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He Y, Fan Z, Guo Y, Wang C, He Y, Ouyang L. Analysis of clinical characteristics of terbinafine-induced subacute cutaneous lupus erythematosus. Expert Opin Drug Saf 2024:1-5. [PMID: 39136391 DOI: 10.1080/14740338.2024.2390644] [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: 03/07/2024] [Accepted: 05/03/2024] [Indexed: 08/18/2024]
Abstract
INTRODUCTION Terbinafine may cause subacute cutaneous lupus erythematosus (SCLE), and we aimed to analyze its clinical characteristics. METHODS We collected literature on terbinafine-induced SCLE from 1997 to 2023 for retrospective analysis. Thirty-seven patients (33 females and 4 males) were included. RESULTS The patients have a median age of 49.5 years (range 18-79) and onset time of 5 weeks (range 1-12). SCLE is mainly manifested as annular erythematous (83.3%), scaly erythematous (44.4%), and maculopapular erythematous (13.9%). Mainly, histopathological manifestations are lymphocytic infiltrate (55.6%), hyperkeratosis (38.9%) and keratinocyte necrosis (38.9%). Positive immunological parameters mainly include antinuclear antibody (100.0%), anti-Ro/SSA antibody (94.1%), and anti-La/SSB antibody (72.2%). Past medical history usually includes photosensitivity (33.3%), inflammatory disease (33.33%), and lupus erythematosus (12.1%). Symptoms are completely resolved within a median time of 35 days (range 7-84) after discontinuation of terbinafine and treatment with topical corticosteroids, systemic corticosteroids, hydroxychloroquine, and immunosuppressant. No recurrence was observed within 12 months (range 1.5-48) of follow-up. CONCLUSION These results suggest that terbinafine-induced SCLE should be comprehensively diagnosed based on clinical symptoms, histopathological manifestations, immunological parameters, and past medical history. Terbinafine should be immediately discontinued when SCLE occurs, while systemic and topical corticosteroids combined with hydroxychloroquine may be an effective treatment.
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Affiliation(s)
- Yang He
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Zhiqiang Fan
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yuge Guo
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yiran He
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Linqi Ouyang
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
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2
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Kurz B, Klein B, Berneburg M, Meller S. [Ultraviolet radiation in the pathogenesis of lupus erythematosus]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:528-538. [PMID: 38916603 DOI: 10.1007/s00105-024-05369-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/26/2024]
Abstract
Photosensitivity represents an increased inflammatory reaction to sunlight, which can be observed particularly in the autoimmune disease lupus erythematosus. Cutaneous lupus erythematosus (CLE) can be provoked by ultraviolet (UV) radiation and can cause both acute, nonscarring and chronic, scarring skin changes. In systemic lupus erythematosus, on the other hand, provocation by UV radiation can lead to flare or progression of systemic involvement. The etiology of lupus erythematosus is multifactorial and includes genetic, epigenetic and immunologic mechanisms. In this review, we address the effect of UV radiation on healthy skin and photosensitive skin using the example of lupus erythematosus. We describe possible mechanisms of UV-triggered immune responses that could offer therapeutic approaches. Currently, photosensitivity can only be prevented by avoiding UV exposure itself. Therefore, it is important to better understand the underlying mechanisms in order to develop strategies to counteract the deleterious effects of photosensitivity.
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Affiliation(s)
- Bernadett Kurz
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Benjamin Klein
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Stephan Meller
- Klinik und Poliklinik für Dermatologie, Universität Düsseldorf, Düsseldorf, Deutschland
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3
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Miyagawa F. Current Knowledge of the Molecular Pathogenesis of Cutaneous Lupus Erythematosus. J Clin Med 2023; 12:987. [PMID: 36769633 PMCID: PMC9918007 DOI: 10.3390/jcm12030987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
Cutaneous lupus erythematosus (CLE) is an autoimmune disease, which can be limited to the skin or associated with systemic lupus erythematosus (SLE). Gene expression analysis has revealed that both the innate and adaptive immune pathways are activated in CLE. Ultraviolet (UV) light, the predominant environmental factor associated with CLE, induces apoptosis in keratinocytes, and the endogenous nucleic acids released from the apoptotic cells are recognized via pattern recognition receptors, including Toll-like receptors. This leads to the production of type I interferon, a major contributor to the pathogenesis of CLE, by plasmacytoid dendritic cells. UV irradiation can also induce the externalization of autoantigens, such as SS-A/Ro, exposing them to circulating autoantibodies. T-helper 1 cells have been reported to play important roles in the adaptive immune response to CLE. Other environmental factors associated with CLE include drugs and cigarette smoke. Genetic factors also confer a predisposition to the development of CLE, and many susceptibility genes have been identified. Monogenetic forms of CLE also exist. This article aims to review current knowledge about the pathogenesis of CLE. A better understanding of the environmental, genetic, and immunoregulatory factors that drive CLE may provide important insights for the treatment of CLE.
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Affiliation(s)
- Fumi Miyagawa
- Department of Dermatology, Nara Medical University School of Medicine, 840 Shijo, Kashihara, Nara 634-8522, Japan
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4
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Maz MP, Martens JWS, Hannoudi A, Reddy AL, Hile GA, Kahlenberg JM. Recent advances in cutaneous lupus. J Autoimmun 2022; 132:102865. [PMID: 35858957 PMCID: PMC10082587 DOI: 10.1016/j.jaut.2022.102865] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022]
Abstract
Cutaneous lupus erythematosus (CLE) is an inflammatory and autoimmune skin condition that affects patients with systemic lupus erythematosus (SLE) and exists as an isolated entity without associated SLE. Flares of CLE, often triggered by exposure to ultraviolet (UV) light result in lost productivity and poor quality of life for patients and can be associated with trigger of systemic inflammation. In the past 10 years, the knowledge of CLE etiopathogenesis has grown, leading to promising targets for better therapies. Development of lesions likely begins in a pro-inflammatory epidermis, conditioned by excess type I interferon (IFN) production to undergo increased cell death and inflammatory cytokine production after UV light exposure. The reasons for this inflammatory predisposition are not well-understood, but may be an early event, as ANA + patients without criteria for autoimmune disease exhibit similar (although less robust) findings. Non-lesional skin of SLE patients also exhibits increased innate immune cell infiltration, conditioned by excess IFNs to release pro-inflammatory cytokines, and potentially increase activation of the adaptive immune system. Plasmacytoid dendritic cells are also found in non-lesional skin and may contribute to type I IFN production, although this finding is now being questioned by new data. Once the inflammatory cycle begins, lesional infiltration by numerous other cell populations ensues, including IFN-educated T cells. The heterogeneity amongst lesional CLE subtypes isn't fully understood, but B cells appear to discriminate discoid lupus erythematosus from other subtypes. Continued discovery will provide novel targets for additional therapeutic pursuits. This review will comprehensively discuss the contributions of tissue-specific and immune cell populations to the initiation and propagation of disease.
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Affiliation(s)
- Mitra P Maz
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA; Program in Immunology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jacob W S Martens
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA; Program in Immunology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Andrew Hannoudi
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Alayka L Reddy
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Grace A Hile
- Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - J Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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5
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Klein B, Kunz M. Current concepts of photosensitivity in cutaneous lupus erythematosus. Front Med (Lausanne) 2022; 9:939594. [PMID: 36091671 PMCID: PMC9452788 DOI: 10.3389/fmed.2022.939594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Cutaneous lupus erythematosus (CLE) represents a complex autoimmune disease with a broad phenotypic spectrum ranging from acute to chronic destructive cutaneous lesions. Patients with CLE exhibit high photosensitivity and ultraviolet (UV) irradiation can lead to systemic flares in systemic lupus erythematosus. However, the exact mechanisms how UV irradiation enhances cutaneous inflammation in lupus are not fully understood. Recently, new molecular mechanisms of UV-driven immune responses in CLE were identified, offering potential therapeutic approaches. Especially the induction of type I interferons, central cytokines in lupus pathogenesis which are released by various skin cells, have become the focus of current research. In this review, we describe current pathogenic concepts of photosensitivity in lupus erythematosus, including UV-driven activation of intracellular nucleic acid sensors, cellular cytokine production and immune cell activation. Furthermore, we discuss activated pathways contributing to enhanced apoptosis as well as intracellular translocation of autoantigens thereby promoting CLE upon UV light exposure.
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Affiliation(s)
- Benjamin Klein
- Department of Dermatology, Venereology, and Allergology, University Hospital Leipzig, Leipzig, Germany
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6
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Arase N, Tsuji H, Takamatsu H, Jin H, Konaka H, Hamaguchi Y, Tonomura K, Kotobuki Y, Ueda-Hayakawa I, Matsuoka S, Hirano T, Yorifuji H, Murota H, Ohmura K, Nakashima R, Sato T, Kumanogoh A, Katayama I, Arase H, Fujimoto M. Cell surface-expressed Ro52/IgG/HLA-DR complex is targeted by autoantibodies in patients with inflammatory myopathies. J Autoimmun 2021; 126:102774. [PMID: 34896887 DOI: 10.1016/j.jaut.2021.102774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
Intracellular proteins are often targeted by autoantibodies in autoimmune diseases; however, the mechanism through which intracellular molecules are targeted remains unknown. We previously found that several intracellular misfolded proteins are transported to the cell surface by HLA class II molecules and are recognized by autoantibodies in some autoimmune diseases, such as rheumatoid arthritis, antiphospholipid syndrome, and microscopic polyangiitis. Ro52 is an intracellular Fc receptor that is a target antigen for myositis-associated autoantibodies. We analyzed the role of HLA class II molecules in the autoantibody recognition of Ro52. Ro52 alone was not transported to the cell surface by HLA class II molecules; however, it was transported to the cell surface in the presence of both IgG heavy chain and HLA class II molecules to form a Ro52/IgG/HLA-DR complex. The Ro52/IgG/HLA-DR complex was specifically recognized by autoantibodies from some patients with inflammatory myopathies. We then evaluated 120 patients with inflammatory myopathies with four types of myositis-specific antibodies and analyzed the autoantibodies against the Ro52/IgG/HLA-DR complex. The specific antibodies against the Ro52/IgG/HLA-DR complex were detected in 90% and 93% of patients who were positive for anti-MDA5 and anti-ARS antibodies, respectively. In individual patients with these two inflammatory myopathies, changes in serum titers of anti-Ro52/IgG/HLA-DR-specific antibodies were correlated with the levels of KL-6 (R = 0.51 in anti-MDA5 antibody-positive DM patients, R = 0.67 in anti-ARS antibody-positive PM/DM patients with respiratory symptoms) and CK (R = 0.63 in anti-ARS antibody-positive PM/DM patients with muscle symptoms) over time. These results suggest that antibodies against Ro52/IgG/HLA-DR expressed on the cell surface could be involved in the pathogenesis of inflammatory myopathy subgroups.
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Affiliation(s)
- Noriko Arase
- Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hideaki Tsuji
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan; Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Hui Jin
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Hachiro Konaka
- Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Kyoko Tonomura
- Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | - Sumiko Matsuoka
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Toru Hirano
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Yorifuji
- Osaka University Graduate School of Medicine, Osaka, Japan; Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Hiroyuki Murota
- Osaka University Graduate School of Medicine, Osaka, Japan; Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | | | - Ran Nakashima
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoharu Sato
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Kumanogoh
- Osaka University Graduate School of Medicine, Osaka, Japan; World Premier International Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Ichiro Katayama
- Osaka University Graduate School of Medicine, Osaka, Japan; Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Arase
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan; World Premier International Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Manabu Fujimoto
- Osaka University Graduate School of Medicine, Osaka, Japan; World Premier International Immunology Frontier Research Center, Osaka University, Osaka, Japan
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7
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Jones EL, Laidlaw SM, Dustin LB. TRIM21/Ro52 - Roles in Innate Immunity and Autoimmune Disease. Front Immunol 2021; 12:738473. [PMID: 34552597 PMCID: PMC8450407 DOI: 10.3389/fimmu.2021.738473] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/16/2021] [Indexed: 12/19/2022] Open
Abstract
TRIM21 (Ro52/SSA1) is an E3 ubiquitin ligase with key roles in immune host defence, signal transduction, and possibly cell cycle regulation. It is also an autoantibody target in Sjögren's syndrome, systemic lupus erythematosus, and other rheumatic autoimmune diseases. Here, we summarise the structure and function of this enzyme, its roles in innate immunity, adaptive immunity and cellular homeostasis, the pathogenesis of autoimmunity against TRIM21, and the potential impacts of autoantibodies to this intracellular protein.
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Affiliation(s)
- Esther L Jones
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Stephen M Laidlaw
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Lynn B Dustin
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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8
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Estadt SN, Maz MP, Musai J, Kahlenberg JM. Mechanisms of Photosensitivity in Autoimmunity. J Invest Dermatol 2021; 142:849-856. [PMID: 34167786 DOI: 10.1016/j.jid.2021.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022]
Abstract
Aberrant responses to UV light frequently lead to the formation of skin lesions and the activation of systemic inflammation in some autoimmune diseases, especially systemic lupus erythematosus. Whereas the effects of UV light on the skin have been studied for decades, only recently have some of the mechanisms that contribute to abnormal responses to UV light in patients with autoimmune diseases been uncovered. This review will discuss the biology of UV in the epidermis and discuss the abnormal epidermal and inflammatory mechanisms that contribute to photosensitivity. Further research is required to fully understand how to normalize UV-mediated inflammation in patients with autoimmune diseases.
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Affiliation(s)
- Shannon N Estadt
- Division of Rheumatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Graduate Program in Immunology, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Mitra P Maz
- Division of Rheumatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Graduate Program in Immunology, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Jon Musai
- Division of Rheumatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - J Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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Tani J, Liao HT, Hsu HC, Chen LF, Chang TS, Shin-Yi Lin C, Sung JY. Immune-mediated axonal dysfunction in seropositive and seronegative primary Sjögren's syndrome. Ann Clin Transl Neurol 2020; 7:819-828. [PMID: 32415709 PMCID: PMC7261763 DOI: 10.1002/acn3.51053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The present study investigates the peripheral neuropathy in Primary Sjögren's syndrome (pSS) using the nerve excitability test to further elucidate how peripheral nerves are affected by the autoantibodies. METHODS Each patient received clinical evaluation, examination for anti-SSA/Ro and anti-SSB/La antibodies titer, paired motor and sensory nerve excitability test, thermal quantitative sensory test (QST), and nerve conduction study (NCS). RESULTS A total of 40 pSS patients wasenrolled. Motor axonal study of the pSS with positive anti-SSA/Ro or anti-SSB/La antibodies (n = 28) was found to have increased stimulus for 50% compound muscle action potential (CMAP) (P < 0.05), increased rheobase (P < 0.01), increased minimum I/V slope (P < 0.01) and hyperpolarizing I/V slope (P < 0.05), increased relative refractory period (RRP, P < 0.001), decreased accommodation of threshold electrotonus toward depolarizing current (P < 0.05), and increased accommodation toward hyperpolarizing current (P < 0.05). Seronegative pSS (n = 10) showed much less prominent motor axonal changes, showing only increased minimum I/V slope (P < 0.05). Sensory axonal study in seropositive pSS patients is found to have increased stimulus for 50% sensory nerve action potential (SNAP) (P < 0.01), decreased latency (P < 0.01), increased RRP (P < 0.01), and increased subexcitability (P < 0.05). Seronegative pSS patients have shown no significant sensory axonal changes. Thermal QST showed more prominent abnormalities in seronegative pSS compared to seropositive pSS. INTERPRETATION Anti-SSA/Ro and anti-SSB/La autoantibodies might cause dysfunction in nodal and internodal region of the axon and small nerve fibers; meanwhile, autoreactive antibodies in seronegative pSS mainly affect small nerve fibers. Thus, the underlying pathophysiology for the two types of pSS is different.
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Affiliation(s)
- Jowy Tani
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Ching Hsu
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Lung-Fang Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsui-San Chang
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cindy Shin-Yi Lin
- Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan.,Central Clinical School, Faculty of Medicine and Health, Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Jia-Ying Sung
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Wolf SJ, Estadt SN, Gudjonsson JE, Kahlenberg JM. Human and Murine Evidence for Mechanisms Driving Autoimmune Photosensitivity. Front Immunol 2018; 9:2430. [PMID: 30405625 PMCID: PMC6205973 DOI: 10.3389/fimmu.2018.02430] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/02/2018] [Indexed: 01/29/2023] Open
Abstract
Ultraviolet (UV) light is an important environmental trigger for systemic lupus erythematosus (SLE) patients, yet the mechanisms by which UV light impacts disease are not fully known. This review covers evidence in both human and murine systems for the impacts of UV light on DNA damage, apoptosis, autoantigen exposure, cytokine production, inflammatory cell recruitment, and systemic flare induction. In addition, the role of the circadian clock is discussed. Evidence is compared in healthy individuals and SLE patients as well as in wild-type and lupus-prone mice. Further research is needed into the effects of UV light on cutaneous and systemic immune responses to understand how to prevent UV-light mediated lupus flares.
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Affiliation(s)
- Sonya J. Wolf
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- Immunology Program, University of Michigan, Ann Arbor, MI, United States
| | - Shannon N. Estadt
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- Immunology Program, University of Michigan, Ann Arbor, MI, United States
| | | | - J. Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
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11
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Mohania D, Chandel S, Kumar P, Verma V, Digvijay K, Tripathi D, Choudhury K, Mitten SK, Shah D. Ultraviolet Radiations: Skin Defense-Damage Mechanism. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 996:71-87. [PMID: 29124692 DOI: 10.1007/978-3-319-56017-5_7] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
UV-radiations are the invisible part of light spectra having a wavelength between visible rays and X-rays. Based on wavelength, UV rays are subdivided into UV-A (320-400 nm), UV-B (280-320 nm) and UV-C (200-280 nm). Ultraviolet rays can have both harmful and beneficial effects. UV-C has the property of ionization thus acting as a strong mutagen, which can cause immune-mediated disease and cancer in adverse cases. Numbers of genetic factors have been identified in human involved in inducing skin cancer from UV-radiations. Certain heredity diseases have been found susceptible to UV-induced skin cancer. UV radiations activate the cutaneous immune system, which led to an inflammatory response by different mechanisms. The first line of defense mechanism against UV radiation is melanin (an epidermal pigment), and UV absorbing pigment of skin, which dissipate UV radiation as heat. Cell surface death receptor (e.g. Fas) of keratinocytes responds to UV-induced injury and elicits apoptosis to avoid malignant transformation. In addition to the formation of photo-dimers in the genome, UV also can induce mutation by generating ROS and nucleotides are highly susceptible to these free radical injuries. Melanocortin 1 receptor (MC1R) has been known to be implicated in different UV-induced damages such as pigmentation, adaptive tanning, and skin cancer. UV-B induces the formation of pre-vitamin D3 in the epidermal layer of skin. UV-induced tans act as a photoprotection by providing a sun protection factor (SPF) of 3-4 and epidermal hyperplasia. There is a need to prevent the harmful effects and harness the useful effects of UV radiations.
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Affiliation(s)
- Dheeraj Mohania
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medial Sciences (AIIMS), Ansari Nagar, New Delhi, India.
| | - Shikha Chandel
- Department of Research, Sir Ganga Ram Hospital (SGRH), New Delhi, India
| | - Parveen Kumar
- Dr. B.R. Ambedkar Centre for Biomedical Research, University of Delhi, (North Campus), New Delhi, India
| | - Vivek Verma
- Dr. B.R. Ambedkar Centre for Biomedical Research, University of Delhi, (North Campus), New Delhi, India
| | - Kumar Digvijay
- Department of Research, Sir Ganga Ram Hospital (SGRH), New Delhi, India
| | - Deepika Tripathi
- Department of Research, Sir Ganga Ram Hospital (SGRH), New Delhi, India
| | | | | | - Dilip Shah
- Drexel University College of Medicine, Philadelphia, PA, USA
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12
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Sontheimer C, Liggitt D, Elkon KB. Ultraviolet B Irradiation Causes Stimulator of Interferon Genes-Dependent Production of Protective Type I Interferon in Mouse Skin by Recruited Inflammatory Monocytes. Arthritis Rheumatol 2017; 69:826-836. [PMID: 27863141 DOI: 10.1002/art.39987] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 11/03/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Photosensitivity is common in patients with systemic lupus erythematosus, although the mechanisms linking ultraviolet (UV) light to flares are not well understood. We undertook this study to determine whether repetitive UVB exposure could induce type I interferon (IFN) production in normal mouse skin, and to investigate the roles of inflammatory monocytes and plasmacytoid dendritic cells (PDCs) in type I IFN production and development of UVB irradiation-induced inflammation. METHODS Mice were irradiated with UVB at 100 mJ/cm2 for 5 days, and cutaneous manifestations were examined by messenger RNA expression of inflammatory and type I IFN response genes, histology, and flow cytometry. Inflammatory monocyte and PDC depletion experiments were performed in CCR2-diphtheria toxin receptor (DTR)-transgenic mice and blood dendritic cell antigen 2-DTR-transgenic mice. The roles of type I IFN and of the adaptor protein stimulator of IFN genes (STING) in UVB irradiation-induced inflammation were investigated using IFN-α/β/ω receptor (IFNAR)-knockout mice and STING-knockout mice. RESULTS Repeated UVB irradiation stimulated an inflammatory cell infiltrate and induction of type I IFN and proinflammatory cytokines. Interestingly, the type I IFN response was independent of PDCs but dependent on inflammatory monocytes, which were recruited following UVB irradiation. The adaptor protein STING was necessary for both type I IFN and proinflammatory cytokine expression in the skin. UVB-irradiated IFNAR-knockout mice showed increased levels of proinflammatory genes and more severe inflammation by histology, suggesting a protective role for type I IFN. CONCLUSION In wild-type mice, repeated doses of UVB irradiation induce monocyte-dependent and PDC-independent expression of type I IFN together with expression of other proinflammatory cytokines. Induction is dependent on the adaptor protein STING. Surprisingly, studies using IFNAR-deficient mice revealed that type I IFN protects against UVB irradiation-induced skin inflammation, in part by attenuating proinflammatory cytokine expression and limiting tissue damage.
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Lembo S, Hawk JLM, Murphy GM, Kaneko K, Young AR, McGregor JM, Walker SL, Palmer RA. Aberrant gene expression with deficient apoptotic keratinocyte clearance may predispose to polymorphic light eruption. Br J Dermatol 2017; 177:1450-1453. [PMID: 27873316 DOI: 10.1111/bjd.15200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Lembo
- Department of Clinical Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy
| | - J L M Hawk
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - G M Murphy
- Department of Dermatology, Beaumont Hospital, Dublin 9, Ireland
| | - K Kaneko
- Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, NG7 2NR, U.K
| | - A R Young
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - J M McGregor
- Department of Cell Biology and Cutaneous Research, Blizzard Institute, Barts and The London School of Medicine and Dentistry, London, E1 2AT, U.K
| | - S L Walker
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - R A Palmer
- Princess Margaret Hospital, Osborne Road, Windsor, SL4 3SJ, U.K
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15
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Abstract
Systemic lupus erythematosus (lupus, SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which bind to antigens and are deposited within tissues to fix complement, resulting in widespread systemic inflammation. The studies presented herein are consistent with hyperpolarized, adenosine triphosphate (ATP)-deficient mitochondria being central to the disease process. These hyperpolarized mitochondria resist the depolarization required for activation-induced apoptosis. The mitochondrial ATP deficits add to this resistance to apoptosis and also reduce the macrophage energy that is needed to clear apoptotic bodies. In both cases, necrosis, the alternative pathway of cell death, results. Intracellular constituents spill into the blood and tissues, eliciting inflammatory responses directed at their removal. What results is “autoimmunity.” Ultraviolet (UV)-A1 photons have the capacity to remediate this aberrancy. Exogenous exposure to low-dose, full-body, UV-A1 radiation generates singlet oxygen. Singlet oxygen has two major palliative actions in patients with lupus and the UV-A1 photons themselves have several more. Singlet oxygen depolarizes the hyperpolarized mitochondrion, triggering non-ATP-dependent apoptosis that deters necrosis. Next, singlet oxygen activates the gene encoding heme oxygenase (HO-1), a major governor of systemic homeostasis. HO-1 catalyzes the degradation of the oxidant heme into biliverdin (converted to bilirubin), Fe, and carbon monoxide (CO), the first three of these exerting powerful antioxidant effects, and in conjunction with a fourth, CO, protecting against injury to the coronary arteries, the central nervous system, and the lungs. The UV-A1 photons themselves directly attenuate disease in lupus by reducing B cell activity, preventing the suppression of cell-mediated immunity, slowing an epigenetic progression toward SLE, and ameliorating discoid and subacute cutaneous lupus. Finally, a combination of these mechanisms reduces levels of anticardiolipin antibodies and protects during lupus pregnancy. Capping all of this is that UV-A1 irradiation is an essentially innocuous, highly manageable, and comfortable therapeutic agency.
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Affiliation(s)
- H McGrath
- Veterans Administration, New Orleans, LA, USA
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16
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Neonatal lupus: Follow-up in infants with anti -SSA/Ro antibodies and review of the literature. Autoimmun Rev 2017; 16:427-432. [DOI: 10.1016/j.autrev.2017.02.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/12/2017] [Indexed: 11/20/2022]
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17
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Choi MY, Barber MRW, Barber CEH, Clarke AE, Fritzler MJ. Preventing the development of SLE: identifying risk factors and proposing pathways for clinical care. Lupus 2017; 25:838-49. [PMID: 27252260 DOI: 10.1177/0961203316640367] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Although challenging, developing evidence-based approaches to an early and accurate diagnosis of systemic lupus erythematosus is a key approach to preventing disease and lupus-associated morbidity and mortality. Advances in our understanding of preclinical and incomplete lupus erythematosus have enabled the identification of risk factors that may predict disease and the development of potential strategies aimed at primary prevention. Emerging data support the notion that there is a temporal disease progression from initial asymptomatic autoimmunity (preclinical lupus) through early clinical features of the disease (incomplete lupus erythematosus) to finally becoming fully classifiable systemic lupus erythematosus (complete lupus erythematosus). Here, we review the demographic, clinical, biomarker as well as genetic and environmental features that are reported to increase the risk of disease progression. Based on these risk factors, we propose a clinical care pathway for patients with early disease. We envisage that such a pathway, through early identification of disease, may improve patient outcomes, while reducing health care costs.
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Affiliation(s)
- M Y Choi
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - M R W Barber
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - C E H Barber
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - A E Clarke
- University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - M J Fritzler
- University of Calgary, Cumming School of Medicine, Calgary, Canada
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18
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Lee JW, Park DJ, Kang JH, Choi SE, Yim YR, Kim JE, Lee KE, Wen L, Kim TJ, Park YW, Sung YK, Lee SS. The rate of and risk factors for frequent hospitalization in systemic lupus erythematosus: results from the Korean lupus network registry. Lupus 2016; 25:1412-1419. [PMID: 27000153 DOI: 10.1177/0961203316640916] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The survival rate of patients with systemic lupus erythematosus has improved in the last few decades, but the rate of hospitalization and health care costs for these patients remain higher than in the general population. Thus, we evaluated the rate of hospitalization and associated risk factors in an inception cohort of Korean patients with lupus. Methods Of the 507 patients with systemic lupus erythematosus enrolled in the KORean lupus NETwork, we investigated an inception cohort consisting of 196 patients with systemic lupus erythematosus presenting within 6 months of diagnosis based on the American College of Rheumatology classification criteria. We evaluated the causes of hospitalization, demographic characteristics, and laboratory and clinical data at the time of systemic lupus erythematosus diagnosis of hospitalized patients and during a follow-up period. We calculated the hospitalization rate as the number of total hospitalizations divided by the disease duration, and defined "frequent hospitalization" as hospitalization more than once per year. Results Of the 196 patients, 117 (59.6%) were admitted to hospital a total of 257 times during the 8-year follow-up period. Moreover, 22 (11.2%) patients were hospitalized frequently. The most common reasons for hospitalization included disease flares, infection, and pregnancy-related morbidity. In the univariate regression analysis, malar rash, arthritis, pericarditis, renal involvement, fever, systemic lupus erythematosus disease activity index > 12, hemoglobin level < 10 mg/dl, albumin level < 3.5 mg/dl, and anti-Sjögren's syndrome A positivity were associated with frequent hospitalization. Finally, multivariate analysis showed that arthritis, pericarditis, and anti-Sjögren's syndrome A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization. Conclusions Our results showed that frequent hospitalization occurred in 11.2% of hospitalized patients and arthritis, pericarditis, and anti-Sjögren's syndrome A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization.
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Affiliation(s)
- J W Lee
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - D J Park
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - J H Kang
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - S E Choi
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Y R Yim
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - J E Kim
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - K E Lee
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - L Wen
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - T J Kim
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Y W Park
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Y K Sung
- 2 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - S S Lee
- 1 Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
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Autoantibodies and their Judicious Use in Pediatric Rheumatology Practice. Indian J Pediatr 2016; 83:53-62. [PMID: 26631069 DOI: 10.1007/s12098-015-1936-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
Autoantibody testing forms an important part of diagnostic workup of patients in Pediatric rheumatology practice. However it is important to understand that the mere presence of autoantibodies does not necessarily mean the presence of an underlying autoimmune disease. Autoantibodies may be present decades before the development of clinical manifestations of an autoimmune disease and may be viewed as harbingers of Autoimmune disease. On the other hand, low-affinity autoantibodies may be present in normal healthy individuals; these natural autoantibodies serve an important function in immune regulation and tolerance. Autoantibody testing in pediatric practice mainly includes testing for anti-nuclear antibodies, anti-dsDNA antibodies, anti-neutrophil cytoplasmic autoantibodies and antiphospholipid antibodies. Rheumatoid factor and anti-CCP do not have much significance in the diagnostic schema in pediatric rheumatology, except perhaps for classification of juvenile idiopathic arthritis (JIA) and prognostication in late-onset polyarticular JIA. The positive predictive value (PPV) of any laboratory test depends on the prevalence of the disease in the population being tested. Hence, test ordering practices greatly impact the performance characteristics and positive predictive value of any laboratory test. A restricted test ordering only in patients with clinical signs and symptoms suggestive of autoimmune disease would thus greatly increase the PPV of tests such as antinuclear antibody used for diagnosing autoimmunity.
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20
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Kuhn A, Wenzel J, Bijl M. Lupus erythematosus revisited. Semin Immunopathol 2015; 38:97-112. [PMID: 26637330 DOI: 10.1007/s00281-015-0550-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022]
Abstract
Lupus erythematosus (LE) is a multifactorial autoimmune disease with clinical manifestations of differing severity. The exact pathomechanisms and interactions resulting in the inflammatory and immunological processes of this heterogeneous disease remain elusive. Approaches in the understanding of the pathomechanisms revealed that the clinical expression of LE is predisposed by susceptibility genes and that various environmental factors are responsible for an abnormal immune response. Several studies demonstrated that ultraviolet (UV) light is one of the major factors in the pathogenesis of the disease. Standardized photoprovocation in patients with LE has been shown to be a safe and efficient model for evaluating the underlying pathomechanisms which lead to the production of autoantibodies and immune complexes. In particular, interferons were defined as important players in the early activation of the immune system and were observed to play a specific role in the immunological interface between the innate and the adaptive immune system. Abnormalities or disturbances in the different processes of cell death, such as apoptosis or necrosis, have also been recognized as crucial in the pathogenesis of LE. Although each process is different and characterized by unique features, the processes are interrelated and result in a complex disease.
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Affiliation(s)
- Annegret Kuhn
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
- Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Joerg Wenzel
- Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - Marc Bijl
- Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, Netherlands
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21
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Chen HH, Tsai LJ, Lee KR, Chen YM, Hung WT, Chen DY. Genetic association of complement component 2 polymorphism with systemic lupus erythematosus. ACTA ACUST UNITED AC 2015; 86:122-33. [DOI: 10.1111/tan.12602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 05/29/2015] [Accepted: 06/09/2015] [Indexed: 12/24/2022]
Affiliation(s)
- H.-H. Chen
- Institute of Molecular Medicine; National Tsing Hua University; Hsinchu Taiwan
| | - L.-J. Tsai
- Graduate Institute of Clinical Medicine; Taipei Medical University; Taipei Taiwan
| | - K.-R. Lee
- Institute of Molecular Medicine; National Tsing Hua University; Hsinchu Taiwan
| | - Y.-M. Chen
- Division of Allergy, Immunology and Rheumatology; Taichung Veterans General Hospital; Taichung Taiwan
- Institute of Microbiology and Immunology; Chung Shan Medical University; Taichung Taiwan
- Institute of Biomedical Science; National Chung Hsing University; Taichung Taiwan
- Rong Hsing Research Center for Translational Medicine; National Chung Hsing University; Taichung Taiwan
| | - W.-T. Hung
- Division of Allergy, Immunology and Rheumatology; Taichung Veterans General Hospital; Taichung Taiwan
- Institute of Microbiology and Immunology; Chung Shan Medical University; Taichung Taiwan
| | - D.-Y. Chen
- Institute of Molecular Medicine; National Tsing Hua University; Hsinchu Taiwan
- Division of Allergy, Immunology and Rheumatology; Taichung Veterans General Hospital; Taichung Taiwan
- Institute of Microbiology and Immunology; Chung Shan Medical University; Taichung Taiwan
- Institute of Biomedical Science; National Chung Hsing University; Taichung Taiwan
- Rong Hsing Research Center for Translational Medicine; National Chung Hsing University; Taichung Taiwan. Faculty of Medicine; National Yang Ming University; Taipei Taiwan
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22
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Jahantigh D, Salimi S, Mousavi M, Moossavi M, Mohammadoo-Khorasani M, Narooei-nejad M, Sandoughi M. Association Between Functional Polymorphisms of DNA Double-Strand Breaks in Repair Genes XRCC5, XRCC6 and XRCC7 with the Risk of Systemic Lupus Erythematosus in South East Iran. DNA Cell Biol 2015; 34:360-6. [DOI: 10.1089/dna.2014.2465] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Danial Jahantigh
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Biology, Sistan and Baluchestan University, Zahedan, Iran
| | - Saeedeh Salimi
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Maryam Moossavi
- Department of Biology, Sistan and Baluchestan University, Zahedan, Iran
| | - Milad Mohammadoo-Khorasani
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehrnaz Narooei-nejad
- Department of Genetics, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Genetic of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahnaz Sandoughi
- Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Abstract
Photoaggravated skin disorders are diseases that occur without UV radiation but are sometimes or frequently exacerbated by UV radiation. In conditions, such as lupus erythematosus, photoaggravation occurs in a majority of patients, whereas in conditions, such as psoriasis and atopic dermatitis, only a subset of patients demonstrate photoaggravation. Polymorphous light eruption is a common photodermatosis in all skin types, making it important to differentiate photoaggravation of an underlying disorder, such as lupus erythematosus, from superimposed polymorphous light eruption. Disease-specific treatments should be instituted where possible. A key component of management of photoaggravated conditions is photoprotection with behavioral change, UV-protective clothing, and broad-spectrum sunscreen.
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Affiliation(s)
- Susan M O'Gorman
- Dermatology Department, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, Ireland.
| | - Gillian M Murphy
- Dermatology Department, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, Ireland; National Photodermatology Unit, Dermatology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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24
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Yang L, Fujimoto M, Murota H, Serada S, Fujimoto M, Honda H, Yamada K, Suzuki K, Nishikawa A, Hosono Y, Yoneda Y, Takehara K, Imura Y, Mimori T, Takeuchi T, Katayama I, Naka T. Proteomic identification of heterogeneous nuclear ribonucleoprotein K as a novel cold-associated autoantigen in patients with secondary Raynaud's phenomenon. Rheumatology (Oxford) 2014; 54:349-58. [PMID: 25172934 DOI: 10.1093/rheumatology/keu325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify cold-associated autoantibodies in patients with RP secondary to CTDs. METHODS Indirect immunofluorescence staining was performed on non-permeabilized cold-stimulated normal human dermal microvascular endothelial cells (dHMVECs), using patients' sera. Cold-induced alterations in cell surface proteomes were analysed by isobaric tag for relative and absolute quantitation (iTRAQ) analysis. Serological proteome analysis (SERPA) was applied to screen cold-associated autoantigens. The prevalence of the candidate autoantibody was determined by ELISA in 290 patients with RP secondary to CTDs (SSc, SLE or MCTD), 10 patients with primary RP and 27 healthy controls. RESULTS Enhanced cell surface immunoreactivity was detected in cold-stimulated dHMVECs when incubated with sera from patients with secondary RP. By iTRAQ analysis, many proteins, including heterogeneous nuclear ribonucleoprotein K (hnRNP-K), were found to be increased on the cell surface of dHMVECs after cold stimulation. By the SERPA approach, hnRNP-K was identified as a candidate autoantigen in patients with secondary RP. Cold-induced translocation of hnRNP-K to the cell surface was confirmed by immunoblotting and flow cytometry. By ELISA analysis, patients with secondary RP show a significantly higher prevalence of anti-hnRNP-K autoantibody (30.0%, 61/203) than patients without RP (9.2%, 8/87, P = 0.0001), patients with primary RP (0%, 0/10, P = 0.0314) or healthy controls (0%, 0/27, P = 0.0001). CONCLUSION By comprehensive proteomics, we identified hnRNP-K as a novel cold-associated autoantigen in patients with secondary RP. Anti-hnRNP-K autoantibody may potentially serve as a biomarker for RP secondary to various CTDs.
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Affiliation(s)
- Lingli Yang
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan. Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Minoru Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Satoshi Serada
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Hiromi Honda
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Kohji Yamada
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan. Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Katsuya Suzuki
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Ayumi Nishikawa
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Yuji Hosono
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Yoshihiro Yoneda
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Kazuhiko Takehara
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Yoshitaka Imura
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Tsuneyo Mimori
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Tsutomu Takeuchi
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Ichiro Katayama
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan
| | - Tetsuji Naka
- Department of Dermatology, Osaka University Graduate School of Medicine, Laboratory of Immune Signal, National Institute of Biomedical Innovation, Department of Dermatology, Kanazawa University, Kanazawa, Biomolecular Dynamics Group, Graduate School of Frontier Biosciences, Osaka University, Osaka, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto and National Institute of Biomedical Innovation, Osaka, Japan.
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Serology of Lupus Erythematosus: Correlation between Immunopathological Features and Clinical Aspects. Autoimmune Dis 2014; 2014:321359. [PMID: 24649358 PMCID: PMC3932647 DOI: 10.1155/2014/321359] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/23/2013] [Indexed: 02/06/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the aberrant production of a broad and heterogenous group of autoantibodies. Even though the presence of autoantibodies in SLE has been known, for more than 60 years, still nowadays a great effort is being made to understand the pathogenetic, diagnostic, and prognostic meaning of such autoantibodies.
Antibodies to ds-DNA are useful for the diagnosis of SLE, to monitor the disease activity, and correlate with renal and central nervous involvements. Anti-Sm antibodies are highly specific for SLE. Anti-nucleosome antibodies are an excellent marker for SLE and good predictors of flares in quiescent lupus. Anti-histone antibodies characterize drug-induced lupus, while anti-SSA/Ro and anti-SSB/La antibodies are associated with neonatal lupus erythematosus and photosensitivity. Anti-ribosomal P antibodies play a role in neuropsychiatric lupus, but their association with clinical manifestations is still unclear. Anti-phospholipid antibodies are associated with the anti-phospholipid syndrome, cerebral vascular disease, and neuropsychiatric lupus. Anti-C1q antibodies amplify glomerular injury, and the elevation of their titers may predict renal flares. Anti-RNP antibodies are a marker of Sharp's syndrome but can be found in SLE as well. Anti-PCNA antibodies are present in 5–10% of SLE patients especially those with arthritis and hypocomplementemia.
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Nishiyama M, Kanazawa N, Hiroi A, Furukawa F. Lupus erythematosus tumidus in Japan: a case report and a review of the literature. Mod Rheumatol 2014. [DOI: 10.3109/s10165-009-0192-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Radic M, Muller S. Epigenetics of autoantigens: new opportunities for therapy of autoimmune diseases. GENETICS & EPIGENETICS 2013; 5:63-70. [PMID: 25512708 PMCID: PMC4222337 DOI: 10.4137/geg.s12144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The field of epigenetics requires that traditional divisions between scientific disciplines give way to cross-fertilization of concepts and ideas from different areas of investigation. Such is the case with research in autoimmunity. Recent discoveries of stimuli that induce autoimmunity reveal that epigenetic marks of autoantigens are recognized by autoreactive B and T cell receptors. Thus, insights into the initiation of autoimmunity, its prevention and therapy will arise from understanding the biochemistry, cell biology and microbiology of autoantigen epigenetics. Here, we highlight potential benefits from the inhibition of a histone modifying enzyme and the administration of a phosphorylated, spliceosome-derived peptide, in the treatment of autoimmunity.
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Affiliation(s)
- Marko Radic
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sylviane Muller
- Immunopathology and therapeutic chemistry/Laboratory of excellence MEDALIS, Institut de Biologie Moléculaire et Cellulaire, CNRS, Strasbourg, France
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28
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Immunologic and genetic considerations of cutaneous lupus erythematosus: a comprehensive review. J Autoimmun 2013; 41:34-45. [PMID: 23380467 DOI: 10.1016/j.jaut.2013.01.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/04/2013] [Indexed: 12/20/2022]
Abstract
Cutaneous lupus erythematosus (CLE) refers to those subtypes of lupus erythematosus (LE) that have predominantly skin manifestations. Discoid lupus erythematosus (DLE), subacute cutaneous lupus erythematosus (SCLE), LE panniculitis (LEP) and lupus erythematosus tumidus (LET) all fall into the category of CLE. The pathogenesis of CLE is likely multifactorial. UV irradiation has been shown to induce keratinocyte apoptosis. Impaired clearance of apoptotic cells is a potential mechanism for the development of CLE. UV irradiation can also induce externalization of autoantigens such as Ro/SSA, exposing them to circulating autoantibodies. Some drugs have been associated with CLE. Possible mechanisms include stimulation of an immune response through disruption of central tolerance and altered T cell function. T17 cells may also play a role in the pathogenesis of CLE as they have been detected in skin lesions of LE. Treg cells have been found to be decreased in LE lesions, which may contribute to the breakdown of self-tolerance. Epidermal Langerhans cells are reduced in CLE while plasmacytoid DCs are increased in the lesions of CLE, suggesting that DCs may also play an important role in the pathogenesis of CLE. Type I IFN- and TNF-α are both upregulated in lesions of CLE. Other cytokines such as IL-6 and IL-17 are also implicated in the pathogenesis of CLE. Cellular and cytokine networks can be impacted by environmental factors and genetic variations and this can result in an increased risk of developing autoimmune diseases such as CLE.
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29
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Clinical and pathological roles of Ro/SSA autoantibody system. Clin Dev Immunol 2012; 2012:606195. [PMID: 23304190 PMCID: PMC3523155 DOI: 10.1155/2012/606195] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/19/2012] [Indexed: 11/17/2022]
Abstract
Anti-Ro/SSA antibodies are among the most frequently detected autoantibodies against extractable nuclear antigens and have been associated with systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS). Although the presence of these autoantibodies is one of the criteria for the diagnosis and classification of SS, they are also sometimes seen in other systemic autoimmune diseases. In the last few decades, the knowledge of the prevalence of anti-Ro/SSA antibodies in various autoimmune diseases and symptoms has been expanded, and the clinical importance of these antibodies is increasing. Nonetheless, the pathological role of the antibodies is still poorly understood. In this paper, we summarize the milestones of the anti-Ro/SSA autoantibody system and provide new insights into the association between the autoantibodies and the pathogenesis of autoimmune diseases.
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Li PH, Wong WHS, Lee TL, Lau CS, Chan TM, Leung AMH, Tong KL, Tse NKC, Mok CC, Wong SN, Lee KW, Ho MHK, Lee PPW, Chong CY, Wong RWS, Mok MY, Ying SKY, Fung SKS, Lai WM, Yang W, Lau YL. Relationship between autoantibody clustering and clinical subsets in SLE: cluster and association analyses in Hong Kong Chinese. Rheumatology (Oxford) 2012; 52:337-45. [DOI: 10.1093/rheumatology/kes261] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Magro CM, Roberts-Barnes J, Crowson AN. Direct Immunofluorescence Testing in the Diagnosis of Immunobullous Disease, Collagen Vascular Disease, and Vascular Injury Syndromes. Dermatol Clin 2012; 30:763-98, viii. [DOI: 10.1016/j.det.2012.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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32
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New insights into mechanisms of therapeutic effects of antimalarial agents in SLE. Nat Rev Rheumatol 2012; 8:522-33. [DOI: 10.1038/nrrheum.2012.106] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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33
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The biological significance of evolution in autoimmune phenomena. Autoimmune Dis 2012; 2012:784315. [PMID: 22482039 PMCID: PMC3312230 DOI: 10.1155/2012/784315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 12/28/2011] [Indexed: 01/16/2023] Open
Abstract
It is an inherent part of living to be in constant modification, which are due to answers resulting from environmental changes. The different systems make adaptations based on natural selection. With respect to the immune system of mammals, these changes have a lot to do with the interactions that occur continuously with other living species, especially microorganisms. The immune system is primarily designed to defend from germs and this response triggers inflammatory reactions which must be regulated in order not to generate damage to healthy tissue. The regulatory processes were added over time to prevent such damage. Through evolution the species have stored “an immunological experience,” which provides information that is important for developing effective responses in the future. The human species, which is at a high level of evolutionary immunological accumulation, have multiple immune defense strategies which, in turn, are highly regulated. Imbalances in these can result in autoimmunity. “There is nothing permanent except change.” (Heraclitus)
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Rodríguez-Caruncho C, Bielsa I. Lupus Erythematosus Tumidus: A Clinical Entity Still Being Defined. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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35
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Rodríguez-Caruncho C, Bielsa I. Lupus eritematoso túmido, una entidad en proceso de definición. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:668-74. [DOI: 10.1016/j.ad.2011.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 04/11/2011] [Accepted: 04/15/2011] [Indexed: 10/17/2022] Open
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36
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Toll-like receptor driven B cell activation in the induction of systemic autoimmunity. Semin Immunol 2011; 23:106-12. [PMID: 21306913 DOI: 10.1016/j.smim.2011.01.016] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 01/10/2011] [Indexed: 11/24/2022]
Abstract
Studies over the past decade have demonstrated a key role for pattern recognition receptors in the activation of autoreactive B cells. Self reactive B cells that manage to escape negative selection often express relatively low affinity receptors for self antigens (ignorant B cells), and can only be activated by integrating a relatively weak BCR signal with signals from additional receptors. Members of the toll-like receptor (TLR) gene family, and especially the nucleic acid binding receptors TLR 7, 8 and 9, appear to play a key role in this regard and promote the production of autoantibodies reactive with DNA- or RNA-associated autoantigens. These autoantibodies are able to form immune complexes with soluble or cell-bound ligands, and these immune complexes can in turn activate a second round of proinflammatory cells that further contribute to the autoimmune disease process. Recent data have emerged showing a pathogenic role for TLR7, with an opposing, protective role for TLR9. Targeting these disregulated pathways offers a therapeutic opportunity to treat autoimmune diseases without crippling the entire immune system. Further understanding of the role of specific receptors, cell subsets, and inhibitory signals that govern these TLR-associated pathways will enable future therapeutics to be tailored to specific categories of autoimmune disease.
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Sule S, Rosen A, Petri M, Akhter E, Andrade F. Abnormal production of pro- and anti-inflammatory cytokines by lupus monocytes in response to apoptotic cells. PLoS One 2011; 6:e17495. [PMID: 21423726 PMCID: PMC3056659 DOI: 10.1371/journal.pone.0017495] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/07/2011] [Indexed: 11/27/2022] Open
Abstract
Monocytes are a key component of the innate immune system involved in the regulation of the adaptive immune response. Previous studies have focused on apoptotic cell clearance abnormalities in systemic lupus erythematosus (SLE) monocytes. However, whether SLE monocytes might express unique patterns of cytokine secretion in response to apoptotic cells is still unknown. Here, we used monocytes from healthy controls and SLE patients to evaluate the production of TNF-α and TGF-β in response to apoptotic cells. Upon recognition of apoptotic material, monocytes from healthy controls showed prominent TGF-β secretion (mean ± SD: 824.6±144.3 pg/ml) and minimal TNF-α production (mean ± SD: 32.6±2.1 pg/ml). In contrast, monocytes from SLE patients had prominent TNF-α production (mean ± SD: 302.2±337.5 pg/ml) and diminished TGF-β secretion (mean ± SD: 685.9±615.9 pg/ml), a difference that was statistically significant compared to normal monocytes (p≤10(-6) for TNF-α secretion, and p = 0.0031 for TGF-β, respectively). Interestingly, the unique cytokine response by SLE monocytes was independent of their phagocytic clearance efficiency, opsonizing autoantibodies and disease activity. We further showed that nucleic acids from apoptotic cells play important role in the induction of TNF-α by lupus monocytes. Together, these observations suggest that, in addition to potential clearance defects, monocytes from SLE patients have an abnormal balance in the secretion of anti- and pro-inflammatory cytokines in response to apoptotic cells. Since the abnormal cytokine response to apoptotic material in SLE is not related to disease activity and opsonizing autoantibodies, it is possible that this response might be an intrinsic property of lupus monocytes. The studies focus attention on toll-like receptors (TLRs) and their downstream pathways as mediators of this response.
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Affiliation(s)
- Sangeeta Sule
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Antony Rosen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Michelle Petri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Ehtisham Akhter
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Felipe Andrade
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Abstract
Congenital heart block (CHB) is a conduction abnormality that affects hearts of foetuses and/or newborn to mothers with autoantibodies reactive with the intracellular soluble ribonucleoproteins 48-kD La, 52-kD Ro and 60-kD Ro. CHB carries substantial mortality and morbidity, with more than 60% of affected children requiring lifelong pacemakers. Several hypotheses have been proposed to explain the pathogenesis of CHB. These can be grouped under three main hypotheses: Apoptosis, Serotoninergic and Ca channel hypothesis. Here, we discuss these hypotheses and provide recent scientific thinking that will most likely dominate the future of this field of research.
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Affiliation(s)
- E Karnabi
- VA New York Harbor Healthcare System, New York, NY, USA
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39
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Abstract
Perfusion of human foetal heart with anti-Ro/SSA antibodies induces transient heart block. Anti-Ro/SSA antibodies may cross-react with T- and L-type calcium channels, and anti-p200 antibodies may cause calcium to accumulate in rat heart cells. These actions may explain a direct electrophysiological effect of these antibodies. Congenital complete heart block is the more severe manifestation of so-called "Neonatal Lupus". In clinical practice, it is important to distinguish in utero complete versus incomplete atrioventricular (AV) block, as complete AV block to date is irreversible, while incomplete AV block has been shown to be potentially reversible after fluorinated steroid therapy. Another issue is the definition of congenital AV block, as cardiologists have considered congenital blocks detected months or years after birth. We propose as congenital blocks detected in utero or within the neonatal period (0-27 days after birth). The possible detection of first degree AV block in utero, with different techniques, might be a promising tool to assess the effects of these antibodies. Other arrhythmias have been described in NL or have been linked to anti-Ro/SSA antibodies: first degree AV block, in utero and after birth, second degree (i.e. incomplete block), sinus bradycardia and QT prolongation, both in infants and in adults, ventricular arrhythmias (in adults). Overall, these arrhythmias have not a clinical relevance, but are important for research purposes.
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Affiliation(s)
- A Brucato
- Internal Medicine, Ospedali Riuniti, Bergamo, Italy.
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40
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Kuhn A, Ruland V, Bonsmann G. Photosensitivity, phototesting, and photoprotection in cutaneous lupus erythematosus. Lupus 2010; 19:1036-46. [DOI: 10.1177/0961203310370344] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disease involving well-defined skin lesions that can be categorized as acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), or intermittent CLE (ICLE). It is commonly accepted that ultraviolet (UV) exposure can induce and exacerbate skin lesions in patients with certain subtypes of CLE. Phototesting with UVA and UVB irradiation using a standardized protocol has proven to be a reliable model to study photosensitivity in CLE and to analyse the underlying pathomechanisms of the disease. In addition to UV-mediated induction of apoptosis, the molecular and cellular factors that may underlie the abnormal long-lasting photoreactivity in CLE include mediators of inflammation such as cytokines and chemokines, inducible nitric oxide (NO) synthase (iNOS), and cellular adhesion molecules. The photosensitivity associated with CLE requires education of the patient about avoidance of excessive sun exposure, continuous photoprotection through physical measures such as protective clothing, and daily application of broad-spectrum sunscreens. Novel approaches to UV-protection, such as alpha-MSH or thymidine dinucleotides, might also have an impact on photosensitivity in patients with CLE. In this review, we summarize the current knowledge about photosensitivity in patients with CLE, including an overview of standardized phototesting procedures, possible molecular pathomechanisms, and photoprotection. Lupus (2010) 19, 1036—1046.
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Affiliation(s)
- A. Kuhn
- Department of Dermatology, University of Münster, Münster, Germany,
| | - V. Ruland
- Department of Dermatology, University of Münster, Münster, Germany
| | - G. Bonsmann
- Department of Dermatology, University of Münster, Münster, Germany
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41
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Paz ML, González Maglio DH, Pino M, Ferrari A, Weill FS, Nasswetter G, Leoni J. Anti-ribonucleoproteins autoantibodies in patients with systemic autoimmune diseases. Relation with cutaneous photosensitivity. Clin Rheumatol 2010; 30:209-16. [PMID: 20490591 DOI: 10.1007/s10067-010-1481-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 04/05/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
Abstract
A common feature between patients with a certain group of systemic autoimmune pathologies (SAPs) with rheumatic component, such as lupus erythematosus (LE) in all its forms, is the presence of cutaneous photosensitivity (CP) as well as the existence of autoantibodies (Aabs). These Aabs have also high incidence in other SAPs that do not present CP, like primary Sjögren's syndrome and rheumatoid arthritis. Cutaneous photosensitivity is a condition that consists of an exacerbated skin reaction to solar radiations; its incidence can reach 90% in systemic LE. The mechanisms involved in the development of CP have been extensively studied focusing on different approaches; however, the exact mechanism has not been fully elucidated yet. There are many theories that relate specifically the presence of circulating anti-Ro/SS-A Aabs with the CP phenomenon, though there are several studies which are in disagreement. In this study, we evaluated the Aabs profile (anti-Ro/SS-A 52 kDa, anti-Ro/SS-A 60 kDa, anti-La/SS-B, anti-Sm and ANAs) as well as their titer or reactivity, in a local cohort of 169 patients with SAPs. We related those Aabs profiles and titers with the presence or absence of CP, and we found that there was no significant association between the presence of anti-Ro/SS-A Aabs and the occurrence of CP. On the other hand, a statistically significant positive association was found between CP and high reactivity anti-Sm Aabs, though this fact could be biased by the incidence of both events in SLE patients. To sum up, in the particular population studied, there is no direct relationship between anti-Ro/SS-A Aabs and CP, which is in agreement with some authors and in disagreement with many others, contributing to the endless discussion of this issue.
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Affiliation(s)
- Mariela L Paz
- Immunology Department, Pharmacy and Biochemistry School, University of Buenos Aires, Junín 956, 4th floor, Buenos Aires, C1113AAD, Argentina.
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42
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Maverakis E, Miyamura Y, Bowen MP, Correa G, Ono Y, Goodarzi H. Light, including ultraviolet. J Autoimmun 2009; 34:J247-57. [PMID: 20018479 DOI: 10.1016/j.jaut.2009.11.011] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ultraviolet (UV) light is intricately linked to the functional status of the cutaneous immune system. In susceptible individuals, UV radiation can ignite pathogenic inflammatory pathways leading to allergy or autoimmunity. In others, this same UV radiation can be used as a phototherapy to suppress pathogenic cutaneous immune responses. These vastly different properties are a direct result of UV light's ability to ionize molecules in the skin and thereby chemically alter them. Sometimes these UV-induced chemical reactions are essential, the formation of pre-vitamin D(3) from 7-dehydrocholesterol, for example. In other instances they can be potentially detrimental. UV radiation can ionize a cell's DNA causing adjacent pyrimidine bases to chemically bond to each other. To prevent malignant transformation, a cell may respond to this UV-induced DNA damage by undergoing apoptosis. Although this pathway prevents skin cancer it also has the potential of inducing or exacerbating autoreactive immune responses by exposing the cell's nuclear antigens. Ultraviolet-induced chemical reactions can activate the immune system by a variety of other mechanisms as well. In response to UV irradiation keratinocytes secrete cytokines and chemokines, which activate and recruit leukocytes to the skin. In some individuals UV-induced chemical reactions can synthesize novel antigens resulting in a photoallergy. Alternatively, photosensitizing molecules can damage cells by initiating sunburn-like phototoxic reactions. Herein we review all types of UV-induced skin reactions, especially those involving the immune system.
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Affiliation(s)
- Emanual Maverakis
- Department of Dermatology, School of Medicine, University of California at Davis, Sacramento, CA 95816, USA.
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43
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Furukawa F, Yamamoto Y, Kanazawa N, Muto M. Race differences in immunogenetic features and photosensitivity of cutaneous lupus erythematosus from the aspect of Japanese studies. Ann N Y Acad Sci 2009; 1173:552-6. [PMID: 19758198 DOI: 10.1111/j.1749-6632.2009.04676.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Skin lesions of collagen diseases are influenced by environmental triggers, such as UV light, and are variable in cutaneous lupus erythematosus (LE), such as systemic LE (SLE), chronic discoid LE (CDLE), subacute cutaneous LE (SCLE), and LE tumidus (LET). Although there are a few conflicting reports on photosensitivity in collagen diseases, many Japanese dermatologists feel there are photosensitivity differences in LE between Asians and Caucasians with SCLE and LET. To address this issue, we have carried out genetic studies of Japanese SLE and CDLE patients and reviewed the race differences in photosensitivity of cutaneous LE from Japanese studies. Human leukocyte antigen (HLA) studies in Japanese patients revealed that HLA-DRB1*1501 association was with CDLE and SLE. The association between HLA-Cw6 and CDLE was first reported in a Japanese population, and a HLA-A33-B44-DRB1*1302 haplotype showed a positive association in CDLE. However, these results are not compatible with those from Caucasian subjects. There are no significant associations among HLA studies, photosensitivity, and anti-Ro/SS-A antibodies in Japanese CLE patients. Photosensitivity will be a key factor to dissolve multifactorial complexes of LE etiopathogenesis. An axis of photosensitivity, anti-Ro/SS-A antibodies, and apoptosis via tumor necrosis factor-alpha is the best marker to verify the contribution of genetics in CLE patients. The incidence and degree of photosensitivity of SCLE and LET are much lower in Japanese than in Caucasians. This discrepancy may lead to investigations of CLE pathogenesis through global collaborations.
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Affiliation(s)
- Fukumi Furukawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan.
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44
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45
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Nishiyama M, Kanazawa N, Hiroi A, Furukawa F. Lupus erythematosus tumidus in Japan: a case report and a review of the literature. Mod Rheumatol 2009; 19:567-72. [PMID: 19562251 DOI: 10.1007/s10165-009-0192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 05/25/2009] [Indexed: 11/30/2022]
Abstract
We report here the case of a 48-year-old Japanese woman showing plaque-forming scattered indurative papules on her face, buttock and extremities. Histological examination revealed a large amount of interstitial mucin deposition, and negative direct immunofluorescence was observed. The provocative phototesting reproduced the skin lesion, and the patient was diagnosed with lupus erythematosus tumidus (LET). A review of ten LET cases previously reported in Japan revealed that all of these cases had clinicopathological features similar to those reported for European cases, although not all of the former fully satisfied the European criteria.
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Affiliation(s)
- Mizuho Nishiyama
- Department of Dermatology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
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46
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Sousa JX, Miyamoto D, Zimbres JM, Costa DV, Aoki V. Clinicopathological evaluation ofin vivoepidermal nuclear fluorescence. Clin Exp Dermatol 2009; 34:314-8. [DOI: 10.1111/j.1365-2230.2008.02947.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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48
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Bens G. [Photosensitivity in lupus erythematosus]. Rev Med Interne 2009; 30:857-65. [PMID: 19304357 DOI: 10.1016/j.revmed.2009.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/24/2009] [Indexed: 11/24/2022]
Abstract
Photosensitivity is one of the ARA diagnostic criteria of systemic lupus erythematosus. Sun exposure can also induce extracutaneous manifestations of the disease. Photosensitivity may be difficult to prove by history taking in lupus patients, as the delay between sun exposure and the onset of specific skin lesions is rather long. Photo-induction of lupus can occur by ultraviolet A (UVA) radiation in the shadow or behind window glass, so that the relationship between radiation exposure and exacerbation of the disease may not seem obvious to the patient. Phototesting procedures for lupus erythematosus have been described, but they are not used in routine practice. Both UVB and UVA play a role in the pathogenesis of lupus erythematosus: in the epidermis they induce DNA damage, they expose nuclear antigens and photo-induced neo-antigens at the cell surface, they lead to an accumulation of apoptotic material, and they induce several pro-inflammatory cytokines. In the dermis, UV radiation triggers skin infiltration by inflammatory cells by modulation of microvascular flow rates and by upregulation of white blood cell migration from dermal capillaries to the skin. Photodistribution of skin lesions and a delay of their onset of more than 48 hours after sun exposure are clinical hallmarks of cutaneous lupus erythematosus that are usually completed by histological confirmation. Photoprotection is essential in the treatment of lupus patients: it comprises sun avoidance suitable for both UVB and UVA radiation, protective clothing, and topical broad-spectrum filters.
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Affiliation(s)
- G Bens
- Service de dermatologie, centre hospitalier régional d'Orléans, hôpital Porte-Madeleine, BP 2439, Orléans cedex 1, France.
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Furukawa F, Yoshimasu T, Yamamoto Y, Kanazawa N, Tachibana T. Mast cells and histamine metabolism in skin lesions from MRL/MP-lpr/lpr mice. Autoimmun Rev 2009; 8:495-9. [PMID: 19162242 DOI: 10.1016/j.autrev.2008.12.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It is likely that mast cell and histamine metabolism are involved in autoimmune tissue injury such as cutaneous lupus erythematosus (LE) because different histamine receptors can regulate Th1 and Th2 cells. In order to verify the role of the axis of mast cell-histamine metabolism-histamine receptor, the autoimmune mouse has been investigated. The MRL/Mp-lpr/lpr (MRL/lpr) mouse is a good model for the spontaneous development of skin lesions similar to those seen in human LE. In skin lesions from MRL/l mice, there are many infiltrating T cells and mast cells in the dermis and impaired histamine metabolism, in which the low activity of histamine-N-methyltransferase and the related prolonged effects of histamine in the skin tissue seem to play a definite pathological role in the development of spontaneous lupus-like eruptions. The expression of H2R on the mast cell decreases within these skin lesions at 5 months of age. It is interesting that the activity of HMT runs in parallel with the expression of H2R over the time course of the skin changes in MRL/l mice, but the relationship between these two observations remains obscure. The accumulation of mast cells expressing H2R and prolonged effects of histamine may occur to regulate the production of Th1 and Th2 cytokines in the skin lesions of MRL/l mice.
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Affiliation(s)
- Fukumi Furukawa
- Department of Dermatology, Wakayama Medical University, Wakayama City, Japan.
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Reich A, Meurer M, Viehweg A, Muller DJ. Narrow-band UVB-induced externalization of selected nuclear antigens in keratinocytes: implications for lupus erythematosus pathogenesis. Photochem Photobiol 2008; 85:1-7. [PMID: 19076311 DOI: 10.1111/j.1751-1097.2008.00480.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to analyze whether sera obtained from patients with lupus erythematosus (LE) react with membrane structures found on keratinocytes irradiated with narrow-band ultraviolet B (NB-UVB). We applied atomic force microscopy (AFM) to visualize cell surface structures expressing nuclear antigens upon apoptosis following NB-UVB irradiation. Immortalized human keratinocytes (HaCaT) were cultured under standard conditions, irradiated with 800 mJ cm(-2) NB-UVB light and imaged by AFM mounted on an inverted optical microscope. It was observed that NB-UVB irradiation provoked significant alterations of the keratinocyte morphology and led to the membrane expression of antigens recognized by anti-La and anti-Ro 60 kDa sera but not by antidouble-strand DNA sera. The presence of La and Ro 60 kDa antigens on keratinocyte surfaces after NB-UVB irradiation was limited mainly to the small bleb-like protrusions found on the keratinocytes by AFM. A closer investigation by AFM also revealed that some structures positively stained with anti-Ro 60 kDa serum were also located submembranously. We hypothesize that the externalization of some nuclear antigens because of NB-UVB exposure might be responsible for exacerbation of skin symptoms in patients suffering from LE.
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Affiliation(s)
- Adam Reich
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland.
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