Predisposition to Cervical Atypia in Systemic Lupus Erythematosus: A Clinical and Cytopathological Study

Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD

Objectives

The aims of this study were to update the evidence on the incidence and prevalence rates of vaccine preventable infections (VPI) in patients with autoimmune inflammatory rheumatic diseases (AIIRD) and compare the data to the general population when available.

Methods

A literature search was performed using Medline, Embase and Cochrane library (October 2009 to August 2018). The primary outcome was the incidence or prevalence of VPI in the adult AIIRD population. Meta-analysis was performed when appropriate.

Results

Sixty-three publications out of 3876 identified records met the inclusion criteria: influenza (n=4), pneumococcal disease (n=7), hepatitis B (n=10), herpes zoster (HZ) (n=29), human papillomavirus (HPV) infection (n=13). An increased incidence of influenza and pneumococcal disease was reported in patients with AIIRD. HZ infection-pooled incidence rate ratio (IRR) was 2.9 (95% CI 2.4 to 3.3) in patients with AIIRD versus general population. Among AIIRD, inflammatory myositis conferred the highest incidence rate (IR) of HZ (pooled IRR 5.1, 95% CI 4.3 to 5.9), followed by systemic lupus erythematosus (SLE) (pooled IRR 4.0, 95% CI 2.3 to 5.7) and rheumatoid arthritis (pooled IRR 2.3, 95% CI 2.1 to 2.6). HPV infection-pooled prevalence ratio was 1.6, 95% CI 0.7 to 3.4 versus general population, based on studies mainly conducted in the SLE population in Latin America and Asia. Pooled prevalence of hepatitis B surface antigen and hepatitis B core antibody in patients with AIIRD was similar to the general population, 3%, 95% CI 1% to 5% and 15%, 95% CI 7% to 26%, respectively.

Conclusion

Current evidence shows an increased risk of VPI in patients with AIIRD, emphasising that prevention of infections is essential in these patients.

Lower Genital Tract Dysplasia in Female Solid Organ Transplant Recipients

OBJECTIVE

To examine the incidence of lower genital tract dysplasia in women after solid organ transplantation, to evaluate risk factors associated with development of dysplasia, and to assess the timeline of disease development.

METHODS

This was a retrospective study of female patients who underwent solid organ transplantation at a large-volume tertiary care center between 2000 and 2015. Demographic and clinicopathologic factors were extracted from electronic medical records. Cumulative incidence of lower genital tract dysplasia was calculated, and univariate and multivariable logistic regression were performed to identify risk factors for the development of dysplasia.

RESULTS

Among 394 female solid organ transplant recipients, the median age was 41 years (interquartile range 29-53). Forty-seven (11.9%; 95% CI 8.8-15.9%) women developed lower genital tract dysplasia over a median follow-up of 7.8 years (interquartile range 4.6-12.9). Thirty-eight (9.6%) developed cervical intraepithelial neoplasia (CIN), with 14 (3.6%) diagnosed with CIN 2 or worse (one was cervical carcinoma). Nineteen (4.8%) developed noncervical lower genital tract dysplasia, including vulvar, vaginal, or anal dysplasia, with 13 (3.3%) diagnosed with high-grade dysplasia or worse (five were lower genital tract carcinoma [three anal, one vulvar, and one vaginal]). Ten (2.5%) developed both cervical and noncervical lower genital tract dysplasia. Black race was significantly associated with developing dysplasia (odds ratio [OR] 2.86; 95% CI 1.33-6.13) as was hydroxychloroquine use (OR 5.95; 95% CI 1.96-18.09). High-grade cervical dysplasia was diagnosed at a median interval of 3.18 years after transplant; noncervical high-grade lower genital tract dysplasia was diagnosed at a median interval of 3.94 years.

CONCLUSIONS

One in eight transplant recipients developed lower genital tract dysplasia and approximately half were high-grade dysplasia or cancer. Black race and hydroxychloroquine use were associated with an increased risk of dysplasia. Yearly cervical screening and comprehensive lower genital examination beyond the cervix is indicated in this population.

MicroRNA-139-5p alleviates UVB-induced injuries by regulating TLR4 in si-IL-6-treated keratinocyte cells

Background: Lupus erythematosus (LE) is an autoimmune disease that is often exacerbated by ultraviolet B (UVB) irradiation. MicroRNAs (miRNAs) play vital roles in response to UVB damage to keratinocyte cells. Herein, our study aimed to explore the functions of miR-139-5p in UVB-induced injuries in keratinocyte cells. Methods: Human keratinocyte cell line HaCaT was per-treated with 20 ng/ml si-IL-6 and transfected with miR-139-5p mimic, pc-TLR4 and corresponding controls. These cells were underwent 30 mJ/cm² UVB irradiation and incubated for 24 h. Thereafter, cell viability and apoptosis were detected by trypan blue staining and flow cytometry assays. Furthermore, the expression levels of miR-139-5p, TLR4, apoptosis-associated factors, Notch and PI3K/AKT pathways factors were examined by qRT-PCR and western blot. Results: Our results showed that UVB irradiation pronouncedly enhanced si-IL-6-induced cell injuries, as decreased cell viability and promoted apoptosis in HaCaT cells. In addition, miR-139-5p was up-regulated in UVB-exposed HaCaT cells and overexpression of miR-139-5p attenuated UVB-induced injuries in si-IL-6-treated HaCaT cells. Further study we found that overexpression of TLR4 significantly abolished the protective effects of miR-139-5p overexpression against UVB-induced injuries in si-IL-6-treated HaCaT cells. Besides, western blot results demonstrated that overexpression of miR-139-5p inactivated Notch and PI3K/AKT pathways by down-regulation of TLR4. Conclusions: These results indicated that miR-139-5p alleviated UVB-induced injuries by regulation of TLR4 in si-IL-6-treated HaCaT cells. The study might provide new therapeutic strategies for treatment of LE.