Increased interleukin-9 levels in skin lesions from cutaneous lupus erythematosus patients may predict the progression to systemic lupus erythematosus

The Genetic Landscape of Cutaneous Lupus Erythematosus

Cutaneous lupus erythematosus (CLE) is an autoimmune connective tissue disease that can exist as a disease entity or within the context of systemic lupus erythematosus (SLE). Over the years, efforts to elucidate the genetic underpinnings of CLE and SLE have yielded a wealth of information. This review examines prior studies investigating the genetics of CLE at the DNA and RNA level and identifies future research areas. In this literature review, we examined the English language literature captured within the MEDLINE and Embase databases using pre-defined search terms. First, we surveyed studies investigating various DNA studies of CLE. We identified three predominant areas of focus in HLA profiling, complement deficiencies, and genetic polymorphisms. An increased frequency of HLA-B8 has been strongly linked to CLE. In addition, multiple genes responsible for mediating innate immune response, cell growth, apoptosis, and interferon response confer a higher risk of developing CLE, specifically TREX1 and SAMHD1. There was a strong association between C2 complement deficiency and CLE. Second, we reviewed literature studying aberrations in the transcriptomes of patients with CLE. We reviewed genetic aberrations initiated by environmental insults, and we examined the interplay of dysregulated inflammatory, apoptotic, and fibrotic pathways in the context of the pathomechanism of CLE. These current learnings will serve as the foundation for further advances in integrating personalized medicine into the care of patients with CLE.

A Systematic Review of the Progression of Cutaneous Lupus to Systemic Lupus Erythematosus

Lupus erythematosus is an autoimmune disease that may manifest in a variety of organs and tissues including the skin, kidney, brain, heart and lung. Many patients present with cutaneous lupus, where disease is often limited to the skin, but are at risk for developing systemic lupus. The objective of our present study is to perform a systematic review of studies that investigated patient cohorts and populations for the occurrence of cutaneous lupus progressing to systemic lupus. Inclusion criteria required that studies present longitudinal data of patients with limited cutaneous lupus erythematosus who were followed for development of systemic lupus erythematosus. Studies were excluded if patients had concurrent diagnosis of SLE, or if they failed to present longitudinal data. Medline and Embase were searched for English language studies using the Ovid platform. A total of 25 adult studies were identified, as well as 8 pediatric studies. The rate of cutaneous to systemic lupus progression ranged between 0% to 42% in the adult studies and 0% to 31% in the pediatric groups. The variability in these rates were due to differences in patient populations, study design, criteria used to diagnose systemic lupus, and follow-up time. Common risk factors associated with systemic lupus erythematosus development including having positive anti-nuclear antibodies, hematologic abnormalities, and higher number of lupus classification criteria at baseline. This study emphasizes the importance for providers to routinely monitor for systemic lupus in patients with cutaneous lupus.

Identification of Serum Biomarkers and Pathways of Systemic Lupus Erythematosus with Skin Involvement Through GC/MS-Based Metabolomics Analysis

Purpose

Skin involvement is the second most common symptom of systemic lupus erythematosus (SLE), and the prevention of skin lesion development might benefit to lessen the system inflammation burden in SLE. However, the mechanisms of skin lesion in SLE remain unclear.

Patients and Methods

Metabolome based on gas chromatography-mass spectrometry (GC-MS) was used for comparison of serum metabolism among 11 SLE patients with skin lesion (SL), 10 SLE patients without skin lesion (SNL), and 16 healthy controls (HC). The analysis of metabolism profiles was through LUG database, Human Metabolome Database (HMDB) as well as Kyoto Encyclopedia of Genes and Genomes (KEGG).

Results

A total of 14 most meaningful metabolites were found in SL patients compared to SNL patients, and 19 metabolic pathways were enriched. Meanwhile, L-alpha-aminobutyric acid, dehydroascorbic acid, glycine, and L-tyrosine achieved an area under receiver-operating characteristic (ROC) curve of 0.8636, 0.8091, 0.7727, and 0.7636, respectively, indicating their diagnostic potential for SL patients. In addition, the combined model of L-alpha-aminobutyric acid and dehydroascorbic acid provided better diagnostic accuracy.

Conclusion

The metabolomic features of SLE patients with skin lesion could be detected by GC/MS assay. Our study tried to provide new insights into the mechanism of SLE skin injury. Further validation of these findings through larger sample size studies may contribute to the use of metabolic profile analysis.