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Al-Azab M, Idiiatullina E, Liu Z, Lin M, Hrovat-Schaale K, Xian H, Zhu J, Yang M, Lu B, Zhao Z, Liu Y, Chang J, Li X, Guo C, Liu Y, Wu Q, Chen J, Lan C, Zeng P, Cui J, Gao X, Zhou W, Zhang Y, Zhang Y, Masters SL. Genetic variants in UNC93B1 predispose to childhood-onset systemic lupus erythematosus. Nat Immunol 2024; 25:969-980. [PMID: 38831104 PMCID: PMC11147776 DOI: 10.1038/s41590-024-01846-5] [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: 09/12/2023] [Accepted: 04/17/2024] [Indexed: 06/05/2024]
Abstract
Rare genetic variants in toll-like receptor 7 (TLR7) are known to cause lupus in humans and mice. UNC93B1 is a transmembrane protein that regulates TLR7 localization into endosomes. In the present study, we identify two new variants in UNC93B1 (T314A, located proximally to the TLR7 transmembrane domain, and V117L) in a cohort of east Asian patients with childhood-onset systemic lupus erythematosus. The V117L variant was associated with increased expression of type I interferons and NF-κB-dependent cytokines in patient plasma and immortalized B cells. THP-1 cells expressing the variant UNC93B1 alleles exhibited exaggerated responses to stimulation of TLR7/-8, but not TLR3 or TLR9, which could be inhibited by targeting the downstream signaling molecules, IRAK1/-4. Heterozygous mice expressing the orthologous Unc93b1V117L variant developed a spontaneous lupus-like disease that was more severe in homozygotes and again hyperresponsive to TLR7 stimulation. Together, this work formally identifies genetic variants in UNC93B1 that can predispose to childhood-onset systemic lupus erythematosus.
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Affiliation(s)
- Mahmoud Al-Azab
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
- Department of Medical Microbiology, Faculty of Medicine, University of Science and Technology, Aden, Yemen
| | - Elina Idiiatullina
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
- Department of Therapy and Nursing, Bashkir State Medical University, Ufa, Russia
| | - Ziyang Liu
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Meng Lin
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Katja Hrovat-Schaale
- Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Huifang Xian
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Jianheng Zhu
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Mandy Yang
- State Key Laboratory of Respiratory Diseases, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Bingtai Lu
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Zhiyao Zhao
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
- Center for Mitochondrial Genetics and Health, Greater Bay Area Institute of Precision Medicine (Guangzhou), Guangzhou, China
| | - Yiyi Liu
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Jingjie Chang
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Xiaotian Li
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Caiqin Guo
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Yunfeng Liu
- Clinical Laboratory, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangdong, China
| | - Qi Wu
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
- National Children Medical Center, Department of Clinical Immunology, Children's Hospital of Fudan University, Shanghai, China
| | - Jiazhang Chen
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Chaoting Lan
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Ping Zeng
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Jun Cui
- School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Xia Gao
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Wenhao Zhou
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Yan Zhang
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China
| | - Yuxia Zhang
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China.
| | - Seth L Masters
- Department of Immunology, Guangzhou Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, and State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, China.
- Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia.
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia.
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Zhan S, Ding L, Li H, Su A. Application of Failure Mode and Effects Analysis to Improve the Quality of the Front Page of Electronic Medical Records in China: Cross-Sectional Data Mapping Analysis. JMIR Med Inform 2024; 12:e53002. [PMID: 38241064 PMCID: PMC10837756 DOI: 10.2196/53002] [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: 09/21/2023] [Revised: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The completeness and accuracy of the front pages of electronic medical records (EMRs) are crucial for evaluating hospital performance and for health insurance payments to inpatients. However, the quality of the first page of EMRs in China's medical system is not satisfactory, which can be partly attributed to deficiencies in the EMR system. Failure mode and effects analysis (FMEA) is a proactive risk management tool that can be used to investigate the potential failure modes in an EMR system and analyze the possible consequences. OBJECTIVE The purpose of this study was to preemptively identify the potential failures of the EMR system in China and their causes and effects in order to prevent such failures from recurring. Further, we aimed to implement corresponding improvements to minimize system failure modes. METHODS From January 1, 2020, to May 31, 2022, 10 experts, including clinicians, engineers, administrators, and medical record coders, in Zhejiang People's Hospital conducted FMEA to improve the quality of the front page of the EMR. The completeness and accuracy of the front page and the risk priority numbers were compared before and after the implementation of specific improvement measures. RESULTS We identified 2 main processes and 6 subprocesses for improving the EMR system. We found that there were 13 potential failure modes, including data messaging errors, data completion errors, incomplete quality control, and coding errors. A questionnaire survey administered to random physicians and coders showed 7 major causes for these failure modes. Therefore, we established quality control rules for medical records and embedded them in the system. We also integrated the medical insurance system and the front page of the EMR on the same interface and established a set of intelligent front pages in the EMR management system. Further, we revamped the quality management systems such as communicating with physicians regularly and conducting special training seminars. The overall accuracy and integrity rate of the front page (P<.001) of the EMR increased significantly after implementation of the improvement measures, while the risk priority number decreased. CONCLUSIONS In this study, we were able to identify the potential failure modes in the front page of the EMR system by using the FMEA method and implement corresponding improvement measures in order to minimize recurring errors in the health care services in China.
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Affiliation(s)
- Siyi Zhan
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Liping Ding
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Hui Li
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Aonan Su
- Zhejiang Provincial People's Hospital, Hangzhou, China
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Eryavuz Onmaz D, Tezcan D, Yilmaz S, Onmaz M, Unlu A. Altered kynurenine pathway metabolism and association with disease activity in patients with systemic lupus. Amino Acids 2023; 55:1937-1947. [PMID: 37925676 DOI: 10.1007/s00726-023-03353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease accompanied by increased release of proinflammatory cytokines that are known to activate the indoleamine 2,3-dioxygenase (IDO-1) enzyme, which catalyzes the rate-limiting step of the kynurenine pathway (KP). This study aimed to measure KP metabolite levels in patients with SLE and investigate the relationship between disease activity, clinical findings, and KP. The study included 100 patients with SLE and 100 healthy controls. Serum tryptophan (TRP), kynurenine (KYN), kynurenic acid (KYNA), 3-hydroxyanthranilic acid (3HAA), 3-hydroxykynurenine (3HK), quinolinic acid (QA) concentrations were measured with tandem mass spectrometry. Serum KYN, KYNA, 3HAA, 3HK, and QA levels of the patients with SLE were significantly higher than the control group. Serum QA levels were elevated in patients with neurological involvement (four patients with peripheral neuropathy and two patients with mononeuropathy), serum KYN levels and KYN/TRP ratio increased in patients with joint involvement, and serum KYN, 3HK, and 3HAA levels and the KYN/TRP ratio were increased in patients with renal involvement. Moreover, KYN and KYN/TRP ratios were positively correlated with the disease activity score. These findings indicated that imbalances in KP metabolites may be associated with the pathogenesis, activation, and clinical manifestations of SLE.
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Affiliation(s)
- Duygu Eryavuz Onmaz
- Department of Biochemistry, Selcuk University Faculty of Medicine, Alaaddin Keykubat Campus, Selcuklu, 42075, Konya, Turkey.
| | - Dilek Tezcan
- Division of Rheumatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Sema Yilmaz
- Division of Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mustafa Onmaz
- Faculty of Medicine, Department of Family Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Unlu
- Department of Biochemistry, Selcuk University Faculty of Medicine, Alaaddin Keykubat Campus, Selcuklu, 42075, Konya, Turkey
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5
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Cayuela L, Pereyra-Rodríguez JJ, Hernández-Rodríguez JC, Muñoz-Jiménez A, Cayuela A. Clustering of systemic lupus erythematosus mortality in southwestern Spain. Lupus 2023; 32:1345-1352. [PMID: 37641198 DOI: 10.1177/09612033231199511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To analyse time trends in systemic lupus erythematosus (SLE) mortality and explore possible provincial clustering of SLE mortality in Spain (2001-2020). METHODS We conducted an ecological study using deaths registered in SLE at the Spanish National Institute of Statistics between 2001 and 2020. Jointpoint regression models have been used to evaluate temporal trends. To analyse the spatial pattern of SLE mortality in men and women in Spain, crude rates, age-standardised mortality rates (ASMRs), smooth relative risk (RR) and posterior probabilities (PP) for RR greater than one for the period 2001-2020 were calculated. The Global Moran I index was used to assess the existence of global spatial autocorrelation. Local indicators of spatial association (LISA) and Kulldorff's spatial scan statistic were used to identify clusters. RESULTS Over the 20 years analyzed in this study, the SLE average ASMR for the period was 2.7 for women and 0.7 for men, with a sex ratio (female/male) of 3.8. In men, no province showed a RR>1. Conversely, in women, eight provinces showed values of RR> 1 with a PP greater than 0.8 (Seville, Cadiz, Huelva and Murcia in the south, Barcelona, Zaragoza, Huesca and Leon in the north). In men, neither of the two methods detected a clustering of provinces. However, in women, both methods identified a cluster of provinces located in the southwest of the country (Huelva, Cádiz, Seville and Malaga) as a cluster with significant excess mortality. In the second cluster (centred on the province of Huelva) obtained with the Kulldorff method, two more provinces were added (Badajoz and Cordoba, also located in the southwest). CONCLUSIONS We detected a cluster of provinces with an excess risk of female SLE mortality in the southwest of Spain.
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Affiliation(s)
- Lucía Cayuela
- Department of Internal Medicine, Hospital Severo Ochoa, Leganés, Spain
| | - José-Juan Pereyra-Rodríguez
- Department of Medicine, School of Medicine, University of Seville, Seville, Spain
- Department of Dermatology, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Alejandro Muñoz-Jiménez
- Department of Medicine, School of Medicine, University of Seville, Seville, Spain
- Reumatology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Aurelio Cayuela
- Unit of Public Health, Prevention and Health Promotion, South Seville Health Management Area, Seville, Spain
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Tian J, Zhang D, Yao X, Huang Y, Lu Q. Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study. Ann Rheum Dis 2023; 82:351-356. [PMID: 36241363 PMCID: PMC9933169 DOI: 10.1136/ard-2022-223035] [Citation(s) in RCA: 91] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To quantify global, regional and country-specific estimates of epidemiology of systemic lupus erythematosus (SLE). METHODS Four databases were systematically searched, and a Bayesian hierarchical linear mixed model was constructed to estimate the global, regional, and country-specific incidence and prevalence of SLE. RESULTS 112 studies met the inclusion criteria. The global SLE incidence and newly diagnosed population were estimated to be 5.14 (1.4 to 15.13) per 100 000 person-years and 0.40 million people annually, respectively. In women, the values were 8.82 (2.4 to 25.99) per 100 000 person-years and 0.34 million people annually, while in men, the estimates were 1.53 (0.41 to 4.46) per 100 000 person-years and 0.06 million people annually, respectively. Poland, the USA and Barbados had the highest estimates of SLE incidence. Regarding prevalence, the global SLE prevalence and affected population were estimated to be 43.7 (15.87 to 108.92) per 100 000 persons and 3.41 million people, respectively. In women, the values were 78.73 (28.61 to 196.33) per 100 000 persons and 3.04 million people, while in men the estimates were 9.26 (3.36 to 22.97) per 100 000 persons and 0.36 million people, respectively. The United Arab Emirates, Barbados and Brazil had the highest SLE prevalence. In addition to regional and sex differences, age and prevalence estimation method (period or point prevalence) differences could also lead to variations in epidemiological SLE findings. CONCLUSIONS Epidemiological data on SLE are lacking for 79.8% of countries worldwide. The epidemiology of SLE varies substantially between different sex and age groups and is distributed unequally among geographical regions; specifically, SLE occurs more frequently in high-income countries.
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Affiliation(s)
- Jingru Tian
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China,Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Dingyao Zhang
- Graduate Program in Biological and Biomedical Sciences, Yale University, New Haven, Connecticut, USA,Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA
| | - Xu Yao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yaqing Huang
- Department of Pathology, Yale University, New Haven, Connecticut, USA
| | - Qianjin Lu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China .,Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
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