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Blanco LP, Patino‐Martinez E, Nakabo S, Zhang M, Pedersen HL, Wang X, Carmona Rivera C, Claybaugh D, Yu Z, Desta E, Kaplan MJ. Modulation of the itaconate pathway attenuates murine lupus. Arthritis Rheumatol 2022; 74:1971-1983. [DOI: 10.1002/art.42284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/26/2022] [Accepted: 06/23/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Luz P. Blanco
- Systemic Autoimmunity Branch National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Eduardo Patino‐Martinez
- Systemic Autoimmunity Branch National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Shuichiro Nakabo
- Systemic Autoimmunity Branch National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Mingzeng Zhang
- Systemic Autoimmunity Branch National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Hege L. Pedersen
- Systemic Autoimmunity Branch National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Xinghao Wang
- Systemic Autoimmunity Branch National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Carmelo Carmona Rivera
- Systemic Autoimmunity Branch National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Dillon Claybaugh
- Systemic Autoimmunity Branch National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
| | - Zu‐Xi Yu
- Pathology Core National Heart, Lung, and Blood Institute (NHLBI)
| | - Equar Desta
- Laboratory of Animal Science Section National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda Maryland USA
| | - Mariana J. Kaplan
- Systemic Autoimmunity Branch National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
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Wang X, Blanco LP, Carmona-Rivera C, Nakabo S, Pedersen HL, Yu ZX, Kaplan MJ. Effects of Gasdermin D in Modulating Murine Lupus and its Associated Organ Damage. Arthritis Rheumatol 2020; 72:2118-2129. [PMID: 32692482 DOI: 10.1002/art.41444] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Gasdermin D (GSDMD) is the key executioner of an inflammatory cell death mechanism known as pyroptosis. Recent reports have also implicated GSDMD in other mechanisms of cell death, including apoptosis, necroptosis, and NETosis. Given the role of dysregulated cell death in autoimmune syndromes such as systemic lupus erythematosus (SLE), this study was undertaken in a murine lupus model to investigate whether GSDMD plays a pathogenic role in systemic autoimmunity by promoting inflammatory cell death, leading to increased generation of nuclear autoantigens and autoantibodies. METHODS An imiquimod-induced model of SLE was tested in GSDMD-/- mice (n = 30), with wild-type (WT) mice as controls (n = 34), on a C57BL/6 background. At the time of euthanasia, the mice were examined for serum autoantibodies, immune complex deposition, organ inflammation, immune dysregulation, and type I interferon responses. A model of pristane-induced lung injury in GSDMD-/- mice (n = 7), with WT mice as controls (n = 10), was used to confirm the pulmonary phenotype. Regulation of various mechanisms of cell death by GSDMD was investigated in the mice. RESULTS Unexpectedly, GSDMD-/- mice developed enhanced mortality, more severe renal and pulmonary inflammation, and exacerbated autoantibody production in response to imiquimod. Pulmonary involvement was also more severe in the absence of GSDMD in mice with pristane-induced lung injury. Compared to WT mice, lack of GSDMD was associated with increased levels of circulating nuclear autoantigens (P < 0.01), anti-double-stranded DNA autoantibodies (P < 0.01), tissue immune complex deposition (P < 0.05), expansion of myeloid cell subsets (P < 0.05), and enhanced B cell activation and plasma cell differentiation (P = 0.001). Moreover, in the absence of GSDMD, enhanced autoantigen generation was associated with increased local induction of cell death in vivo. CONCLUSION GSDMD negatively regulates autoantigen generation and immune dysregulation in response to tissue injury and may play previously unappreciated protective roles in systemic autoimmunity.
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Affiliation(s)
- Xinghao Wang
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, United States
| | - Luz P Blanco
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, United States
| | - Carmelo Carmona-Rivera
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, United States
| | - Shuichiro Nakabo
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, United States
| | - Hege L Pedersen
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, United States
| | - Zu-Xi Yu
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, United States
| | - Mariana J Kaplan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, United States
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Fortner KA, Blanco LP, Buskiewicz I, Huang N, Gibson PC, Cook DL, Pedersen HL, Yuen PST, Murphy MP, Perl A, Kaplan MJ, Budd RC. Targeting mitochondrial oxidative stress with MitoQ reduces NET formation and kidney disease in lupus-prone MRL- lpr mice. Lupus Sci Med 2020; 7:e000387. [PMID: 32343673 PMCID: PMC7199895 DOI: 10.1136/lupus-2020-000387] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Recent investigations in humans and mouse models with lupus have revealed evidence of mitochondrial dysfunction and production of mitochondrial reactive oxygen species (mROS) in T cells and neutrophils. This can provoke numerous cellular changes including oxidation of nucleic acids, proteins, lipids and even induction of cell death. We have previously observed that in T cells from patients with lupus, the increased mROS is capable of provoking oligomerisation of mitochondrial antiviral stimulator (MAVS) and production of type I interferon (IFN-I). mROS in SLE neutrophils also promotes the formation of neutrophil extracellular traps (NETs), which are increased in lupus and implicated in renal damage. As a result, in addition to traditional immunosuppression, more comprehensive treatments for lupus may also include non-immune therapy, such as antioxidants. METHODS Lupus-prone MRL-lpr mice were treated from weaning for 11 weeks with the mitochondria-targeted antioxidant, MitoQ (200 µM) in drinking water. Mice were then assessed for ROS production in neutrophils, NET formation, MAVS oligomerisation, serum IFN-I, autoantibody production and renal function. RESULTS MitoQ-treated mice manifested reduced neutrophil ROS and NET formation, decreased MAVS oligomerisation and serum IFN-I, and reduced immune complex formation in kidneys, despite no change in serum autoantibody . CONCLUSIONS These findings reveal the potential utility of targeting mROS in addition to traditional immunosuppressive therapy for lupus.
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Affiliation(s)
- Karen A Fortner
- Vermont Center for Immunology and Infectious Diseases, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Luz P Blanco
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Iwona Buskiewicz
- Department of Microbiology and Immunology, Upstate Medical University, Syracuse, NY, New York
| | - Nick Huang
- Rheumatology Clinic, Upstate University Hospital, Syracuse, NY, New York
| | - Pamela C Gibson
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Deborah L Cook
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Hege L Pedersen
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Peter S T Yuen
- Renal Diagnostics and Therapeutic Unit, Kidney Diseases Branch, National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
| | - Michael P Murphy
- MRC Mitochondrial Biology Unit, Biomedical Campus, University of Cambridge, Cambridge, CB2 0XY, UK
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Andras Perl
- Rheumatology Clinic, Upstate University Hospital, Syracuse, NY, New York
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Ralph C Budd
- Vermont Center for Immunology and Infectious Diseases, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
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Blanco LP, Pedersen HL, Wang X, Lightfoot YL, Seto N, Carmona-Rivera C, Yu ZX, Hoffmann V, Yuen PS, Kaplan MJ. Improved Mitochondrial Metabolism and Reduced Inflammation Following Attenuation of Murine Lupus With Coenzyme Q10 Analog Idebenone. Arthritis Rheumatol 2020; 72:454-464. [PMID: 31566908 PMCID: PMC7050361 DOI: 10.1002/art.41128] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 09/26/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A role for mitochondrial dysfunction has been proposed in the immune dysregulation and organ damage characteristic of systemic lupus erythematosus (SLE). Idebenone is a coenzyme Q10 synthetic quinone analog and an antioxidant that has been used in humans to treat diverse diseases in which mitochondrial function is impaired. This study was undertaken to assess whether idebenone ameliorates lupus in murine models. METHODS Idebenone was administered orally to MRL/lpr mice at 2 different doses (1 gm/kg or 1.5 gm/kg idebenone-containing diet) for 8 weeks. At peak disease activity, clinical, immunologic, and metabolic parameters were analyzed and compared to those in untreated mice (n = 10 per treatment group). Results were confirmed in the lupus-prone NZM2328 mouse model. RESULTS In MRL/lpr mice, idebenone-treated mice showed a significant reduction in mortality incidence (P < 0.01 versus untreated mice), and the treatment attenuated several disease features, including glomerular inflammation and fibrosis (each P < 0.05 versus untreated mice), and improved renal function in association with decreased renal expression of interleukin-17A (IL-17A) and mature IL-18. Levels of splenic proinflammatory cytokines and inflammasome-related genes were significantly decreased (at least P < 0.05 and some with higher significance) in mice treated with idebenone, while no obvious drug toxicity was observed. Idebenone inhibited neutrophil extracellular trap formation in neutrophils from lupus-prone mice (P < 0.05) and human patients with SLE. Idebenone also improved mitochondrial metabolism (30% increase in basal respiration and ATP production), reduced the extent of heart lipid peroxidation (by one-half that of untreated mice), and significantly improved endothelium-dependent vasorelaxation (P < 0.001). NZM2328 mice exposed to idebenone also displayed improvements in renal and systemic inflammation, reducing the kidney pathology score (P < 0.05), IgG/C3 deposition (P < 0.05), and the gene expression of interferon, proinflammatory, and inflammasome-related genes (at least P < 0.05 and some with higher significance). CONCLUSION Idebenone ameliorates murine lupus disease activity and the severity of organ damage, supporting the hypothesis that agents that modulate mitochondrial biologic processes may have a therapeutic role in human SLE.
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Affiliation(s)
- Luz P. Blanco
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Hege L. Pedersen
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Xinghao Wang
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Yaíma L. Lightfoot
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Nickie Seto
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Zu-Xi Yu
- Pathology Core, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Victoria Hoffmann
- Office of the Director, Division of Veterinary Resources, Diagnostic and Research Services Branch, NIH, Bethesda, Maryland, USA
| | - Peter S.T. Yuen
- Renal Diagnostics and Therapeutic Unit, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, USA
| | - Mariana J. Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
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Pedersen HL, Horvei KD, Thiyagarajan D, Norby GE, Seredkina N, Moroni G, Eilertsen GØ, Holdaas H, Strøm EH, Bakland G, Meroni PL, Rekvig OP. Lupus nephritis: low urinary DNase I levels reflect loss of renal DNase I and may be utilized as a biomarker of disease progression. J Pathol Clin Res 2018; 4:193-203. [PMID: 29624903 PMCID: PMC6065113 DOI: 10.1002/cjp2.99] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 01/10/2018] [Accepted: 02/19/2018] [Indexed: 11/21/2022]
Abstract
Renal DNase I is lost in advanced stages of lupus nephritis. Here, we determined if loss of renal DNase I reflects a concurrent loss of urinary DNase I, and whether absence of urinary DNase I predicts disease progression. Mouse and human DNase I protein and DNase I endonuclease activity levels were determined by western blot, gel, and radial activity assays at different stages of the murine and human forms of the disease. Cellular localization of DNase I was analyzed by immunohistochemistry, immunofluorescence, confocal microscopy, and immunoelectron microscopy. We further compared DNase I levels in human native and transplanted kidneys to determine if the disease depended on autologous renal genes, or whether the nephritic process proceeded also in transplanted kidneys. The data indicate that reduced renal DNase I expression level relates to serious progression of lupus nephritis in murine, human native, and transplanted kidneys. Notably, silencing of renal DNase I correlated with loss of DNase I endonuclease activity in the urine samples. Thus, urinary DNase I levels may therefore be used as a marker of lupus nephritis disease progression and reduce the need for renal biopsies.
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Affiliation(s)
- Hege L Pedersen
- Department of Medical Biology, UiT-the Arctic University of Norway, Tromsø, Norway
| | - Kjersti D Horvei
- Department of Medical Biology, UiT-the Arctic University of Norway, Tromsø, Norway
| | - Dhivya Thiyagarajan
- Department of Medical Biology, UiT-the Arctic University of Norway, Tromsø, Norway
| | - Gudrun E Norby
- Department of Rheumatology, OUH-Oslo University Hospital, Oslo, Norway
| | - Natalya Seredkina
- Department of Medical Biology, UiT-the Arctic University of Norway, Tromsø, Norway
| | - Gabriella Moroni
- Nephrological Unit, Fondazione Ca' Granda IRCCS, Ospedale Maggiore, Milano, Italy
| | - Gro Ø Eilertsen
- Department of Clinical Medicine, UiT-the Arctic University of Norway, Tromsø, Norway
| | - Hallvard Holdaas
- Department of Medicine, OUH-Oslo University Hospital, Oslo, Norway
| | - Erik H Strøm
- Department of Pathology, OUH-Oslo University Hospital, Oslo, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway
| | - Pier-Luigi Meroni
- Department of Clinical Sciences and Community Health, University of Milan and IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Ole P Rekvig
- Department of Medical Biology, UiT-the Arctic University of Norway, Tromsø, Norway
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Thiyagarajan D, Pedersen HL, Seredkina N, Horvei KD, Arranz L, Sonneveld R, Nijenhuis T, van der Vlag J, Rekvig OP. IL-1β Promotes a New Function of DNase I as a Transcription Factor for the Fas Receptor Gene. Front Cell Dev Biol 2018; 6:7. [PMID: 29468159 PMCID: PMC5807897 DOI: 10.3389/fcell.2018.00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/23/2018] [Indexed: 12/26/2022] Open
Abstract
Recently we described that endonuclease inactive DNase I translocated into the nucleus in response to increased endogenous IL-1β expression. Here, we demonstrate impact and function of translocated DNase I in tubular cells. Effect of cytokines on expression level and nuclear localisation of DNase I and corresponding levels of Fas receptor (FasR) and IL-1β were determined by confocal microscopy, qPCR and western blot analyses, in presence or absence of siRNA against IL-1β and DNase I mRNA. Nuclear DNase I bound to the FAS promotor region as determined by chromatin immuno-precipitation analysis. Data demonstrate that; (i) translocation of DNase I depended on endogenous de novo-expressed IL-1β, (ii) nuclear DNase I bound FAS DNA, (iii) FasR expression increased after translocation of DNase I, (iv) interaction of exogenous Fas ligand (FasL) with upregulated FasR induced apoptosis in human tubular cells stimulated with TNFα. Thus, translocated DNase I most probably binds the promoter region of the FAS gene and function as a transcription factor for FasR. In conclusion, DNase I not only executes chromatin degradation during apoptosis and necrosis, but also primes the cells for apoptosis by enhancing FasR expression.
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Affiliation(s)
- Dhivya Thiyagarajan
- RNA and Molecular Pathology Research Group, Department of Medical Biology, University Hospital of North Norway, Tromsø, Norway
| | - Hege L. Pedersen
- RNA and Molecular Pathology Research Group, Department of Medical Biology, University Hospital of North Norway, Tromsø, Norway
| | - Natalya Seredkina
- RNA and Molecular Pathology Research Group, Department of Medical Biology, University Hospital of North Norway, Tromsø, Norway
| | - Kjersti D. Horvei
- RNA and Molecular Pathology Research Group, Department of Medical Biology, University Hospital of North Norway, Tromsø, Norway
| | - Lorena Arranz
- Stem Cell Aging and Cancer Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ramon Sonneveld
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tom Nijenhuis
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Johan van der Vlag
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ole P. Rekvig
- RNA and Molecular Pathology Research Group, Department of Medical Biology, University Hospital of North Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
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Rekvig OP, Thiyagarajan D, Pedersen HL, Horvei KD, Seredkina N. Future Perspectives on Pathogenesis of Lupus Nephritis: Facts, Problems, and Potential Causal Therapy Modalities. Am J Pathol 2016; 186:2772-2782. [PMID: 27664472 DOI: 10.1016/j.ajpath.2016.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/30/2016] [Indexed: 12/22/2022]
Abstract
Divergent incommensurable models have been developed to explain the pathogenesis of lupus nephritis. Most contemporary models favor a central role for anti-chromatin antibodies. How they exert their pathogenic effect has, however, endorsed conflicts that at least for now preclude insight into definitive pathogenic pathways. The following paradigms are contemporarily in conflict with each other: i) the impact of anti-double-stranded DNA (dsDNA) antibodies that cross-react with inherent renal antigens, ii) the impact of anti-dsDNA antibodies targeting exposed chromatin in glomeruli, and iii) the impact of relative antibody avidity for dsDNA, chromatin fragments, or cross-reacting antigens. Aside from these three themes, the pathogenic role of T cells in lupus nephritis is not clear. These different models should be tested through a collaboration between scientists belonging to the different paradigms. If it turns out that there are different pathogenic pathways in lupus nephritis, the emerging pathogenic mechanism(s) may be encountered with new individual causal therapy modalities. Today, therapy is still unspecific and far from interfering with the cause(s) of the disorder. This review attempts to describe what we know about processes that may cause lupus nephritis and how such basic processes may be affected if we can specifically interrupt them. Secondary inflammatory mechanisms, cytokine signatures, activation of complement, and other contributors to inflammation will not be discussed herein; rather, the events that trigger these factors will be discussed.
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Affiliation(s)
- Ole P Rekvig
- RNA and Molecular Pathology Research Group, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Department of Radiology, University Hospital of North Norway, Tromsø, Norway; Norwegian Center for Molecular Medicine, University of Oslo, Oslo, Norway.
| | - Dhivya Thiyagarajan
- RNA and Molecular Pathology Research Group, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Hege L Pedersen
- RNA and Molecular Pathology Research Group, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Kjersti D Horvei
- RNA and Molecular Pathology Research Group, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Natalya Seredkina
- RNA and Molecular Pathology Research Group, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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Koschielniak-Nielsen ZJ, Christensen LQ, Pedersen HL, Brushø J. Effect of digital pressure on the neurovascular sheath during perivascular axillary block. Br J Anaesth 1995; 75:702-6. [PMID: 8672317 DOI: 10.1093/bja/75.6.702] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We have assessed prospectively the influence of digital pressure on the effectiveness of perivascular axillary block using a catheter technique in two groups of patients. Ninety-eight patients received axillary injections of 2% mepivacaine with adrenaline 20 ml mixed with contrast agent 20 ml. During injection firm digital pressure was applied either on the neurovascular sheath (group 1) or 6-8 cm below it (group 2). The patient's arm was then adducted. Axillary radiographs were obtained in 90 patients after 30 min. In the last eight patients radiographs were obtained after injecting 2, 20 and 40 ml of the mixture to study the dynamics of spread. There were no statistically significant differences in proximal flow of mepivacaine or in the success rate of the block between the groups. Signs of flow obstruction by the head of the humerus were seen in only eight patients. In the majority of patients local anaesthetic spread above the coracoid process, which increased the success rate of the block, but did not guarantee an effective block.
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Koscielniak-Nielsen ZJ, Schierbeck J, Pedersen HL, Perko G. Flumazenil facilitates intraoperative arousal during scoliosis surgery: a randomized, double-blind, placebo-controlled study. Acta Anaesthesiol Scand 1994; 38:43-7. [PMID: 8140872 DOI: 10.1111/j.1399-6576.1994.tb03835.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Intraoperative arousal was evaluated in 24 patients (median age 16.5 years), undergoing spondylodesis with Cotrel-Dubousset or Harrington-Luque instrumentation. Flumazenil and placebo groups of 12 patients each were similar with respect to age, body weight, dosage of anaesthetic drugs and surgery times. Premedication consisted of diazepam 0.2-0.3 mg kg-1 orally. Anaesthesia was induced with thiopentone 5-7 mg kg-1, and maintained with 66% nitrous oxide in oxygen, and repeated doses of fentanyl, midazolam and atracurium. After placement and fixation of the metal rods, N2O was switched off, and either flumazenil or placebo was given in refracted doses until the patient responded to command. Intraoperative motor response times (medians with ranges), defined as the time from the injection of the first dose until the patient responded to command, were 2.5 min (1.0-5.2 min) after flumazenil, and 8.0 min (1.7-28.5 min) after placebo (P = 0.02). Five patients in the placebo group did not wake up within 10 min and received naloxone. The quality of awakening was similar in both groups. Two patients (one in each group) woke up violently and needed physical restraint. Postoperatively, motor responses were assessed after 12.0 min (5-42 min) in the flumazenil group, and after 15.2 min (4-40 min) in the placebo group (NS). Recovery from anaesthesia took 27.5 min (7-415 min) in the flumazenil group, and 25.0 min (8-160 min) in the placebo group (NS). One patient given flumazenil and one patient given placebo remembered moving their feet, but neither of them could recall anything unpleasant.(ABSTRACT TRUNCATED AT 250 WORDS)
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Abstract
Ultrasound and short-wave diathermy are widely used in physiotherapy to induce heating of deep tissues, since this causes a concomitant increase in local blood flow. A metallic implant in the treated field is generally regarded as a contra-indication to diathermy because of the risk of thermodamage to surrounding tissues. It is not certain, however, if copperbearing IUDs contain sufficient metal as to constitute a risk. In order to exclude the possibility that diathermy might lead to intra-uterine burns in women using copperbearing IUDs a technique was devised of measuring temperatures in the copper wire of an IUD in situ during short-wave an ultrasonic therapy. The results indicate diathermy to be perfectly safe in women whit copper-bearing IUDs.
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Affiliation(s)
- A Heick
- Department of Surgery, Tønder Hospital, Denmark
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