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Raut SS, Acharya S, Kumar S, Wanjari A, Bardiya NA. A Case of Diffuse Scleroderma Presenting as Hypertensive Encephalopathy Due to Scleroderma Renal Crisis. Cureus 2024; 16:e61732. [PMID: 38975413 PMCID: PMC11226219 DOI: 10.7759/cureus.61732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
This case report details a rare presentation of diffuse scleroderma, where a 38-year-old female developed hypertensive encephalopathy due to scleroderma renal crisis (SRC). SRC, characterized by sudden severe hypertension and renal failure, poses a life-threatening emergency. The patient's clinical features, including skin changes and abnormalities on nailfold capillaroscopy, facilitated the diagnosis of diffuse scleroderma. Comprehensive diagnostic investigations revealed multisystem involvement. Management involved angiotensin-converting enzyme inhibitors, hydroxychloroquine, and packed red cell transfusions, highlighting a holistic therapeutic approach. This case underscores the importance of recognizing diverse scleroderma manifestations in hypertensive emergencies for timely intervention and improved outcomes.
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Affiliation(s)
- Sarang S Raut
- General Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sourya Acharya
- General Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sunil Kumar
- General Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Anil Wanjari
- General Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Nidhi A Bardiya
- General Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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Otman E, Gucenmez S, Solmaz D, Akar S, Ozmen M. Hydroxychloroquine might reduce mortality in patients with systemic sclerosis. Int J Rheum Dis 2023; 26:1640-1642. [PMID: 36933946 DOI: 10.1111/1756-185x.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 03/20/2023]
Affiliation(s)
- Eda Otman
- Division of Rheumatology, Department of Internal Medicine, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Sercan Gucenmez
- Division of Rheumatology, Department of Internal Medicine, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Dilek Solmaz
- Division of Rheumatology, Department of Internal Medicine, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Mustafa Ozmen
- Division of Rheumatology, Department of Internal Medicine, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
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Zheng C, Wu A, Zhai X, Ji H, Chen Z, Chen X, Yu X. The cellular immunotherapy of integrated photothermal anti-oxidation Pd-Se nanoparticles in inhibition of the macrophage inflammatory response in rheumatoid arthritis. Acta Pharm Sin B 2021; 11:1993-2003. [PMID: 34386333 PMCID: PMC8343190 DOI: 10.1016/j.apsb.2021.02.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022] Open
Abstract
Reducing the inflammatory response is a major goal in the therapy of rheumatoid arthritis (RA). Herein, we integrated palladium nanoparticles (Pd NPs) with selenium nanoparticles (Se NPs) and obtained a multiple nanosystem (Pd@Se-HA NPs) that could simultaneously scavenge hydroxyl radicals (⋅OH) and provide a photothermal effect. The Pd@Se-HA NPs were constructed by a simple self-assembly method in which Se NPs were electrostatically bonded to Pd NPs; hyaluronic acid (HA) was linked to the NPs by ester bonding to provide macrophage targeting ability. The experiments show that the combined therapy of eliminating ⋅OH with Se NPs and utilizing PTT with Pd NPs could effectively reduce the inflammatory response in macrophages more effectively than either individual NP treatment. In addition, the outer layer of HA could specifically target the CD44 receptor to enhance the accumulation of Pd@Se NPs at the lesion, further enhancing the therapeutic effect. After treatment for 15 days, the Pd@Se-HA NPs nearly eliminated the inflammatory response in the joints of mice in an induced RA model, and prevented joint damage and degradation.
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Sakata K, Yasuoka H, Yoshimoto K, Takeuchi T. Decreased activation of ataxia telangiectasia mutated (ATM) in monocytes from patients with systemic sclerosis. Rheumatology (Oxford) 2021; 59:3961-3970. [PMID: 32743653 DOI: 10.1093/rheumatology/keaa312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/06/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The regulation system for oxidative stress in systemic sclerosis (SSc) remains unclear. This study aimed to clarify the possible involvement of ataxia telangiectasia mutated (ATM), which plays a key role in DNA repair and redox balance, in the pathogenesis of SSc. METHODS Thirty patients with SSc and 15 healthy controls were enrolled. Expression of ATM and phosphorylated ATM (pATM), an activated form of ATM, in phagocytes in whole blood samples was analysed by FACS. Correlations between expression levels of ATM/pATM and clinical parameters of SSc patients were statistically analysed. Peripheral monocytes were cultured with an ATM-specific inhibitor (KU55933), and reactive oxygen species production in the cells was measured. RESULTS Expression level of pATM in peripheral monocytes and neutrophils from SSc patients was significantly lower than those in healthy controls (P = 0.04 and P < 0.001, respectively), while no significant difference in total ATM expression was observed between SSc and healthy controls. In addition, pATM expression in monocytes of SSc patients with interstitial lung disease or digital pitting scar was remarkably lower than in the patients without these clinical features (P = 0.02 and P = 0.03), respectively. Moreover, pATM expression in monocytes positively correlated with forced vital capacity and negatively correlated with the serum Krebs von den Lungen-6 level. Notably, KU55933, an ATM-specific inhibitor, enhanced reactive oxygen species production by monocytes under oxidative stress. CONCLUSION Our data revealed that decreased ATM activation in monocytes was associated with SSc-interstitial lung disease and that impaired ATM activation in monocytes may contribute to the disease process of SSc via uncontrolled reactive oxygen species production.
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Affiliation(s)
- Komei Sakata
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo
| | - Hidekata Yasuoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo.,Division of Infectious Diseases and Rheumatology, Department of Internal Medicine, Fujita Health University School of Medicine, Aichi
| | - Keiko Yoshimoto
- Department of Biotechnology, Tokyo Technical College, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo
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Raschi E, Privitera D, Bodio C, Lonati PA, Borghi MO, Ingegnoli F, Meroni PL, Chighizola CB. Scleroderma-specific autoantibodies embedded in immune complexes mediate endothelial damage: an early event in the pathogenesis of systemic sclerosis. Arthritis Res Ther 2020; 22:265. [PMID: 33168071 PMCID: PMC7654597 DOI: 10.1186/s13075-020-02360-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Consistently with their diagnostic and prognostic value, autoantibodies specific for systemic sclerosis (SSc) embedded in immune complexes (ICs) elicited a pro-inflammatory and pro-fibrotic cascade in healthy skin fibroblasts, engaging Toll-like receptors (TLRs) via their nucleic acid components. The objective of this study was to investigate the pathogenicity of SSc-ICs in endothelial cells. METHODS ICs were purified from the sera of SSc patients bearing different autoantibody specificities (antibodies against DNA topoisomerase I, centromeric proteins, RNA polymerase, and Th/To), patients with systemic lupus erythematosus (SLE) and primary anti-phospholipid syndrome (PAPS), or healthy controls (NHS) using polyethylene glycol precipitation. Human umbilical vein endothelial cells (HUVECs) were incubated with ICs, positive and negative controls. mRNA levels of endothelin-1 (et-1), collagenIα1 (colIα1), interferon (IFN)-α, and IFN-β were investigated by real-time PCR; et-1 and il-6 mRNA levels were assessed after pre-treatment with bafilomycin. ICAM-1 expression was evaluated by cell ELISA; secretion of IL-6, IL-8, and transforming growth factor (TGF)-β1 in culture supernatants was measured by ELISA. The expression of Fcγ receptors (CD64, CD32, and CD16) was assessed in endothelial cells at FACS analysis. Intracellular signaling pathways culminating with NFκB, p38MAPK, SAPK-JNK, and Akt were assessed by Western blotting. Healthy skin fibroblasts were stimulated with supernatants from HUVECs incubated with ICs, and TGF-β1 secretion and mRNA levels of colIα1 and matrix metalloproteinase (mmp)-1, protein expression of α smooth muscle actin (α-SMA), and IL-6 were evaluated by Western blotting; et-1 mRNA levels were assessed in fibroblasts pre-treated with IL-6 and TGF-β inhibitors and stimulated with ATA-ICs. RESULTS All SSc stimulated IL-6 secretion; ACA-ICs and anti-Th/To-ICs increased ICAM-1 expression; all SSc-ICs but anti-Th/To-ICs augmented IL-8 levels; all SSc-ICs but ACA-ICs and ARA-ICs upregulated et-1, and all SSc-ICs but ARA-ICs affected TGF-β1 secretion. colIα1, IFN-α, and IFN-β mRNA levels were not affected by any SSc-IC. FcγRII (CD32) and FcγRIII (CD16) were not detectable on HUVECs, while FcγRI (CD64) was minimally expressed. A differential modulation of tlr expression was observed: tlr2, tlr3, and tlr4 were upregulated by ATA-ICs and ACA-ICs, while anti-Th/To-ICs resulted in tlr9 upregulation. Pre-treatment with bafilomycin did not affect the upregulation of et-1 and il-6 induced by ATA-ICs, ACA-ICs, and anti-Th/To-ICs; a 23% reduction in both genes was reported for ARA-ICs. All SSc-ICs activated p38MAPK and Akt, and all SSc-ICs but ARA-ICs yielded the activation of NFκB; ATA-ICs and ACA-ICs increased the activation rate of both subunits of SAPK-JNK. When healthy skin fibroblasts were stimulated with supernatants from HUVECs incubated with SSc-ICs, TGF-β1 secretion, colIα1, α-SMA, and IL-6 expression levels were significantly modulated. Pre-treatment with IL-6 and TGF-β inhibitors prevented et-1 upregulation induced by ATA-ICs by 85% and 77%, respectively. CONCLUSIONS These data provide the first demonstration of the pathogenicity of ICs from scleroderma patients with different autoantibodies on the endothelium. Endothelial activation induced by SSc-ICs ultimately led to a pro-fibrotic phenotype in healthy skin fibroblasts.
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Affiliation(s)
- Elena Raschi
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy
| | - Daniela Privitera
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy
| | - Caterina Bodio
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy
| | - Paola Adele Lonati
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy
| | - Maria Orietta Borghi
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Francesca Ingegnoli
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.,Division of Clinical Rheumatology, Research Center for Adult and Pediatric Rheumatic Diseases, ASST G. Pini, Piazza C Ferrari 1, 20122, Milan, Italy
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy.,Allergology, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - Cecilia Beatrice Chighizola
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Via Zucchi 18, Cusano Milanino, 20095, Milan, Italy. .,Allergology, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy.
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Picchianti Diamanti A, Rosado MM, Pioli C, Sesti G, Laganà B. Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity. Int J Mol Sci 2020; 21:E3330. [PMID: 32397174 PMCID: PMC7247555 DOI: 10.3390/ijms21093330] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 02/08/2023] Open
Abstract
On 7 January 2020, researchers isolated and sequenced in China from patients with severe pneumonitis a novel coronavirus, then called SARS-CoV-2, which rapidly spread worldwide, becoming a global health emergency. Typical manifestations consist of flu-like symptoms such as fever, cough, fatigue, and dyspnea. However, in about 20% of patients, the infection progresses to severe interstitial pneumonia and can induce an uncontrolled host-immune response, leading to a life-threatening condition called cytokine release syndrome (CRS). CRS represents an emergency scenario of a frequent challenge, which is the complex and interwoven link between infections and autoimmunity. Indeed, treatment of CRS involves the use of both antivirals to control the underlying infection and immunosuppressive agents to dampen the aberrant pro-inflammatory response of the host. Several trials, evaluating the safety and effectiveness of immunosuppressants commonly used in rheumatic diseases, are ongoing in patients with COVID-19 and CRS, some of which are achieving promising results. However, such a use should follow a multidisciplinary approach, be accompanied by close monitoring, be tailored to patient's clinical and serological features, and be initiated at the right time to reach the best results. Autoimmune patients receiving immunosuppressants could be prone to SARS-CoV-2 infections; however, suspension of the ongoing therapy is contraindicated to avoid disease flares and a consequent increase in the infection risk.
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Affiliation(s)
- Andrea Picchianti Diamanti
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00182 Rome, Italy; (G.S.); (B.L.)
| | | | - Claudio Pioli
- Laboratory of Biomedical Technologies, Division of Health Protection Technologies, Ente per le Nuove Tecnologie, L’energia e l’Ambiente (ENEA), 00196 Rome, Italy;
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00182 Rome, Italy; (G.S.); (B.L.)
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00182 Rome, Italy; (G.S.); (B.L.)
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