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Qi J, Wu T, Wang J, Zhang J, Chen L, Jiang Z, Li Y, Jiang H, Sun Q, Gu Q, Ying Z. Research trends and frontiers in lupus nephritis: a bibliometric analysis from 2012 to 2022. Int Urol Nephrol 2024; 56:781-794. [PMID: 37581688 PMCID: PMC10808147 DOI: 10.1007/s11255-023-03715-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/16/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES Lupus nephritis is a prevalent renal manifestation of systemic lupus erythematosus (SLE) and represents a significant cause of morbidity and mortality associated with the disease. This study endeavors to undertake a meticulous bibliometric analysis of LN publications to comprehend the research hotspots and future directions. METHODS The literature on LN was acquired from the Web of Science Core Collection (WoSCC). Co-occurrence and cooperative relationship analysis of authors, institutions, countries, journals, references and keywords in the publication was performed through CiteSpace, VOSviewer and a bibliometric online analysis platform. The knowledge graphs were created, and clustering and emergence analyses were performed. RESULTS According to the search strategy, a total of 2077 publications related to lupus nephritis (LN) have been identified, with China being the largest contributor globally. The Ohio State University emerged as the most prolific institution. Lupus is the most cited and published journal. Jan J Weening and Brad Rovin were the most prolific and cocited authors. The current research focus revolved around the "nirp3 inflammasome," "biomarker," and "voclosporin". "international society," "thrombotic microangiopathy (TMA)," and "pathway" were identified to be future research hotpots by keyword burst analysis. CONCLUSIONS This bibliometric analysis summarizes for the first time the progress of LN research (2012-2022), and qualitatively and quantitatively evaluates the bibliometric information of LN research. There has been a steady increase in the scientific literature on LN over the past 11 years, with an average growth rate of 7.27%. In this field, researchers are primarily based in China and the United States. The pathogenic mechanisms, management strategies and prognostic outcomes of LN are acknowledged as prospective research hotspots. Bibliometrically, the research status and trends of LN publications may greatly assist and be a significant reference for future research in the area.
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Affiliation(s)
- Jiaping Qi
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China
- Bengbu Medical College, Bengbu, China
| | - Teng Wu
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
- Dalian Medical University, Dalian, China
| | - Jing Wang
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China
| | - Ju Zhang
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China
| | - Lin Chen
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China
| | - Zhaoyu Jiang
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China
| | - Yixuan Li
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China
| | - Huan Jiang
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China
| | - Qiong Sun
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China
| | - Qingchen Gu
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China
| | - Zhenhua Ying
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China.
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, 310000, Zhejiang, China.
- Bengbu Medical College, Bengbu, China.
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Cao TT, Chen L, Zhen XF, Zhao GJ, Zhang HF, Hu Y. Dan Bai Xiao Formula combined with glucocorticoids and cyclophosphamide for pediatric lupus nephritis: A pilot prospective study. World J Clin Cases 2022; 10:11391-11402. [PMID: 36387787 PMCID: PMC9649537 DOI: 10.12998/wjcc.v10.i31.11391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/01/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients with lupus nephritis (LN) typically undergo long-term treatment with glucocorticoids (GCs) and immunosuppressants. There is a growing demand for optimal therapy with better remission results and fewer side effects. Sustained traditional Chinese medicine (TCM) might be quite valuable for multitarget therapy, reducing the total dosage of GCs and minimizing the side effects of immunosuppressants.
AIM To evaluate whether Dan Bai Xiao Formula (DBXF) can reduce the exposure to GCs and cyclophosphamide (CYC) and to assess the efficacy and safety of DBXF for the resolution of proteinuria and hematuria in children with LN.
METHODS A 24-wk pilot study was conducted at Beijing Children’s Hospital. Children with active LN were divided into either a TCM group or a control group. Children in the TCM group received DBXF combined with GCs and CYC, and the ones in the control group received GCs and CYC every 4 wk for 24 wk. The primary endpoints of this trial were urinary protein excretion of < 150 mg/d and normal serum albumin concentration and renal function.
RESULTS The trial included 78 children, of whom 38 received GCs and CYC treatment (control group) and the remaining 40 received DBXF combined with GCs and CYC treatment (TCM group). At week 24, the TCM group showed a better rate of complete remission (42.5%); however, there was no significant difference compared with the control group (31.5%, P > 0.05). The urine red blood cell count and urine protein level were significantly lower in the TCM group than in the control group at weeks 4, 12, and 24 (P < 0.05). Furthermore, patients in the TCM group had a lower proportion of methylprednisolone pulses than those in the control group (1.30 ± 1.41 vs 3.05 ± 2.02, P < 0.0001). The ending GC dose was significantly lower in the TCM group than in the control group (P < 0.001). Moreover, more hepatic function damage, gastrointestinal adverse effects, and hypertension were observed in the control group than in the TCM group (P < 0.05).
CONCLUSION The findings suggest that DBXF treatment is effective and safe as a supplementary therapy for LN and is superior to routine GC and CYC therapy. DBXF containing combination treatment possibly results in a faster resolution of proteinuria and hematuria, smoother GC reduction, fewer methylprednisolone pulses, and fewer adverse events.
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Affiliation(s)
- Tong-Tong Cao
- Department of Traditional Chinese Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Li Chen
- Department of Traditional Chinese Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Xiao-Fang Zhen
- Department of Traditional Chinese Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Gao-Jie Zhao
- Department of Traditional Chinese Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Hui-Fang Zhang
- Department of Traditional Chinese Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Yan Hu
- Department of Traditional Chinese Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
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Kawato Y, Fukahori H, Nakamura K, Kanno A, Kubo K, Hiramitsu M, Matsuda T, Hanada Y, Furukawa T, Nakajima Y, Kinugasa F, Morokata T. Potential benefit of the cathepsin S inhibitor, ASP1617, as a treatment for systemic lupus erythematosus. Eur J Pharmacol 2022; 919:174826. [DOI: 10.1016/j.ejphar.2022.174826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
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Cuitino L, Obreque J, Gajardo-Meneses P, Villarroel A, Crisóstomo N, San Francisco IF, Valenzuela RA, Méndez GP, Llanos C. Heme-Oxygenase-1 Is Decreased in Circulating Monocytes and Is Associated With Impaired Phagocytosis and ROS Production in Lupus Nephritis. Front Immunol 2019; 10:2868. [PMID: 31921135 PMCID: PMC6923251 DOI: 10.3389/fimmu.2019.02868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/22/2019] [Indexed: 12/18/2022] Open
Abstract
Lupus nephritis (LN) is one of the most serious manifestations of systemic lupus erythematosus (SLE). Based on studies showing the potential role of heme oxygenase-1 (HO-1), an enzyme that catalyzes the degradation of heme and has anti-inflammatory properties in SLE development, we decided to explore HO-1 in LN. Accordingly, we evaluated HO-1 levels and function in circulating and infiltrating monocytes and neutrophils of LN patients. HO-1 levels were assessed in peripheral monocytes of LN patients and controls by flow cytometry and immunofluorescence microscopy. Phagocytosis and the production of reactive oxygen species (ROS) were evaluated to determine the effect of HO-1 in monocyte function. In addition, renal biopsies with proliferative LN were used to identify HO-1 in infiltrating cells and renal tissue by immunofluorescence and immunohistochemistry. Biopsies of healthy controls (HC) and patients who underwent nephrectomy were included as controls. Circulating pro-inflammatory monocytes and activated neutrophils were increased in LN patients. HO-1 levels were decreased in all subsets of monocytes and in activated neutrophils. LN monocytes showed increased phagocytosis and higher production of ROS than those of HC. When HO-1 was induced, phagocytosis and ROS levels became similar to those of HC. HO-1 was mostly expressed in renal tubular epithelial cells (RTEC). Renal tissue of LN patients showed lower levels of HO-1 than HC, whereas infiltrating immune cells of LN showed lower levels of HO-1 than biopsies of patients who had renal surgery. HO-1 is decreased in circulating monocytes and activated neutrophils of LN patients. HO-1 levels modulate the phagocytosis of LN monocytes and ROS production. HO-1 expression in RTEC might be an attempt of self-protection from inflammation.
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Affiliation(s)
- Loreto Cuitino
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Obreque
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricia Gajardo-Meneses
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Villarroel
- Departamento de Anatomía Patológica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Crisóstomo
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio F San Francisco
- Departamento de Urología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo A Valenzuela
- Departamento de Ciencias Químicas y Biológicas, Facultad de Salud, Universidad Bernardo O'Higgins, Santiago, Chile
| | - Gonzalo P Méndez
- Departamento de Anatomía Patológica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Llanos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Biswas PS. IL-17 in Renal Immunity and Autoimmunity. THE JOURNAL OF IMMUNOLOGY 2019; 201:3153-3159. [PMID: 30455371 DOI: 10.4049/jimmunol.1801042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
Abstract
The kidney is an organ particularly susceptible to damage caused by infections and autoimmune conditions. Renal inflammation confers protection against microbial infections. However, if unchecked, unresolved inflammation may lead to kidney damage. Although proinflammatory cytokine IL-17 is required for immunity against extracellular pathogens, dysregulated IL-17 response is also linked to autoimmunity. In this review, we will discuss the current knowledge of IL-17 activity in the kidney in context to renal immunity and autoimmunity and raise the intriguing question to what extent neutralization of IL-17 is beneficial or harmful to renal inflammation.
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Affiliation(s)
- Partha S Biswas
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA 15261
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Liu B, Ou Q, Tang Y, Fu S, Liang P, Yu Y, Xu Z, Chen Y, Xu A. Corticosteroids combined with doublet or single-agent immunosuppressive therapy for active proliferative lupus nephritis. Clin Rheumatol 2019; 38:2519-2528. [PMID: 31081535 DOI: 10.1007/s10067-019-04596-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/22/2019] [Accepted: 05/06/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We performed a meta-analysis to assess whether corticosteroids (C) plus (+) doublet immunosuppressive therapy (IT) is superior to the classical combination of C with single-agent IT in active proliferative lupus nephritis (LN). METHOD Randomized trials evaluating the benefits and risks of C+doublet versus single-agent IT in active proliferative LN were obtained by searching PubMed, EMBASE, and Cochrane Central Register. The primary outcome was overall response rate (ORR). The secondary outcomes were the change from baseline in Systemic Lupus Erythematosus Disease Activity Index (SLE-DAI) score, negative conversion ratio of anti-double-stranded DNA (anti-dsDNA), and adverse events. The PROSPERO registry number is CRD42017068491. RESULTS Eleven trials with 1855 patients were included. Compared with C+single-agent IT, C+doublet IT had a significantly higher ORR (relative risk [RR], 1.22; 95% confidence interval [CI], 1.09 to 1.35; P < 0.01). In a subgroup analysis, C+doublet IT without biologics had a significantly higher ORR than C+single-agent IT (RR, 1.30; 95% CI, 1.13 to 1.50; P < 0.01), while C+doublet IT including biologics improved ORR only for refractory severe LN (RR, 1.46; 95% CI, 1.09 to 1.96; P = 0.012). A larger change from baseline in SLE-DAI scores (standardized mean difference, - 0.49; 95% CI, - 0.68 to - 0.30; P < 0.01) and a higher negative conversion ratio of anti-dsDNA (RR, 1.34; 95% CI, 1.06 to 1.69; P = 0.014) were observed with C+doublet IT than with C+single-agent IT. The rates of adverse events were similar between the two regimens. CONCLUSIONS Compared with single-agent IT, the combination of C and doublet IT without biologics improved clinical outcomes in active proliferative LN. Key Points • Compared with corticosteroids + single-agent immunosuppressive therapy, corticosteroids + doublet immunosuppressive therapy without biologics had a significantly higher overall response rate in active proliferative lupus nephritis. • Compared with corticosteroids + single-agent immunosuppressive therapy, corticosteroids + doublet immunosuppressive therapy including biologics improved overall response rate only for refractory severe lupus nephritis. • A larger change from baseline in SLE-DAI scores and a higher negative conversion ratio of anti-dsDNA were observed with corticosteroids + doublet immunosuppressive therapy than with corticosteroids + single-agent immunosuppressive therapy.
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Affiliation(s)
- Bo Liu
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Qiyun Ou
- Department of Ultrasound in Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Ying Tang
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Sha Fu
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Peifen Liang
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yunfang Yu
- Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Zhenjian Xu
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yongjian Chen
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
| | - Anping Xu
- Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
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dos Santos M, Favero G, Bonomini F, Stacchiotti A, Rodella LF, Veronese FV, Rezzani R. Oral supplementation of melatonin protects against lupus nephritis renal injury in a pristane-induced lupus mouse model. Life Sci 2018; 193:242-251. [DOI: 10.1016/j.lfs.2017.10.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022]
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Theron M, Bentley D, Nagel S, Manchester M, Gerg M, Schindler T, Silva A, Ecabert B, Teixeira P, Perret C, Reis B. Pharmacodynamic Monitoring of RO5459072, a Small Molecule Inhibitor of Cathepsin S. Front Immunol 2017; 8:806. [PMID: 28769925 PMCID: PMC5512459 DOI: 10.3389/fimmu.2017.00806] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 06/26/2017] [Indexed: 12/16/2022] Open
Abstract
Major histocompatibility complex class II (MHCII)-restricted antigen priming of CD4+ T cells is both involved in adaptive immune responses and the pathogenesis of autoimmune diseases. Degradation of invariant chain Ii, a protein that prevents premature peptide loading, is a prerequisite for nascent MHCII–peptide complex formation. A key proteolytic step in this process is mediated by cathepsin S. Inhibition of this cysteine protease is known to result in the intracellular accumulation of Lip10 in B cells. Here, we describe the development and application of a neoepitope-based flow cytometry assay measuring accumulation of Lip10. This novel method enabled the investigation of cathepsin S-dependent MHCII maturation in professional antigen-presenting cell (APC) subsets. Inhibition of cathepsin S by a specific inhibitor, RO5459072, in human PBMC ex vivo resulted in accumulation of Lip10 in B cells and myeloid dendritic cells, but not in plasmacytoid dendritic cells and only to a minor degree in monocytes. We qualified Lip10 as a pharmacodynamic biomarker by showing the cathepsin S inhibitor-dependent accumulation of Lip10 in vivo in cynomolgus monkeys treated with RO5459072. Finally, dosing of RO5459072 in a first-in-human clinical study (www.ClinicalTrials.gov, identifier NCT02295332) exhibited a dose-dependent increase in Lip10, confirming target engagement and demonstrating desired pharmacologic inhibition in vivo. The degree of cathepsin S antagonist-induced maximum Lip10 accumulation in APCs varied significantly between individuals both in vitro and in vivo. This finding has not been reported previously using alternative, less sensitive methods and demands further investigation as to the potential of this biomarker to predict response to treatment. These results will help guide subsequent clinical studies investigating the pharmacokinetic and pharmacodynamic relationship of cathepsin S inhibitor RO5459072 after multiple dosing.
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Affiliation(s)
- Michel Theron
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Darren Bentley
- Roche Pharmaceutical Research and Early Development, Clinical Pharmacology, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Sandra Nagel
- Roche Pharmaceutical Research and Early Development, Clinical Pharmacology, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Marianne Manchester
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Michael Gerg
- Roche Diagnostics, Roche Innovation Center Munich, F. Hoffmann-La Roche Ltd., Penzberg, Germany
| | - Thomas Schindler
- Roche Pharmaceutical Research and Early Development, Immunology and Inflammation, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Ana Silva
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Barbara Ecabert
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Priscila Teixeira
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Camille Perret
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Bernhard Reis
- Roche Pharmaceutical Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Liu Z, Zhang H, Liu Z, Xing C, Fu P, Ni Z, Chen J, Lin H, Liu F, He Y, He Y, Miao L, Chen N, Li Y, Gu Y, Shi W, Hu W, Liu Z, Bao H, Zeng C, Zhou M. Multitarget therapy for induction treatment of lupus nephritis: a randomized trial. Ann Intern Med 2015; 162:18-26. [PMID: 25383558 DOI: 10.7326/m14-1030] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Treatment of lupus nephritis (LN) remains challenging. OBJECTIVE To assess the efficacy and safety of a multitarget therapy consisting of tacrolimus, mycophenolate mofetil, and steroid compared with intravenous cyclophosphamide and steroid as induction therapy for LN. DESIGN 24-week randomized, open-label, multicenter study. (ClinicalTrials.gov: NCT00876616). SETTING 26 renal centers in China. PATIENTS Adults (aged 18 to 65 years) with biopsy-proven LN. INTERVENTION Tacrolimus, 4 mg/d, and mycophenolate mofetil, 1.0 g/d, versus intravenous cyclophosphamide with a starting dose of 0.75 (adjusted to 0.5 to 1.0) g/m2 of body surface area every 4 weeks for 6 months. Both groups received 3 days of pulse methylprednisolone followed by a tapering course of oral prednisone therapy. MEASUREMENTS The primary end point was complete remission at 24 weeks. Secondary end points included overall response (complete and partial remission), time to overall response, and adverse events. RESULTS After 24 weeks of therapy, more patients in the multitarget group (45.9%) than in the intravenous cyclophosphamide group (25.6%) showed complete remission (difference, 20.3 percentage points [95% CI, 10.0 to 30.6 percentage points]; P < 0.001). The overall response incidence was higher in the multitarget group than in the intravenous cyclophosphamide group (83.5% vs. 63.0%; difference, 20.4 percentage points [CI, 10.3 to 30.6 percentage points]; P < 0.001), and the median time to overall response was shorter in the multitarget group (difference, -4.1 weeks [CI, -7.9 to -2.1 weeks]). Incidence of adverse events did not differ between the multitarget and intravenous cyclophosphamide groups (50.3% [91 of 181] vs. 52.5% [95 of 181]). LIMITATION The study was limited to 24 weeks of follow-up. CONCLUSION Multitarget therapy provides superior efficacy compared with intravenous cyclophosphamide as induction therapy for LN. PRIMARY FUNDING SOURCE National Basic Research Program of China, National Key Technology R&D Program.
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Affiliation(s)
- Zhihong Liu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Haitao Zhang
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Zhangsuo Liu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Changying Xing
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Ping Fu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Zhaohui Ni
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Jianghua Chen
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Hongli Lin
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Fuyou Liu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Yongcheng He
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Yani He
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Lining Miao
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Nan Chen
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Ying Li
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Yong Gu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Wei Shi
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Weixin Hu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Zhengzhao Liu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Hao Bao
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Caihong Zeng
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Minlin Zhou
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
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10
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Couser WG, Johnson RJ. The etiology of glomerulonephritis: roles of infection and autoimmunity. Kidney Int 2014; 86:905-14. [DOI: 10.1038/ki.2014.49] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 12/13/2013] [Accepted: 01/02/2014] [Indexed: 02/06/2023]
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11
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Yao L, Chen HP, Ma Q. Piperlongumine alleviates lupus nephritis in MRL-Fas(lpr) mice by regulating the frequency of Th17 and regulatory T cells. Immunol Lett 2014; 161:76-80. [PMID: 24837470 DOI: 10.1016/j.imlet.2014.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
Recent data have shown that piperlongumine (PL), an important component of Piper longum fruits, is known to possess anti-inflammatory and vascular-protective activities. This study aimed to examine the therapeutic effects and underlying mechanisms of PL on lupus-prone MRL-Fas(lpr) mice. Female MRL-Fas(lpr) mice were intraperitoneally treated with PL (2.4 mg kg(-1) d(-1)) for 10 weeks, and the proteinuria level was biweekly monitored. After the mice were euthanized, serum biochemical parameters and renal damage were determined. Splenocytes of MRL-Fas(lpr) mice were isolated for in vitro study. Treatment of the mice with PL significantly attenuated the progression of proteinuria and glomerulonephritis. The improvement was accompanied by decreased serum levels of nephritogenic anti-dsDNA antibodies, IL-6, IL-17, IL-23 and TNF-α. Treatment of the mice with PL suppressed the frequency of Th17 cells and increased the regulatory T cells (Tregs). In vitro, the levels of IL-6, IL-17, IL-23 and TNF-α were significantly decreased in the cultures of splenocytes from PL-treated mice compared with those from vehicle-treated mice. In addition, PL treatment impeded activation of the JAK/STAT3 signaling in splenocytes. Of great important, the survival of MRL-Fas(lpr) mice were improved by PL treatment. In summary, PL effectively ameliorates lupus syndrome in MRL-Fas(lpr) mice by suppressing the pathogenic Th17 cells and increasing the Tregs as well as inhibiting activation of the JAK/STAT3 signaling pathway. This study sheds new light on the immune-modulatory role of PL.
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Affiliation(s)
- Lan Yao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hai-ping Chen
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Qing Ma
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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12
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Kamal A, Khamashta M. The efficacy of novel B cell biologics as the future of SLE treatment: a review. Autoimmun Rev 2014; 13:1094-101. [PMID: 25149393 DOI: 10.1016/j.autrev.2014.08.020] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/28/2014] [Indexed: 01/01/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with wide ranging multi-systemic effects. Current understanding centralises B cells in SLE pathogenesis with clinical features resulting from autoantibody formation, immune complex deposition, antigen presentation and cytokine activation. Existing standard of care therapies generates adverse side effects; secondary to corticosteroid use and untargeted immunosuppression. The inability to uphold remission and abolish the disease process, in addition to the increasing numbers of patients seen with refractory disease with these therapies, has provoked the development of novel B cell biologics targeting specific pathogenic pathways fundamental to the SLE disease process. Current evidence highlighting the efficacy of Rituximab, Ocrelizumab and Epratuzumab in inducing B cell depletion and achieving disease amelioration through specific B cell surface receptor antagonism is discussed. We review the efficacy of Atacicept, Briobacept and Belimumab in antagonising B lymphocyte stimulator (BLyS) and A proliferation inducing ligand (APRIL), two stimulatory cytokines crucial to B cell survival, growth and function. Two large multicentre randomised controlled trials, BLISS-52 and BLISS-76, have led to FDA approval of Belimumab. Following this breakthrough, other anti-BLyS therapies, Blisibimod and Tabalumab, are currently under Phase III evaluation. Similarly, murine models and Phase I/II trials have demonstrated significant efficacy of Rituximab, Epratuzumab, Briobacept and Atacicept as potential future therapies and we now eagerly await results from Phase III trials. Future research must compare the efficacy of different biologics amongst different patient subpopulations and SLE manifestations, in order to develop clinically and cost effective therapies.
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Affiliation(s)
- Ameer Kamal
- King's College London, The Rayne Institute, 4th Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH London, UK
| | - Munther Khamashta
- Graham Hughes Lupus Research Laboratory, Division of Women's Health, King's College London, The Rayne Institute, Lambeth Wing, 4th Floor, St Thomas' Hospital, London SE1 7EH, UK.
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13
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Lech M, Lorenz G, Kulkarni OP, Grosser MOO, Stigrot N, Darisipudi MN, Günthner R, Wintergerst MWM, Anz D, Susanti HE, Anders HJ. NLRP3 and ASC suppress lupus-like autoimmunity by driving the immunosuppressive effects of TGF-β receptor signalling. Ann Rheum Dis 2014; 74:2224-35. [PMID: 25135254 DOI: 10.1136/annrheumdis-2014-205496] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/30/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The NLRP3/ASC inflammasome drives host defence and autoinflammatory disorders by activating caspase-1 to trigger the secretion of mature interleukin (IL)-1β/IL-18, but its potential role in autoimmunity is speculative. METHODS We generated and phenotyped Nlrp3-deficient, Asc-deficient, Il-1r-deficient and Il-18-deficient C57BL/6-lpr/lpr mice, the latter being a mild model of spontaneous lupus-like autoimmunity. RESULTS While lack of IL-1R or IL-18 did not affect the C57BL/6-lpr/lpr phenotype, lack of NLRP3 or ASC triggered massive lymphoproliferation, lung T cell infiltrates and severe proliferative lupus nephritis within 6 months, which were all absent in age-matched C57BL/6-lpr/lpr controls. Lack of NLRP3 or ASC increased dendritic cell and macrophage activation, the expression of numerous proinflammatory mediators, lymphocyte necrosis and the expansion of most T cell and B cell subsets. In contrast, plasma cells and autoantibody production were hardly affected. This unexpected immunosuppressive effect of NLRP3 and ASC may relate to their known role in SMAD2/3 phosphorylation during tumour growth factor (TGF)-β receptor signalling, for example, Nlrp3-deficiency and Asc-deficiency significantly suppressed the expression of numerous TGF-β target genes in C57BL/6-lpr/lpr mice and partially recapitulated the known autoimmune phenotype of Tgf-β1-deficient mice. CONCLUSIONS These data identify a novel non-canonical immunoregulatory function of NLRP3 and ASC in autoimmunity.
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Affiliation(s)
- Maciej Lech
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - Georg Lorenz
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - Onkar P Kulkarni
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - Marian O O Grosser
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - Nora Stigrot
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - Murthy N Darisipudi
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - Roman Günthner
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - Maximilian W M Wintergerst
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - David Anz
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - Heni Eka Susanti
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
| | - Hans-Joachim Anders
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig Maximilians Universität, München-Innenstadt, Munich, Germany
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14
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Ramani K, Pawaria S, Maers K, Huppler AR, Gaffen SL, Biswas PS. An essential role of interleukin-17 receptor signaling in the development of autoimmune glomerulonephritis. J Leukoc Biol 2014; 96:463-72. [PMID: 24935958 DOI: 10.1189/jlb.3a0414-184r] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In recent years, proinflammatory cytokines in the nephritic kidney appear to contribute to the pathogenesis of AGN. The complex inflammatory cytokine network that drives renal pathology is poorly understood. IL-17, the signature cytokine of Th17 cells, which promotes autoimmune pathology in a variety of settings, is beginning to be identified in acute and chronic kidney diseases as well. However, the role of IL-17-mediated renal damage in the nephritic kidney has not been elucidated. Here, with the use of a murine model of experimental AGN, we showed that IL-17RA signaling is critical for the development of renal pathology. Despite normal systemic autoantibody response and glomerular immune-complex deposition, IL-17RA(-/-) mice exhibit a diminished influx of inflammatory cells and kidney-specific expression of IL-17 target genes correlating with disease resistance in AGN. IL-17 enhanced the production of proinflammatory cytokines and chemokines from tECs. Finally, we were able to show that neutralization of IL-17A ameliorated renal pathology in WT mice following AGN. These results clearly demonstrated that IL-17RA signaling significantly contributes to renal tissue injury in experimental AGN and suggest that blocking IL-17RA may be a promising therapeutic strategy for the treatment of proliferative and crescentic glomerulonephritis.
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Affiliation(s)
- Kritika Ramani
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pennsylvania, USA; and
| | - Sudesh Pawaria
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pennsylvania, USA; and
| | - Kelly Maers
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pennsylvania, USA; and
| | - Anna R Huppler
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pennsylvania, USA; and Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sarah L Gaffen
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pennsylvania, USA; and
| | - Partha S Biswas
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pennsylvania, USA; and
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15
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Abstract
The possible role of infections in driving autoimmune disease (AD) has long been debated. Many theories have emerged including release of hidden antigens, epitope spread, anti-idiotypes, molecular mimicry, the adjuvant effect, antigenic complementarity, or simply that AD could be a direct consequence of activation or subversion of the immune response by microbes. A number of issues are not adequately addressed by current theories, including why animal models of AD require adjuvants containing microbial peptides in addition to self tissue to induce disease, and why ADs occur more often in one sex than the other. Reviews published in the past 3 years have focused on the role of the innate immune response in driving AD and the possible role of persistent infections in altering immune responses. Overall, recent evidence suggests that microbes activating specific innate immune responses are critical, while antigenic cross-reactivity may perpetuate immune responses leading to chronic autoinflammatory disease.
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16
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Rupanagudi KV, Kulkarni OP, Lichtnekert J, Darisipudi MN, Mulay SR, Schott B, Gruner S, Haap W, Hartmann G, Anders HJ. Cathepsin S inhibition suppresses systemic lupus erythematosus and lupus nephritis because cathepsin S is essential for MHC class II-mediated CD4 T cell and B cell priming. Ann Rheum Dis 2013; 74:452-63. [PMID: 24300027 DOI: 10.1136/annrheumdis-2013-203717] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Major histocompatibility complex (MHC) class II-mediated priming of T and B lymphocytes is a central element of autoimmunity in systemic lupus erythematosus (SLE) and lupus nephritis. The cysteine protease cathepsin S degrades the invariant peptide chain during MHC II assembly with antigenic peptide in antigen-presenting cells; therefore, we hypothesised that cathepsin S inhibition would be therapeutic in SLE. METHODS We developed a highly specific small molecule, orally available, cathepsin S antagonist, RO5461111, with suitable pharmacodynamic and pharmacokinetic properties that efficiently suppressed antigen-specific T cell and B cell priming in vitro and in vivo. RESULTS When given to MRL-Fas(lpr) mice with SLE and lupus nephritis, RO5461111 significantly reduced the activation of spleen dendritic cells and the subsequent expansion and activation of CD4 T cells and CD4/CD8 double-negative T cells. Cathepsin S inhibition impaired the spatial organisation of germinal centres, suppressed follicular B cell maturation to plasma cells and Ig class switch. This reversed hypergammaglobulinemia and significantly suppressed the plasma levels of numerous IgG (but not IgM) autoantibodies below baseline, including anti-dsDNA. This effect was associated with less glomerular IgG deposits, which protected kidneys from lupus nephritis. CONCLUSIONS Together, cathepsin S promotes SLE by driving MHC class II-mediated T and B cell priming, germinal centre formation and B cell maturation towards plasma cells. These afferent immune pathways can be specifically reversed with the cathepsin S antagonist RO5461111, which prevents lupus nephritis progression even when given after disease onset. This novel therapeutic strategy could correct a common pathomechanism of SLE and other immune complex-related autoimmune diseases.
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Affiliation(s)
- Khader Valli Rupanagudi
- Medizinische Klinik and Poliklinik IV, Renal Division, Klinikum der Universität München, München, Germany
| | - Onkar P Kulkarni
- Medizinische Klinik and Poliklinik IV, Renal Division, Klinikum der Universität München, München, Germany
| | - Julia Lichtnekert
- Medizinische Klinik and Poliklinik IV, Renal Division, Klinikum der Universität München, München, Germany
| | - Murthy Narayana Darisipudi
- Medizinische Klinik and Poliklinik IV, Renal Division, Klinikum der Universität München, München, Germany
| | - Shrikant R Mulay
- Medizinische Klinik and Poliklinik IV, Renal Division, Klinikum der Universität München, München, Germany
| | - Brigitte Schott
- CV & Metabolism DTA, Pharma Research and Early Development, Hoffmann La Roche, Basel, Switzerland
| | - Sabine Gruner
- CV & Metabolism DTA, Pharma Research and Early Development, Hoffmann La Roche, Basel, Switzerland
| | - Wolfgang Haap
- CV & Metabolism DTA, Pharma Research and Early Development, Hoffmann La Roche, Basel, Switzerland
| | - Guido Hartmann
- CV & Metabolism DTA, Pharma Research and Early Development, Hoffmann La Roche, Basel, Switzerland
| | - Hans-Joachim Anders
- Medizinische Klinik and Poliklinik IV, Renal Division, Klinikum der Universität München, München, Germany
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Toll-like receptor and accessory molecule mRNA expression in humans and mice as well as in murine autoimmunity, transient inflammation, and progressive fibrosis. Int J Mol Sci 2013; 14:13213-30. [PMID: 23803655 PMCID: PMC3742183 DOI: 10.3390/ijms140713213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/05/2013] [Accepted: 06/14/2013] [Indexed: 12/29/2022] Open
Abstract
The cell type-, organ-, and species-specific expression of the Toll-like receptors (TLRs) are well described, but little is known about the respective expression profiles of their accessory molecules. We therefore determined the mRNA expression levels of LBP, MD2, CD36, CD14, granulin, HMGB1, LL37, GRP94, UNC93b1, TRIL, PRAT4A, AP3B1, AEP and the respective TLRs in human and mouse solid organs. Humans and mice displayed significant differences between their respective mRNA expression patterns of these factors. In addition, the expression profiles in transient tissue inflammation upon renal ischemia-reperfusion injury, in spleens and kidneys from mice with lupus-like systemic autoimmunity, and in progressive tissue fibrosis upon unilateral ureteral obstruction were studied. Several TLR co-factors were specifically regulated during the different phases of these disease entities, suggesting a functional involvement in the disease process. Thus, the organ- and species-specific expression patterns need to be considered in the design and interpretation of studies related to TLR-mediated innate immunity, which seems to be involved in the tissue injury phase, in the phase of tissue regeneration, and in progressive tissue remodelling.
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Abud-Mendoza C. Lupus nephritis: advances in the knowledge of its immunopathogenesis without the expected therapeutic success? REUMATOLOGIA CLINICA 2013; 9:77-79. [PMID: 23465964 DOI: 10.1016/j.reuma.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/04/2013] [Accepted: 02/06/2013] [Indexed: 06/01/2023]
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