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Samavati SF, Yarani R, Kiani S, HoseinKhani Z, Mehrabi M, Levitte S, Primavera R, Chetty S, Thakor AS, Mansouri K. Therapeutic potential of exosomes derived from mesenchymal stem cells for treatment of systemic lupus erythematosus. J Inflamm (Lond) 2024; 21:20. [PMID: 38867277 PMCID: PMC11170788 DOI: 10.1186/s12950-024-00381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/14/2024] [Indexed: 06/14/2024] Open
Abstract
Autoimmune diseases are caused by an imbalance in the immune system, producing autoantibodies that cause inflammation leading to tissue damage and organ dysfunction. Systemic Lupus Erythematosus (SLE) is one of the most common autoimmune diseases and a major contributor to patient morbidity and mortality. Although many drugs manage the disease, curative therapy remains elusive, and current treatment regimens have substantial side effects. Recently, the therapeutic potential of exosomes has been extensively studied, and novel evidence has been demonstrated. A direct relationship between exosome contents and their ability to regulate the immune system, inflammation, and angiogenesis. The unique properties of extracellular vesicles, such as biomolecule transportation, biodegradability, and stability, make exosomes a promising treatment candidate for autoimmune diseases, particularly SLE. This review summarizes the structural features of exosomes, the isolation/purification/quantification method, their origin, effect, immune regulation, a critical consideration for selecting an appropriate source, and their therapeutic mechanisms in SLE.
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Affiliation(s)
- Shima Famil Samavati
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Yarani
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Sara Kiani
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zohreh HoseinKhani
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masomeh Mehrabi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Steven Levitte
- Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Rosita Primavera
- Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Shashank Chetty
- Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Avnesh S Thakor
- Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Kamran Mansouri
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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2
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Karpman D, Tontanahal A. Extracellular vesicles in renal inflammatory and infectious diseases. Free Radic Biol Med 2021; 171:42-54. [PMID: 33933600 DOI: 10.1016/j.freeradbiomed.2021.04.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
Extracellular vesicles can mediate cell-to-cell communication, or relieve the parent cell of harmful substances, in order to maintain cellular integrity. The content of extracellular vesicles includes miRNAs, mRNAs, growth factors, complement factors, cytokines, chemokines and receptors. These may contribute to inflammatory and infectious diseases by the exposure or transfer of potent effectors that induce vascular inflammation by leukocyte recruitment and thrombosis. Furthermore, vesicles release cytokines and induce their release from cells. Extracellular vesicles possess immune modulatory and anti-microbial properties, and induce receptor signaling in the recipient cell, not least by the transfer of pro-inflammatory receptors. Additionally, the vesicles may carry virulence factors systemically. Extracellular vesicles in blood and urine can contribute to the development of kidney diseases or exhibit protective effects. In this review we will describe the role of EVs in inflammation, thrombosis, immune modulation, angiogenesis, oxidative stress, renal tubular regeneration and infection. Furthermore, we will delineate their contribution to renal ischemia/reperfusion, vasculitis, glomerulonephritis, lupus nephritis, thrombotic microangiopathies, IgA nephropathy, acute kidney injury, urinary tract infections and renal transplantation. Due to their content of miRNAs and growth factors, or when loaded with nephroprotective modulators, extracellular vesicles have the potential to be used as therapeutics for renal regeneration.
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Affiliation(s)
- Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, 22185, Lund, Sweden.
| | - Ashmita Tontanahal
- Department of Pediatrics, Clinical Sciences Lund, Lund University, 22185, Lund, Sweden
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3
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Trendelenburg M. Autoantibodies against complement component C1q in systemic lupus erythematosus. Clin Transl Immunology 2021; 10:e1279. [PMID: 33968409 PMCID: PMC8082710 DOI: 10.1002/cti2.1279] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is the archetype of a systemic autoimmune disease, but the multifaceted pathogenic mechanisms leading to inflammation and organ damage are not fully understood. Homozygous deficiency of complement C1q, the first component of the classical pathway of complement, is strongly associated with the development of SLE, thus pointing at a primarily protective role of C1q. However, while most SLE patients do not have hereditary C1q deficiency, there is indirect evidence for the importance of C1q in the inflammatory processes of the disease, including hypocomplementemia as a result of activation via the classical pathway, deposition of C1q in affected tissues and the occurrence of autoantibodies against C1q (anti‐C1q). The growing body of knowledge on anti‐C1q led to the establishment of a biomarker that is used in the routine clinical care of SLE patients. Exploring the binding characteristics of anti‐C1q allows to understand the mechanisms, that lead to the expression of relevant autoantigenic structures and the role of genetic as well as environmental factors. Lastly, the analysis of the pathophysiological consequences of anti‐C1q is of importance because C1q, the target of anti‐C1q, is a highly functional molecule whose downstream effects are altered by the binding of the autoantibody. This review summarises current study data on anti‐C1q and their implications for the understanding of SLE.
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Affiliation(s)
- Marten Trendelenburg
- Division of Internal Medicine University Hospital Basel Basel Switzerland.,Clinical Immunology Department of Biomedicine University of Basel Basel Switzerland
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4
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Zhang B, Zhao M, Lu Q. Extracellular Vesicles in Rheumatoid Arthritis and Systemic Lupus Erythematosus: Functions and Applications. Front Immunol 2021; 11:575712. [PMID: 33519800 PMCID: PMC7841259 DOI: 10.3389/fimmu.2020.575712] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/27/2020] [Indexed: 12/18/2022] Open
Abstract
In the last two decades, extracellular vesicles (EVs) have aroused wide interest among researchers in basic and clinical research. EVs, small membrane vesicles are released by almost all kinds of cells into the extracellular environment. According to many recent studies, EVs participate in immunomodulation and play an important role in the pathogenesis of autoimmune diseases. In addition, EVs have great potential in the diagnosis and therapy of autoimmune diseases. Here, we reviewed the latest research advances on the functions and mechanisms of EVs and their roles in the pathogenesis, diagnosis, and treatment of rheumatoid arthritis and systemic lupus erythematosus.
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Affiliation(s)
- Bo Zhang
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China.,Clinical Immunology Research Center, Central South University, Changsha, China.,Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Ming Zhao
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China.,Clinical Immunology Research Center, Central South University, Changsha, China.,Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
| | - Qianjin Lu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China.,Clinical Immunology Research Center, Central South University, Changsha, China.,Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, China
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5
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Zhao Y, Wei W, Liu ML. Extracellular vesicles and lupus nephritis - New insights into pathophysiology and clinical implications. J Autoimmun 2020; 115:102540. [PMID: 32893081 PMCID: PMC9107953 DOI: 10.1016/j.jaut.2020.102540] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022]
Abstract
Lupus nephritis (LN) is a major cause for overall morbidity and mortality in patients with systemic lupus erythematosus (SLE), while its pathogenic mechanisms are still not well understood. Extracellular vesicles (EVs) are membrane vesicles that are released from almost all cell types. EVs can be subdivided into exosomes, microvesicles, and apoptotic bodies. Latest studies have shown that EVs can be released during several cellular events, including cell activation, autophagy, and several types of programed cell death, i.e. apoptosis, necroptosis, pyroptosis, and NETosis. Emerging evidence demonstrates that EVs harbor different bioactive molecules, including nucleic acids, proteins, lipids, cytokines, immune complexes (ICs), complements, and other molecules, some of which may contribute to pathogenesis of autoimmune diseases. EVs can serve as novel information shuttle to mediate local autocrine or paracrine signals to nearby cells, and distant endocrine signals to cells located far away. In LN, EVs may have pathogenic effects by transportation of autoantigens or complements, promotion of IC deposition or complement activation, and stimulation of inflammatory responses, renal tissue injury, or microthrombus formation. Additionally, EVs released from kidney cells may serve as specific biomarkers for diagnosis or monitoring of disease activity and therapeutic efficacy. In this review, we will summarize the latest progress about EV generation from basic research, their potential pathologic effects on LN, and their clinical implications. The cutting-edge knowledge about EV research provides insights into novel therapeutic strategy, new tools for diagnosis or prognosis, and evaluation approaches for treatment effectiveness in LN.
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Affiliation(s)
- Yin Zhao
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, 300020, China
| | - Wei Wei
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, 300020, China.
| | - Ming-Lin Liu
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Corporal Michael J. Crescenz VA Medical Center (Philadelphia), Philadelphia, PA, 19104, USA.
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6
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Liu Y, Li S, Rong W, Zeng C, Zhu X, Chen Q, Li L, Liu ZH, Zen K. Podocyte-Released Migrasomes in Urine Serve as an Indicator for Early Podocyte Injury. KIDNEY DISEASES 2020; 6:422-433. [PMID: 33313063 DOI: 10.1159/000511504] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/10/2020] [Indexed: 12/20/2022]
Abstract
Background Levels of urinary microvesicles, which are increased during various kidney injuries, have diagnostic potential for renal diseases. However, the significance of urinary microvesicles as a renal disease indicator is dampened by the difficulty to ascertain their cell source. Objectives The aim of this study was to demonstrate that podocytes can release migrasomes, a unique class of microvesicle with size ranging between 400 and 2,000 nm, and the urine level of migrasomes may serve as novel non-invasive biomarker for early podocyte injury. Method In this study, immunofluorescence labeling, electronic microscopy, nanosite, and sequential centrifugation were used to purify and analyze migrasomes. Results Migrasomes released by podocytes differ from exosomes as they have different content and mechanism of release. Compared to podocytes, renal tubular cells secrete markedly less migrasomes. Moreover, secretion of migrasomes by human or murine podocytes was strongly augmented during podocyte injuries induced by LPS, puromycin amino nucleoside (PAN), or a high concentration of glucose (HG). LPS, PAN, or HG-induced podocyte migrasome release, however, was blocked by Rac-1 inhibitor. Strikingly, a higher level of podocyte migrasomes in urine was detected in mice with PAN-nephropathy than in control mice. In fact, increased urinary migrasome number was detected earlier than elevated proteinuria during PAN-nephropathy, suggesting that urinary migrasomes are a more sensitive podocyte injury indicator than proteinuria. Increased urinary migrasome number was also detected in diabetic nephropathy patients with proteinuria level <5.5 g/day. Conclusions Our findings reveal that podocytes release the "injury-related" migrasomes during migration and provide urinary podocyte migrasome as a potential diagnostic marker for early podocyte injury.
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Affiliation(s)
- Ying Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Jiangsu Engineering Research Center for MicroRNA Biotechnology, Nanjing University School of Life Sciences, Nanjing, China
| | - Shan Li
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Jiangsu Engineering Research Center for MicroRNA Biotechnology, Nanjing University School of Life Sciences, Nanjing, China
| | - Weiwei Rong
- Jiangsu Engineering Research Center for MicroRNA Biotechnology, Nanjing University School of Life Sciences, Nanjing, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiaodong Zhu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Qilin Chen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Limin Li
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Jiangsu Engineering Research Center for MicroRNA Biotechnology, Nanjing University School of Life Sciences, Nanjing, China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ke Zen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Jiangsu Engineering Research Center for MicroRNA Biotechnology, Nanjing University School of Life Sciences, Nanjing, China
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7
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Rasmussen NS, Nielsen CT, Jacobsen S, Nielsen CH. Stimulation of Mononuclear Cells Through Toll-Like Receptor 9 Induces Release of Microvesicles Expressing Double-Stranded DNA and Galectin 3-Binding Protein in an Interferon-α-Dependent Manner. Front Immunol 2019; 10:2391. [PMID: 31681284 PMCID: PMC6797593 DOI: 10.3389/fimmu.2019.02391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 09/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Microvesicles (MVs) expressing the type 1 interferon (IFN)-inducible protein galectin-3 binding protein (G3BP) may play a pathogenic role in systemic lupus erythematosus (SLE). Co-expression of double-stranded DNA (dsDNA) on such MVs may render them immunogenic and targets for anti-dsDNA antibodies. Little is known about the mechanisms underlying generation of this MV population. In this study, we investigated how Toll-like receptors (TLRs), IFN-α, and T cells are involved in this process in healthy subjects. Methods: Peripheral blood mononuclear cells (PBMCs) isolated from 12 healthy donors were stimulated in-vitro for 24 h with a series of TLR-agonists or the T cell activating antibody OKT3 or were subjected to apoptosis by incubation with staurosporine. MVs in the supernatants were subsequently isolated by differential centrifugation and were quantified and characterized with respect to expression of G3BP and dsDNA by flow cytometry. Results: Stimulation of PBMCs with the TLR9-agonist and strong IFN-α inducer ODN2395 significantly increased the release of MVs expressing G3BP. The production of MVs with this phenotype was markedly enhanced by co-stimulation of T cells. Furthermore, dependency on IFN-α in the generation of G3BP-expressing MVs was indicated by a marked reduction following addition of the IFN-α inhibitor IFN alpha-IFNAR-IN-1 hydrochloride. Conclusion: Release of G3BP-expressing MVs from healthy donor PBMCs is induced by stimulation of TLR9 in an IFN-α-dependent manner and is enhanced by co-stimulation of T cells.
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Affiliation(s)
- Niclas Stefan Rasmussen
- Center for Rheumatology and Spine Diseases, Institute for Inflammation Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoffer Tandrup Nielsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus Henrik Nielsen
- Center for Rheumatology and Spine Diseases, Institute for Inflammation Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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8
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Zhao C, Mao Y, Liu L, Wu Q, Dan Y, Pan H. Plasma galectin‐3 levels do not differ in systemic lupus erythematosus patients. Int J Rheum Dis 2019; 22:1820-1824. [DOI: 10.1111/1756-185x.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/15/2019] [Accepted: 07/14/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Chan‐Na Zhao
- Department of Epidemiology and Biostatistics, School of Public Health Anhui Medical University Hefei China
- Anhui Province Key Laboratory of Major Autoimmune Diseases Hefei China
| | - Yan‐Mei Mao
- Department of Epidemiology and Biostatistics, School of Public Health Anhui Medical University Hefei China
- Anhui Province Key Laboratory of Major Autoimmune Diseases Hefei China
| | - Li‐Na Liu
- Department of Epidemiology and Biostatistics, School of Public Health Anhui Medical University Hefei China
- Anhui Province Key Laboratory of Major Autoimmune Diseases Hefei China
| | - Qian Wu
- Department of Epidemiology and Biostatistics, School of Public Health Anhui Medical University Hefei China
- Anhui Province Key Laboratory of Major Autoimmune Diseases Hefei China
| | - Yi‐Lin Dan
- Department of Epidemiology and Biostatistics, School of Public Health Anhui Medical University Hefei China
- Anhui Province Key Laboratory of Major Autoimmune Diseases Hefei China
| | - Hai‐Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health Anhui Medical University Hefei China
- Anhui Province Key Laboratory of Major Autoimmune Diseases Hefei China
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9
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Rethinking Lupus Nephritis Classification on a Molecular Level. J Clin Med 2019; 8:jcm8101524. [PMID: 31547518 PMCID: PMC6832959 DOI: 10.3390/jcm8101524] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 12/19/2022] Open
Abstract
The International Society of Nephrology/Renal Pathology Society (ISN/RPS) lupus nephritis (LN) classification is under reconsideration, given challenges with inter-rater reliability and resultant inconsistent relationship with treatment response. Integration of molecular classifiers into histologic evaluation can improve diagnostic precision and identify therapeutic targets. This study described the relationship between histological and molecular phenotypes and clinical responses in LN. Renal compartmental mRNA abundance was measured in 54 biopsy specimens from LN patients and correlated to ISN/RPS classification and individual histologic lesions. A subset of transcripts was also evaluated in sequential biopsies of a separate longitudinal cohort of 36 patients with paired samples obtained at the time of flare and at follow up. Unsupervised clustering based on mRNA abundance did not demonstrate a relationship with the (ISN/RPS) classification, nor did univariate statistical analysis. Exploratory analyses suggested a correlation with individual histologic lesions. Glomerular FN1 (fibronectin), SPP1 (secreted phosphoprotein 1), and LGALS3 (galectin 3) abundance correlated with disease activity and changed following treatment. Exploratory analyses suggested relationships between specific transcripts and individual histologic lesions, with the important representation of interferon-regulated genes. Our findings suggested that the current LN classification could be refined by the inclusion of molecular descriptors. Combining molecular and pathologic kidney biopsy phenotypes may hold promise to better classify disease and identify actionable treatment targets and merits further exploration in larger cohorts.
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10
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Microparticles and autophagy: a new frontier in the understanding of atherosclerosis in rheumatoid arthritis. Immunol Res 2019; 66:655-662. [PMID: 30574665 DOI: 10.1007/s12026-018-9053-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Microparticles (MPs) are small membrane vesicles released by many cell types under physiological and pathological conditions. In the last years, these particles were considered as inert cell debris, but recently many studies have demonstrated they could have a role in intercellular communication. Increased levels of MPs have been reported in various pathological conditions including infections, malignancies, and autoimmune diseases, such as rheumatoid arthritis (RA). RA is an autoimmune systemic inflammatory disease characterized by chronic synovial inflammation, resulting in cartilage and bone damage with accelerated atherosclerosis increasing mortality. According to the literature data, also MPs could have a role in endothelial dysfunction, contributing to atherosclerosis in RA patients. Moreover many researchers have shown that a dysregulated autophagy seems to be involved in endothelial dysfunction. Autophagy is a reparative process by which cytoplasmic components are sequestered in double-membrane vesicles and degraded on fusion with lysosomal compartments. It has been shown in many works that basal autophagy is essential to proper vascular function. Taking into account these considerations, we hypothesized that in RA patients MPs could contribute to atherosclerosis process by dysregulation of endothelial autophagy process.
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Dumestre-Pérard C, Clavarino G, Colliard S, Cesbron JY, Thielens NM. Antibodies targeting circulating protective molecules in lupus nephritis: Interest as serological biomarkers. Autoimmun Rev 2018; 17:890-899. [PMID: 30009962 DOI: 10.1016/j.autrev.2018.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 12/15/2022]
Abstract
Lupus nephritis (LN) is one of the most frequent and severe manifestations of systemic lupus erythematosus (SLE), considered as the major predictor of poor prognosis. An early diagnosis of LN is a real challenge in the management of SLE and has an important implication in guiding treatments. In clinical practice, conventional parameters still lack sensitivity and specificity for detecting ongoing disease activity in lupus kidneys and early relapse of nephritis. LN is characterized by glomerular kidney injury, essentially due to deposition of immune complexes involving autoantibodies against cellular components and circulating proteins. One of the possible mechanisms of induction of autoantibodies in SLE is a defect in apoptotic cells clearance and subsequent release of intracellular autoantigens. Autoantibodies against soluble protective molecules involved in the uptake of dying cells, including complement proteins and pentraxins, have been described. In this review, we present the main autoantibodies found in LN, with a focus on the antibodies against these protective molecules. We also discuss their pathogenic role and conclude with their potential interest as serological biomarkers in LN.
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Affiliation(s)
- Chantal Dumestre-Pérard
- Laboratoire d'Immunologie, Pôle de Biologie, CHU Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France; BNI TIMC-IMAG, UMR5525, CNRS-Université Grenoble Alpes, BP170, 38042 Grenoble Cedex 9, France.
| | - Giovanna Clavarino
- Laboratoire d'Immunologie, Pôle de Biologie, CHU Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France; BNI TIMC-IMAG, UMR5525, CNRS-Université Grenoble Alpes, BP170, 38042 Grenoble Cedex 9, France
| | - Sophie Colliard
- Laboratoire d'Immunologie, Pôle de Biologie, CHU Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France
| | - Jean-Yves Cesbron
- Laboratoire d'Immunologie, Pôle de Biologie, CHU Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France; BNI TIMC-IMAG, UMR5525, CNRS-Université Grenoble Alpes, BP170, 38042 Grenoble Cedex 9, France
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12
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Abstract
The number of peer-reviewed articles published during the 2016 solar year and retrieved using the "autoimmunity" key word remained stable while gaining a minimal edge among the immunology articles. Nonetheless, the quality of the publications has been rising significantly and, importantly, acquisitions have become available through scientific journals dedicated to immunology or autoimmunity. Major discoveries have been made in the fields of systemic lupus erythematosus, rheumatoid arthritis, autoimmunity of the central nervous system, vasculitis, and seronegative spondyloarthrithritides. Selected examples include the role of IL17-related genes and long noncoding RNAs in systemic lupus erythematosus or the effects of anti-pentraxin 3 (PTX3) in the treatment of this paradigmatic autoimmune condition. In the case of rheumatoid arthritis, there have been reports of the role of induced regulatory T cells (iTregs) or fibrocytes and T cell interactions with exciting implications. The large number of studies dealing with neuroimmunology pointed to Th17 cells, CD56(bright) NK cells, and low-level TLR2 ligands as involved in multiple sclerosis, along with a high salt intake or the micriobiome-derived Lipid 654. Lastly, we focused on the rare vasculitides to which numerous studies were devoted and suggested that unsuspected cell populations, including monocytes, mucosal-associated invariant T cells, and innate lymphoid cells, may be crucial to ANCA-associated manifestations. This brief and arbitrary discussion of the findings published in 2016 is representative of a promising background for developments that will enormously impact the work of laboratory scientists and physicians at an exponential rate.
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Affiliation(s)
- Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Medical Biotechnologies and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy.
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13
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Ahn SS, Park Y, Lee DD, Bothwell ALM, Jung SM, Song JJ, Park YB, Lee SW. SerumWisteria floribundaagglutinin-positive Mac-2-binding protein can reflect systemic lupus erythematosus activity. Lupus 2017; 27:771-779. [DOI: 10.1177/0961203317747719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S S Ahn
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y Park
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D D Lee
- Seoul International School, Seongnam, Republic of Korea
| | - A L M Bothwell
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - S M Jung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J J Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y-B Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S-W Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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14
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Panteleev MA, Abaeva AA, Balandina AN, Belyaev AV, Nechipurenko DY, Obydennyi SI, Sveshnikova AN, Shibeko AM, Ataullakhanov FI. Extracellular vesicles of blood plasma: content, origin, and properties. BIOCHEMISTRY MOSCOW SUPPLEMENT SERIES A-MEMBRANE AND CELL BIOLOGY 2017. [DOI: 10.1134/s1990747817030060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Abstract
Extracellular vesicles, such as exosomes and microvesicles, are host cell-derived packages of information that allow cell-cell communication and enable cells to rid themselves of unwanted substances. The release and uptake of extracellular vesicles has important physiological functions and may also contribute to the development and propagation of inflammatory, vascular, malignant, infectious and neurodegenerative diseases. This Review describes the different types of extracellular vesicles, how they are detected and the mechanisms by which they communicate with cells and transfer information. We also describe their physiological functions in cellular interactions, such as in thrombosis, immune modulation, cell proliferation, tissue regeneration and matrix modulation, with an emphasis on renal processes. We discuss how the detection of extracellular vesicles could be utilized as biomarkers of renal disease and how they might contribute to disease processes in the kidney, such as in acute kidney injury, chronic kidney disease, renal transplantation, thrombotic microangiopathies, vasculitides, IgA nephropathy, nephrotic syndrome, urinary tract infection, cystic kidney disease and tubulopathies. Finally, we consider how the release or uptake of extracellular vesicles can be blocked, as well as the associated benefits and risks, and how extracellular vesicles might be used to treat renal diseases by delivering therapeutics to specific cells.
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Affiliation(s)
- Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Klinikgatan 28, 22184 Lund, Sweden
| | - Anne-Lie Ståhl
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Klinikgatan 28, 22184 Lund, Sweden
| | - Ida Arvidsson
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Klinikgatan 28, 22184 Lund, Sweden
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16
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Nielsen CT, Østergaard O, Rasmussen NS, Jacobsen S, Heegaard NHH. A review of studies of the proteomes of circulating microparticles: key roles for galectin-3-binding protein-expressing microparticles in vascular diseases and systemic lupus erythematosus. Clin Proteomics 2017; 14:11. [PMID: 28405179 PMCID: PMC5385087 DOI: 10.1186/s12014-017-9146-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/31/2017] [Indexed: 02/06/2023] Open
Abstract
Subcellular microvesicles (MVs) have attracted increasing interest during the past decades. While initially considered as inert cellular debris, several important roles for MVs in physiological homeostasis, cancer, cardiovascular, and autoimmune diseases have been uncovered. Although still poorly understood, MVs are involved in trafficking of information from cell-to-cell, and are implicated in the regulation of immunity, thrombosis, and coagulation. Different subtypes of extracellular MVs exist. This review focuses on the cell membrane-derived shedded MVs (ranging in size from 200 to 1000 nm) typically termed microparticles (MPs). The numbers and particularly the composition of MPs appear to reflect the state of their parental cells and MPs may therefore carry great potential as clinical biomarkers which can be elucidated and developed by proteomics in particular. Determination of the identity of the specific proteins and their quantities, i.e. the proteome, in complex samples such as MPs enables an in-depth characterization of the phenotypical changes of the MPs during disease states. At present, only a limited number of proteomic studies of circulating MPs have been carried out in healthy individuals and disease populations. Interestingly, these studies indicate that a small set of MP-proteins, in particular, overexpression of galectin-3-binding protein (G3BP) distinguish MPs in patients with venous thromboembolism and the systemic autoimmune disease, systemic lupus erythematosus (SLE). G3BP is important in cell–cell adhesion, clearance, and intercellular signaling. MPs overexpressing G3BP may thus be involved in thrombosis and hemostasis, vascular inflammation, and autoimmunity, further favoring G3BP as a marker of “pathogenic” MPs. MPs expressing G3BP may also hold a potential as biomarkers in other conditions such as cancer and chronic viral infections. This review highlights the methodology and results of the proteome studies behind these discoveries and places them in a pathophysiological and biomarker perspective.
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Affiliation(s)
- Christoffer T Nielsen
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Ole Østergaard
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Niclas S Rasmussen
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Niels H H Heegaard
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, University of Southern Denmark, Søndre Boulevard 29, 5000 Odense, Denmark
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17
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Perez-Hernandez J, Redon J, Cortes R. Extracellular Vesicles as Therapeutic Agents in Systemic Lupus Erythematosus. Int J Mol Sci 2017; 18:ijms18040717. [PMID: 28350323 PMCID: PMC5412303 DOI: 10.3390/ijms18040717] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 12/20/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that affects multiple organs. Currently, therapeutic molecules present adverse side effects and are only effective in some SLE patient subgroups. Extracellular vesicles (EV), including exosomes, microvesicles and apoptotic bodies, are released by most cell types, carry nucleic acids, proteins and lipids and play a crucial role in cell-to-cell communication. EVs can stimulate or suppress the immune responses depending on the context. In SLE, EVs can work as autoadjuvants, enhance immune complex formation and maintaining inflammation state. Over the last years, EVs derived from mesenchymal stem cells and antigen presenting cells have emerged as cell-free therapeutic agents to treat autoimmune and inflammatory diseases. In this review, we summarize the current therapeutic applications of extracellular vesicles to regulate immune responses and to ameliorate disease activity in SLE and other autoimmune disorders.
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Affiliation(s)
- Javier Perez-Hernandez
- Genomic and Genetic Diagnosis Unit, INCLIVA Biomedical Research Institute, Accesorio 4, Avd. Menendez Pelayo, 46010 Valencia, Spain.
- Research Group of Cardiometabolic and Renal Risk, INCLIVA Biomedical Research Institute, Accesorio 4, Avd. Menendez Pelayo, 46010 Valencia, Spain.
| | - Josep Redon
- Genomic and Genetic Diagnosis Unit, INCLIVA Biomedical Research Institute, Accesorio 4, Avd. Menendez Pelayo, 46010 Valencia, Spain.
- Research Group of Cardiometabolic and Renal Risk, INCLIVA Biomedical Research Institute, Accesorio 4, Avd. Menendez Pelayo, 46010 Valencia, Spain.
| | - Raquel Cortes
- Genomic and Genetic Diagnosis Unit, INCLIVA Biomedical Research Institute, Accesorio 4, Avd. Menendez Pelayo, 46010 Valencia, Spain.
- Research Group of Cardiometabolic and Renal Risk, INCLIVA Biomedical Research Institute, Accesorio 4, Avd. Menendez Pelayo, 46010 Valencia, Spain.
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18
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Tanha N, Pilely K, Faurschou M, Garred P, Jacobsen S. Plasma ficolin levels and risk of nephritis in Danish patients with systemic lupus erythematosus. Clin Rheumatol 2017; 36:335-341. [PMID: 27981461 DOI: 10.1007/s10067-016-3508-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/04/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
Given the scavenging properties of ficolins, we hypothesized that variation in the plasma concentrations of the three ficolins may be associated with development of lupus nephritis (LN), type of LN, end-stage renal disease (ESRD), and/or mortality among patients with systemic lupus erythematosus (SLE). SLE patients attending a Danish tertiary rheumatology referral center were included. Plasma concentrations of ficolin-1, ficolin-2, and ficolin-3 were determined and dichotomized by the median into high and low. LN was defined by clinical criteria; type of LN by renal biopsy; ESRD follow-up time was defined as time from onset of LN to the development of ESRD or censoring at the end of follow-up. The study included 112 SLE patients with median disease duration of 8 years of which 53 (47%) had LN at the time of inclusion. During a median follow-up of 10 years, five patients developed ESRD. Sixteen patients died. Odds ratios (ORs) of LN were 1.2 (95% CI: 0.6-2.7), 4.1 (95% CI: 1.7-9.7), and 0.9 (95% CI: 0.4-2.0) for patients with low ficolin-1, ficolin-2, and ficolin-3 plasma levels, respectively. The distribution of histological classes differed between patients with high and low plasma levels of ficolin-1 (p = 0.009). Patients with high ficolin-1 plasma levels had an increased risk of ESRD. There was no association between the levels of the analyzed plasma ficolins and mortality. Low plasma ficolin-2 levels were associated with an increased risk of having LN. High plasma levels of ficolin-1 were associated with the histological subtype of LN and development of ESRD.
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Affiliation(s)
- Nima Tanha
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Section 4242, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Katrine Pilely
- Laboratory of Molecular Medicine, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Mikkel Faurschou
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Section 4242, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Section 4242, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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19
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Saccon F, Gatto M, Ghirardello A, Iaccarino L, Punzi L, Doria A. Role of galectin-3 in autoimmune and non-autoimmune nephropathies. Autoimmun Rev 2016; 16:34-47. [PMID: 27666815 DOI: 10.1016/j.autrev.2016.09.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023]
Abstract
Galectins are evolutionary conserved β-galactoside binding proteins with a carbohydrate-recognition domain (CRD) of approximately 130 amino acids. In mammals, 15 members of the galectin family have been identified and classified into three subtypes according to CRD organization: prototype, tandem repeat-type and chimera-type galectins. Galectin-3 (gal-3) is the only chimera type galectin in vertebrates containing one CRD linked to an unusual long N-terminal domain which displays non-lectin dependent activities. Although recent studies revealed unique, pleiotropic and context-dependent functions of gal-3 in both extracellular and intracellular space, gal-3 specific pathways and its ligands have not been clearly defined yet. In the kidney gal-3 is involved in later stages of nephrogenesis as well as in renal cell cancer. However, gal-3 has recently been associated with lupus glomerulonephritis, with Familial Mediterranean Fever-induced proteinuria and renal amyloidosis. Gal-3 has been studied in experimental acute kidney damage and in the subsequent regeneration phase as well as in several models of chronic kidney disease, including nephropathies induced by aging, ischemia, hypertension, diabetes, hyperlipidemia, unilateral ureteral obstruction and chronic allograft injury. Because of the pivotal role of gal-3 in the modulation of immune system, wound repair, fibrosis and tumorigenesis, it is not surprising that gal-3 can be an intriguing prognostic biomarker as well as a promising therapeutic target in a great variety of diseases, including chronic kidney disease, chronic heart failure and cardio-renal syndrome. This review summarizes the functions of gal-3 in kidney pathophysiology focusing on the reported role of gal-3 in autoimmune diseases.
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Affiliation(s)
- Francesca Saccon
- Division of Rheumatology, Department of Medicine (DIMED), University of Padova, Italy
| | - Mariele Gatto
- Division of Rheumatology, Department of Medicine (DIMED), University of Padova, Italy
| | - Anna Ghirardello
- Division of Rheumatology, Department of Medicine (DIMED), University of Padova, Italy
| | - Luca Iaccarino
- Division of Rheumatology, Department of Medicine (DIMED), University of Padova, Italy
| | - Leonardo Punzi
- Division of Rheumatology, Department of Medicine (DIMED), University of Padova, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine (DIMED), University of Padova, Italy.
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20
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Fortin PR, Cloutier N, Bissonnette V, Aghdassi E, Eder L, Simonyan D, Laflamme N, Boilard E. Distinct Subtypes of Microparticle-containing Immune Complexes Are Associated with Disease Activity, Damage, and Carotid Intima-media Thickness in Systemic Lupus Erythematosus. J Rheumatol 2016; 43:2019-2025. [PMID: 27585687 DOI: 10.3899/jrheum.160050] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Microparticles (MP) are small extracellular vesicles present in body fluids. MP originate from different cellular lineages, principally from platelets in blood, and may expose phosphatidylserine (PS). In systemic lupus erythematosus (SLE), MP harbor immunoglobulin G (IgG), thereby forming MP-containing immune complexes (mpIC). We aimed to verify an association between SLE disease activity, damage, and surrogate markers of atherosclerosis and MP harboring IgG, taking into account the platelet origin and PS exposure of MP. METHODS MP expressing surface IgG, platelet antigen (CD41+), and PS were quantified using flow cytometry in plasma of 191 women with SLE. Carotid ultrasounds (US) were available in 113 patients. Spearman correlation analysis was used to analyze whether levels of MP were associated with the following outcomes: SLE Disease Activity Index 2000 (SLEDAI-2K), Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), and carotid US plaques and intima-media thickness (CIMT) as surrogates for vascular damage. RESULTS We found CD41+ MP harboring IgG present in SLE. A positive correlation was found between SLEDAI-2K and levels of CD41+ MP harboring IgG and exposing (p = 0.027) and non-exposing PS (p = 0.001). Conversely, SDI (p = 0.024) and CIMT (p = 0.016) correlated with concentrations of CD41- MP harboring IgG and exposing PS. Associations were independent of low-density lipoprotein cholesterol level, body mass index, and antimalarial drug use. CONCLUSION Different subtypes of mpIC are produced in SLE and are associated with distinct clinical characteristics such as disease activity and vascular damage. The assessment of MP subtypes might serve for the design of predictive markers of disease activity and vascular damage in patients.
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Affiliation(s)
- Paul R Fortin
- From the Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec- Université Laval and Faculté de Médecine, Université Laval; Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, Université Laval, Québec City, Québec; Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; Women's College Research Institute, Women's College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,P.R. Fortin, MD, MPH, FRCPC, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; N. Cloutier, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, and Faculté de Médecine, Université Laval; V. Bissonnette, BSc, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval, and Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval; E. Aghdassi, PhD, RD, Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, Department of Medicine, University of Toronto; D. Simonyan, MSc, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; N. Laflamme, PhD, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; E. Boilard, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, Faculté de Médecine, Université Laval.
| | - Nathalie Cloutier
- From the Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec- Université Laval and Faculté de Médecine, Université Laval; Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, Université Laval, Québec City, Québec; Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; Women's College Research Institute, Women's College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,P.R. Fortin, MD, MPH, FRCPC, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; N. Cloutier, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, and Faculté de Médecine, Université Laval; V. Bissonnette, BSc, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval, and Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval; E. Aghdassi, PhD, RD, Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, Department of Medicine, University of Toronto; D. Simonyan, MSc, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; N. Laflamme, PhD, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; E. Boilard, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, Faculté de Médecine, Université Laval
| | - Vincent Bissonnette
- From the Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec- Université Laval and Faculté de Médecine, Université Laval; Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, Université Laval, Québec City, Québec; Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; Women's College Research Institute, Women's College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,P.R. Fortin, MD, MPH, FRCPC, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; N. Cloutier, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, and Faculté de Médecine, Université Laval; V. Bissonnette, BSc, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval, and Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval; E. Aghdassi, PhD, RD, Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, Department of Medicine, University of Toronto; D. Simonyan, MSc, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; N. Laflamme, PhD, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; E. Boilard, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, Faculté de Médecine, Université Laval
| | - Ellie Aghdassi
- From the Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec- Université Laval and Faculté de Médecine, Université Laval; Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, Université Laval, Québec City, Québec; Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; Women's College Research Institute, Women's College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,P.R. Fortin, MD, MPH, FRCPC, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; N. Cloutier, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, and Faculté de Médecine, Université Laval; V. Bissonnette, BSc, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval, and Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval; E. Aghdassi, PhD, RD, Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, Department of Medicine, University of Toronto; D. Simonyan, MSc, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; N. Laflamme, PhD, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; E. Boilard, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, Faculté de Médecine, Université Laval
| | - Lihi Eder
- From the Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec- Université Laval and Faculté de Médecine, Université Laval; Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, Université Laval, Québec City, Québec; Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; Women's College Research Institute, Women's College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,P.R. Fortin, MD, MPH, FRCPC, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; N. Cloutier, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, and Faculté de Médecine, Université Laval; V. Bissonnette, BSc, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval, and Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval; E. Aghdassi, PhD, RD, Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, Department of Medicine, University of Toronto; D. Simonyan, MSc, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; N. Laflamme, PhD, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; E. Boilard, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, Faculté de Médecine, Université Laval
| | - David Simonyan
- From the Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec- Université Laval and Faculté de Médecine, Université Laval; Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, Université Laval, Québec City, Québec; Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; Women's College Research Institute, Women's College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,P.R. Fortin, MD, MPH, FRCPC, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; N. Cloutier, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, and Faculté de Médecine, Université Laval; V. Bissonnette, BSc, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval, and Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval; E. Aghdassi, PhD, RD, Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, Department of Medicine, University of Toronto; D. Simonyan, MSc, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; N. Laflamme, PhD, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; E. Boilard, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, Faculté de Médecine, Université Laval
| | - Nathalie Laflamme
- From the Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec- Université Laval and Faculté de Médecine, Université Laval; Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, Université Laval, Québec City, Québec; Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; Women's College Research Institute, Women's College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,P.R. Fortin, MD, MPH, FRCPC, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; N. Cloutier, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, and Faculté de Médecine, Université Laval; V. Bissonnette, BSc, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval, and Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval; E. Aghdassi, PhD, RD, Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, Department of Medicine, University of Toronto; D. Simonyan, MSc, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; N. Laflamme, PhD, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; E. Boilard, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, Faculté de Médecine, Université Laval
| | - Eric Boilard
- From the Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec- Université Laval and Faculté de Médecine, Université Laval; Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, Université Laval, Québec City, Québec; Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; Women's College Research Institute, Women's College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,P.R. Fortin, MD, MPH, FRCPC, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval; N. Cloutier, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, and Faculté de Médecine, Université Laval; V. Bissonnette, BSc, Centre de recherche du CHU de Québec - Université Laval, Axe Maladies Infectieuses et Immunitaires and Division of Rheumatology, Department of Medicine, Université Laval, and Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval; E. Aghdassi, PhD, RD, Dalla Lana School of Public Health, University of Toronto, Division of Neurology, University Health Network, Toronto Western Hospital; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, Department of Medicine, University of Toronto; D. Simonyan, MSc, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; N. Laflamme, PhD, Centre de recherche du CHU de Québec - Université Laval, Plateforme de recherche clinique et évaluative, and Faculté de Médecine, Université Laval; E. Boilard, PhD, Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHU de Québec - Université Laval, Faculté de Médecine, Université Laval.
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