented in the literature. Retinotoxicity has received the most attention, whereas neuromyotoxicity and cardiotoxicity have been described in isolated case reports. We present 2 cases of potential cardiotoxicity occurring in patients with SLE while receiving long-term HCQ therapy. OBJECTIVE To review the incidence, presentation, and mechanism of serious antimalarial toxicity, and to discuss the impact of HCQ on cardiac health in SLE. METHODS The authors reviewed the English-language literature from 1948 to December 2002 using Medline databases. RESULTS In addition to our patients, there are 2 published cases of biopsy-proven HCQ cardiotoxicity in the English-language literature. Both occurred in patients with SLE. The literature indicates that antimalarial cardiotoxicity may be of particular importance in patients with SLE given their already increased cardiac risk due to primary heart disease and accelerated atherosclerosis. Endomyocardial biopsy reveals a constellation of findings including vacuolar myopathy, myeloid bodies, and curvilinear bodies. CONCLUSIONS As HCQ use among SLE patients increases, clinicians should be alert to the possibility of antimalarial cardiotoxicity. The potential severity and reversibility of this complication underscore the importance of timely diagnosis. The cases presented here, one with biopsy and one without, illustrate the utility of endomyocardial biopsy in HCQ-treated SLE patients with cardiac complaints to ensure accurate diagnosis and appropriate management.
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Affiliation(s)
- Jessica E Nord
- Department of Psychiatry and Biobehavioral Sciences, UCLA Neuropsychiatric Institute, Los Angeles, California, USA
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Wozniacka A, Carter A, McCauliffe DP. Antimalarials in cutaneous lupus erythematosus: mechanisms of therapeutic benefit. Lupus 2002; 11:71-81. [PMID: 11958581 DOI: 10.1191/0961203302lu147rr] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antimalarials are arguably the best modality currently available for treating patients with cutaneous lupus erythematosus (LE). Although antimalarials have been used for decades in treating cutaneous LE, the precise mechanisms by which they provide therapeutic benefit are not well defined. The putative mechanisms by which antimalarials might provide therapeutic benefit to patients with cutaneous LE include a number of interrelated anti-inflammatory and immunosuppressive effects that include photoprotection, lysosomal stabilization, suppression of antigen presentation, and inhibition of prostaglandin and cytokine synthesis. If we had a more precise understanding of how antimalarials provide therapeutic benefit in cutaneous LE we might gain better insight into the pathogenic mechanisms of LE and ways of developing better therapies for afflicted patients.
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Affiliation(s)
- A Wozniacka
- Department of Dermatology, Medical University of Lodz, Krzemieniecka, Poland
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Abstract
The 4-aminoquinoline radical containing antimalarial drugs are also used in the management of various connective tissue diseases including systemic lupus erythematosus (SLE) and rheumatoid arthritis. These agents are particularly useful for the management of inflammatory polyarthritis and skin disease. By raising the pH in intracellular compartments, these drugs interfere with normal phagocytic function which consequently enables them to interfere with antigen processing. Other actions include inhibition of platelet aggregation, this is advantageous in patients with phospholipid antibodies (aPL) which are known to predispose patients to recurrent arterial and venous clinical thrombotic events. Hydroxychloroquine has also been demonstrated to reduce serum lipid levels including cholesterol, triglycerides and low density lipoproteins. As it is now known that patients with SLE are at risk for accelerated artherogenesis and premature heart disease, this action may be an added benefit for these patients. The use of the 4-aminoquinoline radical containing antimalarial drugs during pregnancy is controversial. It is known that these agents can cross the placenta and are deposited in fetal pigmented tissues. These findings have led to the recommendation that these agents should be discontinued in pregnancy for patients with connective tissue diseases even though they have long been recommended for malarial prophylaxis in pregnant women travelling to malarial infested areas. Flares of SLE disease have been documented when these agents are discontinued and as flares of SLE disease activity are known to be detrimental to pregnancy outcome in patients with SLE, it is our opinion that these drugs should not be discontinued during pregnancy in a patient with lupus, particularly when the known terminal elimination half life is 1 to 2 months.
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Affiliation(s)
- M B Borden
- University of Connecticut, Farmington, Connecticut, USA
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Gergely P, Grossman C, Niland B, Puskas F, Neupane H, Allam F, Banki K, Phillips PE, Perl A. Mitochondrial hyperpolarization and ATP depletion in patients with systemic lupus erythematosus. ARTHRITIS AND RHEUMATISM 2002; 46:175-90. [PMID: 11817589 PMCID: PMC4020417 DOI: 10.1002/1529-0131(200201)46:1<175::aid-art10015>3.0.co;2-h] [Citation(s) in RCA: 283] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Peripheral blood lymphocytes (PBLs) from systemic lupus erythematosus (SLE) patients exhibit increased spontaneous and diminished activation-induced apoptosis. We tested the hypothesis that key biochemical checkpoints, the mitochondrial transmembrane potential (deltapsim) and production of reactive oxygen intermediates (ROIs), mediate the imbalance of apoptosis in SLE. METHODS We assessed the deltapsim with potentiometric dyes, measured ROI production with oxidation-sensitive fluorochromes, and monitored cell death by annexin V and propidium iodide staining of lymphocytes, using flow cytometry. Intracellular glutathione levels were measured by high-performance liquid chromatography, while ATP and ADP levels were assessed by the luciferin-luciferase assay. RESULTS Both deltapsim and ROI production were elevated in the 25 SLE patients compared with the 25 healthy subjects and the 10 rheumatoid arthritis patients. Intracellular glutathione contents were diminished, suggesting increased utilization of reducing equivalents in SLE. H2O2, a precursor of ROIs, increased deltapsim and caused apoptosis in normal PBLs. In contrast, H2O2-induced apoptosis and deltapsim elevation were diminished, particularly in T cells, and the rate of necrotic cell death was increased in patients with SLE. The intracellular ATP content and the ATP:ADP ratio were reduced and correlated with the deltapsim elevation in lupus. CD3:CD28 costimulation led to transient elevation of the deltapsim, followed by ATP depletion, and sensitization of normal PBLs to H2O2-induced necrosis. Depletion of ATP by oligomycin, an inhibitor of F0F1-ATPase, had similar effects. CONCLUSION T cell activation and apoptosis are mediated by deltapsim elevation and increased ROI production. Mitochondrial hyperpolarization and the resultant ATP depletion sensitize T cells for necrosis, which may significantly contribute to inflammation in patients with SLE.
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Affiliation(s)
- Peter Gergely
- State University of New York, College of Medicine, Syracuse 13210, USA
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Lai JH, Ho LJ, Lu KC, Chang DM, Shaio MF, Han SH. Western and Chinese antirheumatic drug-induced T cell apoptotic DNA damage uses different caspase cascades and is independent of Fas/Fas ligand interaction. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2001; 166:6914-24. [PMID: 11359853 DOI: 10.4049/jimmunol.166.11.6914] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spontaneous or therapeutic induction of T cell apoptosis plays a critical role in establishing transplantation tolerance and maintaining remission of autoimmune diseases. We investigated the mechanisms of apoptosis induced by Chinese and Western antirheumatic drugs (ARDs) in human T cells. We found that hydroxychloroquine, Tripterygium wilfordii hook F, and tetrandrine (Tet), but not methotrexate, at therapeutic concentrations can cause T cell death. In addition, Tet selectively killed T cells, especially activated T cells. Although ARD-induced cytotoxicity was mediated through apoptotic mechanisms, Fas/Fas ligand interaction was not required. We further demonstrated that the processes of phosphatidylserine externalization and DNA damage along the ARD-induced T cell apoptotic pathway could operate independently, and that selective inhibition of DNA damage by caspase inhibitors did not prevent T cells from undergoing cell death. Moreover, we found that Tet- and Tripterygium wilfordii hook F-induced T cell DNA damage required caspase-3 activity, and hydroxychloroquine-induced T cell DNA damage was mediated through a caspase-3- and caspase-8-independent, but Z-Asp-Glu-Val-Asp-fluomethyl ketone-sensitive, signaling pathway. Finally, the observation that ARD-induced activation of caspase-3 in both Fas-sensitive and Fas-resistant Jurkat T cells indicates that Fas/Fas ligand interaction plays no role in ARD-induced T cell apoptosis. Our observations provide new information about the complex apoptotic mechanisms of ARDs, and have implications for combining Western and Chinese ARDs that have different immunomodulatory mechanisms in the therapy of autoimmune diseases and transplantation rejection.
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Affiliation(s)
- J H Lai
- Rheumatology/Immunology and Allergy, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China.
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Lagneaux L, Delforge A, Carlier S, Massy M, Bernier M, Bron D. Early induction of apoptosis in B-chronic lymphocytic leukaemia cells by hydroxychloroquine: activation of caspase-3 and no protection by survival factors. Br J Haematol 2001; 112:344-52. [PMID: 11167827 DOI: 10.1046/j.1365-2141.2001.02553.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have investigated the effect of hydroxychloroquine (HCQ), an anti-rheumatic drug, on malignant B cells from 20 patients with B-chronic lymphocytic leukaemia (B-CLL). HCQ induced a decrease in cell viability in a dose- and time-dependent manner. The mean IC50 was 32 +/- 7 microg/ml (range, 10-75 microg/ml) for 24 h of exposure. This cytotoxic effect was owing to apoptosis, as demonstrated by morphological changes, annexin V binding capacity and DNA fragmentation (28 +/- 4% of apoptotic cells as early as 5 h post incubation, increasing to 82 +/- 4% at 18 h post treatment). The apoptosis was associated with caspase-3 activation because the cleavage and activity of caspase-3 were increased by HCQ. The amount of bcl-2 protein was reduced during apoptosis, evidenced using quantitative flow cytometry. As early as 1 h post-HCQ treatment, a reduction of the mitochondrial transmembrane potential was measured by 3,3'-dihexyloxacarbocyanine iodide. Interestingly, the HCQ effect was not affected by exposure to interleukin-4 or co-culture with bone marrow stromal cells. Our observations suggest that HCQ may offer a new therapeutic tool in the treatment of B-CLL patients.
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Affiliation(s)
- L Lagneaux
- Laboratoire d'Hématologie Expérimentale, Institut Jules Bordet, Brussels, Belgium.
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Affiliation(s)
- R Wolf
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Israel
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Ho LJ, Chang DM, Lee TC, Chang ML, Lai JH. Plant alkaloid tetrandrine downregulates protein kinase C-dependent signaling pathway in T cells. Eur J Pharmacol 1999; 367:389-98. [PMID: 10079015 DOI: 10.1016/s0014-2999(98)00941-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tetrandrine, a purified traditional Chinese medicinal herb that acts as an immunosuppressant and a Ca2+ channel blocker, has been clinically used to treat patients with arthritis, silicosis and hypertension. Since T cells play a critical role as autoreactive and pathogenic population in autoimmune diseases, in this study, we examined the immunosuppressive effect of tetrandrine on human peripheral blood T cells. We showed that tetrandrine inhibited phorbol 12-myristate 13-acetate (PMA) + ionomycin-induced T cell proliferation, interleukin-2 secretion and the expression of the T cell activation antigen, CD71. Further investigation of the molecular mechanism demonstrated that tetrandrine inhibited the expression of the protein kinase C-dependent interleukin-2 receptor alpha chain and CD69 but not the expression of the Ca2+-dependent CD40 ligand and CD69. Interestingly, when tetrandrine and cyclosporin A were added together, significant synergism in the suppression of T cell activation was observed. Moreover, of the several tetrandrine analogues studied, hernandezine was the most potent inhibitor of protein kinase C signaling events. These results also suggest that the protein kinase C-inhibitory capacity of tetrandrine and its analogues may not be associated with their function as Ca2+ channel blockers. Lastly, we showed that, within therapeutic concentrations, tetrandrine and its analogues could induce cellular apoptosis, which is defective in autoimmune diseases. In conclusion, our findings provide novel information about the molecular mechanism of the immunosuppressive effect of tetrandrine and its analogues in human peripheral blood T cells.
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Affiliation(s)
- L J Ho
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
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Alvarado-de la Barrera C, Alcocer-Varela J, Richaud-Patin Y, Alarcón-Segovia D, Llorente L. Differential oncogene and TNF-alpha mRNA expression in bone marrow cells from systemic lupus erythematosus patients. Scand J Immunol 1998; 48:551-6. [PMID: 9822266 DOI: 10.1046/j.1365-3083.1998.00427.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to investigate the bone marrow expression of genes involved in cell growth and apoptosis in patients with systemic lupus erythematosus (SLE). Spontaneous expression of bcl-2, bax, c-myc. c-fos, c-jun, p53, Fas and tumour necrosis factor (TNF)-alpha by bone marrow cells was measured using either semiquantitative or quantitative reverse transcription polymerase chain reaction in SLE patients (n = 8) and in eight normal control subjects. The expression of bcl-2 was found to be higher in SLE patients than in controls. Bone marrow cells from SLE patients showed significant down-regulation of bax, c-myc, c-fos and p53 (P < or = 0.05), as compared to normal controls. In both SLE patients and controls the expression of c-jun and Fas was very low or undetectable. Finally, TNF-alpha gene expression was higher in bone marrow samples from SLE patients than in those of controls (P= 0.01). The abnormal expression of genes regulating cell growth and apoptosis in bone marrow cells from SLE patients may help explain the presence of autoreactive cells in secondary lymphoid organs and peripheral blood of SLE patients.
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Affiliation(s)
- C Alvarado-de la Barrera
- Department of Immunology and Rheumatology, Instituto Nacional de la Nutrición Salvador Zubirán, Tlalpan, Mexico
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