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Pati A, Das BK, Panda AK. Elevated toll-like receptor 9 is associated with disease severity and kidney involvement in systemic lupus erythematosus. Hum Immunol 2024; 85:111104. [PMID: 39255560 DOI: 10.1016/j.humimm.2024.111104] [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: 05/28/2024] [Revised: 07/22/2024] [Accepted: 09/02/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) is associated with the activation of both innate and adaptive immune system. Infection is a significant environmental factor that is responsible for the development of SLE. Toll-like receptors (TLRs) are responsible for recognizing pathogens, and the expression of TLRs has been found to differ in SLE patients. Additionally, various infections have been reported to influence TLR expression. This study aimed to explore the relationship between TLRs and the onset, severity, and symptoms of SLE in the eastern Indian population. METHODS The study included 70 SLE patients and a control group matched for age and sex. RT-PCR was used to evaluate mRNA expression of TLRs 2, 4, 7, and 9. Statistical analyses were performed using GraphPad Prism software v.10.2.3. RESULTS Patients with SLE expressed significantly higher levels of TLR2 (p < 0.0001) and TLR9 (p = 0.012) than healthy controls. In lupus nephritis, TLR9 expression was higher than in SLE patients without kidney involvement (p = 0.037). Furthermore, a significant relationship was found between TLR9 expression and systemic lupus erythematosus disease activity index (SLEDAI) scores (p < 0.0001, Spearman's r = 0.47), implying the potential role of TLRs in SLE development. However, mRNA expression of TLR4 and TLR7 was not associated with SLE, clinical indices, or disease severity. CONCLUSIONS TLR9 is associated with SLE pathogenesis and clinical severity, making it a promising molecule for targeted therapy in SLE management.
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Affiliation(s)
- Abhijit Pati
- ImmGen EvSys Laboratory, Department of Biotechnology, Berhampur University, Odisha 767007, India
| | - Bidyut K Das
- Department of Clinical Immunology and Rheumatology, SCB Medical College Cuttack, Odisha 753007, India
| | - Aditya K Panda
- ImmGen EvSys Laboratory, Department of Biotechnology, Berhampur University, Odisha 767007, India; Centre of Excellence on Bioprospecting of "Ethnopharmaceuticals of Southern Odisha" (CoE-BESO), Berhampur University, Bhanja Bihar, Berhampur, Odisha 760007, India.
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Mohammed SA, Al Kady LM, Boghdadi GS, Dawa GA, Gerges MA, El Shafai MA. Immunogenetic Relationship of HLA-G 14 bp Insertion/Deletion Polymorphism and Toll-Like Receptor 9 with Systemic Lupus Erythematosus in Egyptian Patients: A Case-Control Study. Int J Gen Med 2022; 15:661-674. [PMID: 35082516 PMCID: PMC8785136 DOI: 10.2147/ijgm.s344376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction The level of expression of the immunoregulatory human leukocyte antigen-G (HLA-G) has been suggested to play a role in the immunopathogenesis of systemic lupus erythematosus (SLE). A 14 bp insertion/deletion (ins/del) polymorphism in the 3ˊuntranslated region of HLA-G gene may influence the level of expression. The role of Toll-like receptor 9 (TLR9) in the pathogenesis of SLE has been highlighted. Data among Egyptian patients are quite limited. Purpose To detect the association of HLA-G 14 bp ins/del gene polymorphism with the susceptibility to SLE and to correlate TLR9 serum level with disease activity among Egyptian patients. Patients and Methods A case-control study that included 102 SLE female patients and 102 healthy matched volunteers as controls was carried out. Disease activity in patients was determined using the modified Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). HLA-G 14 bp ins/del genotype was detected by polymerase chain reaction (PCR). TLR9 serum level was estimated using enzyme-linked immunosorbent assay (ELISA) technique. Results The ins/ins genotype was significantly increased among SLE patients compared to healthy subjects (58.8% vs 9.8%; odds ratio [OR] = 11.79, P < 0.001). The 14 bp ins allele was significantly more frequent in SLE patients than in healthy subjects (65.7% vs 27.9%, respectively) and significantly associated with an increased risk of SLE (OR 4.94, P < 0.001). The mean TLR9 serum level showed a significant increase in SLE patients compared to healthy subjects (397.04±137.86 vs 195.22±45.14 ng/L, p < 0.001) and was significantly associated with disease activity as well as to patients’ HLA-G genotypes (p < 0.001). Conclusion Among Egyptian population, HLA-G 14 bp ins/ins homozygous genotype and ins allele may constitute a potential risk for SLE susceptibility, while TLR9 serum level is significantly associated with disease activity.
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Affiliation(s)
- Shrouk A Mohammed
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Laila M Al Kady
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ghada S Boghdadi
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ghada A Dawa
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Marian A Gerges
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Correspondence: Marian A Gerges, Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt, Tel +20 1003819530, Email
| | - Maher A El Shafai
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Li XL, Zhang Z, Zhang H. Expression Level of TLR9, but not Hypomethylation, Is Correlated With SLE Disease Activity. Physiol Res 2019; 68:973-980. [PMID: 31647295 DOI: 10.33549/physiolres.934167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This study aims to investigate the associations of hypomethylation and over expression of the TLR9 gene with systemic lupus erythematosus (SLE). Fifteen SLE patients who were diagnosed and not treated, were selected as cases, and 32 healthy subjects were enrolled as controls. DNA and total RNA of peripheral blood mononuclear cells (PBMCs) were extracted. The methylation status of the promoter region CpG motifs of the TLR9 gene was quantitatively measured using bisulfite sequencing PCR, and the mRNA expression of the TLR9 gene was determined using real-time fluorescent quantitative PCR. The methylation level of the 10 TLR9 CpG motifs of gene did not show difference between cases and controls (P>0.05). By contrast, we observed an abnormal increase of TLT9 mRNA expression in patients (P=9.379×10(-8)), which was significantly correlated with SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) (P=9.018×10(-7)). The change of TLR9 gene expression may play an important role in the pathogenesis of SLE.
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Affiliation(s)
- Xiao-Lan Li
- Department of Dermatology, The Second affiliated Hospital of Kunming Medical University, Kunming, China.
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Hegazy MK, Auf FA, Neseem NO, Al-Harrass MF. Toll-like receptor (TLR9) -1486 T/C (rs187084) gene polymorphism in Egyptian patients with rheumatoid arthritis. EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Molecular mechanisms of glucocorticoid resistance in systemic lupus erythematosus: A review. Life Sci 2018; 209:383-387. [PMID: 30125579 DOI: 10.1016/j.lfs.2018.08.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/14/2018] [Accepted: 08/14/2018] [Indexed: 12/23/2022]
Abstract
The treatment of systemic lupus erythematosus (SLE) with glucocorticoids (GCs) is quite effective; however, GC resistance or insensitivity is a major barrier to the treatment of SLE. Therefore, it is necessary to identify the underlying mechanisms that lead to GC resistance. Much evidence shows that the mechanism of GC resistance is very complicated. GC receptor is involved in the main mechanism of GC resistance and was illustrated by a lot of literature. Therefore, this paper focuses on the GC resistance mechanisms of non-glucocorticoids receptor, including P-gp, MIF, TLR9, and Th17 cells. These molecular mechanisms may help diagnose GC resistance and provide an alternative treatment strategy to reverse GC resistance by blocking the underlying mechanisms.
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Gillis T, Crane M, Hinkle C, Wei N. Repository corticotropin injection as adjunctive therapy in patients with rheumatoid arthritis who have failed previous therapies with at least three different modes of action. Open Access Rheumatol 2017; 9:131-138. [PMID: 28790870 PMCID: PMC5530054 DOI: 10.2147/oarrr.s131046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective Many types of treatment are available for patients with rheumatoid arthritis (RA), however, some patients fail to achieve remission. This report aims to determine the safety and efficacy of using repository corticotropin injection (RCI) as an adjunctive therapy in patients with RA refractory to at least three therapeutics with different mechanisms of action. Method In this open-label, interventional, single-group study, patients received 80 U RCI twice weekly via subcutaneous injection over 12 weeks. Changes in the Ritchie–Camp Articular Index and health assessment questionnaire scores were monitored for changes from baseline measures. Results Eight patients were enrolled and consisted of seven females and one male with an average age of 64.6 years and disease duration of 20.9 years. Use of RCI resulted in significant improvement in swollen and tender joint counts. The disease activity score 28 and the physician and patient visual analog scale scores were significantly reduced at treatment week 12. The reduction in health assessment questionnaire scores did not reach statistical significance after RCI treatment. Once RCI therapy was discontinued, all improvements in disease activity score 28, physician and patient visual analog scale, and tender and swollen joint counts achieved during treatment were lost by the week 16 follow-up visit. Conclusion While larger clinical trials are necessary to further confirm the efficacy of RCI in patients with refractory RA, the response of patients with refractory RA in this study suggests that RCI can be an effective add-on therapy for patients who have exhausted several classes of treatments. Furthermore, this study suggests that RCI has an alternative mode of action, compared to other available antirheumatic drugs.
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Affiliation(s)
| | - Megan Crane
- Arthritis Treatment Center, Frederick, MD, USA
| | | | - Nathan Wei
- Arthritis Treatment Center, Frederick, MD, USA
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Up-regulated Complement 3 Production by Toll-like receptor 9/ Transforming Growth Factor-Beta 1/Complement 3 Pathway in Whole Blood Cells of Lupus Thrombocytopenia. Arch Rheumatol 2017; 32:275-283. [PMID: 29901007 DOI: 10.5606/archrheumatol.2017.6279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/18/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to assess the complement 3 (C3) expressions in whole blood cells and verify a pathway toll-like receptor 9 (TLR9)/ transforming growth factor-beta 1 (TGF-β1)/C3 for C3 regulation in mediating thrombocytopenia (TCP) in patients with systemic lupus erythematosus (SLE). Patients and methods The study included 63 newly diagnosed SLE patients (2 males, 61 females; mean age 39.5 years; range 15 to 67 years). Whole blood messenger ribonucleic acid expression for C3, TLR9 and TGF-β1 were measured by quantitative reverse transcription real-time polymerase chain reaction in SLE patients with TCP (n=38) and age- and sex-matched SLE patients without TCP (n=25) at baseline and in 10 SLE patients with TCP after four weeks of treatment. Whole blood cells from SLE patients with TCP were cultured in the presence of TLR9 ligand cytosine-phosphate- guanine, recombinant human TGF-β1, TGF-β receptor inhibitor/activin receptor-like kinase inhibitor SB431542. TGF-β1 and C3 levels in whole blood cells cultures were determined by quantitative reverse transcription real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Results Whole blood cells from SLE patients with TCP displayed an enhanced gene expression for C3, TLR9 and TGF-β1 compared with that of SLE patients without TCP (p<0.01 for C3, p<0.05 for TLR9 and TGF-β1). SLE patients with TCP had decreased plasma levels of C3 suggesting excessive consumption. In whole blood cell culture, engagement of TLR9 led to the increased gene expression of C3. Furthermore, TGF-β1 inhibitor abolished TLR9 stimulation on C3 gene expression. Conclusion These results suggest that blood cells are the source of extra-hepatic synthesis of C3 in SLE patients with TCP and this synthesis of C3 was up-regulated by TLR9 via induction of TGF-β1. Thus TLR9/TGF-β1/C3 pathway might be in operation mediating lupus thrombocytopenia.
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Mortezagholi S, Babaloo Z, Rahimzadeh P, Namdari H, Ghaedi M, Gharibdoost F, Mirzaei R, Bidad K, Salehi E. Evaluation of TLR9 expression on PBMCs and CpG ODN-TLR9 ligation on IFN-α production in SLE patients. Immunopharmacol Immunotoxicol 2017; 39:11-18. [PMID: 28049380 DOI: 10.1080/08923973.2016.1263859] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONTEXT Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by autoreactive antibodies. Recent findings revealed the importance of innate immune responses, especially Toll-like receptors (TLRs) in the pathogenesis of SLE. OBJECTIVE In this study, the level of TLR9 expression on peripheral blood mononuclear cells (PBMCs) was analyzed. The levels of produced IFN-α were also measured in supernatant of PBMCs from SLE patients and healthy controls after stimulation with CpG ODN2216 which is a plasmocytoid dendritic cell (pDC)-specific TLR9 ligand. MATERIALS AND METHODS TLR9 expression was analyzed by real-time polymerase chain reaction (PCR) and flow cytometry in 35 SLE patients and 38 healthy controls and IFN-α concentration was measured in supernatants using enzyme-linked immunosorbent assay (ELISA). RESULTS The results showed that the TLR9 expression in the mRNA and the protein level was significantly higher in PBMCs from SLE patients. However, IFN-α concentration in patients and controls significantly increased in response to CpG stimulation but this increase was significantly higher in healthy controls compared with SLE patients. Our results do not show any association between taking hydroxychloroquine and reduction in IFN-α production in SLE patients. DISCUSSION AND CONCLUSIONS Regarding the findings of the study, there is the possibility that TLR9 has played a role in SLE pathogenesis, and consequently it implies that TLRs can be considered to be the therapeutic targets for systemic autoimmunity. We may conclude that PBMCs in patients are functionally impaired in response to TLR ligation via innate response stimulating pathogen-associated molecular patterns (PAMPs).
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Affiliation(s)
- Sahar Mortezagholi
- a Department of Immunology, School of Medicine , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Zohreh Babaloo
- a Department of Immunology, School of Medicine , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Parisa Rahimzadeh
- b Department of Immunology, School of Public Health , Tehran University of Medical Sciences , Tehran , Iran
| | - Haideh Namdari
- c Department of Immunology, School of Medicine , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Mojgan Ghaedi
- b Department of Immunology, School of Public Health , Tehran University of Medical Sciences , Tehran , Iran
| | - Farhad Gharibdoost
- d Department of Rheumatology, Rheumatology Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Reza Mirzaei
- e Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | | | - Eisa Salehi
- e Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran
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XIAO GONG, NING WANGBIN, ZHANG CHUNHU, WU SHIYAO, ZUO XIAOXIA. Inhibiting Notch-1 reduces the expression of Toll-like receptor 9 in BABL/C-lpr mouse kidneys and improves glucocorticoid sensitivity. Mol Med Rep 2015; 12:2765-70. [DOI: 10.3892/mmr.2015.3758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 04/10/2015] [Indexed: 11/06/2022] Open
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Vaz J, Akbarshahi H, Andersson R. Controversial role of toll-like receptors in acute pancreatitis. World J Gastroenterol 2013; 19:616-630. [PMID: 23431068 PMCID: PMC3574587 DOI: 10.3748/wjg.v19.i5.616] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 01/12/2013] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is a common clinical condition with an incidence of about 300 or more patients per million annually. About 10%-15% of patients will develop severe acute pancreatitis (SAP) and of those, 10%-30% may die due to SAP-associated complications. Despite the improvements done in the diagnosis and management of AP, the mortality rate has not significantly declined during the last decades. Toll-like receptors (TLRs) are pattern-recognition receptors that seem to play a major role in the development of numerous diseases, which make these molecules attractive as potential therapeutic targets. TLRs are involved in the development of the systemic inflammatory response syndrome, a potentially lethal complication in SAP. In the present review, we explore the current knowledge about the role of different TLRs that have been described associated with AP. The main candidate for targeting seems to be TLR4, which recognizes numerous damage-associated molecular patterns related to AP. TLR2 has also been linked with AP, but there are only limited studies that exclusively studied its role in AP. There is also data suggesting that TLR9 may play a role in AP.
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