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Mitander A, Fei Y, Trysberg E, Mohammad M, Hu Z, Sakiniene E, Pullerits R, Jin T. Complement Consumption in Systemic Lupus Erythematosus Leads to Decreased Opsonophagocytosis In Vitro. J Rheumatol 2018; 45:1557-1564. [PMID: 30173146 DOI: 10.3899/jrheum.171325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Infections remain a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The high prevalence of infections in SLE is attributed to both the disease and its treatments. The complement system plays an important role in host immune responses against invading microorganisms. We sought to provide the experimental and clinical evidence supporting the hypothesis that low levels of complement factors cause defective complement-mediated opsonization in patients with SLE. METHODS Staphylococcus aureus was opsonized with sera from healthy individuals (n = 16), SLE patients with normal (n = 5) or low complement (n = 8) levels. Phagocytosis of S. aureus by healthy human neutrophils was analyzed by an imaging flow cytometry-based method. We retrospectively examined the infection incidence in relation to complement levels in a cohort of 165 patients with SLE during a 1.5-year period. The association was analyzed for infection incidence and disease-related variables. RESULTS Uptake of S. aureus by neutrophils was decreased when S. aureus was opsonized with sera from SLE patients with low complement levels compared to sera from healthy individuals and SLE patients with normal complement. In our SLE cohort, 44% of patients had at least 1 infection during the 1.5 years. No significant association was observed between complement levels and infection risk. Importantly, high-dose glucocorticoids (GC; prednisone ≥ 10 mg/day) were the most important predictive factor for infections in patients with SLE. CONCLUSION Low complement levels affect bacterial opsonization in SLE blood and lead to downregulated phagocytosis by neutrophils. High-dose GC increase the infection risk in patients with SLE.
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Affiliation(s)
- Amanda Mitander
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Ying Fei
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Estelle Trysberg
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Majd Mohammad
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Zhicheng Hu
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Egidija Sakiniene
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Rille Pullerits
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Tao Jin
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. .,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital.
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