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Sircana MC, Erre GL, Castagna F, Manetti R. Crosstalk between Inflammation and Atherosclerosis in Rheumatoid Arthritis and Systemic Lupus Erythematosus: Is There a Common Basis? Life (Basel) 2024; 14:716. [PMID: 38929699 PMCID: PMC11204900 DOI: 10.3390/life14060716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in patients with rheumatoid arthritis and systemic lupus erythematosus. Traditional cardiovascular risk factors, although present in lupus and rheumatoid arthritis, do not explain such a high burden of early cardiovascular disease in the context of these systemic connective tissue diseases. Over the past few years, our understanding of the pathophysiology of atherosclerosis has changed from it being a lipid-centric to an inflammation-centric process. In this review, we examine the pathogenesis of atherosclerosis in systemic lupus erythematosus and rheumatoid arthritis, the two most common systemic connective tissue diseases, and consider them as emblematic models of the effect of chronic inflammation on the human body. We explore the roles of the inflammasome, cells of the innate and acquired immune system, neutrophils, macrophages, lymphocytes, chemokines and soluble pro-inflammatory cytokines in rheumatoid arthritis and systemic lupus erythematosus, and the roles of certain autoantigens and autoantibodies, such as oxidized low-density lipoprotein and beta2-glycoprotein, which may play a pathogenetic role in atherosclerosis progression.
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Affiliation(s)
| | | | | | - Roberto Manetti
- Department of Medical, Surgical and Pharmacology, University of Sassari, 07100 Sassari, Italy; (G.L.E.); (F.C.)
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Rezazadeh M, Jokar MH, Mehrnaz Aghili S, Mirfeizi Z, Mahmoudi M, Morovatdar N, Hashemzadeh K. Association between levels of serum and urinary B cell-activating factor and systemic lupus erythematosus disease activity. Arch Rheumatol 2023; 38:429-440. [PMID: 38046245 PMCID: PMC10689013 DOI: 10.46497/archrheumatol.2023.9549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/15/2022] [Indexed: 12/05/2023] Open
Abstract
Objectives This study investigated the correlation between serum and urinary B cell-activating factor (BAFF) levels and systemic lupus erythematosus (SLE) disease activity. Patients and methods This case-control study was conducted with 87 participants between December 2020 and September 2021. Sixty-two SLE patients who fulfilled the eligibility criteria were enrolled. SLE patients were categorized into active (n=34) and inactive (n=28) groups based on their Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores. The control group consisted of 25 healthy subjects. Serum and urine samples were collected for the measurement of BAFF levels. Finally, the relationship between these variables and SLE disease activity was investigated. Results The mean age of active (SLEDAI-2K >4) and inactive (SLEDAI-2K ≤4) SLE patients and healthy individuals were 32.8±7.8, 32.5±6.8, and 31.7±7.8 years, respectively (p=0.62). The median serum BAFF (s-BAFF) and urinary BAFF (u-BAFF) in active lupus patients (10.4 [2.3] ng/mL and 8.2 [3.7] ng/mL, respectively) were significantly higher than in inactive lupus patients (6 (7.1) ng/mL and 1.7 (4.7) ng/mL, respectively; p<0.001) and the control group (3 (3.7) ng/mL and 1.6 (2.2) ng/mL, respectively; p<0.001). However, s-BAFF (p=0.07) and u-BAFF (p=0.43) did not significantly differ between the inactive group and the control group. A significant positive correlation was observed between s-BAFF (r=0.41 and p=0.001) and u-BAFF (r=0.78 and p<0.001) levels and the SLEDAI-2K score. Conclusion There is a significant positive correlation between serum and urinary BAFF levels and SLE disease activity. Furthermore, significantly higher levels of s-BAFF and u-BAFF have been observed in patients with active lupus compared to inactive and healthy subjects, indicating a possible role for BAFF in the pathogenesis of SLE disease activity.
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Affiliation(s)
- Maryam Rezazadeh
- Mashhad University of Medical Sciences, Rheumatic Diseases Research Center, Mashhad, Iran
| | - Mohammad Hasan Jokar
- Mashhad University of Medical Sciences, Rheumatic Diseases Research Center, Mashhad, Iran
| | - Seyedeh Mehrnaz Aghili
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Zahra Mirfeizi
- Mashhad University of Medical Sciences, Rheumatic Diseases Research Center, Mashhad, Iran
| | - Mahmoud Mahmoudi
- Mashhad University of Medical Sciences, Bu-Ali Research Institute, Mashhad, Iran
| | - Negar Morovatdar
- Mashhad University of Medical Sciences, Clinical Research Unit, Mashhad, Iran
| | - Kamila Hashemzadeh
- Mashhad University of Medical Sciences, Rheumatic Diseases Research Center, Mashhad, Iran
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Giordano D, Kuley R, Draves KE, Elkon KB, Giltiay NV, Clark EA. B cell-activating factor (BAFF) from dendritic cells, monocytes and neutrophils is required for B cell maturation and autoantibody production in SLE-like autoimmune disease. Front Immunol 2023; 14:1050528. [PMID: 36923413 PMCID: PMC10009188 DOI: 10.3389/fimmu.2023.1050528] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023] Open
Abstract
Purpose and methods B cell-activating factor (BAFF) contributes to the pathogenesis of autoimmune diseases including systemic lupus erythematosus (SLE). Although several anti-BAFF Abs and derivatives have been developed for the treatment of SLE, the specific sources of BAFF that sustain autoantibody (auto-Ab) producing cells have not been definitively identified. Using BAFF-RFP reporter mice, we identified major changes in BAFF-producing cells in two mouse spontaneous lupus models (Tlr7 Tg mice and Sle1), and in a pristane-induced lupus (PIL) model. Results First, we confirmed that similar to their wildtype Tlr7 Tg and Sle1 mice counterparts, BAFF-RFP Tlr7 Tg mice and BAFF-RFP Sle1 mice had increased BAFF serum levels, which correlated with increases in plasma cells and auto-Ab production. Next, using the RFP reporter, we defined which cells had dysregulated BAFF production. BAFF-producing neutrophils (Nphs), monocytes (MOs), cDCs, T cells and B cells were all expanded in the spleens of BAFF-RFP Tlr7 Tg mice and BAFF-RFP Sle1 mice compared to controls. Furthermore, Ly6Chi inflammatory MOs and T cells had significantly increased BAFF expression per cell in both spontaneous lupus models, while CD8- DCs up-regulated BAFF expression only in the Tlr7 Tg mice. Similarly, pristane injection of BAFF-RFP mice induced increases in serum BAFF levels, auto-Abs, and the expansion of BAFF-producing Nphs, MOs, and DCs in both the spleen and peritoneal cavity. BAFF expression in MOs and DCs, in contrast to BAFF from Nphs, was required to maintain homeostatic and pristane-induced systemic BAFF levels and to sustain mature B cell pools in spleens and BMs. Although acting through different mechanisms, Nph, MO and DC sources of BAFF were each required for the development of auto-Abs in PIL mice. Conclusions Our findings underscore the importance of considering the relative roles of specific myeloid BAFF sources and B cell niches when developing treatments for SLE and other BAFF-associated autoimmune diseases.
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Affiliation(s)
- Daniela Giordano
- Department of Medicine, Division of Rheumatology, University of Washington, Seattle, WA, United States
- *Correspondence: Daniela Giordano,
| | - Runa Kuley
- Department of Medicine, Division of Rheumatology, University of Washington, Seattle, WA, United States
| | - Kevin E. Draves
- Department of Microbiology, University of Washington, Seattle, WA, United States
| | - Keith B. Elkon
- Department of Medicine, Division of Rheumatology, University of Washington, Seattle, WA, United States
| | - Natalia V. Giltiay
- Department of Medicine, Division of Rheumatology, University of Washington, Seattle, WA, United States
| | - Edward A. Clark
- Department of Medicine, Division of Rheumatology, University of Washington, Seattle, WA, United States
- Department of Microbiology, University of Washington, Seattle, WA, United States
- Department of Immunology, University of Washington, Seattle, WA, United States
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Tabouni M, Ali A, Aljaberi N, Alblooshi H. Lupus nephritis: A focus on the United Arab Emirates and the potential role of genetics. Lupus 2022; 31:1415-1422. [PMID: 36017600 DOI: 10.1177/09612033221122982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE), characterized by chronic and progressive inflammation of the kidneys. As with many other autoimmune diseases, LN is a multifactorial disease caused by genetic and environmental factors. Globally, LN can affect around 60% of SLE patients, and it was observed to be less frequent and severe in Caucasian patients compared to other ethnic groups, including Arabs. Data on LN in the United Arab Emirates (UAE) are scattered and scarce in literature. Nevertheless, LN is common, occurring in around 43%-55% of SLE patients in the UAE. Anecdotally, the demographics and clinical features of SLE in the UAE have been distinct. However, the paucity of supporting literature makes it difficult to draw meaningful conclusions. Over the past two decades, there have been improvements in understanding the pathogenesis of LN; however, many cellular and molecular mechanisms which are implicated in the disease development and progression remain ambiguous. Investigating the clinical, pathological, and genetic characteristics of LN in different cohorts of patients is of importance for a better understanding of its pathogenesis, and thus improving its outcome. As a result, we acknowledge the need for large-scale epidemiological, clinical, and genetic investigation of LN cohorts in the UAE and surrounding regions.
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Affiliation(s)
- Mohammed Tabouni
- Department of Genetics and Genomics, College of Medicine and Health Sciences, 62776United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amanat Ali
- Department of Genetics and Genomics, College of Medicine and Health Sciences, 62776United Arab Emirates University, Al Ain, United Arab Emirates
| | - Najla Aljaberi
- Department of Pediatrics, College of Medicine and Health Sciences, 62776United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hiba Alblooshi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, 62776United Arab Emirates University, Al Ain, United Arab Emirates
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Sari S, Cinar S, Yalcinkaya Y, Artim-Esen B, Ozluk Y, Gul A, Ocal L, Deniz G, Inanc M. The relationship between serum A proliferation-inducing ligand and B-cell activating factor levels with disease activity and organ involvement in systemic lupus erythematosus. Lupus 2022; 31:555-564. [DOI: 10.1177/09612033221086123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives We aim to investigate the association between serum B-cell activating factor (BAFF) and A proliferation-inducing ligand (APRIL) levels with disease activity and clinical findings in SLE patients. Methods Seventy-nine patients with SLE and 27 healthy controls were included into the study. Serum BAFF and APRIL levels were measured by using ELISA. In 19 patients with active disease at the time of the assessment, BAFF/APRIL levels were reassessed after 6 months of follow-up and disease activity was evaluated by using SLEDAI-2K. The relationship between renal histopathology index scores and lupus nephritis (LN) classes with serum BAFF/APRIL levels was examined in 16 patients who had recent renal involvement and underwent biopsy during the study. Results Although both BAFF/APRIL levels were higher in patients with SLE compared to the control group ( p < 0.001), no correlation was found between BAFF/APRIL levels and SLEDAI scores. Serum BAFF levels were higher in patients with renal disease activity ( p = 0.01), and there was a significant correlation between APRIL levels and proteinuria (r = 0.42, p = 0.02). A weak inverse correlation was observed between BAFF and C3 levels (r = 0.25, p = 0.02). No correlation was found between BAFF/APRIL levels and renal SLEDAI scores, renal histopathology, activity, and chronicity index scores. In the active disease group after treatment, there was no significant change in serum BAFF levels, but a significant increase in serum APRIL levels was observed. Conclusion These results suggest that both cytokines are involved in the pathogenesis of SLE and that serum BAFF can be valuable as a biomarker in SLE especially in patients with renal activity.
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Affiliation(s)
- Selma Sari
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Suzan Cinar
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Yalcinkaya
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahar Artim-Esen
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Lale Ocal
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Günnur Deniz
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Jiang SH, Mercan S, Papa I, Moldovan M, Walters GD, Koina M, Fadia M, Stanley M, Lea-Henry T, Cook A, Ellyard J, McMorran B, Sundaram M, Thomson R, Canete PF, Hoy W, Hutton H, Srivastava M, McKeon K, de la Rúa Figueroa I, Cervera R, Faria R, D’Alfonso S, Gatto M, Athanasopoulos V, Field M, Mathews J, Cho E, Andrews TD, Kitching AR, Cook MC, Riquelme MA, Bahlo M, Vinuesa CG. Deletions in VANGL1 are a risk factor for antibody-mediated kidney disease. Cell Rep Med 2021; 2:100475. [PMID: 35028616 PMCID: PMC8714939 DOI: 10.1016/j.xcrm.2021.100475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/11/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022]
Abstract
We identify an intronic deletion in VANGL1 that predisposes to renal injury in high risk populations through a kidney-intrinsic process. Half of all SLE patients develop nephritis, yet the predisposing mechanisms to kidney damage remain poorly understood. There is limited evidence of genetic contribution to specific organ involvement in SLE.1,2 We identify a large deletion in intron 7 of Van Gogh Like 1 (VANGL1), which associates with nephritis in SLE patients. The same deletion occurs at increased frequency in an indigenous population (Tiwi Islanders) with 10-fold higher rates of kidney disease compared with non-indigenous populations. Vangl1 hemizygosity in mice results in spontaneous IgA and IgG deposition within the glomerular mesangium in the absence of autoimmune nephritis. Serum transfer into B cell-deficient Vangl1+/- mice results in mesangial IgG deposition indicating that Ig deposits occur in a kidney-intrinsic fashion in the absence of Vangl1. These results suggest that Vangl1 acts in the kidney to prevent Ig deposits and its deficiency may trigger nephritis in individuals with SLE.
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Affiliation(s)
- Simon H. Jiang
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
- Centre for Personalised Immunology, NHMRC Centre for Research Excellence, Australian National University, Canberra 2601, Australia
- Department of Renal Medicine, The Canberra Hospital, Canberra 2605, Australia
| | - Sevcan Mercan
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
- Department of Bioengineering, Kafkas University, Kars 36100, Turkey
| | - Ilenia Papa
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
| | - Max Moldovan
- Centre for Population Health Research, University of South Australia, South Australian Health and Medical Research Institute (SAHMRI), Adelaide 5001, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney 2109, Australia
| | - Giles D. Walters
- Department of Renal Medicine, The Canberra Hospital, Canberra 2605, Australia
| | - Mark Koina
- Department of Pathology, The Canberra Hospital, Canberra 2605, Australia
| | - Mitali Fadia
- Department of Pathology, The Canberra Hospital, Canberra 2605, Australia
| | - Maurice Stanley
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
| | - Tom Lea-Henry
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
| | - Amelia Cook
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
| | - Julia Ellyard
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
- Centre for Personalised Immunology, NHMRC Centre for Research Excellence, Australian National University, Canberra 2601, Australia
| | - Brendan McMorran
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
| | - Madhivanan Sundaram
- Department of Renal Medicine, Royal Darwin Hospital, Northern Territory 0811, Australia
| | - Russell Thomson
- Centre for Research in Mathematics and Data Science, School of Computer, Data and Mathematical Sciences, Western Sydney University, Parramatta 2150, NSW, Australia
| | - Pablo F. Canete
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
- Centre for Personalised Immunology, NHMRC Centre for Research Excellence, Australian National University, Canberra 2601, Australia
| | - Wendy Hoy
- Centre for Chronic Disease, Faculty of Health, The University of Queensland, Brisbane 4029, QLD, Australia
| | - Holly Hutton
- Centre for Inflammatory Diseases, Monash University, Melbourne 3168, VIC, Australia
| | - Monika Srivastava
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
| | - Kathryn McKeon
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
- Centre for Personalised Immunology, NHMRC Centre for Research Excellence, Australian National University, Canberra 2601, Australia
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona 08036, Spain
| | - Raquel Faria
- Unidade de Imunologia Clinica, Centro Hospitalar Unisersitario do Porto, Porto 4099-001, Portugal
| | | | - Mariele Gatto
- Department of Rheumatology, University of Padova, Italy
| | - Vicki Athanasopoulos
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
- Centre for Personalised Immunology, NHMRC Centre for Research Excellence, Australian National University, Canberra 2601, Australia
| | - Matthew Field
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns 4870, QLD, Australia
| | - John Mathews
- School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
| | - Eun Cho
- Genome Informatics Laboratory, John Curtin School of Medical Research, Australian National University, Canberra 2601, Australia
| | - Thomas D. Andrews
- Genome Informatics Laboratory, John Curtin School of Medical Research, Australian National University, Canberra 2601, Australia
| | - A. Richard Kitching
- Centre for Inflammatory Diseases, Monash University, Melbourne 3168, VIC, Australia
- Departments Nephrology and Paediatric Nephrology. Monash Health, Melbourne 3168, Australia
| | - Matthew C. Cook
- Department of Immunology, The Canberra Hospital, Canberra 2605, Australia
| | - Marta Alarcon Riquelme
- Department of Medical Genomics, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
| | - Melanie Bahlo
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne 3052, Australia
- Department of Medical Biology, The University of Melbourne, Parkville 3010 VIC, Australia
| | - Carola G. Vinuesa
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Canberra, Australian National University, Canberra 2601, Australia
- Centre for Personalised Immunology, NHMRC Centre for Research Excellence, Australian National University, Canberra 2601, Australia
- China Australia Centre for Personalised Immunology, Renji Hospital Shanghai, JiaoTong University Shanghai 200001, China
- Francis Crick Institute, 1 Midland Rd, London NW1 1AT, UK
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Möckel T, Basta F, Weinmann-Menke J, Schwarting A. B cell activating factor (BAFF): Structure, functions, autoimmunity and clinical implications in Systemic Lupus Erythematosus (SLE). Autoimmun Rev 2020; 20:102736. [PMID: 33333233 DOI: 10.1016/j.autrev.2020.102736] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/28/2020] [Indexed: 12/30/2022]
Abstract
The B cell activating factor (BAFF), or B lymphocyte stimulator (BLyS), is a B cell survival factor which supports autoreactive B cells and prevents their deletion. BAFF expression is closely linked with autoimmunity and is enhanced by genetic alterations and viral infections. Furthermore, BAFF seems to be involved in adipogenesis, atherosclerosis, neuro-inflammatory processes and ischemia reperfusion (I/R) injury. BAFF is commonly overexpressed in Systemic Lupus Erythematosus (SLE) and strongly involved in the pathogenesis of the disease. The relationship between BAFF levels, disease activity and damage accrual in SLE is controversial, but growing evidence is emerging on its role in renal involvement. Belimumab, a biologic BAFF inhibitor, has been the first biologic agent licensed for SLE therapy so far. As Rituximab (RTX) has been shown to increase BAFF levels following B cell depletion, the combination therapy of RTX plus belimumab (being evaluated in two RCT) seems to be a valuable option for several clinical scenarios. In this review we will highlight the growing body of evidence of immune and non-immune related BAFF expression in experimental and clinical settings.
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Affiliation(s)
- Tamara Möckel
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Fabio Basta
- Acura Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany
| | - Julia Weinmann-Menke
- Department of Internal Medicine I, Division of Nephrology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Schwarting
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Acura Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany
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8
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Jiang SH, Stanley M, Vinuesa CG. Rare genetic variants in systemic autoimmunity. Immunol Cell Biol 2020; 98:490-499. [PMID: 32315078 DOI: 10.1111/imcb.12339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 01/03/2023]
Abstract
Autoimmune disease is a substantial cause of morbidity and is strongly influenced by genetic risk. Extensive efforts have characterized the overall genetic basis of many autoimmune diseases, typically by investigation of common variants. While these common variants have modest effects and may cumulatively predispose to disease, it is also increasingly apparent that rare variants have significantly greater effect on phenotype and are likely to contribute to autoimmune disease. Recent advances have illustrated the next fundamental step in elucidating the genetic basis of autoimmunity, moving beyond association to demonstrate the functional consequences of these variants.
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Affiliation(s)
- Simon H Jiang
- Centre for Personalised Immunology, NHMRC Centre for Research Excellence, Acton, ACT, 2601, Australia.,Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Australian National University, Acton, ACT, 2601, Australia.,Department of Renal Medicine, The Canberra Hospital, Garran, ACT, 2601, Australia
| | - Maurice Stanley
- Centre for Personalised Immunology, NHMRC Centre for Research Excellence, Acton, ACT, 2601, Australia.,Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Australian National University, Acton, ACT, 2601, Australia
| | - Carola G Vinuesa
- Centre for Personalised Immunology, NHMRC Centre for Research Excellence, Acton, ACT, 2601, Australia.,Department of Immunology and Infectious Disease, John Curtin School of Medical Research, Australian National University, Acton, ACT, 2601, Australia.,China Australia Centre for Personalised Immunology, Shanghai Renji Hospital, Jiao Tong University Shanghai, Huangpu Qu, 200333, China
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9
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Protecting the kidney in systemic lupus erythematosus: from diagnosis to therapy. Nat Rev Rheumatol 2020; 16:255-267. [PMID: 32203285 DOI: 10.1038/s41584-020-0401-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2020] [Indexed: 12/20/2022]
Abstract
Lupus nephritis (LN) is a common manifestation of systemic lupus erythematosus that can lead to irreversible renal impairment. Although the prognosis of LN has improved substantially over the past 50 years, outcomes have plateaued in the USA in the past 20 years as immunosuppressive therapies have failed to reverse disease in more than half of treated patients. This failure might reflect disease complexity and heterogeneity, as well as social and economic barriers to health-care access that can delay intervention until after damage has already occurred. LN progression is still poorly understood and involves multiple cell types and both immune and non-immune mechanisms. Single-cell analysis of intrinsic renal cells and infiltrating cells from patients with LN is a new approach that will help to define the pathways of renal injury at a cellular level. Although many new immune-modulating therapies are being tested in the clinic, the development of therapies to improve regeneration of the injured kidney and to prevent fibrosis requires a better understanding of the mechanisms of LN progression. This mechanistic understanding, together with the development of clinical measures to evaluate risk and detect early disease and better access to expert health-care providers, should improve outcomes for patients with LN.
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