Systemic lupus erythematosus: 25 years of treatment related to immunopathology

A new endocrinological and immunological syndrome in SLE: elevation of human chorionic gonadotropin and of antibodies directed against ovary and endometrium antigens

We have analysed the levels of gonadotropins in male and female patients with systemic lupus erythematosus (SLE). Human chorionic gonadotropin hCG was elevated in 23.8% of patients compared with 12.7% of controls. hCG isolated from the serum of SLE patients was bioactive in vitro. Levels of hCG were significantly correlated with those of its beta-subunit but not with the levels of follicle stimulating hormone, luteinizing hormone, prolactin alphafetoprotein or carcino embryonic antigen. A high percentage of patients presented an organ-specific humoral immune response against ovarian (26.7%) and endometrial (40%) antigens compared with controls (8% and 7.6%, respectively). Endometrial antibodies were significantly correlated to the levels of prolactin. The ovarian tumour marker CA-125 was elevated in 32.5% of patients, including two males. As a whole, these elements delineate a new endocrine and immunological syndrome in SLE in which the elevation of hCG could provide a central physiological explanation for a series of endocrine alterations that characterize this disease.

Extracorporeal photochemotherapy for the treatment of systemic lupus erythematosus. A pilot study

OBJECTIVE

To investigate the effectiveness and feasibility of extracorporeal photochemotherapy (ECP) in the treatment of an autoimmune disease with known cutaneous photosensitivity.

METHODS

Ten patients with systemic lupus erythematosus (SLE) were treated with ECP in an open clinical trial. The efficacy of treatment was analyzed by means of established disease activity scores.

RESULTS

Eight patients completed the trial. In 7 of the 8, there was a significant response to the treatment, with no or minor side effects. The clinical activity score in the group of 8 patients decreased from a median of 7 (range 4-9) to a median of 1 (range 0-5) (P less than 0.05). Laboratory abnormalities did not change significantly, but were mild at the outset.

CONCLUSION

ECP led to clinical improvement of SLE without side effects. The effectiveness of this method should be investigated further in controlled clinical trials.

Therapeutic effect of 15-deoxyspergualin on the progression of lupus nephritis in MRL mice. I. Immunopathological analyses

The effect of 15-deoxyspergualin (DSP), a newly developed immunosuppressive agent, on the development of spontaneously occurring lupus glomerulonephritis in MRL-lpr mice was examined. Administration of the drug was initiated at the age of 13 or 17 weeks, when polyclonal B cell activation and lupus nephropathy were apparent or became prominent. Treatment with DSP for up to 19 weeks of age at a dose of 2 mg/kg twice a day or 5 mg/kg daily strongly suppressed the increment of IgG-producing cell numbers in the spleen and serum levels of immune complexes and anti-DNA antibodies. Glomerular histological score estimated by light microscopy and IgG and C3 deposition in renal glomeruli were improved, compared with untreated control mice. Thus, DSP was shown to suppress the progression of polyclonal B cell activation and lupus nephropathy in MRL/lpr mice. These results suggest that DSP may be used as a therapeutic agent for systemic lupus erythematosus.

Connective tissue responses in blacks in relation to disease: further observations

Additional information is presented in support of the hypothesis (Polednak: Am. J. Phys. Anthropol. 41:49-58, 1974) that in some black populations certain connective-tissue responses, which are involved in protection against infection and repair after injury, also may predispose to specific chronic diseases. These diseases include some autoimmune disorders (i.e., systemic lupus erythematosus, sarcoidosis, and scleroderma) and various benign and malignant tumors involving connective-tissue cells. Complex interactions between genetic factors (HLA and non-HLA loci) and environmental agents may be involved both in the etiology of these autoimmune diseases and in population differences in the incidence of these diseases. A framework is reviewed whereby cellular responses to infectious agents, involving chiefly immunoglobulin-producing cells and macrophages, may have consequences in terms of pathogenesis of specific chronic diseases more common in some black populations. The possible role of natural selection in maintaining some of these diseases is also considered, along with the need for involvement of biomedical anthropologists in their investigation.

Immunosuppressive activities of deoxyspergualin. I. Effect of the long-term administration of the drug on the development of murine lupus

The effect of 15-deoxyspergualin, a newly developed anti-tumor agent, on the development of spontaneously occurring lupus glomerulonephritis in male BXSB and MRL/lpr mice was examined. The prophylactic effect of 15-deoxyspergualin was evaluated using 8-week-old male BXSB mice. Its therapeutic effect was estimated using male BXSB and MRL/lpr mice of 13 weeks of age. Treatment with 15-deoxyspergualin at a dose of 5 mg/kg for 5 weeks suppressed the increment of IgG-producing cells in the spleen, decreased serum levels of circulating immune complexes assessed by solid-phase C1q-binding assay and effectively prevented the deposition of immune complexes in renal glomeruli estimated by immunofluorescent studies in both strains of mice. 15-Deoxyspergualin was also effective in preventing the massive lymphoproliferation characteristic of MRL/lpr mice as assessed by the weight of mesenteric lymph nodes. It seemed quite valuable that 15-deoxyspergualin drastically suppressed the progress of polyclonal B cell activation in both strains of autoimmune mice, which have different mechanisms leading to B cell activation. These results suggest that 15-deoxyspergualin might be used as a therapeutic agent for human erythematosus.

Erythrocyte CR1 (C3b/C4b receptor) levels and disease activity in patients with SLE

Fifty-four patients with systemic lupus erythematosus (SLE) were examined for (1) CR1 (C3b/C4b receptor) levels on erythrocytes by an enzyme-linked immunosorbent assay, (2) levels of circulating immune complexes (IC) by a polyethylene glycol precipitation complement consumption method, and (3) concentrations of C3d split products in plasma by intermediate gel rocket immunoelectrophoresis. A preponderance of low CR1 levels was found among patients with SLE (mean 40%, range 13-106) as compared with normal controls (mean 70%, range 24-130) (p less than 0.001). The concentrations of circulating IC were elevated in 38% of 58 samples. The concentrations of C3d were elevated in 72%, and were positively correlated with the levels of IC (tau = 0.28; p less than 0.005) and with disease activity as assessed by a modification of the UCH/Middlesex criteria. Negative correlations were seen between the CR1 numbers and disease activity (p = 0.01), concentrations of circulating IC (tau = -0.14; p less than 0.005), and C3d (tau = -0.21; p less than 0.005). The changes found in CR1 levels on repeated study were, however, relatively small (less than or equal to 27%; median 5), even during periods of changing disease activity.

Are rheumatoid arthritis and systemic lupus erythematosus inversely related diseases?

Although rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have certain features in common, the literature suggests that the two diseases are inversely related to each other in at least eight major respects, viz., age of onset in relation to reproductive fertility; psychosis; kidney disease; nutritional status; and the differential effects of pregnancy, oral contraceptive use, jaundice, and penicillamine. It is suggested that associated with RA and SLE are differing blood and/or tissue levels of a common but as yet undetermined factor: deficient levels in RA, toxic levels in SLE.

Systemic lupus erythematosus, renal disease, hemodialysis and vitamin A

Recent studies indicate that clinically-active systemic lupus erythematosus (SLE) is uncommon in patients with end-stage renal disease undergoing long-term hemodialysis. Several lines of indirect evidence suggest that the dialysis procedure itself may be responsible for inducing remission; that SLE could reflect a toxicity reaction to excessive tissue levels of vitamin A; and that remission associated with dialysis may be due to a gradual reduction in vitamin A levels at the sites of SLE activity.

Immunology of multisystem ocular disease

In this review based on Prof. James' 1983 George Nelms Wise Lecture, the authors summarize proven and speculated relationships involved in the immunology of multisystem ocular disease. Extensive tables elucidate the mechanisms underlying such conditions as, systemic lupus erythematosus, polyarteritis nodosa, Sjögren's syndrome, Wegener's granulomatosis, scleritis, sarcoidosis, Behcet's disease, idiopathic retinal vasculitis, sympathetic ophthalmia, Vogt-Koyanagi-Harada syndrome, and dysthyroid eye disease.

Transcobalamin II, a serum protein reflecting autoimmune disease activity, its plasma dynamics, and the relationship to established serum parameters in systemic lupus erythematosus

Earlier investigations have shown that the activity of autoimmune diseases appears to correlate with increased levels of the vitamin B12 (cobalamin)-binding serum protein, transcobalamin II (M. Fráter-Schröder et al., Schweìz. Med. Wochensch 110, 1441, 1980; M. Fráter-Schröde et al., Lancet 2, 238, 1978). These preliminary findings were confirmed and extended with regard to SLE in the present prospective study. The correlation of serum levels with the degree of disease activity (determined by clinical scoring of 44 patients with systemic lupus erythematosus (SLE), fulfilling four or more of the American Rheumatoid Association criteria) was shown to be most reliable for transcobalamin II (P less than 0.001), when compared to other serological parameters. An answer to the question "what induces increased levels of transcobalamin II in active SLE?" was sought by injecting 15 SLE patients with cyanocobalamin which influences plasma dynamics of transcobalamin II. Results indicate that transcobalamin II-cobalamin "clearance" is probably unchanged in SLE, and that increased production or stimulation of transcobalamin II secretion may be the cause of elevated plasma levels in active SLE.

Evidence against HLA and immunological dependence of disease outbreak in SLE. Immunological characterisation of identical twins clinically discordant for SLE

Identical female twins clinically discordant for 20 years for SLE were studied. Their HLA-haplotype was A1,28; B8w6,w35; Cw3,w7; Dr3,4. Both twins had a raised erythrocyte sedimentation rate, autoantibodies, and circulating immune complexes. The diseases sibling had a reversed OKT4/OKT8 ratio (0.43), decreased helper T cell number, defective pokeweed mitogen (PWM) induced plasma cell differentiation, and overactive hydrocortisone sensitive suppressor cells. Immunological abnormalities may be only partly HLA related (B8; Dr3), but are most probably secondary to the disease process in the sibling with SLE. Exogenous and/or endogenous factor(s) other than genetic or immunological are suggested as being operative in the predisposition to and expression of SLE.