A model for systemic lupus erythematosus based on chromatin disruption by polyamines

Polyamine patterns in plasma of patients with systemic lupus erythematosus and fever

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with various clinical manifestations and serologic markers. In this study, we analyzed nine polyamine (PA) profiles of plasma from patients with SLE and healthy controls (HCs), and the relationship between the PA profiles and disease activity. PA alterations in plasma of 44 patients with SLE and fever were investigated using gas chromatography mass spectrometry (GC-MS) in selected ion monitoring mode using N-ethoxycarbonyl/ N-pentafluoropropionyl derivatives, and compared with those of 43 HCs. Patients with SLE and HCs showed differences in five of nine PA profiles. Among five changed PA levels, four PAs, namely N¹-acetylcadaverine, spermidine, N¹-acetylspermidine, and spermine, were dramatically decreased. However, the level of cadaverine was increased in patients with SLE. In the partial correlation with PA profiles and disease activity markers of SLE, several disease activity markers and nutritional markers were correlated with cadaverine, spermidine, and N ⁸-acetylspermidine. Thus, our results provide a comprehensive understanding of the relationship between PA metabolomics and disease activity markers in patients with SLE.

Autoimmune disorders result from loss of epigenetic control following chromosome damage

Multiple sclerosis, systemic lupus erythematosus, and rheumatoid arthritis share common features in typical cases such as: adult onset, central nervous system problems, female predominance, episodes triggered by a variety of stresses, and an autoimmune reaction. At times, the different disorders are found in the same patient or close relatives. These disorders are quite complex but they may share a common mechanism that results in different, tissue-specific consequences based on the cell types in which the mechanism occurs. Here, it is hypothesized that DNA damage can lead to loss of epigenetic control, particularly when the damaged chromatin is distributed unevenly to daughter cells. Expression of genes and pseudogenes that have lost their epigenetic restraints can lead to autoimmune disorders. Loss of control of genes on the X chromosome and loss of control of polyamine expression are discussed as examples of this mechanism.

Calculating the etiology of systemic lupus erythematosus

Objective was to clarify the etiology and pathogenesis of systemic lupus erythematosus (SLE). Drug-induced lupus (DIL) and SLE are both found in humans, are exacerbated by the same viruses or drugs, and they are both more common in slow acetylators. Thus, DIL can be used as a model for SLE and the Adhami equation of DIL can be applied to SLE. Polyamines are the only possible link between the viral and amine hypotheses of SLE pathogenesis. Based on the Adhami equation, polyamines can explain the actual annual incidence of SLE in the general population. Putrescine is a very weak SLE-causing agent, while spermine and spermidine contribute equally in triggering SLE. The positively charged polyamines bind to negatively charged internucleosomal DNA and change its conformation from B (non-immunogenic) to Z (immunogenic). This is the major contribution of polyamines in triggering SLE. The other effects of polyamines are only secondary. Apoptosis is a necessary step in SLE pathogenesis, because it causes the internucleosomal fragmentation of DNA and exposes Z-DNA to the immune system (due to cell death). The next step is the production of anti-DNA antibodies, followed by other SLE phenomena. Polyamines not only cause SLE, but they are also important in sustaining the disease. Other endogenous and exogenous amines have additive effects with polyamines and may contribute in exacerbating SLE. When SLE is in the active phase, polyamine levels are higher as compared to remissions. Fluctuations in polyamine levels due to diet, metabolic factors, infections, intestinal flora, etc. or the presence of other amines may explain the course of SLE, characterized by remissions and exacerbations. Acetylcysteine is a drug that can be completely metabolized to acetyl groups. As such, this drug is proposed as the ideal acetyl donor for the acetylation of polyamines and other SLE-triggering compounds. Clinical trials will be necessary to test the role of acetylcysteine in the etiologic treatment of SLE.

CONCLUSIONS

Changes in DNA conformation by polyamines are the first step in SLE pathogenesis. Many genetic and environmental factors may increase or decrease the effects or levels of polyamines, causing SLE exacerbations or remissions. Viruses and other infectious agents may cause SLE by producing polyamines or by increasing the levels of endogenous polyamines. The major autoimmune diseases are characterized by remissions and exacerbations and not by a continuously progressive course, as commonly believed. Consequently, they are not sustained by internal vicious cycles, but by the initial triggering agent(s). While the conventional treatment of autoimmune disorders is important in minimizing tissue damage, the neutralization of their etiology may be important in curing and preventing autoimmunity.

Analysis of polyamines as markers of (patho)physiological conditions

The aliphatic polyamines, putrescine, spermidine and spermine, are normal cell constituents that play important roles in cell proliferation and differentiation. The equilibrium between cellular uptake and release and the balanced activities of biosynthetic and catabolic enzymes of polyamines are essential for normal homeostasis in the proliferation and functions of cells and tissues. However, the intracellular polyamine content increases in hyperplastic or neoplastic growth. Although the involvement of polyamines in physiological and pathological cell proliferation and differentiation has been well established, the role they play is quite different in relation to cell systems and animal models and is dependent on inducer agents and stimuli. Also, the experimental procedures used to deplete polyamines have been shown to influence the cell responses. In this paper, the assay methods currently in use for polyamines are reviewed and compared with respect to sensitivity, reproducibility and applicability to routine analysis. The relevance of polyamine metabolism and the uptake/release process in many physiological and pathological processes is highlighted, and the cellular polyamine pathways are discussed in relation to the possible diagnostic and therapeutic significance of these mediators.

Systemic lupus erythematosus and related autoimmune diseases are antigen-driven, epigenetic diseases

Autoimmune diseases result when cellular stresses (ex UV, cell cycle, hormones, viruses, and/or drugs) induce altered expression of polyamines, leading to chromatin disruption, interference with chromatin methylation, exposure of sequestered genes, and interference with tissue-specific processes. Exposure of previously sequestered Alu and LINE-1 sequences can lead to reverse transcription of Alu-RNA (and other transcripts) by the LINE-1 reverse transcriptase, yielding autoantigenic, hypomethylated DNA fragments. Release from the cell of the hypomethylated DNA fragments, along with polyamine-associated nucleoprotein complexes formed with the fragments, would elicit the autoimmune response. Loss of gene control due to hypomethylation and chromatin disruption by polyamines or other factors can include loss of dosage compensation from the inactive X chromosome for spermine synthase and spermidine/spermine N(1)-acetyltransferase at Xp22.1. This leads to ongoing altered polyamine levels. Thus, autoimmune diseases result from epigenetic changes that lead to autoantigen generation.

Polyamine involvement in the cell cycle, apoptosis, and autoimmunity

The polyamines: putrescine, spermidine and spermine, are ubiquitous polycations which have numerous, unique interactions in eukaryotic cells. Polyamines are essential for cell growth, with the bulk of polyamine expression co-ordinated with the cell cycle. The length, charge, and charge distribution of polyamines permit them to interact with large anionic molecules such as DNA, RNA, and phospholipids. Here, a mechanism is proposed whereby cell cycle expression of polyamines at the start of S phase leads to disruption of transcription and splicing, giving priority to DNA and histone synthesis. Inappropriate initiation of this process in non-viable cells leads to apoptosis and may be an underlying cause of autoimmunity.