1
|
Liphaus BL, Silva SC, Palmeira P, Silva CA, Goldenstein-Schainberg C, Carneiro-Sampaio M. Reduced expressions of apoptosis-related proteins TRAIL, Bcl-2, and TNFR1 in NK cells of juvenile-onset systemic lupus erythematosus patients: relations with disease activity, nephritis, and neuropsychiatric involvement. Front Immunol 2024; 15:1327255. [PMID: 38562920 PMCID: PMC10982494 DOI: 10.3389/fimmu.2024.1327255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Lupus pathogenesis is mainly ascribed to increased production and/or impaired clearance of dead cell debris. Although self-reactive T and B lymphocytes are critically linked to lupus development, neutrophils, monocytes, and natural killer (NK) cells have also been implicated. This study assessed apoptosis-related protein expressions in NK cells of patients with juvenile-onset systemic lupus erythematosus (jSLE) and relations to disease activity parameters, nephritis, and neuropsychiatric involvement. Methods Thirty-six patients with jSLE, 13 juvenile dermatomyositis (JDM) inflammatory controls, and nine healthy controls had Fas, FasL, TRAIL, TNFR1, Bcl-2, Bax, Bim, and caspase-3 expressions in NK cells (CD3-CD16+CD56+) simultaneously determined by flow cytometry. Disease activity parameters included Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, erythrocyte sedimentation rate, C-reactive protein level, anti-double strain DNA antibody level, complement fractions C3 and C4 levels. Results Patients with jSLE had a profile of significantly reduced expression of TRAIL, Bcl-2, and TNFR1 proteins in NK cells when compared to healthy controls. Similar profile was observed in patients with jSLE with active disease, positive anti-dsDNA, nephritis, and without neuropsychiatric involvement. Patients with jSLE with positive anti-dsDNA also had reduced expression of Bax in NK cells when compared healthy controls and to those with negative anti-dsDNA. Yet, patients with jSLE with negative anti-dsDNA had reduced mean fluorescence intensity (MFI) of Bim in NK cells compared to healthy controls. Patients with jSLE with nephritis also had reduced MFI of Fas in NK cells when compared to those without nephritis. In addition, in patients with jSLE, the proportion of FasL-expressing NK cells directly correlated with the SLEDAI-2K score (rs = 0.6, p = 0.002) and inversely correlated with the C3 levels (rs = -0.5, p = 0.007). Moreover, patients with jSLE had increased NK cell percentage and caspase-3 protein expression in NK cells when compared to JDM controls. Conclusion This study extends to NK cells an altered profile of TRAIL, Bcl-2, TNFR1, Fas, FasL, Bax, Bim, and caspase-3 proteins in patients with jSLE, particularly in those with active disease, positive anti-dsDNA, nephritis, and without neuropsychiatric involvement. This change in apoptosis-related protein expressions may contribute to the defective functions of NK cells and, consequently, to lupus development. The full clarification of the role of NK cells in jSLE pathogenesis may pave the way for new therapies like those of NK cell-based.
Collapse
Affiliation(s)
- Bernadete L. Liphaus
- Laboratory of Medical Investigation, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Pediatric Rheumatology Unit, Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Simone C. Silva
- Laboratory of Medical Investigation, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Patrícia Palmeira
- Laboratory of Medical Investigation, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Clovis A. Silva
- Pediatric Rheumatology Unit, Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Disciplina de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Magda Carneiro-Sampaio
- Laboratory of Medical Investigation, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Pennesi M, Benvenuto S. Lupus Nephritis in Children: Novel Perspectives. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1841. [PMID: 37893559 PMCID: PMC10607957 DOI: 10.3390/medicina59101841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Childhood-onset systemic lupus erythematosus is an inflammatory and autoimmune condition characterized by heterogeneous multisystem involvement and a chronic course with unpredictable flares. Kidney involvement, commonly called lupus nephritis, mainly presents with immune complex-mediated glomerulonephritis and is more frequent and severe in adults. Despite a considerable improvement in long-term renal prognosis, children and adolescents with lupus nephritis still experience significant morbidity and mortality. Moreover, current literature often lacks pediatric-specific data, leading clinicians to rely exclusively on adult therapeutic approaches. This review aims to describe pediatric lupus nephritis and provide an overview of the novel perspectives on the pathogenetic mechanisms, histopathological classification, therapeutic approach, novel biomarkers, and follow-up targets in children and adolescents with lupus nephritis.
Collapse
Affiliation(s)
- Marco Pennesi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Simone Benvenuto
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, 34127 Trieste, Italy
| |
Collapse
|
3
|
Diagnostic Challenges in Patients with Inborn Errors of Immunity with Different Manifestations of Immune Dysregulation. J Clin Med 2022; 11:jcm11144220. [PMID: 35887984 PMCID: PMC9324612 DOI: 10.3390/jcm11144220] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
Inborn errors of immunity (IEI), formerly known as primary immunodeficiency disorders (PIDs), are inherited disorders caused by damaging germline variants in single genes, which result in increased susceptibility to infections and in allergic, autoimmune, autoinflammatory, nonmalignant lymphoproliferative, and neoplastic conditions. Along with well-known warning signs of PID, attention should be paid to signs of immune dysregulation, which seem to be equally important to susceptibility to infection in defining IEI. The modern diagnostics of IEI offer a variety of approaches but with some problems. The aim of this review is to discuss the diagnostic challenges in IEI patients in the context of an immune dysregulation background.
Collapse
|
4
|
Sullivan KE. The yin and the yang of early classical pathway complement disorders. Clin Exp Immunol 2022; 209:151-160. [PMID: 35648651 DOI: 10.1093/cei/uxac056] [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: 03/30/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
The classical pathway of the complement cascade has been recognized as a key activation arm, partnering with the lectin activation arm and the alternative pathway to cleave C3 and initiate the assembly of the terminal components. While deficiencies of classical pathway components have been recognized since 1966, only recently have gain-of-function variants been described for some of these proteins. Loss-of-function variants in C1, C4, and C2 are most often associated with lupus and systemic infections with encapsulated bacteria. C3 deficiency varies slightly from this phenotypic class with membranoproliferative glomerulonephritis and infection as the dominant phenotypes. The gain-of- function variants recently described for C1r and C1s lead to periodontal Ehlers Danlos syndrome, a surprisingly structural phenotype. Gain-of-function in C3 and C2 are associated with endothelial manifestations including hemolytic uremic syndrome and vasculitis with C2 gain-of-function variants thus far having been reported in patients with a C3 glomerulopathy. This review will discuss the loss-of-function and gain-of-function phenotypes and place them within the larger context of complement deficiencies.
Collapse
Affiliation(s)
- Kathleen E Sullivan
- Division of Allergy Immunology, The Children's Hospital of Philadelphia, 3615 Civic Center Blvd, Philadelphia, PA 19104, USA
| |
Collapse
|
5
|
Trindade VC, Carneiro-Sampaio M, Bonfa E, Silva CA. An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus. Paediatr Drugs 2021; 23:331-347. [PMID: 34244988 PMCID: PMC8270778 DOI: 10.1007/s40272-021-00457-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/06/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a prototype of a multisystemic, inflammatory, heterogeneous autoimmune condition. This disease is characterized by simultaneous or sequential organ and system involvement, with unpredictable flare and high levels of morbidity and mortality. Racial/ethnic background, socioeconomic status, cost of medications, difficulty accessing health care, and poor adherence seem to impact lupus outcomes and treatment response. In this article, the management of cSLE patients is updated. Regarding pathogenesis, a number of potential targets for drugs have been studied. However, most treatments in pediatric patients are off-label drugs with recommendations based on inadequately powered studies, therapeutic consensus guidelines, or case series. Management practices for cSLE patients include evaluations of disease activity and cumulative damage scores, routine non-live vaccinations, physical activity, and addressing mental health issues. Antimalarials and glucocorticoids are still the most common drugs used to treat cSLE, and hydroxychloroquine is recommended for nearly all cSLE patients. Disease-modifying antirheumatic drugs (DMARDs) should be standardized for each patient, based on disease flare and cSLE severity. Mycophenolate mofetil or intravenous cyclophosphamide is suggested as induction therapy for lupus nephritis classes III and IV. Calcineurin inhibitors (cyclosporine, tacrolimus, voclosporin) appear to be another good option for cSLE patients with lupus nephritis. Regarding B-cell-targeting biologic agents, rituximab may be used for refractory lupus nephritis patients in combination with another DMARD, and belimumab was recently approved by the US Food and Drug Administration for cSLE treatment in children aged > 5 years. New therapies targeting CD20, such as atacicept and telitacicept, seem to be promising drugs for SLE patients. Anti-interferon therapies (sifalimumab and anifrolumab) have shown beneficial results in phase II randomized control trials in adult SLE patients, as have some Janus kinase inhibitors, and these could be alternative treatments for pediatric patients with severe interferon-mediated inflammatory disease in the future. In addition, strict control of proteinuria and blood pressure is required in cSLE, especially with angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use.
Collapse
Affiliation(s)
- Vitor Cavalcanti Trindade
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Clovis Artur Silva
- Children and Adolescent Institute, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| |
Collapse
|
6
|
Almaghlouth I, Su J, Johnson SR, Pullenayegum E, Gladman D, Urowitz M. Acquired low immunoglobulin levels and risk of clinically relevant infection in adult patients with systemic lupus erythematosus: a cohort study. Rheumatology (Oxford) 2021; 60:1456-1464. [PMID: 33006611 DOI: 10.1093/rheumatology/keaa641] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Infection is a leading cause of death in the SLE population. Low immunoglobulin levels might be a potential risk for infection. We aimed to assess whether acquired low levels of any type of immunoglobulin increase the risk of clinically relevant infection in adult patients with SLE. METHODS We compared adult SLE patients who had acquired any low immunoglobulin levels (IgA, IgM or IgG) for 2 years with patients with normal or high levels with respect to clinically relevant infection (defined as infections requiring intravenous or oral antibiotics) in a prospective cohort study. Group balance was achieved using propensity score adjustment, matching and inverse probability weighting. Primary analysis was time to event using Cox-regression modelling adjusting for potential confounders. Sensitivity analyses were conducted to examine several exposure and outcome definitions. RESULTS Patients with hypogammaglobulinaemia had longer disease duration, more lupus nephritis history, higher proteinuria and more accumulated damage. Low IgA level was associated with increased risk of clinically relevant infection [hazard ratio (HR): 2.24, 95% CI: 1.61, 3.12] while low IgG (HR: 1.15, 95% CI: 0.84, 1.59) or low IgM (HR: 0.95, 95% CI: 0.73, 1.23) was not. Low immunoglobulin recovery in the first year was 2.5% (11), second year 8.2% (36), third year 10.1% (44) and fourth year 18.4% (80), and 60% (263) of acquired hypogammaglobulinaemia recovered over 4 years. CONCLUSION The majority of acquired hypogammaglobulinaemia in adult patients with SLE is transient. Only low acquired IgA was associated with increased risk of infection among adult patients with SLE. Whether immunoglobulin replacement provides additional protective effect requires further investigation.
Collapse
Affiliation(s)
- Ibrahim Almaghlouth
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Rheumatology Unit, Department of Medicine, King Saud University, Saudi Arabia.,College of Medicine Research Center, King Saud University, Saudi Arabia
| | - Jiandong Su
- Centre for Prognosis in Rheumatic Diseases, University Health Network, Canada
| | - Sindhu R Johnson
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Eleanor Pullenayegum
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Canada.,Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Dafna Gladman
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Prognosis in Rheumatic Diseases, University Health Network, Canada
| | - Murray Urowitz
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Centre for Prognosis in Rheumatic Diseases, University Health Network, Canada
| |
Collapse
|
7
|
Almaghlouth I, Johnson SR, Pullenayegum E, Gladman D, Urowitz M. Immunoglobulin levels in systemic lupus erythematosus: A narrative review. Lupus 2021; 30:867-875. [PMID: 33779380 DOI: 10.1177/09612033211004714] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Immunoglobulins play a fundamental role in the protection of the human body against internal and external threats. They also contribute to the immune system homeostasis and maintenance of self-tolerance. Hypogammaglobulinemia is occasionally encountered in routine clinical practice by rheumatologists. Low levels of immunoglobulins can occur as primary or secondary issues and may predispose patients to various forms of infection. However, the impact of the low immunoglobulin level abnormality varies with the underlying condition. In this narrative review, we shed light on the overall types and functions of immunoglobulins for clinicians. We discuss important principles of immunoglobulin measurements. We then consider the primary and secondary causes of low immunoglobulins with a special focus on hypogammaglobulinemia in patients with systemic lupus erythematosus (SLE).
Collapse
Affiliation(s)
- Ibrahim Almaghlouth
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, University of Toronto and the Schroeder Arthritis Institute, University Health Network, Toronto, Canada.,Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia.,College of Medicine Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Sindhu R Johnson
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, University of Toronto and the Schroeder Arthritis Institute, University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Eleanor Pullenayegum
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Dafna Gladman
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, University of Toronto and the Schroeder Arthritis Institute, University Health Network, Toronto, Canada.,Centre for Prognosis in Rheumatic Diseases, University Health Network, Toronto, Canada
| | - Murray Urowitz
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, University of Toronto and the Schroeder Arthritis Institute, University Health Network, Toronto, Canada.,Centre for Prognosis in Rheumatic Diseases, University Health Network, Toronto, Canada
| |
Collapse
|
8
|
Al-Mayouf SM, Alreefi HA, Alsinan TA, AlSalmi G, AlRowais A, Al-Herz W, Alazami AM, Alsonbul A, Al-Mousa H. Lupus manifestations in children with primary immunodeficiency diseases: Comprehensive phenotypic and genetic features and outcome. Mod Rheumatol 2021; 31:1171-1178. [PMID: 33563058 DOI: 10.1080/14397595.2021.1886627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To report the phenotypic, genetic findings and outcome of children with lupus manifestations associated with primary immunodeficiency diseases (PIDs). METHODS Data are retrospectively collected on patients with lupus manifestations and PIDs seen between 1998 and 2019. Data comprised the clinical findings and genetic testing, the response to treatment and the accrual damage related to SLE. RESULTS A total of 39 patients (22 female) were reviewed. Thirty-four patients had lupus manifestations and six patients with SLE-like manifestations. Genetic analysis was performed in 25 patients. Complement deficiency was the most frequent PIDs; 26 patients were C1q deficient, three patients had C3 deficiency, two patients had C4 deficiency and one patient with heterozygous C8b variant. The other seven patients had different PIDs genetic defects that include SCID caused by PNP deficiency, CGD, CVID (PIK3CD), IL-2RB mutation, DNase II deficiency, STAT1 mutation, ISG15 mutation and Griscelli syndrome type 3. Mucocutaneous lesions, arthritis and lung involvement were the main clinical features. 84.1% experienced recurrent infections. The mean accrual damage was 2.7 ± 2.2. There were five deaths because of infection. CONCLUSION This study suggests that patients with lupus manifestations and early onset disease, family history of SLE or recurrent infections should undergo immunological work-up and genetic testing to rule out PIDs.
Collapse
Affiliation(s)
- Sulaiman M Al-Mayouf
- Department of Pediatrics, Pediatric Rheumatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hajar A Alreefi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tuqa A Alsinan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ghada AlSalmi
- Department of Pediatrics, Pediatric Rheumatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz AlRowais
- Department of Pediatrics, Pediatric Rheumatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.,Pediatric Department, Allergy & Clinical Immunology Unit, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Anas M Alazami
- Department of Genetics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alsonbul
- Department of Pediatrics, Pediatric Rheumatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Hamoud Al-Mousa
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Pediatrics, Allergy & Immunology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Farmer JR, Uzel G. Mapping Out Autoimmunity Control in Primary Immune Regulatory Disorders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:653-659. [PMID: 33358993 DOI: 10.1016/j.jaip.2020.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022]
Abstract
There is a growing understanding of the clinical overlap between primary immune deficiency and autoimmunity. An atypical or treatment-refractory clinical presentation of autoimmunity may in fact signal an underlying congenital condition of primary immune dysregulation (an inborn error of immunity). Detailed profiling of the family history is critical in the diagnostic process and must not be limited to the occurrence of frequent or atypical infections, but additionally should include inquiries into chronic forms of autoimmunity, hyperinflammation, and malignancy. A genetic and a functional diagnostic approach are complementary and nonoverlapping methods of identifying and validating an inborn error of immunity. Extended immune phenotyping of both affected and unaffected family members may provide insight into disease mode of inheritance, penetrance, and secondary inherited or environmentally acquired modifiers. Clinical care of a family with an inborn error of immunity may require local and national expertise in addition to cross-disciplinary care from the disciplines of pediatrics and internal medicine. Physician communication across subspecialties as well as distinct medical institutes can facilitate the appropriate disclosure of genetic testing results toward their prompt incorporation into patient care. Targeted immunomodulation based directly on genetic and functional immune phenotyping has the potential to reduce unnecessary immunosuppression and provide more exacting therapeutic benefit to our patients.
Collapse
Affiliation(s)
- Jocelyn R Farmer
- Division of Rheumatology, Allergy & Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Ragon Institute of MGH, MIT and Harvard, Boston, Mass.
| | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| |
Collapse
|
10
|
Khil'chenko S, Boch K, van Beek N, Vorobyev A, Zillikens D, Schmidt E, Ludwig RJ. Alterations of Total Serum Immunoglobulin Concentrations in Pemphigus and Pemphigoid: Selected IgG2 Deficiency in Bullous Pemphigoid. Front Med (Lausanne) 2020; 7:472. [PMID: 33015084 PMCID: PMC7493804 DOI: 10.3389/fmed.2020.00472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/14/2020] [Indexed: 12/28/2022] Open
Abstract
Pemphigus and pemphigoid diseases are organ-specific autoimmune diseases of the skin and/or mucous membranes, which are caused by autoantibodies targeting structural proteins of the skin. In other autoimmune diseases, a high prevalence of primary antibody deficiencies was noted. Conversely, a high prevalence of autoimmune diseases is reported in patients with primary antibody deficiencies. With the exception of one study, pointing toward a decrease of IgG in pemphigus patients, with a relative enrichment of IgG4, serum immunoglobulin (Ig) concentrations had not been studied in pemphigus and pemphigoid. Hence, we here aimed to investigate serum concentrations of IgM, IgA, IgG, and IgG1-4 in pemphigus and pemphigoid patients, as well as in healthy controls. Serum Ig concentrations were determined by ELISA in 105 healthy controls, 100 pemphigus vulgaris (PV), 100 pemphigus foliaceus, 99 bullous pemphigoid (BP), and 55 linear IgA bullous dermatosis (LAD) patients. In healthy controls, age had a significant impact on Ig serum concentrations: In controls at ages of 69 years or older, IgM and IgG were decreased, while all other Ig, except IgA and IgG4, were increased. When stratified by sex, lower IgM concentrations were observed in males. When corrected for age and/or sex, and compared to controls, an increase in serum IgA was noted in LAD. In almost all patient cohorts, an increase in IgG1 and IgG4 was observed, while a decrease in IgG2 or IgG3 was seen in BP or PV patients. This points toward a possible association of BP with IgG2 deficiency and warrants evaluation of IgG2 in BP patients prior to immunosuppressive therapy.
Collapse
Affiliation(s)
- Stanislav Khil'chenko
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Katharina Boch
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Nina van Beek
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Artem Vorobyev
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| |
Collapse
|
11
|
Tesser A, de Carvalho LM, Sandrin-Garcia P, Pin A, Pastore S, Taddio A, Roberti LR, de Paula Queiroz RG, Ferriani VPL, Crovella S, Tommasini A. Higher interferon score and normal complement levels may identify a distinct clinical subset in children with systemic lupus erythematosus. Arthritis Res Ther 2020; 22:91. [PMID: 32334613 PMCID: PMC7183668 DOI: 10.1186/s13075-020-02161-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/25/2020] [Indexed: 12/21/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) is a complex multi-system disease, characterized by both autoimmune and autoinflammatory clinical and laboratory features. The role of type I interferon (IFN) in SLE has been demonstrated from the 2000s, by gene expression analyses showing significant over-expression of genes related to type I IFN signalling pathway (IFN signature). However, several studies questioned the role of measuring the intensity of IFN signature (IFN score) to chase SLE activity. We would assess if the IFN signature can help the clinical and therapeutic stratification of patients with pediatric SLE. Methods We measured the IFN score in peripheral whole blood from a series of subjects with childhood-onset SLE and correlated the results with clinical and laboratory parameters. Results Thirty-one subjects were included in the study, among which the 87% displayed a positive IFN score. The only significant relation was found for high IFN score in subjects with normocomplementemia. No correlation was observed between IFN score and SLEDAI-2K, BILAG-2004 and SLICC. Patients with high IFN score and normal complement levels also presented lower anti-dsDNA antibodies. Conclusions The integration between IFN signature analysis and complement levels may easily distinguish two groups of subjects, in which the autoimmune or autoinflammatory component of the disease seems to be prevalent.
Collapse
Affiliation(s)
- Alessandra Tesser
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | - Alessia Pin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Serena Pastore
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Andrea Taddio
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | | | | | - Sergio Crovella
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Tommasini
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. .,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
| |
Collapse
|
12
|
Sharma M, Vignesh P, Tiewsoh K, Rawat A. Revisiting the complement system in systemic lupus erythematosus. Expert Rev Clin Immunol 2020; 16:397-408. [PMID: 32228236 DOI: 10.1080/1744666x.2020.1745063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease, characterized by the production of autoantibodies. Numerous mechanisms contribute to the pathogenesis and autoimmunity in SLE. One of the most important mechanisms is the defective function of the early complement components that are involved in clearing the immune-complexes and apoptotic debris. Major evidence supporting this hypothesis is the development of severe lupus in individuals with monogenic defects in any one of the early complement components such as C1q, C1 s, C1 r, C2, or C4.Areas covered: In this review, we discuss hereditary defects in classical complement components and their clinical manifestations, acquired defects of complements in lupus, the role of complements in the pathogenesis of antiphospholipid antibody syndrome and lupus nephritis, and laboratory assessment of complement components and their functions. Articles from the last 20 years were retrieved from PubMed for this purpose.Expert opinion: Complements have a dual role in the pathogenesis of SLE. On one hand, deficiency of complement components predisposes to lupus, while, on the other, excess complement activation plays a role in the organ damage. Understanding the intricacies of the role of complements in SLE can pave way for the development of targeted therapies.
Collapse
Affiliation(s)
- Madhubala Sharma
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pandiarajan Vignesh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karalanglin Tiewsoh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
13
|
Afzali P, Isaeian A, Sadeghi P, Moazzami B, Parvaneh N, Robatjazi M, Ziaee V. Complement deficiency in pediatric-onset systemic lupus erythematosus. J Lab Physicians 2020; 10:232-236. [PMID: 29692593 PMCID: PMC5896194 DOI: 10.4103/jlp.jlp_171_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: Pediatric-onset systemic lupus erythematosus (pSLE) accounts for about 10%–20% of all patients with SLE. Deficiencies in early complement components of the classical pathway are the strong genetic risk factor for the development of SLE. In this study, clinical and laboratory manifestations of both complement-deficient and normal complement pSLE patients were compared. MATERIALS AND METHODS: To investigate clinical and immunological manifestations of pSLE in Iran, 36 consecutive pSLE patients (onset before 18 years) who were followed up over a period of 2 years, were studied. Complement C1q and C2 levels were measured using radial immunodifusion assay and complement C3 and C4 levels were measured using nephelometry. Medical records were retrospectively evaluated from patient database of Children Medical Center Hospital. Data were assessed through descriptive analysis (confidence interval = 95%), paired t-test, and Pearson correlation test. RESULTS: Twenty-one patients (58%) had at least one component of complement deficiency. Ten patients (27%) had low C1q level, 11 patients (30.5%) had low C2, nine patients (25%) had low C3, and four patients (11%) had low C4 level. Serum level of complement in pSLE was significantly lower than the control group, except C4 (P = 0.005). The low C1q patients had an earlier age of onset of disease (P < 0.0001). The cutaneous manifestations were more frequent and much more severe in pSLE with low complement (100% vs. 73%). The frequency of renal and musculoskeletal symptoms was equal, but renal morbidity was more common in pSLE with low complement. Positivity for anti-ds-DNA was less common in pSLE with low complement (71% vs. 86%). CONCLUSION: In pSLE patients with early disease onset and more aggressive SLE manifestations and negative anti-ds-DNA test, complement deficiency should be considered.
Collapse
Affiliation(s)
- Parisa Afzali
- Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Anna Isaeian
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Peyman Sadeghi
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bobak Moazzami
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Nima Parvaneh
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran.,Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Robatjazi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Vahid Ziaee
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran.,Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.,Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Elevated serum interleukin-34 level in juvenile systemic lupus erythematosus and disease activity. Clin Rheumatol 2020; 39:1627-1632. [DOI: 10.1007/s10067-019-04899-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/25/2019] [Accepted: 12/15/2019] [Indexed: 12/12/2022]
|
15
|
Azizi G, Ziaee V, Tavakol M, Alinia T, Yazdai R, Mohammadi H, Abolhassani H, Aghamohammadi A. Approach to the Management of Autoimmunity in Primary Immunodeficiency. Scand J Immunol 2017; 85:13-29. [PMID: 27862144 DOI: 10.1111/sji.12506] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/04/2016] [Indexed: 12/14/2022]
Abstract
Primary immunodeficiency diseases (PIDs) consist of a genetically heterogeneous group of immune disorders that affect distinct elements of the immune system. PID patients are more prone to infections and non-infectious complications, particularly autoimmunity. The concomitance of immunodeficiency and autoimmunity appears to be paradoxical and leads to difficulty in the management of autoimmune complications in PID patients. Therefore, management of autoimmunity in patients with PID requires special considerations because dysregulations and dysfunctions of the immune system along with persistent inflammation impair the process of diagnosis and treatment.
Collapse
Affiliation(s)
- G Azizi
- Department of Laboratory Medicine, Imam Hassan Mojtaba Hospital, Alborz University of Medical Sciences, Karaj, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - V Ziaee
- Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - M Tavakol
- Department of Allergy and Clinical Immunology, Shahid Bahonar Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - T Alinia
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - R Yazdai
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - H Mohammadi
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - H Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - A Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Vignesh P, Rawat A, Sharma M, Singh S. Complement in autoimmune diseases. Clin Chim Acta 2017; 465:123-130. [PMID: 28040558 DOI: 10.1016/j.cca.2016.12.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/18/2022]
|
17
|
van Schaarenburg RA, Magro-Checa C, Bakker JA, Teng YKO, Bajema IM, Huizinga TW, Steup-Beekman GM, Trouw LA. C1q Deficiency and Neuropsychiatric Systemic Lupus Erythematosus. Front Immunol 2016; 7:647. [PMID: 28082982 PMCID: PMC5186770 DOI: 10.3389/fimmu.2016.00647] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/13/2016] [Indexed: 12/25/2022] Open
Abstract
C1q deficiency is a rare immunodeficiency, which is strongly associated with the development of systemic lupus erythematosus (SLE). A mutation in one of the C1q genes can either lead to complete deficiency or to low C1q levels with C1q polypeptide in the form of low-molecular weight (LMW) C1q. Patients with C1q deficiency mainly present with cutaneous and renal involvement. Although less frequent, neuropsychiatric (NP) involvement has also been reported in 20% of the C1q-deficient patients. This involvement appears to be absent in other deficiencies of early components of the complement classical pathway (CP) (C1r/C1s, C2, or C4 deficiencies). We describe a new case with C1q deficiency with a homozygous G34R mutation in C1qC-producing LMW-C1q presenting with a severe SLE flare with NP involvement. The serum of this patient contained very low levels of a LMW variant of C1q polypeptides. Cell lysates contained the three chains of C1q, but no intact C1q was detected, consistent with the hypothesis of the existence of a LMW-C1q. Furthermore, we provide a literature overview of NP-SLE in C1q deficiency and hypothesize about the potential role of C1q in the pathogenesis of NP involvement in these patients. The onset of NP-SLE in C1q-deficient individuals is more severe when compared with complement competent NP-SLE patients. An important number of cases present with seizures and the most frequent findings in neuroimaging are changes in basal ganglia and cerebral vasculitis. A defective CP, because of non-functional C1q, does not protect against NP involvement in SLE. The absence of C1q and, subsequently, some of its biological functions may be associated with more severe NP-SLE.
Collapse
Affiliation(s)
| | - César Magro-Checa
- Department of Rheumatology, Leiden University Medical Center , Leiden , Netherlands
| | - Jaap A Bakker
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center , Leiden , Netherlands
| | - Y K Onno Teng
- Department of Nephrology, Leiden University Medical Center , Leiden , Netherlands
| | - Ingeborg M Bajema
- Department of Pathology, Leiden University Medical Center , Leiden , Netherlands
| | - Tom W Huizinga
- Department of Rheumatology, Leiden University Medical Center , Leiden , Netherlands
| | | | - Leendert A Trouw
- Department of Rheumatology, Leiden University Medical Center , Leiden , Netherlands
| |
Collapse
|
18
|
Gomes RC, Silva MF, Kozu K, Bonfá E, Pereira RM, Terreri MT, Magalhães CS, Sacchetti SB, Marini R, Fraga M, Carvalho LM, Barbosa CM, Carneiro-Sampaio M, Silva CA. Features of 847 Childhood-Onset Systemic Lupus Erythematosus Patients in Three Age Groups at Diagnosis: A Brazilian Multicenter Study. Arthritis Care Res (Hoboken) 2016; 68:1736-1741. [PMID: 27014968 DOI: 10.1002/acr.22881] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/14/2016] [Accepted: 03/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate demographic data and clinical and laboratory features at disease diagnosis in 3 different age groups of childhood-onset systemic lupus erythematosus (SLE): group A, early-onset (<6 years); group B, school age (≥6 to <12 years); and group C, adolescent (≥12 to <18 years). METHODS This was a Brazilian multicenter cohort retrospective study in 10 pediatric rheumatology centers, including 847 childhood-onset SLE patients. RESULTS Patients were divided into 3 groups: group A with 39 patients (4%), group B with 395 patients (47%), and group C with 413 patients (49%). Of 39 childhood-onset SLE patients in group A, 3 (8%) were ages <2 years, 4 (10%) were ≥2 to <3 years, and 32 (82%) were ≥3 and <6 years. A total of 74 childhood-onset SLE patients were analyzed for C1q levels, and complete C1q deficiency was observed in 3 of 74 patients (4%), all in group A. Groups were similar regarding high frequencies of female sex, nephritis, neuropsychiatric involvement, Systemic Lupus Erythematosus Disease Activity Index 2000 score ≥8, autoantibody profile, elevated acute phase proteins, and low complement levels (P > 0.05). However, the frequency of fever (78% versus 61% versus 47%; P < 0.0001), hepatomegaly (42% versus 29% versus 14%; P < 0.0001), splenomegaly (28% versus 12% versus 4%; P < 0.0001), and discoid lupus (13% versus 4% versus 4%; P = 0.020) was significantly higher in group A compared to groups B and C. The frequency of weight loss >2 kg (19% versus 28% versus 36%; P = 0.017), photosensitivity (34% versus 41% versus 51%; P = 0.006), leukopenia <4,000/mm3 (14% versus 25% versus 30%; P = 0.048), and lymphopenia <1,500/mm3 (22% versus 41% versus 47%; P = 0.011) was significantly lower in group A. CONCLUSION Our large multicenter study identified the finding that the initial appearance of childhood-onset SLE is characterized by comparable high frequency of internal organ involvement and some distinct clinical and laboratory features in early-onset and adolescent groups.
Collapse
Affiliation(s)
- Roberta C Gomes
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marco F Silva
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Katia Kozu
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfá
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa M Pereira
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Roberto Marini
- State University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Melissa Fraga
- Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Clovis A Silva
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
| |
Collapse
|
19
|
Silva MF, Ferriani MP, Terreri MT, Pereira RM, Magalhães CS, Bonfá E, Campos LM, Okuda EM, Appenzeller S, Ferriani VP, Barbosa CM, Ramos VC, Lotufo S, Silva CA. A Multicenter Study of Invasive Fungal Infections in Patients with Childhood-onset Systemic Lupus Erythematosus. J Rheumatol 2016; 42:2296-303. [PMID: 26568586 DOI: 10.3899/jrheum.150142] [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: 12/29/2022]
Abstract
OBJECTIVE To study the prevalence, risk factors, and mortality of invasive fungal infections (IFI) in patients with childhood-onset systemic lupus erythematosus (cSLE). METHODS A retrospective multicenter cohort study was performed in 852 patients with cSLE from 10 pediatric rheumatology services. An investigator meeting was held and all participants received database training. IFI were diagnosed according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group criteria (proven, probable, and possible). Also evaluated were demographic, clinical, and laboratory data, and disease activity [SLE Disease Activity Index 2000 (SLEDAI-2K)], cumulative damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), treatment, and outcomes. RESULTS IFI were observed in 33/852 patients (3.9%) with cSLE. Proven IFI was diagnosed in 22 patients with cSLE, probable IFI in 5, and possible IFI in 6. Types of IFI were candidiasis (20), aspergillosis (9), cryptococcosis (2), and 1 each disseminated histoplasmosis and paracoccidioidomycosis. The median of disease duration was lower (1.0 vs 4.7 yrs, p < 0.0001) with a higher current SLEDAI-2K [19.5 (0-44) vs 2 (0-45), p < 0.0001] and current prednisone (PRED) dose [50 (10-60) vs 10 (2-90) mg/day, p < 0.0001] in patients with IFI compared with those without IFI. The frequency of death was higher in the former group (51% vs 6%, p < 0.0001). Logistic regression analysis revealed that SLEDAI-2K (OR 1.108, 95% CI 1.057-1.163, p < 0.0001), current PRED dose (OR 1.046, 95% CI 1.021-1.071, p < 0.0001), and disease duration (OR 0.984, 95% CI 0.969-0.998, p = 0.030) were independent risk factors for IFI (R(2) Nagelkerke 0.425). CONCLUSION To our knowledge, this is the first study to characterize IFI in patients with cSLE. We identified that disease activity and current glucocorticoid use were the main risk factors for these life-threatening infections, mainly in the first years of disease course, with a high rate of fatal outcome.
Collapse
Affiliation(s)
- Marco F Silva
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Mariana P Ferriani
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Maria T Terreri
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Rosa M Pereira
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Claudia S Magalhães
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Eloisa Bonfá
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Lucia M Campos
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Eunice M Okuda
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Simone Appenzeller
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Virgínia P Ferriani
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Cássia M Barbosa
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Valéria C Ramos
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Simone Lotufo
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo
| | - Clovis A Silva
- From the Pediatric Rheumatology Unit, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; Pediatric Rheumatology Unit, Universidade Federal de São Paulo; Faculdade de Medicina de Botucatu, São Paulo State University; Irmandade da Santa Casa de Misericórdia de São Paulo; State University of Campinas; Ribeirão Preto Medical School, University of São Paulo; Hospital Infantil Darcy Vargas; Pontifical Catholic University of Sorocaba; Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil.M.F. Silva, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.P. Ferriani, MD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; M.T. Terreri, MD, PhD, Pediatric Rheumatology Unit, Universidade Federal de São Paulo; R.M. Pereira, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; C.S. Magalhães, MD, PhD, Faculdade de Medicina de Botucatu, São Paulo State University; E. Bonfá, MD, PhD, Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; L.M. Campos, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo; E.M. Okuda, MD, PhD, Irmandade da Santa Casa de Misericórdia de São Paulo; S. Appenzeller, MD, PhD, State University of Campinas; V.P. Ferriani, MD, PhD, Ribeirão Preto Medical School, University of São Paulo; C.M. Barbosa, MD, PhD, Hospital Infantil Darcy Vargas; V.C. Ramos, MD, Pontifical Catholic University of Sorocaba; S. Lotufo, MD, Hospital Municipal Infantil Menino Jesus; C.A. Silva, MD, PhD, Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo.
| |
Collapse
|
20
|
Rivas-Larrauri F, Yamazaki-Nakashimada MA. Lupus eritematoso sistémico: ¿es una sola enfermedad? ACTA ACUST UNITED AC 2016; 12:274-81. [DOI: 10.1016/j.reuma.2016.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/21/2015] [Accepted: 01/08/2016] [Indexed: 01/01/2023]
|
21
|
Perazzio SF, Granados Á, Salomão R, Silva NP, Carneiro-Sampaio M, Andrade LEC. High frequency of immunodeficiency-like states in systemic lupus erythematosus: a cross-sectional study in 300 consecutive patients. Rheumatology (Oxford) 2016; 55:1647-55. [DOI: 10.1093/rheumatology/kew227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Indexed: 12/29/2022] Open
|
22
|
Dimitriades VR, Sorensen R. Rheumatologic manifestations of primary immunodeficiency diseases. Clin Rheumatol 2016; 35:843-50. [PMID: 26971790 DOI: 10.1007/s10067-016-3229-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 12/16/2022]
Abstract
In the last 5 years, several hundred articles have been published concerning the link between primary immunodeficiency disease (PID) and rheumatologic diseases. Although rheumatologic complications were originally thought to be at the opposite ends of the spectrum of immunopathologic manifestations, they are now all being considered secondary manifestations of a causative primary "immune derangement." For the rheumatologist, it is important to be able to identify patients who may present with typical rheumatologic findings but who have an underlying PID. In a systematic manner, this overview addresses both the systemic and organ-based rheumatologic diseases which have known associations with primary immunodeficiencies, and explores how immunodeficiency may actually cause these clinical manifestations.
Collapse
Affiliation(s)
- V R Dimitriades
- Department of Pediatrics, Division of Allergy/Immunology, Louisiana State University Health Sciences Center, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA. .,Department of Pediatrics, Division of Rheumatology, Louisiana State University Health Sciences Center, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA.
| | - R Sorensen
- Department of Pediatrics, Division of Allergy/Immunology, Louisiana State University Health Sciences Center, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA.,Faculty of Medicine, University of La Frontera, Francisco Salazar 1145, Temuco, Chile
| |
Collapse
|
23
|
Macedo ACL, Isaac L. Systemic Lupus Erythematosus and Deficiencies of Early Components of the Complement Classical Pathway. Front Immunol 2016; 7:55. [PMID: 26941740 PMCID: PMC4764694 DOI: 10.3389/fimmu.2016.00055] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/05/2016] [Indexed: 12/24/2022] Open
Abstract
The complement system plays an important role in the innate and acquired immune response against pathogens. It consists of more than 30 proteins found in soluble form or attached to cell membranes. Most complement proteins circulate in inactive forms and can be sequentially activated by the classical, alternative, or lectin pathways. Biological functions, such as opsonization, removal of apoptotic cells, adjuvant function, activation of B lymphocytes, degranulation of mast cells and basophils, and solubilization and clearance of immune complex and cell lysis, are dependent on complement activation. Although the activation of the complement system is important to avoid infections, it also can contribute to the inflammatory response triggered by immune complex deposition in tissues in autoimmune diseases. Paradoxically, the deficiency of early complement proteins from the classical pathway (CP) is strongly associated with development of systemic lupus erythematous (SLE) - mainly C1q deficiency (93%) and C4 deficiency (75%). The aim of this review is to focus on the deficiencies of early components of the CP (C1q, C1r, C1s, C4, and C2) proteins in SLE patients.
Collapse
Affiliation(s)
- Ana Catarina Lunz Macedo
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Faculty of Medicine, Children's Hospital, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Lourdes Isaac
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo , São Paulo , Brazil
| |
Collapse
|
24
|
Pereira KMC, Faria AGA, Liphaus BL, Jesus AA, Silva CA, Carneiro-Sampaio M, Andrade LEC. Low C4, C4A and C4B gene copy numbers are stronger risk factors for juvenile-onset than for adult-onset systemic lupus erythematosus. Rheumatology (Oxford) 2016; 55:869-73. [PMID: 26800705 DOI: 10.1093/rheumatology/kev436] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Complete deficiency of Complement C4 component is a strong genetic risk factor for SLE. C4 is encoded by two different genes, C4A and C4B, which show considerable gene copy number (GCN) variation. This study investigates the association of total C4, C4A and C4B GCN with JSLE. METHODS Ninety JSLE patients, 170 adult-onset SLE (aSLE) patients and 200 healthy individuals were evaluated for C4A and C4B GCN by quantitative real-time PCR. RESULTS JSLE patients had lower GCN for C4A (mean = 1.7; 95% CI: 1.5, 1.9) and C4B (mean = 1.5; 95% CI: 1.3, 1.6) compared with healthy individuals (mean C4A = 2.3; 95% CI: 2.2, 2.5, P < 0.001; C4B = 2.0; 95% CI: 1.8, 2.1; P < 0.001) or with aSLE patients (mean C4A = 1.9; 95% CI: 1.8, 2.1, P = 0.006; mean C4B = 1.8; 95% CI: 1.7, 1.9, P < 0.001). Low total C4 GCN (<4 copies) was more frequent in JSLE than in healthy individuals (59% vs 28%; P < 0.001). The same was observed for low C4A (⩽1 copy) (52% vs 18%; P < 0.001) and for low C4B (60% vs 31%; P < 0.001). JSLE had a stronger association with low total C4 (OR = 3.68, 95% CI: 2.19, 6.20), C4A (OR = 4.98, 95% CI: 2.88, 8.62) and C4B (OR = 3.26; 95% CI: 1.95, 5.47) than aSLE (C4 OR = 2.03; 95% CI: 1.32, 3.13; C4A OR = 2.36; 95% CI: 1.46, 3.81; C4B OR = 1.13; 95% CI: 0.73, 1.74). In addition, pericarditis in JSLE patients was associated with low C4 (OR = 4.13; 95% CI: 1.02, 16.68; P = 0.047) and low C4A (OR = 5.54; 95% CI: 1.37, 22.32; P = 0.016). CONCLUSION Low total C4, C4A and C4B GCN were associated with a stronger risk for developing JSLE than aSLE. Additionally, low total C4 and C4A GCN are risk factors for pericarditis in JSLE.
Collapse
Affiliation(s)
- Kaline M C Pereira
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Atila G A Faria
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | | | | | - Clovis A Silva
- Children's Hospital and Department of Pediatrics, Disciplina de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Luis E C Andrade
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo,
| |
Collapse
|
25
|
Associação de imunodeficiência primária com lúpus eritematoso sistêmico: revisão da literatura e as lições aprendidas pela Divisão de Reumatologia de um hospital universitário terciário em São Paulo. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2015.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
26
|
Silva CA, Aikawa NE, Pereira RMR, Campos LMA. Management considerations for childhood-onset systemic lupus erythematosus patients and implications on therapy. Expert Rev Clin Immunol 2015; 12:301-13. [DOI: 10.1586/1744666x.2016.1123621] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Clovis Artur Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nadia Emi Aikawa
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | |
Collapse
|
27
|
Spârchez M, Lupan I, Delean D, Bizo A, Damian L, Muntean L, Tămaș MM, Bolba C, Simionescu B, Slăvescu C, Felea I, Lazăr C, Spârchez Z, Rednic S. Primary complement and antibody deficiencies in autoimmune rheumatologic diseases with juvenile onset: a prospective study at two centers. Pediatr Rheumatol Online J 2015; 13:51. [PMID: 26590091 PMCID: PMC4654875 DOI: 10.1186/s12969-015-0050-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim was to investigate the prevalence and clinical relevance of inherited complement and antibody deficiency states in a large series of patients with various autoimmune rheumatologic diseases (ARD) with juvenile onset. METHODS A total number of 117 consecutive patients from 2 tertiary referral hospitals were included in the study. All patients underwent genetic screening for type I C2 deficiency and C4 allotyping. Serum levels of immunoglobulin classes measured systematically throughout their regular medical care were recorded retrospectively. RESULTS Our cohort of patients included 84 with juvenile idiopathic arthritis (JIA), 21 with systemic lupus erythematosus (SLE), 6 with systemic vasculitis, 2 with juvenile scleroderma, 2 with idiopathic uveitis, 1 with mixed connective tissue disease and 1 with SLE/scleroderma overlap syndrome. We have found 16 patients with evidence of primary immunodeficiency in our series (13.7%), including 7 with C4 deficiency, 5 with selective IgA deficiency, 3 with C2 deficiency and 2 with unclassified hypogammaglobulinemia (one also presented C4D). Of the 84 patients with JIA, 4 (4.8%) had a complement deficiency, which was less prevalent than in the SLE cohort (23.8%), but all of them have exhibited an aggressive disease. Most of our patients with primary antibody deficiencies showed a more complicated and severe disease course and even the co-occurrence of two associated autoimmune diseases (SLE/scleroderma overlap syndrome and SLE/autoimmune hepatitis type 1 overlap). CONCLUSIONS Our findings among others demonstrate that complement and immunoglobulin immunodeficiencies need careful consideration in patients with ARD, as they are common and might contribute to a more severe clinical course of the disease.
Collapse
Affiliation(s)
- Mihaela Spârchez
- 2nd Department of Paediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 3-5 Crisan Street, Cluj-Napoca, 400177, Romania. .,Emergency Children's Hospital, Cluj-Napoca, Romania.
| | - Iulia Lupan
- Molecular Biology Center, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babes-Bolyai University Cluj-Napoca, Cluj-Napoca, Romania
| | - Dan Delean
- Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Aurel Bizo
- 2nd Department of Paediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 3-5 Crisan Street, Cluj-Napoca, 400177 Romania ,Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Laura Damian
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Laura Muntean
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania ,Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Magdalena Tămaș
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania ,Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Bianca Simionescu
- 2nd Department of Paediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 3-5 Crisan Street, Cluj-Napoca, 400177 Romania ,Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Cristina Slăvescu
- 2nd Department of Paediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 3-5 Crisan Street, Cluj-Napoca, 400177 Romania ,Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Ioana Felea
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Călin Lazăr
- Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Zeno Spârchez
- 3rd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Rednic
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania ,Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
28
|
Clinical presentation of human C1q deficiency: How much of a lupus? Mol Immunol 2015; 67:3-11. [DOI: 10.1016/j.molimm.2015.03.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/05/2015] [Accepted: 03/05/2015] [Indexed: 11/20/2022]
|
29
|
Errante PR, Perazzio SF, Frazão JB, da Silva NP, Andrade LEC. Primary immunodeficiency association with systemic lupus erythematosus: review of literature and lessons learned by the Rheumatology Division of a tertiary university hospital at São Paulo, Brazil. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 56:58-68. [PMID: 27267335 DOI: 10.1016/j.rbre.2015.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/08/2015] [Indexed: 01/02/2023] Open
Abstract
Primary immunodeficiency disorders (PID) represent a heterogeneous group of diseases resulting from inherited defects in the development, maturation and normal function of immune cells; thus, turning individuals susceptible to recurrent infections, allergy, autoimmunity, and malignancies. In this retrospective study, autoimmune diseases (AIDs), in special systemic lupus erythematosus (SLE) which arose associated to the course of PID, are described. Classically, the literature describes three groups of PID associated with SLE: (1) deficiency of Complement pathway components, (2) defects in immunoglobulin synthesis, and (3) chronic granulomatous disease (CGD). Currently, other PID have been described with clinical manifestation of SLE, such as Wiskott-Aldrich syndrome (WAS), autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED), autoimmune lymphoproliferative syndrome (ALPS) and idiopathic CD4(+) lymphocytopenia. Also we present findings from an adult cohort from the outpatient clinic of the Rheumatology Division of Universidade Federal de São Paulo. The PID manifestations found by our study group were considered mild in terms of severity of infections and mortality in early life. Thus, it is possible that some immunodeficiency states are compatible with survival regarding infectious susceptibility; however these states might represent a strong predisposing factor for the development of immune disorders like those observed in SLE.
Collapse
Affiliation(s)
- Paolo Ruggero Errante
- Department of Immunology, Institute of Biomedical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil; Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandro Félix Perazzio
- Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Josias Brito Frazão
- Department of Immunology, Institute of Biomedical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Neusa Pereira da Silva
- Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | |
Collapse
|
30
|
Carneiro-Sampaio M, Coutinho A. Early-onset autoimmune disease as a manifestation of primary immunodeficiency. Front Immunol 2015; 6:185. [PMID: 25999944 PMCID: PMC4419659 DOI: 10.3389/fimmu.2015.00185] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/03/2015] [Indexed: 01/09/2023] Open
Abstract
Autoimmune disorders (AID) have been increasingly observed in association with primary immunodeficiencies (PIDs). Here, we discuss the interface between PID and AID, focusing on autoimmune manifestations early in life, which can be diagnostic clues for underlying PIDs. Inflammatory bowel disease in infants and children has been associated with IL-10 and IL-10R deficiencies, chronic granulomatous disease, immunedysregulation-polyendocrinopathy-enteropathy-X-linked syndrome (IPEX), autoinflammatory disorders, and others. Some PIDs have been identified as underlying defects in juvenile systemic lupus erythematosus: C1q-, IgA-, IgM deficiencies, alterations of the IFN-α pathway (in Aicardi–Goutières syndrome due to TREX1 mutation). IPEX (due to FOXP3 mutation leading to Treg cell deficiency), usually appearing in the first months of life, was recently observed in miscarried fetuses with hydrops who presented with CD3+ infiltrating lymphocytes in the pancreas. Hemophagocytic lymphohistiocytosis due to perforin deficiency was also identified as a cause of fetal hydrops. In conclusion, PID should be suspected in any infant with signs of autoimmunity after excluding transferred maternal effects, or in children with multiple and/or severe AID.
Collapse
Affiliation(s)
- Magda Carneiro-Sampaio
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | | |
Collapse
|
31
|
Maharaj SS, Chang SM. Cardiac tamponade as the initial presentation of systemic lupus erythematosus: a case report and review of the literature. Pediatr Rheumatol Online J 2015; 13:9. [PMID: 25802493 PMCID: PMC4369869 DOI: 10.1186/s12969-015-0005-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/07/2015] [Indexed: 11/10/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve any organ system, exhibiting great diversity in presentation. Cardiac tamponade as the initial presentation of childhood onset SLE (cSLE) is rare. We report the case of a 10 year old Afro-Caribbean female who presented with complaints of chest pain, shortness of breath and fever over 4 days. Clinical examination strongly suggested cardiac tamponade which was confirmed by investigations and treated with pericardiocentesis. After a thorough investigation, the underlying diagnosis of SLE was confirmed using the Systemic Lupus International Collaborating Clinics (SLICC) criteria and high dose corticosteroid therapy initiated. A review of recent studies shows that common initial presentations of cSLE include constitutional symptoms, renal disease, musculoskeletal and cutaneous involvement. In presenting this case and reviewing the literature we emphasize the importance of cSLE as a differential diagnosis when presented with pericarditis in the presence or absence of cardiac tamponade. In these patients early diagnosis and treatment is desired and in this regard we also discuss the sensitivity of the SLICC criteria in cSLE.
Collapse
Affiliation(s)
- Satish S Maharaj
- Eric Williams Medical Sciences Complex, The University of the West Indies, Champs Fleurs, Trinidad and Tobago
| | - Simone M Chang
- Eric Williams Medical Sciences Complex, The University of the West Indies, Champs Fleurs, Trinidad and Tobago
| |
Collapse
|
32
|
Liphaus BL, Umetsu N, Jesus AA, Bando SY, Silva CA, Carneiro-Sampaio M. Molecular characterization of the complement C1q, C2 and C4 genes in Brazilian patients with juvenile systemic lupus erythematosus. Clinics (Sao Paulo) 2015; 70:220-7. [PMID: 26017655 PMCID: PMC4449463 DOI: 10.6061/clinics/2015(03)12] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/05/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To perform a molecular characterization of the C1q, C2 and C4 genes in patients with juvenile systemic lupus erythematosus. METHODS Patient 1 (P1) had undetectable C1q, patient 2 (P2) and patient 3 (P3) had decreased C2 and patient 4 (P4) had decreased C4 levels. All exons and non-coding regions of the C1q and C2 genes were sequenced. Mononuclear cells were cultured and stimulated with interferon gamma to evaluate C1q, C2 and C4 mRNA expression by quantitative real-time polymerase chain reaction. RESULTS C1q sequencing revealed heterozygous silent mutations in the A (c.276 A>G Gly) and C (c.126 C>T Pro) chains, as well as a homozygous single-base change in the 3' non-coding region of the B chain (c*78 A>G). C1qA mRNA expression without interferon was decreased compared with that of healthy controls (p<0.05) and was decreased after stimulation compared with that of non-treated cells. C1qB mRNA expression was decreased compared with that of controls and did not change with stimulation. C1qC mRNA expression was increased compared with that of controls and was even higher after stimulation. P2 and P3 had Type I C2 deficiency (heterozygous 28 bp deletion at exon 6). The C2 mRNA expression in P3 was 23 times lower compared with that of controls and did not change after stimulation. The C4B mRNA expression of P4 was decreased compared with that of controls and increased after stimulation. CONCLUSIONS Silent mutations and single-base changes in the 3' non-coding regions may modify mRNA transcription and C1q production. Type I C2 deficiency should be evaluated in JSLE patients with decreased C2 serum levels. Further studies are needed to clarify the role of decreased C4B mRNA expression in JSLE pathogenesis.
Collapse
Affiliation(s)
- Bernadete L Liphaus
- Laboratório de Investigação Médica 36, Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Natalia Umetsu
- Laboratório de Investigação Médica 36, Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriana A Jesus
- Unidade de Reumatologia, Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia Y Bando
- Laboratório de Investigação Médica 36, Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clovis A Silva
- Unidade de Reumatologia, Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Magda Carneiro-Sampaio
- Laboratório de Investigação Médica 36, Instituto da Criança, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
33
|
Fahl K, Silva CA, Pastorino AC, Carneiro-Sampaio M, Jacob CMA. [Autoimmune diseases and autoantibodies in pediatric patients and their first-degree relatives with immunoglobulin A deficiency]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:197-202. [PMID: 25582995 DOI: 10.1016/j.rbr.2014.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 08/01/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Clinical manifestations of Immunoglobulin A Deficiency (IgAD) include recurrent infections, atopy and autoimmune diseases. However, to our knowledge, the concomitant evaluations of autoimmune diseases and autoantibodies in a cohort of IgAD patients with current age > 10 years-old and their relatives have not been assessed. OBJECTIVES To evaluate autoimmune diseases and the presence of autoantibodies in IgAD patients and their first-degree relatives. METHODS A cross-sectional study was performed in 34 IgAD patients (current age > 10 years-old) and their first-degree relatives. All of them were followed at a tertiary Brazilian primary immunodeficiency center: 27 children/adolescents and 7 of their first-degree relatives with a late diagnosis of IgAD. Autoimmune diseases and autoantibodies (antinuclear antibodies, rheumatoid factor, and anti-thyroglobulin, anti-thyroperoxidase and IgA class anti-endomysial antibodies) were also assessed. RESULTS Autoimmune diseases (n=14) and/or autoantibodies (n=10, four of them with isolated autoantibodies) were observed in 18/34 (53%) of the patients and their relatives. The most common autoimmune diseases found were thyroiditis (18%), chronic arthritis (12%) and celiac disease (6%). The most frequent autoantibodies were antinuclear antibodies (2%), anti-thyroglobulin and/or anti-thyroperoxidase (24%). No significant differences were observed in the female gender, age at diagnosis and current age in IgAD patients with and without autoimmune diseases and/or presence of autoantibodies (p>0.05). The frequencies of primary immunodeficiency's in family, autoimmunity in family, atopy and recurrent infections were similar in both groups (p>0.05). CONCLUSION Autoimmune diseases and autoantibodies were observed in IgAD patients during follow-up, reinforcing the necessity of a rigorous and continuous follow-up during adolescence and adulthood.
Collapse
Affiliation(s)
- Kristine Fahl
- Unidade de Alergia Pediátrica e Imunologia, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Clovis A Silva
- Unidade de Reumatologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil; Divisão de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Antonio C Pastorino
- Unidade de Alergia Pediátrica e Imunologia, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Magda Carneiro-Sampaio
- Unidade de Alergia Pediátrica e Imunologia, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Cristina M A Jacob
- Unidade de Alergia Pediátrica e Imunologia, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
| |
Collapse
|
34
|
Costa-Carvalho BT, Grumach AS, Franco JL, Espinosa-Rosales FJ, Leiva LE, King A, Porras O, Bezrodnik L, Oleastro M, Sorensen RU, Condino-Neto A. Attending to warning signs of primary immunodeficiency diseases across the range of clinical practice. J Clin Immunol 2013; 34:10-22. [PMID: 24241582 PMCID: PMC3930833 DOI: 10.1007/s10875-013-9954-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 10/14/2013] [Indexed: 11/23/2022]
Abstract
Purpose Patients with primary immunodeficiency diseases (PIDD) may present with recurrent infections affecting different organs, organ-specific inflammation/autoimmunity, and also increased cancer risk, particularly hematopoietic malignancies. The diversity of PIDD and the wide age range over which these clinical occurrences become apparent often make the identification of patients difficult for physicians other than immunologists. The aim of this report is to develop a tool for educative programs targeted to specialists and applied by clinical immunologists. Methods Considering the data from national surveys and clinical reports of experiences with specific PIDD patients, an evidence-based list of symptoms, signs, and corresponding laboratory tests were elaborated to help physicians other than immunologists look for PIDD. Results Tables including main clinical manifestations, restricted immunological evaluation, and possible related diagnosis were organized for general practitioners and 5 specialties. Tables include information on specific warning signs of PIDD for pulmonologists, gastroenterologists, dermatologists, hematologists, and infectious disease specialists. Conclusions This report provides clinical immunologists with an instrument they can use to introduce specialists in other areas of medicine to the warning signs of PIDD and increase early diagnosis. Educational programs should be developed attending the needs of each specialty.
Collapse
Affiliation(s)
- Beatriz Tavares Costa-Carvalho
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo (UNIFESP-EPM), 725 Otonis Street, São Paulo, SP, 04025-002, Brazil,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Lim E, Tao Y, White AJ, French AR, Cooper MA. Hypogammaglobulinemia in pediatric systemic lupus erythematosus. Lupus 2013; 22:1382-7. [PMID: 24106215 DOI: 10.1177/0961203313507990] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a systemic autoimmune disease typically associated with elevated serum immunoglobulin G (IgG). Hypogammaglobulinemia in SLE patients has been attributed to immunosuppressive treatment or a transient effect associated with nephrotic syndrome. We retrospectively reviewed pediatric SLE patients from a single institution to identify patients with hypogammaglobulinemia and risk factors for hypogammaglobulinemia. METHODS A total of 116 pediatric SLE cases from 1997 to 2011 were reviewed and patients with hypogammaglobulinemia (IgG < 500 mg/dl) were identified. The two cohorts were evaluated for association with age, sex, presence of lupus nephritis at SLE diagnosis, disease activity at diagnosis, initial IgG level, and drug treatment. RESULTS Eighty-six patients were included in our study, with a median age of 15 years and a median follow-up of 39.5 months. Seven percent (six of 86) of patients had hypogammaglobulinemia with a median onset of 27 months (0-72 months) after SLE diagnosis. Significant associations were noted for white race (p value 0.029), male sex (p value 0.009), and the presence of lupus nephritis at SLE diagnosis (p value 0.004). Use of immunosuppressive treatment did not show a statistical association with hypogammaglobulinemia, although two of the patients with hypogammaglobulinemia did receive rituximab. Most patients with hypogammaglobulinemia received intravenous immunoglobulin (IVIG) replacement therapy because of infections and/or concern for infection. CONCLUSION Measurement of immunoglobulin levels during treatment in SLE could help identify patients with hypogammaglobulinemia who might require more aggressive follow-up to monitor for increased risk of infection and need for IVIG treatment. A prospective study is needed to validate associated risk factors identified in this study.
Collapse
Affiliation(s)
- E Lim
- 1Department of Pediatrics, Division of Rheumatology, Washington University School of Medicine, MO, USA; and
| | | | | | | | | |
Collapse
|
36
|
Pediatric Immunological Disorders Biorepository (PIDBioRep) at University of São Paulo Medical School, Brazil. Biopreserv Biobank 2013; 11:324-6. [DOI: 10.1089/bio.2013.1153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
|
37
|
Liphaus BL, Kiss MHB, Carrasco S, Goldenstein-Schainberg C. Reduced expressions of Fas and Bcl-2 proteins in CD14+ monocytes and normal CD14 soluble levels in juvenile systemic lupus erythematosus. Lupus 2013; 22:940-7. [DOI: 10.1177/0961203313496300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In order to evaluate Fas and Bcl-2 expressions in CD14+ monocytes, to measure soluble CD14 serum levels and to analyze the relationships with lupus nephritis and disease activity, we enrolled 41 patients with juvenile systemic lupus erythematosus (JSLE) and 27 healthy volunteers. Disease activity was determined by SLEDAI score. Peripheral monocytes were stained for CD14, Fas and Bcl-2 molecules, and cellular expressions were determined by flow cytometry. Soluble CD14 levels were measured by a quantitative ELISA kit. JSLE patients, those with active disease and those with nephritis, presented significantly reduced expressions of Fas and Bcl-2 proteins in CD14+ monocytes compared with healthy controls. Significant inverse correlations between percentages of CD14+Fas+ cells, SLEDAI score and anti-dsDNA antibodies were observed. JSLE patients had soluble CD14 levels similar to controls, although sCD14 levels positively correlated with ESR, but not with SLEDAI score. JSLE patients with nephritis also presented sCD14 levels similar to controls. In conclusion, the reduced expressions of Fas and Bcl-2 proteins in CD14+ monocytes from JSLE patients depict that monocyte apoptotic mechanisms may be important in lupus pathogenesis.
Collapse
Affiliation(s)
| | | | - S Carrasco
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | | |
Collapse
|
38
|
Silva CA, Avcin T, Brunner HI. Taxonomy for systemic lupus erythematosus with onset before adulthood. Arthritis Care Res (Hoboken) 2013; 64:1787-93. [PMID: 22730317 DOI: 10.1002/acr.21757] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/29/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To propose a common nomenclature to refer to individuals who fulfill the American College of Rheumatology classification criteria for systemic lupus erythematosus (SLE) during childhood or adolescence. METHODS The medical literature was reviewed for studies conducted in the target population between 1960 and December 2011 to obtain information about the terms used to refer to such children and adolescents. We reviewed the threshold ages used and disease features considered to discriminate these individuals from patients with onset of SLE during adulthood. Furthermore, the nomenclature used in other chronic diseases with onset during both childhood and adulthood was assessed. RESULTS There was an astonishing variability in the age cutoffs used to define SLE onset prior to adulthood, ranging from 14-21 years, but most studies used age 18 years. The principal synonyms in the medical literature were SLE without reference to the age at onset of disease, childhood-onset SLE, juvenile SLE, and pediatric (or paediatric) SLE. CONCLUSION Based on the definition of childhood, in analogy with other complex chronic diseases commencing prior to adulthood, and given the current absence of definite genetic variations that discriminate adults from children, the term childhood-onset SLE is proposed when referring to individuals with onset of SLE prior to age 18 years.
Collapse
|
39
|
Primary immunodeficiency diseases in different age groups: a report on 1,008 cases from a single Brazilian reference center. J Clin Immunol 2013; 33:716-24. [PMID: 23354909 DOI: 10.1007/s10875-013-9865-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/07/2013] [Indexed: 01/22/2023]
Abstract
Primary immunodeficiencies (PIDs) represent a large group of diseases that affect all age groups. Although PIDs have been recognized as rare diseases, there is epidemiological evidence suggesting that their real prevalence has been underestimated. We performed an evaluation of a series of 1,008 infants, children, adolescents and adults with well-defined PIDs from a single Brazilian center, regarding age at diagnosis, gender and PID category according to the International Union of Immunological Societies classification. Antibody deficiencies were the most common category in the whole series (61 %) for all age groups, with the exception of <2-year-old patients (only 15 %). In the >30-year-old group, antibody deficiencies comprised 84 % of the diagnoses, mostly consisting of common variable immunodeficiency, IgA deficiency and IgM deficiency. Combined immunodeficiencies represented the most frequent category in <2-years-old patients. Most congenital defects of phagocytes were identified in patients <5 -years of age, as were the diseases of immune dysregulation, with the exception of APECED. DiGeorge syndrome and ataxia-telangiectasia were the most frequent entities in the category of well-defined syndromes, which were mostly identified in patients <10-years of age. Males represented three-quarters and two-thirds of <2 -years-old and 2-5-years -old patients, respectively, whereas females predominated among the >30-year-old patients. Our data indicated that some PIDs were only detected at early ages, likely because affected patients do not survive long. In addition, our data pointed out that different strategies should be used to search for PIDs in infants and young children as compared to older patients.
Collapse
|
40
|
Ornstein BW, Atkinson JP, Densen P. The complement system in pediatric systemic lupus erythematosus, atypical hemolytic uremic syndrome, and complocentric membranoglomerulopathies. Curr Opin Rheumatol 2013; 24:522-9. [PMID: 22810363 DOI: 10.1097/bor.0b013e328356896b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the recent advances in complement biology and the evolving understanding of these contributions to the pathophysiology and treatment of predominantly pediatric disease syndromes. RECENT FINDINGS Identification of lupus patients with complete deficiencies of one of the plasma complement proteins enabled the field to move beyond the notion of complement as a laboratory curiosity. Clinical investigation of the manifestations observed in deficient patients has further defined the biology of the system in normal individuals. Definition of the assembly of the C3 convertases, particularly that of the alternative pathway and its regulation, has led to the appreciation that the complement system includes membrane inhibitors that are every bit as important as those in plasma. The exploration of disease states in which significant complement deposition occurs has moved the field away from consideration of this finding as a bystander effect. Dissection of these syndromes has led to the unanticipated finding of a central role for function-altering mutations in the complement proteins that form or regulate the alternative pathway C3 convertase and has opened the door to new therapeutic approaches. The disease states discussed in the review - pediatric systemic lupus erythematosus, atypical hemolytic uremic syndrome, and the complocentric membranoglomerulopathies - illustrate this evolutionary history of complement biology. SUMMARY This review emphasizes that both the lack of classical pathway complement activation and excessive activation of the alternative pathway contribute to distinct disease pathogenesis, and emphasizes the critical importance of homeostatic regulation, in both plasma and in tissues, of the system as a whole.
Collapse
Affiliation(s)
- Bradley W Ornstein
- Division of Infectious Diseases and Rheumatology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | | | | |
Collapse
|
41
|
Carneiro-Sampaio M, Coutinho A. Interface of autoimmunity and immunodeficiency. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
42
|
|
43
|
Current World Literature. Curr Opin Allergy Clin Immunol 2012; 12:670-5. [DOI: 10.1097/aci.0b013e32835af232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Perazzio SF, Salomão R, Silva NP, Andrade LEC. Increased neutrophil oxidative burst metabolism in systemic lupus erythematosus. Lupus 2012; 21:1543-51. [PMID: 23012249 DOI: 10.1177/0961203312461060] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There is increased frequency of discoid lesions (2.7%) and SLE (0.5%) in patients with chronic granulomatosus disease, but the literature is still controversial about phagocyte oxidative burst in SLE patients. MATERIALS AND METHODS 300 SLE patients and 301 blood donors were evaluated for quantitation of the oxidative burst in phagocytes by flow cytometry based on the oxidation of 2,7-dichlorofluorescein-diacetate after stimuli with Staphylococcus aureus and Pseudomonas aeruginosa. RESULTS Neutrophils from SLE patients displayed higher basal reactive oxygen species (ROS) production than healthy controls [Mean of fluorescence intensity (MFI) = 53.77 ± 11.38 vs 15.08 ± 2.63, p < 0.001] and after stimulation with S. aureus (MFI = 355.46 ± 58.55 vs 151.92 ± 28.25, p < 0.001) or P. aeruginosa (MFI = 82.53 ± 10.1 vs 48.99 ± 6.74, p < 0.001). There was stronger neutrophil response after bacterial stimuli (ΔMFI) in SLE patients than in healthy controls (S. aureus = 301.69 ± 54.42 vs 118.38 ± 26.03, p < 0.001; P. aeruginosa = 28.76 ± 12.3 vs 15.45 ± 5.15, p < 0.001), but no difference with respect to the oxidative burst profile according to disease activity (SLEDAI ≥ 6) or severity (SLICC-DI ≥2). Patients with kidney involvement presented higher basal and stimulated ROS production in neutrophils. DISCUSSION The present findings corroborate the important role of innate immunity in SLE and implicate neutrophils in the pathophysiology of the disease.
Collapse
Affiliation(s)
- S F Perazzio
- Division of Rheumatology, UNIFESP/EPM, São Paulo, Brazil
| | | | | | | |
Collapse
|
45
|
Martínez-Martínez MU, Herrera-Van Oostdam D, Román-Acosta S, Magaña-Aquino M, Baranda-Cándido L, Abud-Mendoza C. Invasive fungal infections in patients with systemic lupus erythematosus. J Rheumatol 2012; 39:1814-8. [PMID: 22707608 DOI: 10.3899/jrheum.111498] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Invasive fungal infections (IFI) are catastrophic diseases associated with a high mortality. Relatively few cases of IFI have been described in systemic lupus erythematosus (SLE) and their related factors have not been completely explored. We evaluated factors associated with IFI in patients with SLE. METHODS All patients with both IFI and SLE admitted to our hospital in the last 7 years were evaluated and each was compared with 5 hospitalized patients with SLE (controls). Demographic factors, duration of SLE, and treatment in the previous month were compared. RESULTS Sixty patients with SLE were evaluated (10 with IFI and 50 controls). Median age was 29 years. High C-reactive protein levels were associated with IFI, along with other factors such as high disease activity, mechanical ventilation, treatment with antibiotics, hemodialysis, high doses of glucocorticoids (GC), and treatment with mycophenolate mofetil. Mortality was 4 times more frequent in patients with IFI than in SLE patients without the deep fungal infection. CONCLUSION IFI is a rare infection observed in patients with rheumatic diseases. We describe factors associated with IFI in patients with SLE. IFI is associated with elevated morbidity and mortality. Early diagnosis and treatment are desirable.
Collapse
Affiliation(s)
- Marco Ulises Martínez-Martínez
- Regional Unit of Rheumatology and Osteoporosis, Central Hospital Dr. Ignacio Morones Prieto, and Faculty of Medicine, Universidad Autónoma de San Luis Potosí, Av. V. Carranza 2395, San Luis Potosí, S.L.P., Mexico, 78240
| | | | | | | | | | | |
Collapse
|
46
|
Errante PR, Franco JL, Espinosa-Rosales FJ, Sorensen R, Condino-Neto A. Advances in primary immunodeficiency diseases in Latin America: epidemiology, research, and perspectives. Ann N Y Acad Sci 2012; 1250:62-72. [PMID: 22364447 DOI: 10.1111/j.1749-6632.2011.06289.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary immunodeficiencies (PIDs) are genetic disorders of the immune system comprising many different phenotypes. Although previously considered rare, recent advances in their clinical, epidemiological, and molecular definitions are revealing how much we still need to learn about them. For example, geographical and ethnic variations as well as the impact of certain practices influence their frequency and presentation, making it necessary to consider their study in terms of regions. The Latin American Society for Immunodeficiencies was established as an organization dedicated to provide scientific support for basic and clinical research and to develop tools and educational resources to promote awareness in the medical community. Initiatives such as these are positively influencing the way PIDs are tackled in these countries, as shown by recent reports and publications. This paper provides a historical compilation and a current view of the many issues faced by scientists studying these diseases in these countries, highlighting the diverse scientific contributions and offering a promising perspective for the further developments in this field in Latin America.
Collapse
Affiliation(s)
- Paolo Ruggero Errante
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | | | | | | | | |
Collapse
|
47
|
Daikeler T, Tichelli A, Passweg J. Complications of autologous hematopoietic stem cell transplantation for patients with autoimmune diseases. Pediatr Res 2012; 71:439-44. [PMID: 22430379 DOI: 10.1038/pr.2011.57] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autologous hematopoietic stem cell transplantation (HSCT) has been used to treat severe and refractory autoimmune diseases (ADs) in children and adults for more than 15 years. The aim of this treatment is to restore tolerance through an intense lymphodepleting conditioning, and many patients have achieved lasting remissions. However, HSCT is associated with significant morbidity and mortality and is therefore not yet standard of care. Pre-existing reduced organ function of patients with ADs may increase the organ toxicity of conditioning. In the early post-HSCT phase, bacterial or fungal infections occur and therapy-associated lymphopenia sets patients at risk for reactivation of endogenous viruses and other opportunistic infections. During re-emerging of lymphopoiesis after HSCT, de novo autoimmunity may develop through loss of central or peripheral control mechanisms. Late effects of autologous HSCT (e.g., on the endocrine system) and a potentially increased frequency of secondary malignancies are of concern. The steadily increasing knowledge about specific complications occurring in patients with ADs after HSCT has led to the adaption of treatment protocols and has already reduced toxicity. Further prospective long-term follow-up studies are needed to identify patients at risk for developing serious complications after HSCT.
Collapse
Affiliation(s)
- Thomas Daikeler
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland.
| | | | | |
Collapse
|