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Mulalin K, Mahakkanukrauh A, Suwannaroj S, Pongkulkiat P, Onchan T, Kasa S, Foocharoen C. Levels of anti-topoisomerase I antibody correlated with short onset of cardiopulmonary involvement in Thai systemic sclerosis patients. Sci Rep 2024; 14:10354. [PMID: 38710779 PMCID: PMC11074118 DOI: 10.1038/s41598-024-61159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024] Open
Abstract
Anti-topoisomerase-I antibody (ATA) is associated with disease severity and internal organ involvement in patients with systemic sclerosis (SSc). The correlation between ATA levels and the clinical course of SSc is unclear. We aimed to determine the correlation between ATA level and survival time and the onset of internal organ fibrosis in SSc patients. This historical cohort study was conducted in adult SSc patients with quantitative tests of ATA between January 2019 and December 2022. Patients with overlap syndrome and no quantitative ATA test were excluded. According to the sample size calculation, and 10% compensated for missing data, a total of 153 patients were needed. The respective mean age on the study date and median ATA level was 59.9 ± 11.3 years and 370 U/mL (range 195-652). Most cases (107 cases; 69.9%) were the diffuse cutaneous SSc subset. According to a multivariable analysis, the ATA titer had a negative correlation with the onset of cardiac involvement (Rho - 0.47, p = 0.01), and had a positive correlation with skin thickness progression (Rho 0.39, p = 0.04). Eleven cases exhibited ATA levels < 7 U/mL and outlier ATA levels were excluded, 142 cases were included in the sensitivity analysis, and multivariable analysis showed the correlation between early onset of ILD and cardiac involvement (Rho - 0.43, p = 0.03 and Rho - 0.51, p = 0.01, respectively). The ATA level was correlated with neither the survival time nor the onset of renal crisis in both analyses. High ATA levels were correlated with a short onset of ILD and cardiac involvement and the presence of extensive skin tightness. Quantitative tests of ATA could serve as an effective tool for identifying patients at risk of an unfavorable prognosis.
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Affiliation(s)
- Kamonwan Mulalin
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Ajanee Mahakkanukrauh
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Siraphop Suwannaroj
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Patnarin Pongkulkiat
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Tippawan Onchan
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Sawinee Kasa
- Clinical Laboratory Section, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Chingching Foocharoen
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
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2
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Carr ZJ, Yan L, Yanez ND, Schonberger RB, Bohorquez M, He Z, Li F, Hines RL, Treggiari MM. Perioperative Complications in Patients with Systemic Sclerosis: A Comparative Cohort Analysis. MEDICAL RESEARCH ARCHIVES 2023; 11:10.18103/mra.v11i10.4606. [PMID: 38037571 PMCID: PMC10688569 DOI: 10.18103/mra.v11i10.4606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background Systemic sclerosis (SSc) is a rare autoimmune disorder with pathological manifestations affecting multiple organ systems. Few studies have examined perioperative outcomes in patients with this disorder. The primary aim of this retrospective single-center comparative cohort analysis was to estimate the incidence of select perioperative complications in a population of SSc patients. In an exploratory analysis, we analyzed the relationship between SSc and susceptibility to select perioperative complications when treated at a large quaternary-care institution. Methods We conducted a single-center retrospective, comparative cohort study to compare perioperative outcomes in a SSc (n=258) and a frequency matched control cohort (n=632). We analyzed for the presence of major composite infection (MCI), major adverse cardiac events (MACE), 30-day readmission, 30-day mortality, in-hospital complications, length of stay and airway management outcomes. Results MCI was higher in the SSc compared to the control cohort [adjusted odds ratio (ORadj)=5.02 (95%CI: 2.47-10.20) p<0.001]. Surgical site infection (3.5% vs. 0%, p<0.001), and other infection types (5% vs. 0%, p<0.001) were higher in the SSc cohort. MACE was not significantly different between SSc vs. Control groups [6.2% vs. 7.9%, ORadj=1.33 (95%CI: 0.61-2.91) p=0.48]. Higher rates of limited cervical range of motion (13.6% vs. 3.5%, p<0.001), microstomia (11.5% vs. 1.3%, p<0.001) and preoperative difficult airway designation (8.7% vs. 0.5%, p<0.001) were observed in the SSc cohort. Bag mask ventilation grade was similar between groups (p=0.44). After adjustment, there was no between-group difference in Cormack-Lehane grade 3 and 4 view on direct laryngoscopy in SSc patients [ORadj = 1.86 (95%CI: 0.612 -5.66) p=0.18] but evidence of higher rates of video laryngoscopy [ORadj= 1.87 (95%CI:1.07 - 3.27) p=0.03]. Length of stay [median: 0.2 vs. 0.3 days, p=0.08], 30-day mortality [1.2% vs. 0.6%, ORadj=2.79 (95%CI: 0.50-15.6) p=0.24] and readmission [11.5% vs. 8.1%, ORadj=1.64 (95%CI: 0.96 - 2.82) p=0.07] were not statistically significant. Conclusions SSc patients demonstrate mostly similar rates of MACE, 30-day mortality, length of stay intraoperative and airway complications. There is evidence of increased risk of overall 30-day MCI risk and readmission after endoscopic procedures.
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Affiliation(s)
- Zyad J. Carr
- Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut
- Yale New Haven Hospital, New Haven, Connecticut
| | - Luying Yan
- Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut
| | - N. David Yanez
- Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut
| | - Robert B. Schonberger
- Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut
- Yale New Haven Hospital, New Haven, Connecticut
| | - Manuel Bohorquez
- Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut
| | - Zili He
- Yale School of Public Health, Center for Analytical Sciences, New Haven, Connecticut
| | - Fangyong Li
- Yale School of Public Health, Center for Analytical Sciences, New Haven, Connecticut
| | - Roberta L Hines
- Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut
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Waldrep KM, Rodgers JI, Garrett SM, Wolf BJ, Feghali-Bostwick CA. The Role of SOX9 in IGF-II-Mediated Pulmonary Fibrosis. Int J Mol Sci 2023; 24:11234. [PMID: 37510994 PMCID: PMC10378869 DOI: 10.3390/ijms241411234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
Pulmonary fibrosis (PF) associated with systemic sclerosis (SSc) results in significant morbidity and mortality. We previously reported that insulin-like growth factor-II (IGF-II) is overexpressed in lung tissues and fibroblasts from SSc patients, and IGF-II fosters fibrosis by upregulating collagen type I, fibronectin, and TGFβ. We now show that IGF-II augments mRNA levels of profibrotic signaling molecules TGFβ2 (p ≤ 0.01) and TGFβ3 (p ≤ 0.05), collagen type III (p ≤ 0.01), and the collagen posttranslational modification enzymes P4HA2 (p ≤ 0.05), P3H2 (p ≤ 0.05), LOX (p = 0.065), LOXL2 (p ≤ 0.05), LOXL4 (p ≤ 0.05) in primary human lung fibroblasts. IGF-II increases protein levels of TGFβ2 (p ≤ 0.01), as well as COL3A1, P4HA2, P4Hβ, and LOXL4 (p ≤ 0.05). In contrast, IGF-II decreases mRNA levels of the collagen degradation enzymes cathepsin (CTS) K, CTSB, and CTSL and protein levels of CTSK (p ≤ 0.05). The SRY-box transcription factor 9 (SOX9) is overexpressed in SSc lung tissues at the mRNA (p ≤ 0.05) and protein (p ≤ 0.01) levels compared to healthy controls. IGF-II induces SOX9 in lung fibroblasts (p ≤ 0.05) via the IGF1R/IR hybrid receptor, and SOX9 regulates TGFβ2 (p ≤ 0.05), TGFβ3 (p ≤ 0.05), COL3A1 (p ≤ 0.01), and P4HA2 (p ≤ 0.001) downstream of IGF-II. Our results identify a novel IGF-II signaling axis and downstream targets that are regulated in a SOX9-dependent and -independent manner. Our findings provide novel insights on the role of IGF-II in promoting pulmonary fibrosis.
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Affiliation(s)
- Kristy M. Waldrep
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA; (K.M.W.); (J.I.R.); (S.M.G.)
| | - Jessalyn I. Rodgers
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA; (K.M.W.); (J.I.R.); (S.M.G.)
| | - Sara M. Garrett
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA; (K.M.W.); (J.I.R.); (S.M.G.)
| | - Bethany J. Wolf
- Department of Public Health Sciences, Biostatistics and Bioinformatics, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Carol A. Feghali-Bostwick
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA; (K.M.W.); (J.I.R.); (S.M.G.)
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González-Sánchez E, Muñoz-Callejas A, Gómez-Román J, San Antonio E, Marengo A, Tsapis N, Bohne-Japiassu K, González-Tajuelo R, Pereda S, García-Pérez J, Cavagna L, González-Gay MÁ, Vicente-Rabaneda E, Meloni F, Fattal E, Castañeda S, Urzainqui A. Everolimus targeted nanotherapy reduces inflammation and fibrosis in scleroderma-related interstitial lung disease (SSc-ILD) developed by PSGL-1 deficient mice. Br J Pharmacol 2022; 179:4534-4548. [PMID: 35726496 DOI: 10.1111/bph.15898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Interstitial lung disease (ILD) is the main cause of mortality in systemic sclerosis (SSc) and current therapies available are of low efficacy or high toxicity. Thus, the identification of innovative less toxic and high efficacy therapeutic approaches to ILD treatment is a crucial point. P-selectin Glycoprotein Ligand-1 (PSGL-1) interaction with P-selectin initiates leukocyte extravasation and the lack of its expression brings to SSc-like syndrome with high incidence of ILD in aged mice. EXPERIMENTAL APPROACH Aged PSGL-1-/- mice were used to assay the therapeutic efficacy of an innovative nanotherapy with everolimus (Ev), included in liposomes decorated with high MW hyaluronic acid (LipHA+Ev) and administrated intratracheally to specifically target CD44-expressing lung cells. KEY RESULTS PSGL-1-/- mice had increased number of CD45+ and CD45- cells, including alveolar and interstitial macrophages, eosinophils, granulocytes and NK cells, and elevated number of myofibroblasts in broncoalveolar lavage (BAL). CD45+ and CD45- cells expressing proinflammatory and profibrotic cytokines were also increased. PSGL-1-/- mice lung histopathology showed increased immune cell infiltration and apoptosis and exacerbated interstitial and peribronchial fibrosis. Targeted nanotherapy with LipHA+Ev reduced BAL number of myofibroblast, cells producing proinflammatory and profibrotic cytokines, and the degree of lung inflammation at histology. LipHA+Ev treatment also provided an important decrease in severity of peribronchial and interstitial lung fibrosis from moderate to mild injury score. CONCLUSIONS AND IMPLICATIONS Our preclinical study in PSGL-1-/- mice indicates that targeted nanotherapy with LipHA+Ev represents an effective treatment for SSc-ILD, reducing the number of inflammatory and fibrotic cells in BAL and reducing inflammation and fibrosis in lungs.
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Affiliation(s)
- Elena González-Sánchez
- Immunology Department, Hospital Universitario de la Princesa, Fundación de Investigación Biomédica (FIB), Instituto de Investigación Sanitaria-Princesa (IIS-Princesa), Madrid, Spain
| | - Antonio Muñoz-Callejas
- Immunology Department, Hospital Universitario de la Princesa, Fundación de Investigación Biomédica (FIB), Instituto de Investigación Sanitaria-Princesa (IIS-Princesa), Madrid, Spain
| | - Javier Gómez-Román
- Pathology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Esther San Antonio
- Immunology Department, Hospital Universitario de la Princesa, Fundación de Investigación Biomédica (FIB), Instituto de Investigación Sanitaria-Princesa (IIS-Princesa), Madrid, Spain
| | - Alessandro Marengo
- Institut Galien Paris Sud, UMR CNRS 8612. School of Pharmacy at University Paris-Saclay, Châtenay-Malabry, France
| | - Nicolas Tsapis
- Institut Galien Paris Sud, UMR CNRS 8612. School of Pharmacy at University Paris-Saclay, Châtenay-Malabry, France
| | - Kamila Bohne-Japiassu
- Institut Galien Paris Sud, UMR CNRS 8612. School of Pharmacy at University Paris-Saclay, Châtenay-Malabry, France
| | - Rafael González-Tajuelo
- Immunology Department, Hospital Universitario de la Princesa, Fundación de Investigación Biomédica (FIB), Instituto de Investigación Sanitaria-Princesa (IIS-Princesa), Madrid, Spain
| | - Saray Pereda
- Pathology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Javier García-Pérez
- Pneumology Department, Fundación de Investigación Biomédica (FIB), Instituto de Investigación Sanitaria-Princesa (IIS-Princesa), Hospital Universitario de la Princesa, Madrid, Spain
| | - Lorenzo Cavagna
- Rheumatology Department, University and IRCCS Policlinico S. Matteo Foundation, Università degli Studi di Pavia, Pavia, Italy
| | - Miguel Ángel González-Gay
- Rheumatology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Esther Vicente-Rabaneda
- Rheumatology Department, Hospital Universitario de la Princesa, Fundación de Investigación Biomédica (FIB), Instituto de Investigación Sanitaria-Princesa (IIS-Princesa), Madrid, Spain
| | - Federica Meloni
- Internal Medicine Department, Pneumology Division, IRCCS San Matteo Foundation and Università degli Studi di Pavia, Pavia, Italy
| | - Elias Fattal
- Institut Galien Paris Sud, UMR CNRS 8612. School of Pharmacy at University Paris-Saclay, Châtenay-Malabry, France
| | - Santos Castañeda
- Rheumatology Department, Hospital Universitario de la Princesa, Fundación de Investigación Biomédica (FIB), Instituto de Investigación Sanitaria-Princesa (IIS-Princesa), Madrid, Spain.,Cathedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ana Urzainqui
- Immunology Department, Hospital Universitario de la Princesa, Fundación de Investigación Biomédica (FIB), Instituto de Investigación Sanitaria-Princesa (IIS-Princesa), Madrid, Spain
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Hochhegger B, Lonzetti L, Rubin A, de Mattos JN, Verma N, Mohammed TLH, Patel PP, Marchiori E. Chest MRI with CT in the assessment of interstitial lung disease progression in patients with systemic sclerosis. Rheumatology (Oxford) 2022; 61:4420-4426. [PMID: 35258556 DOI: 10.1093/rheumatology/keac148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the performance of CT and MRI in the assessment of the progression of interstitial lung disease (ILD) associated with systemic sclerosis (SSc) and demonstrate the correlations of MRI with pulmonary function test (PFT) and CT scores. METHODS This prospective single-center observational study included patients with SSc diagnoses and MR images were assessed visually using the Scleroderma Lung Study (SLS) I system. Differences in the median scores were assessed with t-test and the Wilcoxon rank-sum test. Pearson's and Spearman's Rank correlation coefficients were calculated to correlate imaging scores and PFT results. Using disease progression as the gold standard, we calculated the AUCs of the CT and MRI scores with Harrel's c-index. The best thresholds for the prediction of disease progression were determined by ROC curve analysis with maximum Youden's Index (p < 0.05). The sensitivity, specificity, PPV, and NPV of the scores were calculated. RESULTS The AUCs for MRI and CT scores were 0.86 (0.72-0.98; p = 0.04) and 0.83 (0.70-0.99; p = 0.05), respectively. CT and MRI scores correlated with FVC% (MR: r = -0.54, p= 0.0045-CT: r = -0.44; p= 0.137) and DCO (MR: r = -0.39; p= 0.007-CT r = -0.36: p= 0.006). The sensitivity, specificity, PPV, and NPV were 85%, 87.5%, 88.34% and 86.11% (MR score) and 84.21%, 82.35%, 84.14% and 82.4% (CT score). CONCLUSIONS MRI scores from patients with SSc may be an alternative modality for the assessment of ILD progression in patients with SSc.
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Affiliation(s)
- Bruno Hochhegger
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Lilian Lonzetti
- Santa Casa de Misericórdia de Porto Alegre. Prof. Annes Dias, 285. 90020090. Porto Alegre, RS, Brazil
| | - Adalberto Rubin
- Santa Casa de Misericórdia de Porto Alegre. Prof. Annes Dias, 285. 90020090. Porto Alegre, RS, Brazil
| | - Juliane Nascimento de Mattos
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Santa Casa de Misericórdia de Porto Alegre. Prof. Annes Dias, 285. 90020090. Porto Alegre, RS, Brazil
| | - Nupur Verma
- Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32611, USA
| | - Tan-Lucien H Mohammed
- Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32611, USA
| | - Pratik P Patel
- Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32611, USA
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina. Avenida Brigadeiro Trompowski-Galeão 21941590. Rio de Janeiro, RJ, Brazil
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Wulani V, Budianto T, Amal MY. Variation of usual interstitial pneumonia using HRCT in Scleroderma Patients. Radiol Case Rep 2022; 17:336-339. [PMID: 34876961 PMCID: PMC8633518 DOI: 10.1016/j.radcr.2021.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 12/04/2022] Open
Abstract
Progressive Systemic Sclerosis or Scleroderma is a systemic inflammation marked by endothelial damaged, fibrosis, and inflammation in skin, joints, and visceral organs. Pulmonary hypertension and interstitial pulmonary disease (Ssc-ILD) are the most reported pulmonary complications in scleroderma patients. The pathogenesis of SSc- ILD is not well understood and the spectrum of SSc-ILD ranges from minimal lung involvement, which is often non-progressive, to severe illnesses. Usual Interstitial Pneumonia's (UIP) is one pattern of Ssc-ILD, marked in one-third of the patients with characteristic of honeycomb appearance and bronchiectasis. It is very important to determine the UIP based on radiology imaging especially with the presence of a poor prognosis in patients with UIP. This case report will discuss the importance of finding UIP-type ILD patterns based on HRCT in patients with scleroderma and different outcome.
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Affiliation(s)
- Vally Wulani
- Department of Radiology, Faculty of Medicine, University of Indonesia- Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Taufik Budianto
- Department of Radiology, Faculty of Medicine, University of Indonesia- Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mohamad Yanuar Amal
- Department of Radiology, Faculty of Medicine, University of Indonesia- Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Vafashoar F, Mousavizadeh K, Poormoghim H, Haghighi A, Pashangzadeh S, Mojtabavi N. Progesterone Aggravates Lung Fibrosis in a Mouse Model of Systemic Sclerosis. Front Immunol 2021; 12:742227. [PMID: 34912332 PMCID: PMC8667310 DOI: 10.3389/fimmu.2021.742227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/05/2021] [Indexed: 11/22/2022] Open
Abstract
Background Gender-related factors have explained the higher prevalence of autoimmune diseases in women. Sex hormones play a key role in the immune system and parenchymal cells function; therefore, these hormones can be important in the pathogenesis of autoimmune diseases as a risk or beneficial factor. Lung fibrosis is the main cause of mortality in systemic sclerosis, a female predominant autoimmune disease. The objective of this study was to examine the effect of progesterone on lung fibrosis in a mouse model of systemic sclerosis. Methods Mice with bleomycin-induced lung fibrosis treated with progesterone subcutaneously for 21 and 28 days. Blood was collected for hormone and cytokine measurement at the end of treatment then, skin and lung tissues were harvested for histological assessment, gene expression, cytokine, hydroxyproline, and gelatinase measurement. Results Trichrome staining and hydroxyproline measurements showed that progesterone treatment increased the content of collagen in fibrotic and normal lung tissues. Progesterone increased α-SMA (P < 0.01), TGF- β (P < 0.05) and decreased MMP9 (P < 0.05) in fibrotic lung tissues. Also progesterone treatment decreased the gene expression of Col1a2 (P <0.05), Ctgf (P <01), End1 (0.001) in bleomycin- injured lung tissues. The serum level of TNF-α was decreased, but the serum level of cortisol was increased by progesterone treatment in fibrotic mice (P< 0.05). Conclusion Our results showed that progesterone aggravates lung fibrosis in a mouse model of systemic sclerosis.
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Affiliation(s)
- Fatemeh Vafashoar
- Institute of Immunology and Infectious Disease, Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Immunology, Iran University of Medical Sciences, Tehran, Iran
| | - Kazem Mousavizadeh
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Poormoghim
- Scleroderma Study Group, Firuzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Haghighi
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Salar Pashangzadeh
- Institute of Immunology and Infectious Disease, Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Immunology, Iran University of Medical Sciences, Tehran, Iran
| | - Nazanin Mojtabavi
- Institute of Immunology and Infectious Disease, Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Immunology, Iran University of Medical Sciences, Tehran, Iran
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8
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Teaw S, Hinchcliff M, Cheng M. A review and roadmap of the skin, lung and gut microbiota in systemic sclerosis. Rheumatology (Oxford) 2021; 60:5498-5508. [PMID: 33734316 PMCID: PMC8643452 DOI: 10.1093/rheumatology/keab262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/12/2022] Open
Abstract
As our understanding of the genetic underpinnings of SSc increases, questions regarding the environmental trigger(s) that induce and propagate SSc in the genetically predisposed individual emerge. The interplay between the environment, the immune system, and the microbial species that inhabit the patient's skin and gastrointestinal tract is a pathobiological frontier that is largely unexplored in SSc. The purpose of this review is to provide an overview of the methodologies, experimental study results and future roadmap for elucidating the relationship between the SSc host and his/her microbiome.
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Affiliation(s)
- Shannon Teaw
- Yale School of Medicine, Department of Medicine Section of Rheumatology, Allergy & Immunology, New Haven, CT, USA
| | - Monique Hinchcliff
- Yale School of Medicine, Department of Medicine Section of Rheumatology, Allergy & Immunology, New Haven, CT, USA
| | - Michelle Cheng
- Yale School of Medicine, Department of Medicine Section of Rheumatology, Allergy & Immunology, New Haven, CT, USA
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Velagacherla V, Suresh A, Mehta CH, Nayak UY. Advances and challenges in nintedanib drug delivery. Expert Opin Drug Deliv 2021; 18:1687-1706. [PMID: 34556001 DOI: 10.1080/17425247.2021.1985460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Nintedanib (N.T.B) is an orally administered tyrosine kinase inhibitor that has been approved recently by U.S.F.D.A for idiopathic pulmonary fibrosis (I.P.F) and systemic sclerosis-associated interstitial lung disease (S.Sc-I.L.D). N.T.B is also prescribed in COVID-19 patients associated with I.P.F. However, it has an extremely low bioavailability of around 4.7%, and hence, researchers are attempting to address this drawback by different approaches. AREAS COVERED This review article focuses on enlisting all the formulation attempts explored by researchers to increase the bioavailability of N.T.B while also providing meaningful insight into the unexplored areas in formulation development, such as targeting of the lymphatic system and transdermal delivery. All the patents on the formulation development of N.T.B have also been summarized. EXPERT OPINION N.T.B has the potential to act on multiple diseases that are still being discovered, but its extremely low bioavailability is a challenge that is to be dealt with for obtaining the full benefit. Few studies have been performed aiming at improving the bioavailability, but there are unexplored areas that can be used, a few of which are explained in this article. However, the ability to reproduce laboratory results when scaling up to the industry level is the only factor to be taken into consideration.
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Affiliation(s)
- Varalakshmi Velagacherla
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Akhil Suresh
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Chetan H Mehta
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Usha Y Nayak
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
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Giucă A, Mihai C, Jurcuț C, Gheorghiu AM, Groșeanu L, Dima A, Săftoiu A, Coman IM, Popescu BA, Jurcuț R. Screening for Pulmonary Hypertension in Systemic Sclerosis-A Primer for Cardio-Rheumatology Clinics. Diagnostics (Basel) 2021; 11:diagnostics11061013. [PMID: 34206055 PMCID: PMC8229459 DOI: 10.3390/diagnostics11061013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/20/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare disease, with unfavorable clinical course and prognosis, characterized by progressive multisystemic involvement. SSc associated pulmonary hypertension (SSc-PAH) and interstitial lung disease (ILD) are the most important factors for morbi-mortality in these patients, being responsible for more than 60% of total deaths. Though pulmonary arterial hypertension (PAH) is the dominant subtype seen in SSc, PH secondary to ILD, left-heart pathology, and pulmonary veno-occlusive disease (PVOD) are also possible occurrences. Initial evaluation of a SSc case is complex and should be performed with a multidisciplinary approach. Early detection of SSc-PAH is imperative, given the fact that new and effective medications are available and early treatment was shown to improve outcomes. Therefore, screening algorithms must be used adequately and in a cost-effective manner. Sensitivity and negative predictive value (NPV) are the most important performance measures in a screening test. Several algorithms were developed in the last decade (e.g., DETECT and ASIG) and demonstrated higher efficiency when compared to older algorithms. The present manuscript details the risk factors for SSc-PAH and includes a critical description of current detection algorithms, as a primer for clinicians working in the field of cardio-rheumatology.
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Affiliation(s)
- Adrian Giucă
- Department of Cardiology, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street no. 258, 022328 Bucharest, Romania; (A.G.); (I.M.C.); (B.A.P.)
| | - Carina Mihai
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
- Department of Rheumatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Ciprian Jurcuț
- Department of Internal Medicine, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania;
| | - Ana Maria Gheorghiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
- Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Str.Ion Movilă nr 5-7, 020475 Bucharest, Romania
| | - Laura Groșeanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
- Department of Rheumatology, “Sf. Maria” Clinical Hospital, Bd Ion Mihalache nr 37-39, 011172 Bucharest, Romania
| | - Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, Sos Stefan cel Mare nr 19-21, 020125 Bucharest, Romania;
| | - Adrian Săftoiu
- Department of Internal Medicine, Craiova University of Medicine and Pharmacy, Str Petru Rares nr 2, 200349 Craiova, Romania;
| | - Ioan Mircea Coman
- Department of Cardiology, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street no. 258, 022328 Bucharest, Romania; (A.G.); (I.M.C.); (B.A.P.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
| | - Bogdan A. Popescu
- Department of Cardiology, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street no. 258, 022328 Bucharest, Romania; (A.G.); (I.M.C.); (B.A.P.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
| | - Ruxandra Jurcuț
- Department of Cardiology, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Fundeni Street no. 258, 022328 Bucharest, Romania; (A.G.); (I.M.C.); (B.A.P.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Str Dionisie Lupu nr 37, 020021 Bucharest, Romania; (C.M.); (A.M.G.); (L.G.)
- Correspondence:
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Löfdahl A, Tornling G, Wigén J, Larsson-Callerfelt AK, Wenglén C, Westergren-Thorsson G. Pathological Insight into 5-HT 2B Receptor Activation in Fibrosing Interstitial Lung Diseases. Int J Mol Sci 2020; 22:ijms22010225. [PMID: 33379351 PMCID: PMC7796180 DOI: 10.3390/ijms22010225] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022] Open
Abstract
Interstitial lung disease (ILD) encompasses a heterogeneous group of more than 200 conditions, of which primarily idiopathic pulmonary fibrosis (IPF), idiopathic nonspecific interstitial pneumonia, hypersensitivity pneumonitis, ILD associated with autoimmune diseases and sarcoidosis may present a progressive fibrosing (PF) phenotype. Despite different aetiology and histopathological patterns, the PF-ILDs have similarities regarding disease mechanisms with self-sustaining fibrosis, which suggests that the diseases may share common pathogenetic pathways. Previous studies show an enhanced activation of serotonergic signaling in pulmonary fibrosis, and the serotonin (5-HT)2 receptors have been implicated to have important roles in observed profibrotic actions. Our research findings in support by others, demonstrate antifibrotic effects with 5-HT2B receptor antagonists, alleviating several key events common for the fibrotic diseases such as myofibroblast differentiation and connective tissue deposition. In this review, we will address the potential role of 5-HT and in particular the 5-HT2B receptors in three PF-ILDs: ILD associated with systemic sclerosis (SSc-ILD), ILD associated with rheumatoid arthritis (RA-ILD) and IPF. Highlighting the converging pathways in these diseases discloses the 5-HT2B receptor as a potential disease target for PF-ILDs, which today have an urgent unmet need for therapeutic strategies.
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Affiliation(s)
- Anna Löfdahl
- Lung Biology, Department of Experimental Medical Science, Lund University, BMC C12, 22184 Lund, Sweden; (J.W.); (A.-K.L.-C.); (G.W.-T.)
- Correspondence:
| | - Göran Tornling
- AnaMar AB, Medicon Village, Scheeletorget 1, 22381 Lund, Sweden; (C.W.); (G.T.)
- Respiratory Medicine Division, Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Jenny Wigén
- Lung Biology, Department of Experimental Medical Science, Lund University, BMC C12, 22184 Lund, Sweden; (J.W.); (A.-K.L.-C.); (G.W.-T.)
| | - Anna-Karin Larsson-Callerfelt
- Lung Biology, Department of Experimental Medical Science, Lund University, BMC C12, 22184 Lund, Sweden; (J.W.); (A.-K.L.-C.); (G.W.-T.)
| | - Christina Wenglén
- AnaMar AB, Medicon Village, Scheeletorget 1, 22381 Lund, Sweden; (C.W.); (G.T.)
| | - Gunilla Westergren-Thorsson
- Lung Biology, Department of Experimental Medical Science, Lund University, BMC C12, 22184 Lund, Sweden; (J.W.); (A.-K.L.-C.); (G.W.-T.)
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Branco T, Oliveira LF, Palinkas M, de Vasconcelos PB, Oliveira MC, Simões BP, Regalo IH, Siéssere S, Regalo SCH. Autologous Hematopoietic Stem Cell Therapy of the Subjects with Systemic Sclerosis: Electromyographic Results of the Masticatory Muscles. Prague Med Rep 2020; 121:163-171. [PMID: 33030145 DOI: 10.14712/23362936.2020.15] [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: 10/23/2022] Open
Abstract
Musculoskeletal system impairment is a major cause of functional alterations in subjects with systemic sclerosis. Autologous hematopoietic stem cell therapy (AHSCT) may have an important role in the treatment functional of systemic sclerosis patients. The aim of this pilot study was to assess whether AHSCT interferes with the electromyographic activity of the masseter and temporalis muscles of subjects with systemic sclerosis. Before transplantation, seven subjects with systemic sclerosis (mean age [± SD], 40.1 ± 9.6 years) underwent electromyographic analysis of the masseter and temporalis muscles in mandibular tasks at rest, right and left laterality, protrusion and maximum voluntary contraction. Two months after AHSCT, the subjects re-evaluated using the same methods. Data were analyzed using the repeated-measure test, with p<0.05 considered to be statistically significant. Two months after AHSCT, there was reduction in normalized electromyographic activity in the dental clenching in maximal voluntary contraction, with significant differences, for the left temporal muscle (p=0.04). AHSCT in subjects with systemic sclerosis promotes alterations in stomatognathic system function, especially those related to electromyographic activity of masticatory muscles.
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Affiliation(s)
- Thamyres Branco
- School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Marcelo Palinkas
- Faculty Anhanguera, Ribeirão Preto, São Paulo, Brazil. .,National Institute and Technology - Translational Medicine (INCT.TM), São Paulo, Brazil. .,School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
| | | | - Maria Carolina Oliveira
- Bone Marrow Transplantation Unit, Hospital das Clínicas, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.,School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Belinda Pinto Simões
- Bone Marrow Transplantation Unit, Hospital das Clínicas, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.,School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Selma Siéssere
- National Institute and Technology - Translational Medicine (INCT.TM), São Paulo, Brazil.,School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Simone Cecilio Hallak Regalo
- National Institute and Technology - Translational Medicine (INCT.TM), São Paulo, Brazil.,School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Autoantibodies to stratify systemic sclerosis patients into clinically actionable subsets. Autoimmun Rev 2020; 19:102583. [PMID: 32553611 DOI: 10.1016/j.autrev.2020.102583] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 01/29/2023]
Abstract
Systemic sclerosis (SSc) is a rare chronic disease of unknown etiology characterized by vascular abnormalities and fibrosis involving the skin and internal organs, especially the gastrointestinal tract, lung, heart and kidneys. Although the disease was historically stratified according to the extent of skin involvement, more recent approaches place more emphasis on patterns and extent of internal organ involvement. Despite numerous clinical trials, disease-modifying treatment options are still limited resulting in persistent poor quality of life and high mortality. This review provides an overview of autoantibodies in SSc and novel approaches to stratify the disease into clinically actionable subsets.
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Tezcan D, Turan Ç, Yılmaz S, Sivrikaya A, Gülcemal S, Limon M, Ecer B. What do simple hematological parameters tell us in patients with systemic sclerosis? ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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