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Porsch F, Binder CJ. Autoimmune diseases and atherosclerotic cardiovascular disease. Nat Rev Cardiol 2024; 21:780-807. [PMID: 38937626 DOI: 10.1038/s41569-024-01045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/29/2024]
Abstract
Autoimmune diseases are associated with a dramatically increased risk of atherosclerotic cardiovascular disease and its clinical manifestations. The increased risk is consistent with the notion that atherogenesis is modulated by both protective and disease-promoting immune mechanisms. Notably, traditional cardiovascular risk factors such as dyslipidaemia and hypertension alone do not explain the increased risk of cardiovascular disease associated with autoimmune diseases. Several mechanisms have been implicated in mediating the autoimmunity-associated cardiovascular risk, either directly or by modulating the effect of other risk factors in a complex interplay. Aberrant leukocyte function and pro-inflammatory cytokines are central to both disease entities, resulting in vascular dysfunction, impaired resolution of inflammation and promotion of chronic inflammation. Similarly, loss of tolerance to self-antigens and the generation of autoantibodies are key features of autoimmunity but are also implicated in the maladaptive inflammatory response during atherosclerotic cardiovascular disease. Therefore, immunomodulatory therapies are potential efficacious interventions to directly reduce the risk of cardiovascular disease, and biomarkers of autoimmune disease activity could be relevant tools to stratify patients with autoimmunity according to their cardiovascular risk. In this Review, we discuss the pathophysiological aspects of the increased cardiovascular risk associated with autoimmunity and highlight the many open questions that need to be answered to develop novel therapies that specifically address this unmet clinical need.
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Affiliation(s)
- Florentina Porsch
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
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2
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Yang Y, Chen Y, Li Y, Feng Y, Hu N, Xue L. Expression and Significance of Programmed Death-1 and Its Ligands in the Accelerated Formation of Atherosclerosis in an Induced Murine Lupus Model. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6255383. [PMID: 39050559 PMCID: PMC11268968 DOI: 10.1155/2022/6255383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 07/27/2024]
Abstract
Atherosclerosis (AS) is a chronic inflammatory disease that occurs in artery walls, which seriously affects the survival and prognosis of patients with systemic lupus erythematosus (SLE). Immune and inflammatory responses have notable effects on all stages of AS. In this study, we modeled SLE combined with AS in vivo via intraperitoneal injection of pristane (2,6,10,14-tetramethylpentadecane) into apolipoprotein E-knockout (ApoE-/- ) mice that had accelerated atherosclerotic lesions compared with wild-type (WT) ApoE-/- mice. In pristane-induced ApoE-/- mice, expression of programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) in peripheral blood and on the surfaces of atherosclerotic lesions significantly increased, and levels of proinflammatory cytokines, namely, interferon-gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α) in peripheral blood were elevated. We did not detect expression of programmed death-ligand 2 (PD-L2) in the arterial plaques of either pristane-induced or WT ApoE-/- mice, nor did we observe any significant difference in PD-L2 expression in peripheral blood between the two groups. Taken together, these results suggested that PD-1/PD-L1 signaling pathway might play an important regulatory role in the progression of AS in an induced murine lupus model which implies a potential target for treatment of AS in SLE.
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Affiliation(s)
- Yue Yang
- Department of Rheumatology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Yueying Chen
- Department of Rheumatology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Yongming Li
- Department of Rheumatology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Yiyi Feng
- Department of Rheumatology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Na Hu
- Science and Technology Experimental Center, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Luan Xue
- Department of Rheumatology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
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3
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Dhawan UK, Margraf A, Lech M, Subramanian M. Hypercholesterolemia promotes autoantibody production and a lupus-like pathology via decreased DNase-mediated clearance of DNA. J Cell Mol Med 2022; 26:5267-5276. [PMID: 36098213 PMCID: PMC9575094 DOI: 10.1111/jcmm.17556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022] Open
Abstract
Hypercholesterolemia exacerbates autoimmune response and accelerates the progression of several autoimmune disorders, but the mechanistic basis is not well understood. We recently demonstrated that hypercholesterolemia is associated with increased serum extracellular DNA levels secondary to a defect in DNase-mediated clearance of DNA. In this study, we tested whether the impaired DNase response plays a causal role in enhancing anti-nuclear antibody levels and renal immune complex deposition in an Apoe-/- mouse model of hypercholesterolemia. We demonstrate that hypercholesterolemic mice have enhanced anti-ds-DNA and anti-nucleosome antibody levels which is associated with increased immune complex deposition in the renal glomerulus. Importantly, treatment with DNase1 led to a decrease in both the autoantibody levels as well as renal pathology. Additionally, we show that humans with hypercholesterolemia have decreased systemic DNase activity and increased anti-nuclear antibodies. In this context, our data suggest that recombinant DNase1 may be an attractive therapeutic strategy to lower autoimmune response and disease progression in patients with autoimmune disorders associated with concomitant hypercholesterolemia.
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Affiliation(s)
- Umesh Kumar Dhawan
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andreas Margraf
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Maciej Lech
- LMU Hospital Department of Medicine, Munich, Germany
| | - Manikandan Subramanian
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
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4
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Chen W, Wang Q, Zhou B, Zhang L, Zhu H. Lipid Metabolism Profiles in Rheumatic Diseases. Front Pharmacol 2021; 12:643520. [PMID: 33897433 PMCID: PMC8064727 DOI: 10.3389/fphar.2021.643520] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/18/2021] [Indexed: 12/25/2022] Open
Abstract
Rheumatic diseases are a group of chronic autoimmune disorders that involve multiple organs or systems and have high mortality. The mechanisms of these diseases are still ill-defined, and targeted therapeutic strategies are still challenging for physicians. Recent research indicates that cell metabolism plays important roles in the pathogenesis of rheumatic diseases. In this review, we mainly focus on lipid metabolism profiles (dyslipidaemia, fatty acid metabolism) and mechanisms in rheumatic diseases and discuss potential clinical applications based on lipid metabolism profiles.
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Affiliation(s)
- Weilin Chen
- Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China
| | - Qi Wang
- Department of Radiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Bin Zhou
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lihua Zhang
- Department of Rheumatology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Honglin Zhu
- Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China
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5
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Seneviratne A, Han Y, Wong E, Walter ERH, Jiang L, Cave L, Long NJ, Carling D, Mason JC, Haskard DO, Boyle JJ. Hematoma Resolution In Vivo Is Directed by Activating Transcription Factor 1. Circ Res 2020; 127:928-944. [PMID: 32611235 PMCID: PMC7478221 DOI: 10.1161/circresaha.119.315528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
RATIONALE The efficient resolution of tissue hemorrhage is an important homeostatic function. In human macrophages in vitro, heme activates an AMPK (AMP-activated protein kinase)/ATF1 (activating transcription factor-1) pathway that directs Mhem macrophages through coregulation of HO-1 (heme oxygenase-1; HMOX1) and lipid homeostasis genes. OBJECTIVE We asked whether this pathway had an in vivo role in mice. METHODS AND RESULTS Perifemoral hematomas were used as a model of hematoma resolution. In mouse bone marrow-derived macrophages, heme induced HO-1, lipid regulatory genes including LXR (lipid X receptor), the growth factor IGF1 (insulin-like growth factor-1), and the splenic red pulp macrophage gene Spic. This response was lost in bone marrow-derived macrophages from mice deficient in AMPK (Prkab1-/-) or ATF1 (Atf1-/-). In vivo, femoral hematomas resolved completely between days 8 and 9 in littermate control mice (n=12), but were still present at day 9 in mice deficient in either AMPK (Prkab1-/-) or ATF1 (Atf1-/-; n=6 each). Residual hematomas were accompanied by increased macrophage infiltration, inflammatory activation and oxidative stress. We also found that fluorescent lipids and a fluorescent iron-analog were trafficked to lipid-laden and iron-laden macrophages respectively. Moreover erythrocyte iron and lipid abnormally colocalized in the same macrophages in Atf1-/- mice. Therefore, iron-lipid separation was Atf1-dependent. CONCLUSIONS Taken together, these data demonstrate that both AMPK and ATF1 are required for normal hematoma resolution. Graphic Abstract: An online graphic abstract is available for this article.
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Affiliation(s)
- Anusha Seneviratne
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
| | - Yumeng Han
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus.,Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - Eunice Wong
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus.,Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - Edward R H Walter
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus.,Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - Lijun Jiang
- Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - Luke Cave
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
| | - Nicholas J Long
- Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - David Carling
- MRC London Institute of Medical Sciences (D.C.), Imperial College London Hammersmith Campus
| | - Justin C Mason
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
| | - Dorian O Haskard
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
| | - Joseph J Boyle
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
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Liu T, Shi N, Zhang S, Silverman GJ, Duan XW, Zhang S, Niu H. Systemic lupus erythematosus aggravates atherosclerosis by promoting IgG deposition and inflammatory cell imbalance. Lupus 2020; 29:273-282. [PMID: 32075511 PMCID: PMC7057353 DOI: 10.1177/0961203320904779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Systemic lupus erythematosus (SLE) patients experience a premature and more severe presentation of coronary artery disease. The underlying mechanisms of accelerated coronary artery disease in SLE patients remain to be elucidated. Methods By using atherosclerosis combining a SLE murine model, we proved that the onset of SLE aggravates atherosclerosis. Although the onset of SLE reduced blood lipids slightly, immune deviation contributed to aggravated atherosclerosis in lupus mice. Lupus atheroma were characterized by inflammatory cell infiltration, such as gathered dendritic cells, macrophages, and IgG deposition. Results Decreased lymphocytes and magnified dendritic cells in the spleen were also observed in lupus mice. Hydroxychloroquine prevented atherosclerosis progression mainly by reversing immune status abnormality caused by SLE. Serum interferon alfa levels were not changed in lupus mice. Conclusion These findings strongly suggested that anti-inflammatory therapies and hydroxychloroquine provide a new possible strategy for treating SLE patients with atherosclerosis.
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Affiliation(s)
- T Liu
- NHC Key Laboratory of Human Disease Comparative Medicine, The Institute of Laboratory Animal Sciences, Beijing, China.,Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - N Shi
- NHC Key Laboratory of Human Disease Comparative Medicine, The Institute of Laboratory Animal Sciences, Beijing, China
| | - S Zhang
- School of Medicine, Jinan University, Guangzhou, China
| | - G J Silverman
- Department of Rheumatology, Langone Medical Center, New York, USA
| | - X-W Duan
- Department of Rheumatology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - S Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - H Niu
- School of Medicine, Jinan University, Guangzhou, China
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Abstract
Systemic lupus erythematosus is the most characteristic of auto-immune disorders that can lead to tissue damage in many organs, including kidney. Lupus nephritis occurs in 10 to 40% of lupus patients. Its clinical hallmark is the appearance of a proteinuria as soon as a 0.5 g/g or 0.5 g/d threshold, which calls for a renal histological evaluation in order to determine the lupus nephritis severity and the need for specific therapy. More than half of renal biopsies lead to the diagnosis of active lupus nephritis-class III or class IV A according to the ISN/RPS classification-that are the most severe in regards to renal prognosis and mortality. Their treatment aims to their clinical remission and to the prevention of relapse with minimal adverse effects for eventually the preservation of renal function, the prevention of other irreversible damage, and the reduction of risk of death. The remission is obtained through induction therapies of which the association of high dose steroids and cyclophosphamide is the most experienced. When this association must be challenged by the prevention of side-effect, in particular infertility, mycophenolate can be given instead of cyclophosphamide. Maintenance therapy, for the prevention of relapse, consists in mycophenolate or in azathioprine, mycophenolate being the most efficient however associated with a high risk of teratogenicity. Withdrawal of maintenance therapy is possible after two to three years in absence of high risk factors of relapse of lupus nephritis, however a reliable assessment of the risk of relapse is still lacking. Only pure membranous lupus nephritis (pure class V) associated with high level proteinuria requires specific therapies that usually associates steroids and an immunosuppressive drug. However, their choice hierarchy and even the use of less immunosuppressive strategies remain to be determined in terms of benefice over risk ratios. In spite of its trigger effect on lupus activity, pregnancy can be safe and successful if scheduled in the lowest risk periods with close multidisciplinary monitoring before, during and after. When necessary, renal replacement therapy does not require specific adaptation, renal transplantation is the best option when possible, as early as possible.
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Affiliation(s)
- Quentin Raimbourg
- Service de néphrologie, hôpital Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France; Inserm U1149, Département hospitalo-universitaire (DHU) Fibrosis-Inflammation-Remodeling (FIRE), 16, rue Henri Huchard, 75890 Paris cedex 18, France
| | - Éric Daugas
- Service de néphrologie, hôpital Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France; Inserm U1149, Département hospitalo-universitaire (DHU) Fibrosis-Inflammation-Remodeling (FIRE), 16, rue Henri Huchard, 75890 Paris cedex 18, France.
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9
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Renal Tubular Complement 3 Deposition in Children with Primary Nephrotic Syndrome. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4386438. [PMID: 30003098 PMCID: PMC5998187 DOI: 10.1155/2018/4386438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022]
Abstract
Background This study aimed to investigate the clinical significance of complement 3 (C3) deposition in renal tubules of children with primary nephrotic syndrome (PNS). Methods The clinical and pathological characteristics of PNS were retrospectively reviewed in 99 PNS pediatric patients, who were divided into the C3 deposition and the non-C3 deposition groups. Results A total of 39 patients (39.39%) had renal tubule C3 deposition. In the C3 deposition group, the ratios of urine N-acetylglucosaminidase/creatinine (UNAG/Cr), urine β2 microglobulin/creatinine (Uβ2MG/Cr), and urine transferrin/creatinine (UTRF/Cr) were significantly higher than those of the non-C3 deposition group. The patients of the C3 deposition group had lower serum total protein and albumin, higher cholesterol and D-dimer (DD), lower proportion of CD3+CD8+ cells, and higher proportion of CD19+CD23+ cells. The number of the patients with interstitial fibrosis, renal cell vacuolar degeneration, renal tubular immunoglobulin deposition, and severe tubulointerstitial injury in the C3 deposition group was higher than that of the non-C3 deposition group. The C3 deposition intensity was positively correlated with the number of recurrences. Conclusion PNS pediatric patients with C3 deposition in renal tubules have more severe disease condition, tubulointerstitial injury, and recurrence suggesting a worse long-term prognosis.
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Sage AP, Nus M, Bagchi Chakraborty J, Tsiantoulas D, Newland SA, Finigan AJ, Masters L, Binder CJ, Mallat Z. X-Box Binding Protein-1 Dependent Plasma Cell Responses Limit the Development of Atherosclerosis. Circ Res 2017; 121:270-281. [DOI: 10.1161/circresaha.117.310884] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 02/06/2023]
Abstract
Rationale:
Diverse B cell responses and functions may be involved in atherosclerosis. Protective antibody responses, such as those against oxidized lipid epitopes, are thought to mainly derive from T cell-independent innate B cell subsets. In contrast, both pathogenic and protective roles have been associated with T cell-dependent antibodies, and their importance in both humans and mouse models is still unclear.
Objective:
To specifically target antibody production by plasma cells and determine the impact on atherosclerotic plaque development in mice with and without CD4+ T cells.
Methods and Results:
We combined a model of specific antibody deficiency, B cell-specific CD79a-
Cre
x XBP1 (X-box binding protein-1) floxed mice (XBP1-conditional knockout), with antibody-mediated depletion of CD4+ T cells. Ldlr knockout mice transplanted with XBP1-conditional knockout (or wild-type control littermate) bone marrow were fed western diet for 8 weeks with or without anti-CD4 depletion. All groups had similar levels of serum cholesterol. In Ldlr/XBP1-conditional knockout mice, serum levels of IgG, IgE, and IgM were significantly attenuated, and local antibody deposition in atherosclerotic plaque was absent. Antibody deficiency significantly accelerated atherosclerosis at both the aortic root and aortic arch. T cell and monocyte responses were not modulated, but necrotic core size was greater, even when adjusting for plaque size, and collagen deposition significantly lower. Anti-CD4 depletion in Ldlr/wild-type mice led to a decrease of serum IgG1 and IgG2c but not IgG3, as well as decreased IgM, associated with increased atherosclerosis and necrotic cores, and a decrease in plaque collagen. The combination of antibody deficiency and anti-CD4 depletion has no additive effects on aortic root atherosclerosis.
Conclusions:
The endogenous T cell-dependent humoral response can be protective. This has important implications for novel vaccine strategies for atherosclerosis and in understanding the impacts of immunotherapies used in patients at high risk for cardiovascular disease.
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Affiliation(s)
- Andrew P. Sage
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (A.P.S., M.N., J.B.C., S.A.N., A.J.F., L.M., Z.M.); Department of Laboratory Medicine, (D.T., C.J.B.); Medical University of Vienna, Austria (D.T., C.J.B.); CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna (D.T., C.J.B.); INSERM U970, Paris Cardiovascular Research Center, France (Z.M.); and Université Paris Descartes, Sorbonne Paris Cité, France (Z.M.)
| | - Meritxell Nus
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (A.P.S., M.N., J.B.C., S.A.N., A.J.F., L.M., Z.M.); Department of Laboratory Medicine, (D.T., C.J.B.); Medical University of Vienna, Austria (D.T., C.J.B.); CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna (D.T., C.J.B.); INSERM U970, Paris Cardiovascular Research Center, France (Z.M.); and Université Paris Descartes, Sorbonne Paris Cité, France (Z.M.)
| | - Jayashree Bagchi Chakraborty
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (A.P.S., M.N., J.B.C., S.A.N., A.J.F., L.M., Z.M.); Department of Laboratory Medicine, (D.T., C.J.B.); Medical University of Vienna, Austria (D.T., C.J.B.); CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna (D.T., C.J.B.); INSERM U970, Paris Cardiovascular Research Center, France (Z.M.); and Université Paris Descartes, Sorbonne Paris Cité, France (Z.M.)
| | - Dimitrios Tsiantoulas
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (A.P.S., M.N., J.B.C., S.A.N., A.J.F., L.M., Z.M.); Department of Laboratory Medicine, (D.T., C.J.B.); Medical University of Vienna, Austria (D.T., C.J.B.); CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna (D.T., C.J.B.); INSERM U970, Paris Cardiovascular Research Center, France (Z.M.); and Université Paris Descartes, Sorbonne Paris Cité, France (Z.M.)
| | - Stephen A. Newland
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (A.P.S., M.N., J.B.C., S.A.N., A.J.F., L.M., Z.M.); Department of Laboratory Medicine, (D.T., C.J.B.); Medical University of Vienna, Austria (D.T., C.J.B.); CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna (D.T., C.J.B.); INSERM U970, Paris Cardiovascular Research Center, France (Z.M.); and Université Paris Descartes, Sorbonne Paris Cité, France (Z.M.)
| | - Alison J. Finigan
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (A.P.S., M.N., J.B.C., S.A.N., A.J.F., L.M., Z.M.); Department of Laboratory Medicine, (D.T., C.J.B.); Medical University of Vienna, Austria (D.T., C.J.B.); CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna (D.T., C.J.B.); INSERM U970, Paris Cardiovascular Research Center, France (Z.M.); and Université Paris Descartes, Sorbonne Paris Cité, France (Z.M.)
| | - Leanne Masters
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (A.P.S., M.N., J.B.C., S.A.N., A.J.F., L.M., Z.M.); Department of Laboratory Medicine, (D.T., C.J.B.); Medical University of Vienna, Austria (D.T., C.J.B.); CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna (D.T., C.J.B.); INSERM U970, Paris Cardiovascular Research Center, France (Z.M.); and Université Paris Descartes, Sorbonne Paris Cité, France (Z.M.)
| | - Christoph J. Binder
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (A.P.S., M.N., J.B.C., S.A.N., A.J.F., L.M., Z.M.); Department of Laboratory Medicine, (D.T., C.J.B.); Medical University of Vienna, Austria (D.T., C.J.B.); CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna (D.T., C.J.B.); INSERM U970, Paris Cardiovascular Research Center, France (Z.M.); and Université Paris Descartes, Sorbonne Paris Cité, France (Z.M.)
| | - Ziad Mallat
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, United Kingdom (A.P.S., M.N., J.B.C., S.A.N., A.J.F., L.M., Z.M.); Department of Laboratory Medicine, (D.T., C.J.B.); Medical University of Vienna, Austria (D.T., C.J.B.); CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna (D.T., C.J.B.); INSERM U970, Paris Cardiovascular Research Center, France (Z.M.); and Université Paris Descartes, Sorbonne Paris Cité, France (Z.M.)
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Gerster M, Peker E, Nagel E, Puntmann VO. Deciphering cardiac involvement in systemic inflammatory diseases: noninvasive tissue characterisation using cardiac magnetic resonance is key to improved patients’ care. Expert Rev Cardiovasc Ther 2016; 14:1283-1295. [DOI: 10.1080/14779072.2016.1226130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Huang J, Han SS, Qin DD, Wu LH, Song Y, Yu F, Wang SX, Liu G, Zhao MH. Renal Interstitial Arteriosclerotic Lesions in Lupus Nephritis Patients: A Cohort Study from China. PLoS One 2015; 10:e0141547. [PMID: 26544865 PMCID: PMC4636159 DOI: 10.1371/journal.pone.0141547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/10/2015] [Indexed: 12/01/2022] Open
Abstract
Objective The aim of this study was to evaluate renal arteriosclerotic lesions in patients with lupus nephritis and investigate their associations with clinical and pathological characteristics, especially cardio-vascular features. Design A retrospective cohort study. Participants Seventy-nine patients with renal biopsy-proven lupus nephritis, diagnosed between January 2000 and June 2008 from Peking University First Hospital. Results In clinico-pathological data, patients with arteriosclerosis had higher ratio of hypertension and more severe renal injury indices compared with patients with no renal vascular lesions. More importantly, patients with renal arteriosclerosis had worse cardiac structure and function under transthoracic echocardiographic examination. Patients with renal arteriosclerosis tend to have higher ratios of combined endpoints compared with those of no renal vascular lesions, although the difference didn’t reach statistical meanings (P = 0.104). Conclusion Renal arteriosclerotic lesion was common and associated with vascular immune complex deposits in lupus nephritis. It might have a certain degree of association with poor outcomes and cardiovascular events, which needs further explorations.
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Affiliation(s)
- Jing Huang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Sha-sha Han
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Dan-dan Qin
- Department of Nephrology, The 2nd Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, 150000, PR China
| | - Li-hua Wu
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, PR China
| | - Yan Song
- Department of Nephrology, the First Affiliated Hospital of Chinese PLA General Hospital, 51 Fucheng Road, Beijing, 100048, PR China
- * E-mail: (YS); (FY)
| | - Feng Yu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
- * E-mail: (YS); (FY)
| | - Su-xia Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Gang Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Ming-hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
- Peking-Tsinghua Center for Life Sciences, Beijing, PR China
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Zou QM, Li XH, Song RX, Xu NP, Zhang T, Zhang MM, Lin Y, Shi L, Fu J, Cui XD. Early decreased plasma levels of factor B and C5a are important biomarkers in children with Kawasaki disease. Pediatr Res 2015; 78:205-11. [PMID: 25938736 DOI: 10.1038/pr.2015.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 01/28/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND The mechanisms underpinning Kawasaki disease (KD) are incompletely understood. There is an unmet need for specific biomarkers for the early diagnosis of KD. METHODS Eighty-five KD patients suffering from acute-phase and subacute-phase KD, 40 healthy children, and 40 febrile children comprised the study cohort. An enzyme-linked immunosorbent assay was used to measure plasma levels of C1q, C1q-circulating immune complex (C1q-CIC), mannan-binding lectin-associated serine protease (MASP)-1, factor B, C4d, C3d, C5a, C5b-9 and CD59. RESULTS Plasma concentrations of factor B and C5a in the acute phase were lower than those in healthy and febrile control groups (all P < 0.05). Compared with acute-phase KD patients, plasma concentrations of C1q, factor B, and C3d in KD patients were increased significantly (P < 0.05), but those of C4d, MASP-1 and CD59 decreased significantly (P < 0.05), in patients with sub-acute KD. CONCLUSION These data suggest that more than one pathway in the complement system is activated in KD. Importantly, decreased plasma concentrations of factor B and C5a in the acute phase (6-10 d) could be employed as biomarkers for the early diagnosis of KD.
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Affiliation(s)
- Qing-Mei Zou
- Department of Cardiovascular Diseases, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Xiao-Hui Li
- Department of Cardiovascular Diseases, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Rui-Xia Song
- Department of Cardiovascular Diseases, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Nan-Ping Xu
- Department of Emergency, Children's Hospital of Jiangxi Province, Nanchang, Jiangxi, China
| | - Ting Zhang
- Central Laboratory of Infection and Immunity, Capital Institute of Pediatrics, Beijing, China
| | - Ming-Ming Zhang
- Department of Cardiovascular Diseases, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yao Lin
- Department of Cardiovascular Diseases, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Lin Shi
- Department of Cardiovascular Diseases, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Jin Fu
- Clinical Center Laboratory, Capital Institute of Pediatrics, Beijing, China
| | - Xiao-Dai Cui
- Clinical Center Laboratory, Capital Institute of Pediatrics, Beijing, China
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Diverse vascular lesions in systemic lupus erythematosus and clinical implications. Curr Opin Nephrol Hypertens 2014; 23:218-23. [PMID: 24670401 DOI: 10.1097/01.mnh.0000444812.65002.cb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Vascular injury is one of the typical symptoms of systemic lupus erythematosus (SLE), and may play a key role in the choice of treatment strategy and prediction of prognosis. In this review, diverse vascular lesions in SLE and their clinical significance are discussed. RECENT FINDINGS The clinical features of vascular disease in SLE differ from organ to organ, and may be extreme with regard to renal vascular lesions. Vascular lesions in SLE may be of inflammatory or thrombotic origin, and immune system dysfunction is considered to be a predominant feature. Numerous lines of evidence suggest that the activation and injury of endothelial cells might play a key role in the pathogenesis. SUMMARY Vascular lesions in SLE are mediated by a complex interaction between the immune system and other contributing factors. Different therapies developed for vascular lesions, both immunosuppressive and nonimmunosuppressive, should be selected based on the different clinical and pathological characteristics, and our future understanding of the different mechanisms involved.
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Abstract
PURPOSE OF REVIEW With improved management of the classical disease manifestations of systemic lupus erythematosus (SLE), cardiovascular disease (CVD) has emerged as one of the most important causes of morbidity and mortality. This review in particular focuses on progress over the past year in clinical and basic aspects of SLE-driven accelerated atherosclerosis. RECENT FINDINGS Both subclinical CVD and CV events continue to be recognized at increased frequency in previously unstudied lupus cohorts and populations. Novel associations have been identified between lupus CVD and cognitive impairment, depression, and low-income status. In terms of pathogenesis, there is an ever-increasing focus on the innate immune system and, in particular, type I interferons (IFNs). Recent studies have drawn connections in both human and murine models between neutrophils, plasmacytoid dendritic cells, type I IFNs, and endothelial dysfunction. Whether treatments such as mycophenolate mofetil or statins have a role in prevention of lupus CVD is an area of intensive study. SUMMARY CVD is a major complication of lupus and is now a leading cause of death among people living with this disease. As such, additional studies are needed in order to identify the most effective preventive strategies and most predictive vascular risk biomarkers. Type I IFNs may play a critical role in lupus CVD pathogenesis, and it is recommended that vascular outcomes be included in ongoing trials testing the efficacy of anti-IFN biologics.
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Chu H, Wu LH, Song D, Yu F, Zhao MH. Noninflammatory necrotizing vasculopathy in lupus nephritis: a single-center experience. Lupus 2013; 23:20-30. [PMID: 24218394 DOI: 10.1177/0961203313512391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this study, we assessed the clinicopathological features of lupus nephritis patients with renal noninflammatory necrotizing vasculopathy (NNV). A total of 142 renal biopsies with lupus nephritis were reviewed, including nine cases presented with NNV and 36 without renal vascular lesions. The comparisons of clinical, laboratory and pathological features, treatments, as well as renal outcome between the two groups were further performed. In comparison with the no renal vascular lesions group, patients with NNV changes had significantly higher proportions of noninfection leukocyturia (p = 0.013) and leukocytopenia (p = 0.042), significantly higher serum creatinine (p = 0.012), lower hemoglobin (p = 0.002) and serum C3 (p < 0.001) levels. Renal pathological activity indices and chronicity indices were significantly higher in the NNV group (p = 0.002 and p = 0.006, respectively) than those in the no vascular lesions group. Regarding renal prognosis, the presence of NNV was not a risk factor for renal outcome (p = 0.327). In conclusion, NNV was not infrequent in renal biopsies of lupus nephritis. It was commonly associated with active clinical status and proliferative glomerular lesions of lupus.
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Affiliation(s)
- H Chu
- 1Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
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Stokowska A, Olsson S, Holmegaard L, Jood K, Blomstrand C, Jern C, Pekna M. Cardioembolic and small vessel disease stroke show differences in associations between systemic C3 levels and outcome. PLoS One 2013; 8:e72133. [PMID: 23977229 PMCID: PMC3748011 DOI: 10.1371/journal.pone.0072133] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 07/05/2013] [Indexed: 01/24/2023] Open
Abstract
Background Activation of the complement system has been proposed to play a role in the pathophysiology of stroke. As the specific involvement of the complement proteins may be influenced by stroke etiology, we compared plasma C3 and C3a levels in patients with cardioembolic (CE) and small vessel disease (SVD) subtypes of ischemic stroke and control subjects and evaluated their association to outcome at three months and two years. Methodology/Principal Findings Plasma C3 and C3a levels in 79 CE and 79 SVD stroke patients, sampled within 10 days and at three months after stroke, and age- and sex-matched control subjects from The Sahlgrenska Academy Study on Ischemic Stroke were measured by ELISA. Functional outcome was assesed with modified Rankin Scale. In the CE group, plasma C3 levels were elevated only in the acute phase, whereas C3a was elevated at both time points. The follow-up phase plasma C3 levels in the upper third were associated with an increased risk of unfavorable outcome at three months (OR 7.12, CI 1.72–29.46, P = 0.007) as well as after two years (OR 8.25, CI 1.61–42.28, P = 0.011) after stroke. These associations withstand adjustment for age and sex. Conversely, three-month follow-up plasma C3a/C3 level ratios in the middle third were associated with favorable outcome after two years both in the univariate analysis (OR 0.19, CI 0.05–0.82, P = 0.026) and after adjustment for age and sex (OR 0.19, CI 0.04–0.88, P = 0.033). In the SVD group, plasma C3 and C3a levels were elevated at both time points but showed no significant associations with outcome. Conclusions Plasma C3 and C3a levels are elevated after CE and SVD stroke but show associations with outcome only in CE stroke.
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Affiliation(s)
- Anna Stokowska
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Sandra Olsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lukas Holmegaard
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christian Blomstrand
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christina Jern
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Marcela Pekna
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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