Increased IL-17 and IL-21 producing TCRαβ+CD4−CD8− T cells in Chinese systemic lupus erythematosus patients

Double-Negative T (DNT) Cells in Patients with Systemic Lupus Erythematosus

Double-negative T (DNT) cells are a rare and unconventional T-lymphocyte subpopulation lacking both CD4 and CD8 markers. Their immunopathological roles and clinical relevance have yet to be elucidated. Beyond autoimmune lymphoproliferative syndrome (ALPS), these cells may also play a role in rheumatic disorders, including systemic lupus erythematosus (SLE); indeed, these two diseases share several autoimmune manifestations (including nephritis). Moreover, one of the main experimental murine models used to investigate lupus, namely the MRL/lpr mouse, is characterized by an expansion of DNT cells, which can support the production of pathogenic autoantibodies and/or modulate the immune response in this context. However, lupus murine models are not completely consistent with their human SLE counterpart, of course. In this mini review, we summarize and analyze the most relevant clinical studies investigating the DNT cell population in SLE patients. Overall, based on the present literature review and analysis, DNT cell homeostasis seems to be altered in patients with SLE. Indeed, most of the available clinical studies (which include both adults and children) reported an increased DNT cell percentage in SLE patients, especially during the active phases, even though no clear correlation with disease activity and/or inflammatory parameters has been clearly established. Well-designed, standardized, and longitudinal clinical studies focused on DNT cell population are needed, in order to further elucidate the actual contribution of these cells in SLE pathogenesis and their interactions with other immune cells (also implicated and/or altered in SLE, such as basophils), and clarify whether their expansion and/or immunophenotypic aspects may have any immunopathological relevance (and, then, represent potential disease markers and, in perspective, even therapeutic targets) or are just an unspecific epiphenomenon of autoimmunity.

Anti-prolactin treatment alleviates lupus conditions by regulating the JAK2-STAT3 pathway

OBJECTIVES

We previously revealed the role of prolactin (PRL) in antibody production and disease activity in patients with systemic lupus erythematosus. In this study, we sought to determine whether inhibition of PRL could improve lupus-like disease in MRL/lpr mice.

METHODS

The expression levels of PRL in various cell types of lupus patients were measured by flow cytometry. The effects of anti-PRL on animal survival, renal histopathology, creatinine, proteinuria, anti-dsDNA antibody, cytokine production, splenomegaly and lymphadenopathy were assessed. The effect of anti-PRL on the Jak2-Stat3 signalling pathway was detected by western blotting.

RESULTS

Prolactin was upregulated in B cells, neutrophils, CD4+ T cells, and monocytes isolated from patients with lupus. Furthermore, inhibition of PRL by anti-PRL treatment around the time of onset prolonged the survival of MRL/lpr mice, significantly reduced anti-dsDNA antibody production, and alleviated symptoms of lupus nephritis, splenomegaly, and lymphadenopathy. In addition, anti-PRL-treated mice showed a decrease in the levels of pathogenic cytokines such as IL-21 and IL-6. Furthermore, mechanistically, anti-PRL treatment significantly reduced the levels of p-Jak2 and p-Stat3 in MRL/lpr mice.

CONCLUSIONS

In summary, these data suggest that PRL inhibition alleviates lupus-like disease in MRL/lpr mice by modulating the Jak2-Stat3 signalling cascade. More importantly, our results imply the potential of PRL inhibitors and may provide a novel therapeutic approach for lupus.

The effect of air pollution on systemic lupus erythematosus: A systematic review and meta-analysis

BACKGROUND

Systemic lupus erythematosus (SLE) is an autoimmune disease resulting from impaired inflammatory responses. Given the role of air pollution on increasing inflammatory mediators, thus, we aimed to systematically review and meta-analyze evidence regarding an association between short-term exposure to air pollution and SLE onset, activity, and hospitalization.

METHODS

Electronic databases including Web of Science, PubMed, Scopus, and Embase were searched for all published articles until July 5, 2021. Newcastle Ottawa Scale (NOS) checklist was used to assess the quality of individual studies. Relevant demographic data and the intended results of the selected studies were extracted, and their adjusted risk ratios (RRs) were pooled using random and fixed effect analysis based on the heterogeneity index.

FINDINGS

Twelve studies were entered in our systematic review, and finally, six publications were enrolled in meta-analysis. Overall, Meta-analysis showed no significant association between an increase of PM_2.5 on the third day and SLEDAI score with pooled adjusted RR of 1.212 (95% CI, 0,853-1.721), p-value = 0.284. However, there was a positive relationship between 6 days increase of Particulate matter (PM) 2.5 and the systemic lupus erythematosus disease activity Index (SLEDAI) score (pooled adjusted RR 1.112; 95% CI, 1.005-1.231), p-value = 0.040. There was no significant association between carbon monoxide (CO), nitrogen dioxide (NO₂), PM_2.5, and PM₁₀ increase in the air and hospitalization of SLE patients with pooled RR of 1.021 (95% CI, 0,986-1.1.057), p-value = 0.249, 1.034 (95% CI, 0.996-1.068); p-value = 0.079, 1.042 (95% CI, 0.994-1.092); p-value = 0.084 and 1.004 (95% CI, 0.996-1.013); p-value = 0.323, respectively. Also, analysis showed a significant relation between ozone (O₃) increase and hospitalization with a pooled RR of 1.076 (95% CI, 1.009-1.147); p-value = 0.025. Finally, analysis of SO₂ increase and risk of hospitalization demonstrated no significant relationship with the pooled RR of 1.011; (95% CI, 0.962-1.062), p-value = 0.0.671.

CONCLUSION

Our findings prove that PM_2.5 was associated with increased SLE risk. We also showed that only O₃ was associated with increased hospital admissions of SLE patients.

Effect of IL-21 on the Balance of Th17 Cells/Treg Cells in the Pathogenesis of Graves' Disease

Graves' disease (GD) is a common organ-specific autoimmune disease, and its pathogenesis is still unclear. The aim of this study is to investigate the role of interleukin (IL)-21 in the regulation of Th17/Treg cells in GD. We recruited 28 newly diagnosed GD patients, 27 GD patients in remission (eGD), and 24 normal controls (NC). Thyroid function and autoantibodies were evaluated by electrochemical luminescence. Peripheral blood mononuclear cells (PBMCs) were isolated and cultured with or without recombinant human interleukin-21 (rhIL-21), and mRNA and protein levels were quantified by real-time PCR and ELISA, respectively. Compared with those in the eGD and control groups, the thyroid function indexes and autoantibodies levels were significantly different in the GD group (P < 0.05). Without rhIL-21 stimulation, the expression levels of retinoid-related orphan gamma t (RORγt), IL-17, IL-22, forkhead box protein P3 (Foxp3) and IL-10 mRNA and the IL-10 and IL-22 proteins were significantly higher in the GD group than those in the eGD and control groups (P < 0.05). rhIL-21 stimulation increased the RORγt, IL-17, and IL-22 mRNA levels and IL-22 protein levels and decreased the Foxp3 and IL-10 mRNA levels and IL-10 protein levels (P < 0.05) in the GD group. In conclusion, our analyses demonstrated that IL-21 might induce the differentiation of CD4⁺ T cells to Th17 cells and reduce Treg cell differentiation, which could contribute to activation of the downstream immune response and the pathogenesis of GD.

Alteration of liver-infiltrated and peripheral blood double-negative T-cells in primary biliary cholangitis

BACKGROUND & AIMS

Double-negative (DN) T-cell is a unique regulatory T-cell, which is essential for maintaining immune system homoeostasis. However, the role of DN T-cells in the pathogenesis of primary biliary cholangitis (PBC) is still unknown.

METHODS

We investigated the number and function of DN T-cells in peripheral blood and liver biopsy specimens of PBC patients.

RESULTS

The number and frequency of DN T-cells significantly decreased in peripheral blood and liver tissue of PBC patients. Furthermore, the frequency of DN T-cells in PBC was negatively correlated with disease severity and positively correlated with ursodeoxycholic acid response. In vitro assays showed that perforin expression and the suppressive capability of DN T-cells on the proliferation of CD4⁺ and CD8⁺ T-cells were impaired in PBC. Finally, lithocholic acid, the most hydrophobic acid, could downregulate the proliferation and perforin expression of DN T-cells.

CONCLUSIONS

Decreased quantity and function of DN T-cells in PBC may result in the loss of immune regulations on effector CD4⁺ and cytotoxic CD8⁺ T-cells, and thereby may break the immune tolerance and promote the pathogenesis of PBC.

Therapeutic effects of artesunate on lupus-prone MRL/lpr mice are dependent on T follicular helper cell differentiation and activation of JAK2-STAT3 signaling pathway

BACKGROUND

Anti-malarial drug artesunate (ART), a semi-synthetic derivative of artemisnin, has immunosuppressive effects on several autoimmune diseases, including Systemic lupus erythematosus (SLE), Rheumatoid arthritis (RA), and Colitis. However, molecular mechanisms of ART, especially on follicular helper T cells (Tfh), central players in SLE pathology, are far from clear.

PURPOSE

The object for this work is to investigate the therapeutic effect of ART on lupus-prone MRL/lpr mice and its regulatory function on Tfh cells.

STUDY DESIGN AND METHODS

MRL/lpr mice were used to explore therapeutic effects of ART on lupus-prone MRL/lpr mice and its regulatory functions on Tfh cells. Then, experiments of renal function were accomplished using the biochemical kits. Effects of ART on histopathology of kidneys, inflammatory factors and autoantibodies were examined using H&E staining, ELISA and real-time PCR. Flow cytometry and western blot analysis were used to examine effects of ART on Tfh differentiation and Jak2-Stat3 signaling pathway.

RESULTS

Upon oral administration, ART significantly prolonged the survival of MRL/lpr mice, ameliorated the lupus nephritis symptoms, decreased the levels of anti-dsDNA antibodies deposited in the kidney, and the levels of pathogenic cytokines (IL-6, IFN-γ and IL-21). After ART treatment, T-cell compartment in the spleen of MRL/lpr mice was restored in terms of reduction in the number of Tfh cells and in the maintenance of the ratio of Tfr to follicular regulatory T cells (Tfh). In addition, ART has significantly inhibited the phosphorylation levels of Jak2 and Stat3 in the MRL/lpr mice.

CONCLUSION

ART showed therapeutic effects on lupus-prone MRL/lpr mice by inhibiting the differentiation of Tfh cells as well as altering the activation status of Jak2-Stat3 signaling cascade.

Cytokines (IL-15, IL-21, and IFN-γ) in rheumatoid arthritis: association with positivity to autoantibodies (RF, anti-CCP, anti-MCV, and anti-PADI4) and clinical activity

INTRODUCTION

Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial membrane damage and autoantibody production. RA is a heterogeneous disease, where cytokines such as IL-15, IL-21, and IFN-γ have been associated. However, their association with the autoantibodies has not been clearly described. The aim of this study was to evaluate the relationship between the cytokines IL-15, IL-21, and IFN-γ with the autoantibodies (RF, anti-CCP, anti-MCV, and anti-PADI4) in RA and disease activity.

METHODOLOGY

This study included 153 RA patients and 80 control subjects (CS). The levels of IL-15, IL-21, IFN-γ, anti-CCP, anti-MCV, and anti-PADI4 were quantified by ELISA, whereas RF was quantified by turbidimetry. The disease activity was evaluated by the indices disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR), clinical disease activity index (CDAI), and simple disease activity index (SDAI).

RESULTS

The serum levels of IL-15, IL-21, and IFN-γ, and autoantibodies were increased in RA patients, compared with CS (p < 0.05). A correlation was found between IL-21 and anti-CCP and anti-MCV (p < 0.05). According to RA evolution, RF, anti-CCP, and anti-MCV had higher levels in early RA. In addition, increased levels of IL-21 were observed in RA seropositive patients (RF/anti-CCP/anti-MCV). The higher levels of both cytokines and autoantibodies were observed in moderate activity, evaluated by the three indices.

CONCLUSIONS

Our results suggest that the increased soluble levels of IL-15, IL-21, and IFN-γ are involved in the inflammatory network in RA. However, IL-21 serum levels are associated with higher titers of autoantibodies (RF, anti-CCP, and anti-MCV) and IL-15 with moderate activity. Key Points • IL-15, IL-21, and IFN-y are associated with the immunopathology of RA, but not significantly with the evolution of the disease. • RF, anti-CCP, and anti-MCV had higher levels in early than established RA. • IL-21 has an association with RF, anti-CCP, and anti-MCVand, for this reason, could be proposed as a disease biomarker. • Patients with activity moderate of disease showed higher levels of RF, anti-CCP, anti-MCV, and IL-15.

Serum and urine interleukin-17A levels as biomarkers of disease activity in systemic lupus erythematosus

OBJECTIVES

This study examined the correlations of both serum and urine interleukin-17A (IL-17A) levels with disease activity in systemic lupus erythematosus (SLE). This study was also aimed at determining their sensitivity and specificity as biomarkers of disease activity in SLE.

METHODS

A cross-sectional study was performed involving SLE patients (n = 120 patients) from Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Serum and urinary IL-17A levels were determined by immunoassay while disease activity was assessed using Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) and British Isles Lupus Assessment Group's 2004 index (BILAG 2004) scores. The correlations between serum and urinary IL-17A levels with total SLEDAI-2K and BILAG 2004 scores were determined using bivariate correlation analyses. Receiver operating characteristic curves were calculated to determine their sensitivity and specificity as disease activity biomarkers.

RESULTS

Both serum and urinary IL-17A levels correlated with total scores of BILAG 2004, BILAG renal, BILAG mucocutaneous, and SLEDAI-2K (P < 0.05). Urine IL-17A levels correlated positively with urine protein : creatinine index while serum IL-17 level correlated with the BILAG hematology score (all P < 0.05). The area under curve of serum IL-17A and urine IL-17A with BILAG and SLEDAI scores were low (<0.75).

CONCLUSION

Despite positive correlations between serum and urine IL-17A with SLE disease activity, both were neither sensitive nor specific as biomarkers to predict active disease. Hence, IL-17 measurement has no role in SLE disease activity assessments and future studies are needed to search for other reliable activity biomarkers.

Genetic polymorphisms near IL-21 gene associated with Th17 cytokines confer risk for systemic lupus erythematosus in Chinese Han population

OBJECTIVE

Interleukin-21 (IL-21) contributes to expansion, differentiation, and modulation of various immunocompetent cells. Deregulated production of IL-21 plays a role of cardinal significance in the pathogenesis of systemic lupus erythematosus (SLE). We aimed to determine whether single nucleotide polymorphisms (SNP) near the IL-21 gene have significant association with SLE susceptibility and the T helper-related inflammatory cytokine profile of SLE patients.

METHODS

We enrolled 460 SLE patients and 460 healthy controls. Whole genome analysis was used to investigate different genes including IL-21. Loci rs11725913, rs11937669, rs7676539, rs111438679, rs115935829, rs373549, rs4487356, and rs79923870 were further genotyped using an improved multiplex ligation detection reaction technique. Susceptibility, levels of Th-related inflammatory cytokines, and some clinical indexes of SLE patients were analyzed.

RESULTS

rs11725913 and rs11937669 were identified for association with SLE in Chinese Han Population. The allelic frequency of rs11725913 approached significance (odds ratio (OR) (95% Confidence Interval (CI)) = 1.431 (1.122-1.825), P = 0.004). GT genotype at rs11725913 and GA genotype at rs11937669 were associated with SLE susceptibility (OR (95% CI) = 1.448 (1.074-1.952), P = 0.015; OR (95%CI) = 1.356 (1.013-1.815), P = 0.040, respectively). Dominant model analysis provided us with further validation (rs11725913: OR (95%CI) = 1.502 (1.126-2.004), P = 0.006; rs11937669: OR (95%CI) = 1.356 (1.025-1.793), P = 0.033). Cases with rs11937669 risk GA-genotype had higher serum IL-6 concentration than others ( P = 0.022). Dominant model analysis showed that patients with the wild type (AA-genotype) at rs11937669 had significantly lower soluble CD40 ligand ( P = 0.029) but higher IL-17A ( P = 0.040) compared with others. Cases carrying rs11725913 T allele had higher gamma glutamyl transpeptidase level ( P = 0.045) than those without.

CONCLUSIONS

We identified two new loci, rs11725913 and rs11937669, associated with SLE risk in Chinese Han population. This research provided a new insight into the significant relationship between polymorphisms upstream IL-21 and Th17 inflammatory response, which suggest that the sequence upstream of the IL-21 gene is an important region involved in the Th17-related pathway.

Th17 cells in renal inflammation and autoimmunity

Th17 cells are a distinct lineage of T-cells. These T-cells express IL-17A and the lineage-defining transcription factor RORγt. Th17 cells have a pivotal, physiological role in host defense against pathogens. These pro-inflammatory T-cells are also key players in autoimmunity and a pathogenic role has been demonstrated in several diseases such as rheumatoid arthritis or psoriasis. Recently, there is evidence that Th17 cells may drive renal inflammation and renal autoimmunity in anti-neutrophil-cytoplasmic-antibody-(ANCA)-vasculitis and systemic lupus erythematosus. The aim of this review is to discuss the possible involvement of Th17 cells in renal autoimmunity and its value for future therapeutic approaches.

Leishmaniavirus-Dependent Metastatic Leishmaniasis Is Prevented by Blocking IL-17A

Cutaneous leishmaniasis has various outcomes, ranging from self-healing reddened papules to extensive open ulcerations that metastasise to secondary sites and are often resistant to standard therapies. In the case of L. guyanensis (L.g), about 5-10% of all infections result in metastatic complications. We recently showed that a cytoplasmic virus within L.g parasites (LRV1) is able to act as a potent innate immunogen, worsening disease outcome in a murine model. In this study, we investigated the immunophenotype of human patients infected by L.g and found a significant association between the inflammatory cytokine IL-17A, the presence of LRV1 and disease chronicity. Further, IL-17A was inversely correlated to the protective cytokine IFN-γ. These findings were experimentally corroborated in our murine model, where IL-17A produced in LRV1+ L.g infection contributed to parasite virulence and dissemination in the absence of IFN-γ. Additionally, IL-17A inhibition in mice using digoxin or SR1001, showed therapeutic promise in limiting parasite virulence. Thus, this murine model of LRV1-dependent infectious metastasis validated markers of disease chronicity in humans and elucidated the immunologic mechanism for the dissemination of Leishmania parasites to secondary sites. Moreover, it confirms the prognostic value of LRV1 and IL-17A detection to prevent metastatic leishmaniasis in human patients.

The role of serum IL-17 and IL-6 as biomarkers of disease activity and predictors of remission in patients with lupus nephritis

AIM

To determine the role of IL-17 and IL-6 in the pathogenesis of SLE as biomarkers of disease activity and predictors of remission and outcome of therapy in patients with active lupus nephritis.

METHODS

The study was carried out on 72 SLE female patients and 70 sex- and age-matched normal healthy subjects as controls. SLE disease activity was assessed in all patients with (SLEDAI-2k scores). Plasma levels of IL-6, and IL-17 were measured by enzyme linked immunosorbent assay and their levels were correlated with clinical manifestations of the disease and (SLEDAI-2k). ROC curve analysis was performed to determine the validity of both cytokines in prediction of activity and remission of active lupus nephritis.

RESULTS

SLE patients were found to have significantly higher levels of IL-17 (p<0.001) and IL-6 (p<0.001), in relation to normal subjects. Active group of patients had higher levels of both cytokines than the inactive one (P<0.001). Elevated serum levels of both cytokines were associated with active lupus nephritis, anemia and positively correlated with SLEDAI-2k scores (P=0.025 for IL-17 and P<0.001 for IL-6). There was a significant positive correlation between IL-6 and IL-17 serum concentrations during periods of disease activity (r=0.497, P=0.005) as well as during remission (r=0.662, P<0.001). ROC curve analysis for IL-6 and IL-17, as predictor of disease activity reviled, optimal cutoff level of 12.3 pg/ml and 19.7 pg/ml, with AUC=0.93, and 0.95, for both cytokines respectively, while as predictors of remission of active lupus nephritis, provide a cutoff value of IL-6 at 20.8 pg/ml, with AUC 0.80, and a cutoff value of IL-17 at 27.0 pg/ml, with AUC 0.82.

CONCLUSION

In conjunction with their major role in pathogenesis of SLE, baseline serum levels of IL-6 and IL-17 can be used as sensitive biomarkers for disease activity, as well as predictors of remission of lupus nephritis.