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Solomon O, Lanata CM, Adams C, Nititham J, Taylor KE, Chung SA, Yazdany J, Dall’Era M, Pons-Estel BA, Tusié-Luna T, Tsao B, Morand E, Alarcón-Riquelme ME, Barcellos LF, Criswell LA. Local Ancestry at the Major Histocompatibility Complex Region is Not a Major Contributor to Disease Heterogeneity in a Multiethnic Lupus Cohort. Arthritis Rheumatol 2024; 76:614-619. [PMID: 38073021 PMCID: PMC10965360 DOI: 10.1002/art.42766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disease resulting in debilitating clinical manifestations that vary in severity by race and ethnicity with a disproportionate burden in African American, Mestizo, and Asian populations compared with populations of European descent. Differences in global and local genetic ancestry may shed light on the underlying mechanisms contributing to these disparities, including increased prevalence of lupus nephritis, younger age of symptom onset, and presence of autoantibodies. METHODS A total of 1,139 European, African American, and Mestizos patients with SLE were genotyped using the Affymetrix LAT1 World array. Global ancestry proportions were estimated using ADMIXTURE, and local ancestry was estimated using RFMIXv2.0. We investigated associations between lupus nephritis, age at onset, and autoantibody status with both global and local ancestry proportions within the Major Histocompatibility Complex region. RESULTS Our results showed small effect sizes that did not meet the threshold for statistical significance for global or local ancestry proportions in either African American or Mestizo patients with SLE who presented with the clinical manifestations of interest compared with those who did not. CONCLUSION These findings suggest that local genetic ancestry within the Major Histocompatibility Complex region is not a major contributor to these SLE manifestations among patients with SLE from admixed populations.
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Affiliation(s)
- Olivia Solomon
- University of California, Berkeley, Genetic Epidemiology and Genomic Laboratory
| | | | - Cameron Adams
- University of California, Berkeley, Genetic Epidemiology and Genomic Laboratory
| | - Joanne Nititham
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Kimberly E. Taylor
- Russell/Engleman Rheumatology Research Center, University of California, San Francisco
| | - Sharon A. Chung
- Russell/Engleman Rheumatology Research Center, University of California, San Francisco
| | - Jinoos Yazdany
- Russell/Engleman Rheumatology Research Center, University of California, San Francisco
| | - Maria Dall’Era
- Russell/Engleman Rheumatology Research Center, University of California, San Francisco
| | - Bernado A. Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina
| | - Teresa Tusié-Luna
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Instituto de Investigaciones Biomédicas de la Universidad Nacional Autonoma de México, Mexico City, Mexico
| | - Betty Tsao
- Medical University of South Carolina, Charleston, South Carolina
| | - Eric Morand
- Monash University Faculty of Medicine, Nursing & Health Sciences, Melbourne, Australia
| | - Marta E. Alarcón-Riquelme
- Center for Genomics and Oncological Research (GENYO). Pfizer—University of Granada—Andalusian Government, Parque Tecnologico de la Salud, Granada, Spain
| | - Lisa F. Barcellos
- University of California, Berkeley, Genetic Epidemiology and Genomic Laboratory
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Parodis I, Lanata C, Nikolopoulos D, Blazer A, Yazdany J. Reframing health disparities in SLE: A critical reassessment of racial and ethnic differences in lupus disease outcomes. Best Pract Res Clin Rheumatol 2023:101894. [PMID: 38057256 DOI: 10.1016/j.berh.2023.101894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 12/08/2023]
Abstract
Health disparities in the prevalence and outcomes of systemic lupus erythematosus (SLE) are well documented across racial and ethnic groups. Similar to other chronic diseases, differences in disease severity among individuals with SLE are likely influenced by both genetic predisposition and multiple social determinants of health. However, research in SLE that jointly examines the genetic and environmental contributions to the disease course is limited, resulting in an incomplete understanding of the biologic and social mechanisms that underly health disparities. While research on health disparities can reveal inequalities and inform resource allocation to improve outcomes, research that relies on racial and ethnic categories to describe diverse groups of people can pose challenges. Additionally, results from research comparing outcomes across socially constructed groups without considering other contributing factors can be misleading. We herein comprehensively examine existing literature on health disparities in SLE, including both clinical studies that examine the relationship between self-reported race and ethnicity and disease outcomes and studies that explore the relationships between genomics and lupus outcomes. Having surveyed this body of research, we propose a framework for research examining health disparities in SLE, including ways to mitigate bias in future studies.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Cristina Lanata
- Genomics of Autoimmune Rheumatic Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dionysis Nikolopoulos
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Ashira Blazer
- Division of Rheumatology, Department of Medicine, Hospital for Special, Surgery, New York, NY, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, USA
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3
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Chung CP, Karakoc G, Dickson A, Liu G, Gamboa JL, Mosley JD, Cox NJ, Kawai VK. APOL1 and the risk of adverse renal outcomes in patients of African ancestry with systemic lupus erythematosus. Lupus 2023; 32:763-770. [PMID: 37105192 DOI: 10.1177/09612033231172660] [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: 04/29/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) disproportionately affects individuals of African ancestry (AA) compared to European ancestry (EA). In the general population, high risk (HR) variants in the apolipoprotein L1 (APOL1) gene increase the risk of renal and hypertensive disorders in individuals of AA. Since SLE is characterized by an interferon signature and APOL1 expression is driven by interferon, we examined the hypothesis that APOL1 HR genotypes predominantly drive higher rates of renal and hypertensive-related comorbidities observed in SLE patients of AA versus those of EA. METHODS We performed a retrospective cohort study in patients with SLE of EA and AA using a genetic biobank linked to de-identified electronic health records. APOL1 HR genotypes were defined as G1/G1, G2/G2, or G1/G2 and low risk (LR) genotypes as 1 or 0 copies of the G1 and G2 alleles. To identify renal and hypertensive-related disorders that differed in prevalence by ancestry, we used a phenome-wide association approach. We then used logistic regression to compare the prevalence of renal and hypertensive-related disorders in EA and AA patients, both including and excluding patients with the APOL1 HR genotype. In a sensitivity analysis, we examined the association of end stage renal disease secondary to lupus nephritis (LN-related ESRD) with ancestry and the APOL1 genotype. RESULTS We studied 784 patients with SLE; 195 (24.9%) were of AA, of whom 27 (13.8%) had APOL1 HR genotypes. Eighteen renal and hypertensive-related phenotypes were more common in AA than EA patients (p-value ≤ 1.4E-4). All phenotypes remained significantly different after exclusion of patients with APOL1 HR genotypes, and most point odds ratios (ORs) decreased only slightly. Even among ORs with the greatest decrease, risk for AA patients without the APOL1 HR genotype remained significantly elevated compared to EA patients. In the sensitivity analysis, LN-related ESRD was more prevalent in SLE patients of AA versus EA and AA patients with the APOL1 HR genotype versus LR (p-value < .05 for both). CONCLUSION The higher prevalence of renal and hypertensive disorders in SLE patients of AA compared to those of EA is not fully explained by the presence of APOL1 high risk variants.
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Affiliation(s)
- Cecilia P Chung
- Division of Rheumatology and Immunology, Department of Medicine Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Healthcare System - Nashville Campus, Nashville, TN, USA
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Rheumatology, University of Miami, Miami, FL, USA
- Miami VA Healthcare System, Miami, FL, USA
| | - Gul Karakoc
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alyson Dickson
- Division of Rheumatology and Immunology, Department of Medicine Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ge Liu
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jorge L Gamboa
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D Mosley
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vivian K Kawai
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
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Owen KA, Bell KA, Price A, Bachali P, Ainsworth H, Marion MC, Howard TD, Langefeld CD, Shen N, Yazdany J, Dall'era M, Grammer AC, Lipsky PE. Molecular pathways identified from single nucleotide polymorphisms demonstrate mechanistic differences in systemic lupus erythematosus patients of Asian and European ancestry. Sci Rep 2023; 13:5339. [PMID: 37005464 PMCID: PMC10067935 DOI: 10.1038/s41598-023-32569-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/29/2023] [Indexed: 04/04/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder with a prominent genetic component. Individuals of Asian-Ancestry (AsA) disproportionately experience more severe SLE compared to individuals of European-Ancestry (EA), including increased renal involvement and tissue damage. However, the mechanisms underlying elevated severity in the AsA population remain unclear. Here, we utilized available gene expression data and genotype data based on all non-HLA SNP associations in EA and AsA SLE patients detected using the Immunochip genotyping array. We identified 2778 ancestry-specific and 327 trans-ancestry SLE-risk polymorphisms. Genetic associations were examined using connectivity mapping and gene signatures based on predicted biological pathways and were used to interrogate gene expression datasets. SLE-associated pathways in AsA patients included elevated oxidative stress, altered metabolism and mitochondrial dysfunction, whereas SLE-associated pathways in EA patients included a robust interferon response (type I and II) related to enhanced cytosolic nucleic acid sensing and signaling. An independent dataset derived from summary genome-wide association data in an AsA cohort was interrogated and identified similar molecular pathways. Finally, gene expression data from AsA SLE patients corroborated the molecular pathways predicted by SNP associations. Identifying ancestry-related molecular pathways predicted by genetic SLE risk may help to disentangle the population differences in clinical severity that impact AsA and EA individuals with SLE.
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Affiliation(s)
- Katherine A Owen
- AMPEL BioSolutions LLC and the RILITE Research Institute, Charlottesville, VA, 22902, USA.
| | - Kristy A Bell
- AMPEL BioSolutions LLC and the RILITE Research Institute, Charlottesville, VA, 22902, USA
| | - Andrew Price
- AMPEL BioSolutions LLC and the RILITE Research Institute, Charlottesville, VA, 22902, USA
| | - Prathyusha Bachali
- AMPEL BioSolutions LLC and the RILITE Research Institute, Charlottesville, VA, 22902, USA
| | - Hannah Ainsworth
- Department of Biostatistics and Data Science, Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27109, USA
| | - Miranda C Marion
- Department of Biostatistics and Data Science, Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27109, USA
| | - Timothy D Howard
- Department of Biochemistry, Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27109, USA
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27109, USA
| | - Nan Shen
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinoos Yazdany
- University of California San Francisco, San Francisco, CA, 94117, USA
| | - Maria Dall'era
- University of California San Francisco, San Francisco, CA, 94117, USA
| | - Amrie C Grammer
- AMPEL BioSolutions LLC and the RILITE Research Institute, Charlottesville, VA, 22902, USA
| | - Peter E Lipsky
- AMPEL BioSolutions LLC and the RILITE Research Institute, Charlottesville, VA, 22902, USA
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Zavala-Miranda MF, Perez-Arias AA, Márquez-Macedo SE, Comunidad-Bonilla RA, Romero-Diaz J, Morales-Buenrostro LE, Mejía-Vilet JM. Characteristics and outcomes of a Hispanic lupus nephritis cohort from Mexico. Rheumatology (Oxford) 2023; 62:1136-1144. [PMID: 35822600 DOI: 10.1093/rheumatology/keac407] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To characterize the clinical presentation and outcomes of LN in a Hispanic cohort from Mexico. METHODS We studied 440 subjects with systemic lupus erythematosus and biopsy-proven LN followed for >36 months. We obtained demographic, clinical, laboratory, histopathological and treatment variables. All outcomes were analysed by survival analysis and included response to therapy, renal relapses, progression of kidney disease (decline in eGFR ≥ 30%, doubling of serum creatinine, end-stage kidney disease) and patient survival. RESULTS The median age of the study cohort was 29 years (IQR 23-37) and 96% were female. The median eGFR at inclusion was 81 mL/min/1.73m2 (IQR 48-118) and 24 h-uPCR was 3.4 g/g (IQR 1.9-5.6). Mixed class LN (III/IV+V) was the most frequently observed (69%). Over a median follow-up of 79 months, complete response rates were 22.3%, 40.5% and 51.6%, at 6, 12 and 24 months, respectively. Renal relapse rates were 32.3% and 50.6% at 3 and 5 years. By 3 and 5 years, 20.7% and 31.4% had decline in eGFR ≥30%, 14.4% and 22.5% doubled their serum creatinine, and 9.1% and 17.7% progressed to ESKD. The factors associated with loss of kidney function were age, eGFR at presentation, the histologic chronicity index in the kidney biopsy, and the type of response to therapy. Patient survival was 98.2% and 97.1% at 3 and 5 years. CONCLUSION Although the response to treatment and patient survival in this Latin American cohort is comparable to that observed in other regions, there is still a high rate of renal relapses and progression to decline in kidney function.
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Affiliation(s)
| | | | | | | | - Juanita Romero-Diaz
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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6
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González LA, Ugarte-Gil MF, Pons-Estel GJ, Durán-Barragán S, Toloza S, Burgos PI, Bertoli A, Borgia RE, Alarcón GS. Addressing health disparities as a function of ethnicity in systemic lupus erythematosus patients. Lupus 2022; 31:1691-1705. [PMID: 36036891 DOI: 10.1177/09612033221122983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder with significant health disparities, as it disproportionately and more severely affects vulnerable and disadvantaged population groups in the United States and around the world, that is, women, ethnic minorities, individuals living in poverty, less educated, and lacking medical insurance. Both, genetic and non-genetic factors, contribute to these disparities. To overcome these health disparities and reduce poor outcomes among disadvantaged SLE populations, interventions on non-genetic amendable factors, especially on social health determinants, are necessary.
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Affiliation(s)
- Luis A González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, 161932Universidad de Antioquia, Medellin, Antioquia, Colombia
| | - Manuel F Ugarte-Gil
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,Grupo Peruano de Estudio de Enfermedades Autoimmunes Sistémicas. Universidad Científica Del Sur, Lima, Perú
| | - Guillermo J Pons-Estel
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Sergio Durán-Barragán
- Clínica de Investigación en Reumatología y Obesidad S.C, Guadalajara, Jalisco, México.,Instituto de Investigación en Reumatología y Del Sistema Musculoesquelético, Departamento de Clínicas Médicas, 28033Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Sergio Toloza
- Department of Medicine, Rheumatology Unit, 297792Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Catamarca, Argentina
| | - Paula I Burgos
- Department of Clinical Immunology and Rheumatology, School of Medicine, 3463Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Bertoli
- Sevicio de Reumatología, Clínica Universitaria Reina Fabiola, 9967Universidad Católica de Córdoba, Argentina
| | - R Ezequiel Borgia
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, College of Medicine, 3463University of Florida, Gainesville, FL, USA.,Department of Health Outcomes and Biomedical Informatics, 3463College of Medicine University of Florida, Gainesville, FL, USA
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano, Heredia, Lima, Perú
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7
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Jun T, Mathew D, Sharma N, Nirenberg S, Huang HH, Kovatch P, Wherry EJ, Huang KL. Multiethnic Investigation of Risk and Immune Determinants of COVID-19 Outcomes. Front Cell Infect Microbiol 2022; 12:933190. [PMID: 35942057 PMCID: PMC9355800 DOI: 10.3389/fcimb.2022.933190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Disparate COVID-19 outcomes have been observed between Hispanic, non-Hispanic Black, and White patients. The underlying causes for these disparities are not fully understood. Methods This was a retrospective study utilizing electronic medical record data from five hospitals within a single academic health system based in New York City. Multivariable logistic regression models were used to identify demographic, clinical, and lab values associated with in-hospital mortality. Results A total of 3,086 adult patients with self-reported race/ethnicity information presenting to the emergency department and hospitalized with COVID-19 up to April 13, 2020, were included in this study. While older age (multivariable odds ratio (OR) 1.06, 95% CI 1.05–1.07) and baseline hypoxia (multivariable OR 2.71, 95% CI 2.17–3.36) were associated with increased mortality overall and across all races/ethnicities, non-Hispanic Black (median age 67, interquartile range (IQR) 58–76) and Hispanic (median age 63, IQR 50–74) patients were younger and had different comorbidity profiles as compared to non-Hispanic White patients (median age 73, IQR 62–84; p < 0.05 for both comparisons). Among inflammatory markers associated with COVID-19 mortality, there was a significant interaction between the non-Hispanic Black population and interleukin-1-beta (interaction p-value 0.04). Conclusions This analysis of a multiethnic cohort highlights the need for inclusion and consideration of diverse populations in ongoing COVID-19 trials targeting inflammatory cytokines.
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Affiliation(s)
- Tomi Jun
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Divij Mathew
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Navya Sharma
- University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Sharon Nirenberg
- Scientific Computing, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Hsin-Hui Huang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Patricia Kovatch
- Scientific Computing, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Edward John Wherry
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Kuan-lin Huang
- Department of Genetics and Genomic Sciences, Center for Transformative Disease Modeling, Tisch Cancer Institute, Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- *Correspondence: Kuan-lin Huang,
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Alarcón-Riquelme ME. Transcriptome Studies in Lupus Nephritis. Arch Immunol Ther Exp (Warsz) 2022; 70:15. [PMID: 35469108 DOI: 10.1007/s00005-022-00651-y] [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: 11/30/2021] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
The present review is aimed at describing the main works that have used gene expression to analyze tissue kidney samples of lupus nephritis patients. Most studies used the gene expression arrays, which enormously advanced our knowledge on the possible mechanisms behind lupus nephritis. However, using bulk gene expression platforms, either as arrays, or as sequencing of RNA is not enough to go into detail of the cells and their molecular patterns and single cell mechanisms of disease. More recently, the first single cell RNA Sequencing study was published and this will also be discussed in the context of lupus nephritis. Single cell RNA sequencing allows to retrieve the genes expressed in each cell in the tissue of interest or in blood. In this context, the results of such studies give us a first glimpse of how a lupus nephritis kidney looks like, but much is still to be done to understand the changes that occur with treatment or with the different pathological subtypes of lupus nephritis and their cellular content.
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Affiliation(s)
- Marta E Alarcón-Riquelme
- GENYO. Center for Genomics and Oncological Research. Pfizer / University of Granada / Andalusian Regional Government, Av de la Ilustración 114, 18016, Granada, Spain. .,Institute for Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
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9
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Braga FNHF, das Chagas Medeiros MM, Junior ABV, de Sousa Lima ME, Barros LCM, Pontes MX, de Sousa Lima AW, Fernandes PFCBC. Proteinuria and serum creatinine after 12 months of treatment for lupus nephritis as predictors of long-term renal outcome: a case-control study. Adv Rheumatol 2022; 62:2. [PMID: 34983697 DOI: 10.1186/s42358-021-00232-1] [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: 06/12/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10-25% of patients progressing to end-stage renal disease (ESRD). OBJECTIVE This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. METHODS A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. RESULTS: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). CONCLUSIONS In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.
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Affiliation(s)
| | - Marta Maria das Chagas Medeiros
- Hospital Universitário Walter Cantídio, Universidade Federal Do Ceará, Rua Capitão Francisco Pedro 1290, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Antonio Brazil Viana Junior
- Hospital Universitário Walter Cantídio, Universidade Federal Do Ceará, Rua Capitão Francisco Pedro 1290, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Matheus Eugênio de Sousa Lima
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
| | - Levi Coelho Maia Barros
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
| | - Marcelo Ximenes Pontes
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
| | - Allysson Wosley de Sousa Lima
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
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Keaton JM, Jasper EA, Hellwege JN, Jones SH, Torstenson ES, Edwards TL, Velez Edwards DR. Evidence that geographic variation in genetic ancestry associates with uterine fibroids. Hum Genet 2021; 140:1433-1440. [PMID: 34302236 PMCID: PMC8463481 DOI: 10.1007/s00439-021-02322-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/18/2021] [Indexed: 12/21/2022]
Abstract
Uterine fibroids disproportionately impact Black women. Evidence suggests Black women have earlier onset and higher cumulative risk. This risk disparity may be due an imbalance of risk alleles in one parental geographic ancestry subgroup relative to others. We investigated ancestry proportions for the 1000 Genomes phase 3 populations clustered into 6 geographic groups for association with fibroid traits in Black women (n=583 cases, 797 controls) and White women (n=1,195 cases, 1,164 controls). Global ancestry proportions were estimated using ADMIXTURE. Dichotomous (fibroids status and multiple fibroid status) and continuous outcomes (volume and largest dimension) were modeled for association with ancestry proportions using logistic and linear regression adjusting for age. Effect estimates are reported per 10% increase in genetically inferred ancestry proportion. Among AAs, West African (WAFR) ancestry was associated with fibroid risk, East African ancestry was associated with risk of multiple fibroids, Northern European (NEUR) ancestry was protective for multiple fibroids, Southern European ancestry was protective for fibroids and multiple fibroids, and South Asian (SAS) ancestry was positively associated with volume and largest dimension. In EAs, NEUR ancestry was protective for fibroids, SAS ancestry was associated with fibroid risk, and WAFR ancestry was positively associated with volume and largest dimension. These results suggest that a proportion of fibroid risk and fibroid trait racial disparities are due to genetic differences between geographic groups. Further investigation at the local ancestry and single variant levels may yield novel insights about disease architecture and genetic mechanisms underlying ethnic disparities in fibroid risk.
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Affiliation(s)
- Jacob M Keaton
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth A Jasper
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Jacklyn N Hellwege
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN, USA
| | - Sarah H Jones
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN, USA
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA. .,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA. .,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
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11
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Lanata CM, Blazer A, Criswell LA. The Contribution of Genetics and Epigenetics to Our Understanding of Health Disparities in Rheumatic Diseases. Rheum Dis Clin North Am 2020; 47:65-81. [PMID: 34042055 DOI: 10.1016/j.rdc.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Socioeconomic determinants of health are associated with worse outcomes in the rheumatic diseases and contribute significantly to health disparities. However, genetic and epigenetic risk factors may affect different populations disproportionally and further exacerbate health disparities. We discuss the role of genetics and epigenetics to the health disparities observed in rheumatic diseases. We review concepts of population genetics and natural selection, current genome-wide genetic and epigenetic studies of several autoimmune diseases, and environmental exposures associated with disease risk in different populations. To understand how genomics influence health disparities in the rheumatic diseases, further studies in different populations worldwide are needed.
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Affiliation(s)
- Cristina M Lanata
- Russell/Engleman Rheumatology Research Center, University of California, San Francisco, 513 Parnassus Avenue, MSB S865, San Francisco, CA, USA
| | - Ashira Blazer
- Department of Medicine, Division of Rheumatology, NYU Langone Health, 550 1st Avenue, MSB 606, New York, NY 10029, USA
| | - Lindsey A Criswell
- Russell/Engleman Rheumatology Research Center, University of California, San Francisco, 513 Parnassus Avenue, MSB S864, San Francisco, CA, USA.
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12
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Yip TCF, Saria S, Petri M, Magder LS. Predictors of the start of declining eGFR in patients with systemic lupus erythematosus. Lupus 2020; 30:15-24. [PMID: 33115373 DOI: 10.1177/0961203320966393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize the longitudinal trajectory of estimated glomerular filtration rate (eGFR) in patients with systemic lupus erythematosus (SLE) and identify predictors of the change in eGFR trajectory. METHODS The longitudinal eGFR levels of patients in the Hopkins Lupus Cohort were modelled by piecewise linear regression to evaluate the slope of different line segments. The slopes were classified into declining (≤-4 mL/min/1.73 m2 per year), stable (-4 to 4 mL/min/1.73 m2 per year), and increasing (≥4 mL/min/1.73 m2 per year) states. The transition rate between states and the impact of clinical parameters were estimated by a Markov model. RESULTS The analysis was based on 494 SLE patients. At a mean follow-up of 8.8 years, 347 (70.2%), 107 (21.7%), 33 (6.7%), and 7 (1.4%) patients had zero, one, two, and three state transitions, respectively. In patients with no transition, 37 (10.7%), 308 (88.8%), and 2 (0.6%) were in declining, stable, and increasing state, respectively. In patients with one transition, 43 (40.2%) changed from declining to stable state while 29 (27.1%) changed from stable to declining state. When patients were in a non-declining GFR state, those who were younger and African Americans were more likely to transition to a declining GFR state. In adjusted analyses, high blood pressure, C4 and low hematocrit were associated with change from non-declining to declining state. High urine protein-to-creatinine ratio also tended to be associated with change from non-declining to declining state. African American patients were less likely to move from declining to non-declining state. Use of prednisone was associated with change from declining to non-declining state. CONCLUSIONS Patients with high blood pressure, low complement C4, low haematocrit, and high urine protein-to-creatinine ratio are more likely to have a declining eGFR trajectory, while the use of prednisone stabilizes the declining eGFR trajectory.
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Affiliation(s)
- Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Suchi Saria
- Departments of Computer Science & Statistics, Whiting School of Engineering, Baltimore, MD, USA.,Department of Health Policy, Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle Petri
- Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Laurence S Magder
- Department of Epidemiology & Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
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13
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Di D, Ye Q, Wu X, Zhang L, Wang X, Liu R, Huang Q, Ni J, Leng R. Polymorphisms of BLK are associated with renal disorder in patients with systemic lupus erythematosus. J Hum Genet 2020; 65:675-681. [PMID: 32313195 DOI: 10.1038/s10038-020-0756-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/28/2022]
Abstract
Previous studies are inconclusive on the relationships between BLK gene polymorphisms and clinical features of systemic lupus erythematosus (SLE). The present study aimed to estimate association between BLK loci and SLE clinical features in Chinese population. Associations between BLK single-nucleotide polymorphisms (SNPs) and susceptibility to SLE in this study were estimated using data of 1205 health controls previously reported in the same population. And a total of 814 SLE patients recruited from two different sources according with ACR criteria were analyzed for genotype-phenotype associations. A meta-analysis was conducted of the associations between BLK loci and renal disorder in SLE. The expression quantitative trait locus (eQTL) data were also extracted from the public databases for the selected SNPs. Significant associations were observed between these SNPs and susceptibility to SLE. In addition, the data showed that rs2618479 and rs7812879 were associated with renal disorder [OR = 1.51 (95% CI: 1.15, 1.99) and 1.61 (95% CI: 1.21, 2.14), Pcorr = 0.033 and 0.011, respectively] and proteinuria [OR = 1.47 (95% CI: 1.12, 1.95) and 1.52 (95% CI: 1.14, 2.03), Pcorr = 0.048 and 0.040, respectively]. The consistent associations were observed in two independent centers as well as new cases group. The result of meta-analysis for rs2618479 was also significant [OR = 1.35 (95% CI: 1.12, 1.62)]. In addition, bioinformatics analysis demonstrated that the two SNPs were significantly associated with the expression of BLK in whole blood and several immune cells. Our data support that variant loci of BLK are associated with presence of renal disorder in patients with SLE.
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Affiliation(s)
- Dongsheng Di
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Qianling Ye
- Department of Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiaoxiao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Linlin Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Xufan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Ruishan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Qian Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Jing Ni
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ruixue Leng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China. .,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China.
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14
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multiple system involvement and positive serum autoantibodies. Lupus nephritis (LN) is the most common and serious complication of SLE, and it is the main cause of death in patients with SLE. Abnormalities in the immune system lead to LN and involve a variety of cells (T cells, B cells, macrophages, NK cells, etc.), cytokines (interleukin, tumor necrosis factor α, etc.) and their related pathways. Previous studies have shown that the interactions of genetic, epigenetic and environmental factors contribute to the pathogenesis and development of LN. In recent years, one genome-wide association study (GWAS) and a number of gene association studies have explored the susceptibility genes of LN, including immunization-, inflammation-, adhesion- and other pathway-related genes. These genes participate in or suggest the pathogenesis and progression of LN. In this review, we summarize the genetic susceptibility of LN and discuss the possible mechanism underlying the susceptibility genes of LN.
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15
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Arriens C, Aberle T, Carthen F, Kamp S, Thanou A, Chakravarty E, James JA, Merrill JT, Ogunsanya ME. Lupus patient decisions about clinical trial participation: a qualitative evaluation of perceptions, facilitators and barriers. Lupus Sci Med 2020; 7:e000360. [PMID: 32201595 PMCID: PMC7073780 DOI: 10.1136/lupus-2019-000360] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/18/2019] [Accepted: 01/05/2020] [Indexed: 01/11/2023]
Abstract
Objective Although SLE disproportionately affects minority racial groups, they are significantly under-represented in clinical trials in the USA. This may lead to misleading conclusions in race-based subgroup analyses. We conducted focus groups to evaluate the perceptions of diverse patients with lupus about clinical trial participation. Methods A qualitative research design employed three 90 min focus groups led by a trained moderator and guided by the Theory of Planned Behaviour. Open-ended questions about trial participation included advantages and disadvantages (behavioural beliefs), approving and disapproving significant others (normative beliefs), and participation enhancers and barriers (control beliefs). Discussions were recorded, transcribed and analysed to identify emerging themes. Results Patients with SLE (n=23) aged 21-72, with increased proportion of minority groups (65%), participated. Reported advantages of trial participation included altruism and personal benefit. Disadvantages included uncertainties, disappointment, information burden, and life-health balance. Although some patients had discussed research participation with approving or disapproving family or friends, self-approval superseded external approval. Barriers included logistics and time, and facilitators included flexibility in scheduling, advance notice of studies, streamlined forms, and hope for SLE improvement. Conclusions Knowledge about potential benefits of clinical trial participation was high. Minority patients demonstrated confidence in making their own informed decisions, but major barriers for all participants included burdensome forms, travel, childcare, and work. These suggest a major impact on minority and all recruitment from behavioural and control aspects, which should be considered in the logistics of trial design. This does not minimise the potential importance of improved access and education about clinical research.
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Affiliation(s)
- Cristina Arriens
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Teresa Aberle
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Fredonna Carthen
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Stan Kamp
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Aikaterini Thanou
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Eliza Chakravarty
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joan T Merrill
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Motolani E Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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16
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Vajgel G, Lima SC, Santana DJS, Oliveira CBL, Costa DMN, Hicks PJ, Cavalcante MAGM, Langefeld CD, Valente LM, Crovella S, Kirsztajn GM, Freedman BI, Sandrin-Garcia P. Effect of a Single Apolipoprotein L1 Gene Nephropathy Variant on the Risk of Advanced Lupus Nephritis in Brazilians. J Rheumatol 2019; 47:1209-1217. [PMID: 31732553 DOI: 10.3899/jrheum.190684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Apolipoprotein L1 gene (APOL1) G1 and G2 renal risk alleles (RRA) are associated with endstage renal disease in blacks with lupus nephritis (LN). The present study determined frequencies of APOL1 RRA in nonwhite Brazilian patients with LN and controls to assess association with renal outcomes. METHODS APOL1 RRA were genotyped in 222 healthy blood donors (controls) and 201 cases with LN from 3 outpatient clinics. Two single-nucleotide polymorphisms in the G1 (rs73885319 and rs60910145) and an indel for the G2 (rs71785313) variant were genotyped. RESULTS The frequency of APOL1 RRA in nonwhite Brazilian LN cases did not differ significantly from healthy controls, and few participants had 2 RRA. In the sample, 84.6% of LN cases and 84.2% of controls had 0 RRA, 13.4% and 15.3% had 1 RRA, and 2.0% and 0.4% had 2 RRA, respectively. LN cases with ≥ 1 APOL1 RRA had similar baseline characteristics and renal responses to treatment, yet faced higher risk for progressive chronic kidney disease (CKD) to an estimated glomerular filtration rate < 30 ml/min/1.73 m2 compared to those with 0 RRA (11.2% with 0, 29.6% with 1; 50% with 2 RRA, p = 0.005). Although glomerular lesions and activity scores on initial kidney biopsy did not differ significantly between individuals based on APOL1 genotype, chronicity scores, tubular atrophy, and interstitial fibrosis were more severe in those with ≥ 1 RRA (p = 0.011, p = 0.002, p = 0.018, respectively). CONCLUSION Although initial kidney lesions and treatment responses were similar, a single APOL1 RRA in nonwhite Brazilians with LN was associated with increased risk of advanced CKD and possibly more tubulointerstitial damage.
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Affiliation(s)
- Gisele Vajgel
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil. .,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE.
| | - Suelen Cristina Lima
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Diego Jeronimo S Santana
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Camila B L Oliveira
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Denise Maria N Costa
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Pamela J Hicks
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Maria Alina G M Cavalcante
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Carl D Langefeld
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Lucila Maria Valente
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Sergio Crovella
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Gianna Mastroianni Kirsztajn
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Barry I Freedman
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
| | - Paula Sandrin-Garcia
- From the Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (UFPE); Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory (LIKA), UFPE; Division of Nephrology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil; Division of Public Health Sciences, Department of Biostatistical Sciences, and Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Division of Nephrology, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,G. Vajgel, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Molecular Biology Laboratory, LIKA, UFPE; S.C. Lima, PhD, Molecular Biology Laboratory, LIKA, UFPE; D.J. Santana, UG, Molecular Biology Laboratory, LIKA, UFPE; C.B. Oliveira, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; D.M. Costa, MD, Division of Nephrology, Hospital das Clinicas, UFPE, and Division of Nephrology, IMIP; P.J. Hicks, BS, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; M.A. Cavalcante, MD, Division of Nephrology, Hospital das Clinicas, UFPE; C.D. Langefeld, PhD, Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine; L.M. Valente, MD, PhD, Division of Nephrology, Hospital das Clinicas, UFPE; S. Crovella, PhD, Molecular Biology Laboratory, LIKA, UFPE; G.M. Kirsztajn, MD, PhD, Division of Nephrology, Department of Medicine, UNIFESP; B.I. Freedman, MD, Center for Diabetes Research, and Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; P. Sandrin-Garcia, PhD, Molecular Biology Laboratory, LIKA, UFPE
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17
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Song K, Liu L, Zhang X, Chen X. An update on genetic susceptibility in lupus nephritis. Clin Immunol 2019; 210:108272. [PMID: 31683055 DOI: 10.1016/j.clim.2019.108272] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multiple system involvement and positive serum autoantibodies. Lupus nephritis (LN) is the most common and serious complication of SLE, and it is the main cause of death in patients with SLE. Abnormalities in the immune system lead to LN and involve a variety of cells (T cells, B cells, macrophages, NK cells, etc.), cytokines (interleukin, tumor necrosis factor α, etc.) and their related pathways. Previous studies have shown that the interactions of genetic, epigenetic and environmental factors contribute to the pathogenesis and development of LN. In recent years, one genome-wide association study (GWAS) and a number of gene association studies have explored the susceptibility genes of LN, including immunization-, inflammation-, adhesion- and other pathway-related genes. These genes participate in or suggest the pathogenesis and progression of LN. In this review, we summarize the genetic susceptibility of LN and discuss the possible mechanism underlying the susceptibility genes of LN.
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Affiliation(s)
- Kangkang Song
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, 28 Fuxing Road, Beijing, China
| | - Lu Liu
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Key Laboratory of Dermatology, Ministry of Education (Anhui Medical University), Hefei, Anhui, China
| | - Xuejun Zhang
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Key Laboratory of Dermatology, Ministry of Education (Anhui Medical University), Hefei, Anhui, China; Institute of Dermatology and Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, China
| | - Xiangmei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, 28 Fuxing Road, Beijing, China.
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18
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Lanata CM, Paranjpe I, Nititham J, Taylor KE, Gianfrancesco M, Paranjpe M, Andrews S, Chung SA, Rhead B, Barcellos LF, Trupin L, Katz P, Dall'Era M, Yazdany J, Sirota M, Criswell LA. A phenotypic and genomics approach in a multi-ethnic cohort to subtype systemic lupus erythematosus. Nat Commun 2019; 10:3902. [PMID: 31467281 PMCID: PMC6715644 DOI: 10.1038/s41467-019-11845-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/13/2019] [Indexed: 01/05/2023] Open
Abstract
Systemic lupus erythematous (SLE) is a heterogeneous autoimmune disease in which outcomes vary among different racial groups. Here, we aim to identify SLE subgroups within a multiethnic cohort using an unsupervised clustering approach based on the American College of Rheumatology (ACR) classification criteria. We identify three patient clusters that vary according to disease severity. Methylation association analysis identifies a set of 256 differentially methylated CpGs across clusters, including 101 CpGs in genes in the Type I Interferon pathway, and we validate these associations in an external cohort. A cis-methylation quantitative trait loci analysis identifies 744 significant CpG-SNP pairs. The methylation signature is enriched for ethnic-associated CpGs suggesting that genetic and non-genetic factors may drive outcomes and ethnic-associated methylation differences. Our computational approach highlights molecular differences associated with clusters rather than single outcome measures. This work demonstrates the utility of applying integrative methods to address clinical heterogeneity in multifactorial multi-ethnic disease settings.
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Affiliation(s)
- Cristina M Lanata
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ishan Paranjpe
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joanne Nititham
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kimberly E Taylor
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Milena Gianfrancesco
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Manish Paranjpe
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Shan Andrews
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Sharon A Chung
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Laura Trupin
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Patricia Katz
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Maria Dall'Era
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jinoos Yazdany
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Lindsey A Criswell
- Russell/Engleman Rheumatology Research Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.
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Falasinnu T, Chaichian Y, Palaniappan L, Simard JF. Unraveling Race, Socioeconomic Factors, and Geographical Context in the Heterogeneity of Lupus Mortality in the United States. ACR Open Rheumatol 2019; 1:164-172. [PMID: 31777791 PMCID: PMC6858029 DOI: 10.1002/acr2.1024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective Systemic lupus erythematosus (SLE) is a chronic autoimmune disease disproportionately affecting women and racial/ethnic minorities. We examined SLE-related mortality over time to assess whether the impact of race is attenuated when social economic status (SES) and geographic context are also considered. Methods This study examined whether social environment attenuates racial disparities in SLE-related mortality using race-geographical combinations of the US population known as the "Eight Americas." This framework jointly characterizes race, SES, and geographical location in relation to health disparities in the United States. Using National Vital Statistics and US Census data, we estimated mortality parameters for each of the Eight Americas. Results We identified 24 773 SLE deaths (2003-2014). Average annual mortality rates were highest among blacks in three race-geographical contexts: average-income blacks, southern low-income blacks, and high-risk urban blacks (14 to 15 deaths per million population) and lowest among nonblacks living in average-income settings (3 to 4 deaths per million population). Age at death was lowest (~47.5 years) for blacks and Asians and highest among low-income rural whites (~64.8 years). Conclusion Blacks sharing the same social and geographical contexts as whites were disproportionately more likely to die young. Although blacks inhabited three vastly different contexts, SLE-related mortality parameters did not vary among socially advantaged and disadvantaged blacks. These findings suggest that race may transcend SES and geographical parameters as a key determinant of SLE-related mortality.
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Anjorin A, Lipsky P. Engaging African ancestry participants in SLE clinical trials. Lupus Sci Med 2018; 5:e000297. [PMID: 30613420 PMCID: PMC6307590 DOI: 10.1136/lupus-2018-000297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 01/16/2023]
Abstract
SLE is a complex autoimmune disease with genetic and clinical differences between patients that appear to reside along ancestral lines. Over the last 20 years, a preponderance of evidence has shown that SLE is more common and severe in minority populations, particularly in African ancestry (AA) women. However, in clinical trials for new therapies of SLE, AA is often under-represented. Without enrolling sufficient AA participants, it is difficult to ascertain the safety and efficacy of new potential therapies among individuals with SLE of different ancestries. Although enrolling minority populations in clinical trials has been a significant challenge for many reasons, the various stakeholders involved in clinical research could act within their own realms to develop new paradigms and policies to bolster the inclusion of AA in the development of new therapies.
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Affiliation(s)
- Aderike Anjorin
- RILITE Research Institute, and University of Virginia, Charlottesville, Virginia, USA
| | - Peter Lipsky
- RILITE Research Institute, Charlottesville, Virginia, USA
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Genetic contributions to lupus nephritis in a multi-ethnic cohort of systemic lupus erythematous patients. PLoS One 2018; 13:e0199003. [PMID: 29953444 PMCID: PMC6023154 DOI: 10.1371/journal.pone.0199003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/30/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE African Americans, East Asians, and Hispanics with systemic lupus erythematous (SLE) are more likely to develop lupus nephritis (LN) than are SLE patients of European descent. The etiology of this difference is not clear, and this study was undertaken to investigate how genetic variants might explain this effect. METHODS In this cross-sectional study, 1244 SLE patients from multiethnic case collections were genotyped for 817,810 single-nucleotide polymorphisms (SNPs) across the genome. Continental genetic ancestry was estimated utilizing the program ADMIXTURE. Gene-based testing and pathway analysis was performed within each ethnic group and meta-analyzed across ethnicities. We also performed candidate SNP association tests with SNPs previously established as risk alleles for SLE, LN, and chronic kidney disease (CKD). Association testing and logistic regression models were performed with LN as the outcome, adjusted for continental ancestries, sex, disease duration, and age. RESULTS We studied 255 North European, 263 South European, 238 Hispanic, 224 African American and 264 East Asian SLE patients, of whom 606 had LN (48.7%). In genome-wide gene-based and candidate SNP analyses, we found distinct genes, pathways and established risk SNPs associated with LN for each ethnic group. Gene-based analyses showed significant associations between variation in ZNF546 (p = 1.0E-06), TRIM15 (p = 1.0E-06), and TRIMI0 (p = 1.0E-06) and LN among South Europeans, and TTC34 (p = 8.0E-06) was significantly associated with LN among Hispanics. The SNP rs8091180 in NFATC1 was associated with LN (OR 1.43, p = 3.3E-04) in the candidate SNP meta-analysis with the highest OR among African-Americans (OR 2.17, p = 0.0035). CONCLUSION Distinct genetic factors are associated with the risk of LN in SLE patients of different ethnicities. CKD risk alleles may play a role in the development of LN in addition to SLE-associated risk variants. These findings may further explain the clinical heterogeneity of LN risk and response to therapy observed between different ethnic groups.
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22
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Boedigheimer MJ, Martin DA, Amoura Z, Sánchez-Guerrero J, Romero-Diaz J, Kivitz A, Aranow C, Chan TM, Chong YB, Chiu K, Wang C, Sohn W, Arnold GE, Damore MA, Welcher AA, Sullivan BA, Kotzin BL, Chung JB. Safety, pharmacokinetics and pharmacodynamics of AMG 811, an anti-interferon-γ monoclonal antibody, in SLE subjects without or with lupus nephritis. Lupus Sci Med 2017; 4:e000226. [PMID: 29018537 PMCID: PMC5604705 DOI: 10.1136/lupus-2017-000226] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate safety, pharmacokinetics and pharmacodynamics of anti-interferon (IFN)-γ monoclonal antibody AMG 811 in subjects with SLE without or with lupus nephritis (LN). METHODS In this phase Ib, randomised, multiple-dose escalation study (NCT00818948), subjects without LN were randomised to subcutaneous AMG 811 (6, 20 or 60 mg) or placebo and subjects with LN were randomised to subcutaneous AMG 811 (20, 60 or 120 mg) or placebo every four weeks for three total doses. Outcomes included incidence of adverse events (AEs); pharmacokinetics; levels of serum proteins (CXCL-10, interleukin 18, monocyte chemotactic protein-1); changes in gene transcript profiles and clinical parameters (Safety of Estrogen in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) scores, proteinuria, anti-double-stranded DNA (anti-dsDNA) antibodies, C3 complement, C4 complement). RESULTS Fifty-six subjects enrolled (28 SLE without LN; 28 with LN). Baseline mean SELENA-SLEDAI scores were 2.2 and 12.0 for SLE subjects without and with LN, respectively. Most subjects reported an AE; no meaningful imbalances were observed between AMG 811 and placebo. Pharmacokinetic profiles were similar and mostly dose-proportional in subjects without or with LN. AMG 811 treatment reduced CXCL-10 protein levels and blood-based RNA IFN-γ Blockade Signature compared with placebo. Reductions were less pronounced and not sustained in subjects with LN, even at the highest dose tested, compared with subjects without LN. No effect on SELENA-SLEDAI scores, proteinuria, C3 or C4 complement levels, or anti-dsDNA antibodies was observed. CONCLUSION AMG 811 demonstrated favourable pharmacokinetics and acceptable safety profile but no evidence of clinical impact. IFN-γ-associated biomarkers decreased with AMG 811; effects were less pronounced and not sustained in LN subjects. TRIAL REGISTRATION NUMBER NCT00818948; results.
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Affiliation(s)
| | | | - Zahir Amoura
- French National Reference Center for SLE, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jorge Sánchez-Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juanita Romero-Diaz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, USA
| | - Tak Mao Chan
- Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Yip Boon Chong
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Kit Chiu
- Amgen Inc., Thousand Oaks, California, USA
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Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a disease distributed worldwide, which occurs in both genders, and across racial/ethnic and age groups; however, higher rates are observed in adults, in women and in non-Caucasians. Genetic, environmental, sociodemographic and methodological issues are responsible not only for these differences but for the variable course and outcome of the disease. Non-Caucasians have a more severe disease with a higher risk for early mortality and damage accrual. Males also have a more severe disease; however, a negative impact of male gender on lupus outcomes has not been firmly established. Childhood-onset is associated with a more severe disease; moreover, it is also associated with higher damage and diminished survival; finally, late-onset lupus is mild but it is associated with higher damage accrual and a diminished survival. Areas covered: In this review, we discuss the incidence and prevalence of SLE, the impact of age, gender and race/ethnicity in SLE and in the survival of those affected. Expert commentary: Age, gender and race/ethnicity impact disease expression in SLE patients; despite improvements in survival, mortality in SLE remains almost three times higher than in the general population.
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Affiliation(s)
- Guillermo J Pons-Estel
- a Department of Autoimmune Diseases , Institut Clinic de Medicina I Dermatologia, Hospital Clinic , Barcelona , Catalonia , Spain.,b Division of Rheumatology and Autoimmune Diseases , Sanatorio Parque, Grupo Oroño , Rosario , Argentina
| | - Manuel F Ugarte-Gil
- c Servicio de Reumatología , Hospital Nacional Guillermo Almenara Irigoyen, EsSalud , Lima , Perú.,d School of Medicine , Universidad Científica del Sur , Lima , Perú
| | - Graciela S Alarcón
- e Division of Clinical Immunology and Rheumatology, School of Medicine , The University of Alabama at Birmingham , Birmingham , AL , USA.,f Department of Medicine, School of Medicine , Universidad Peruana Cayetano Heredia , Lima , Perú
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Defining biological subsets in systemic lupus erythematosus: progress toward personalized therapy. Pharmaceut Med 2017; 31:81-88. [PMID: 28827978 DOI: 10.1007/s40290-017-0178-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous disease with respect to disease severity, response to treatment, and organ damage. The pathogenesis of SLE includes immunological mechanisms which are driven by both genetic and environmental factors. There are clear differences in the pathogenesis of SLE between patients of different ancestral backgrounds, including differences in genetic risk factors, immunological parameters, and clinical manifestations. Patients with high vs. low levels of type I interferon (IFN) in circulation represents one major biological subset within SLE, and these two groups of patients are present in all ancestral backgrounds. Genetic factors, autoantibodies, and levels of other cytokines all differ between high and low IFN patients. This distinction has also been important in predicting response to treatment with anti-type I IFN therapies, providing a precedent in SLE for biological subsets predicting treatment response. This review will highlight some recent developments in defining biological subsets of SLE based on disease pathophysiology, and the idea that improved knowledge of disease heterogeneity will inform our efforts to personalize therapy in this disease.
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Arriens C, Chen S, Karp DR, Saxena R, Sambandam K, Chakravarty E, James JA, Merrill JT. Prognostic significance of repeat biopsy in lupus nephritis: Histopathologic worsening and a short time between biopsies is associated with significantly increased risk for end stage renal disease and death. Clin Immunol 2016; 185:3-9. [PMID: 27923701 DOI: 10.1016/j.clim.2016.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE Approximately half of patients with systemic lupus erythematosus (SLE) develop lupus nephritis (LN), a major cause of morbidity and early mortality in that disease. Prolonged renal inflammation is associated with irreversible kidney damage which confers a 30% risk of end stage renal disease (ESRD), making early, aggressive treatment mandatory. Failure to achieve therapeutic response or recurrence of renal flare often prompts repeat biopsy. However, the role of repeat biopsy in determining long-term renal prognosis remains controversial. For this reason repeat biopsies are usually not utilized unless clinical evidence of refractory or recurrent disease is already present, despite known mismatches between clinical and biopsy findings. The current study quantifies the degree to which histopathologic worsening between first and second biopsies and duration between them predicts ESRD and death. METHODS Medical records of 141 LN patients with more than one biopsy were obtained from a single large urban medical center. Cases were attained using billing codes for diagnosis and procedures from 1/1999-1/2015. Biopsy worsening was defined as unfavorable histopathologic classification transitions and/or increased chronicity; if neither were present, the patient was defined as non-worsening. We used Cox proportional hazard models to study the relationship between ESRD and survival adjusting for covariates which included age at first biopsy, gender, race, initial biopsy class, and initial induction therapy. RESULTS Of 630 patients screened, 141 had more than one biopsy. Advancing chronicity was detected in 48 (34.0%) and a renal class switch to worse grade of pathology was found in 54 (38.3%). At least one of these adverse second biopsy features was reported in 79 (56.0%) patients. Five years following initial biopsy, 28 (35.4%) of those with worsening histopathology on second biopsy developed ESRD, compared to 6 (9.7%) of non-worsening patients and 10 (12.7%) of patients with worsening histopathology had died compared to 2 (3.2%) of non-worsening patients. Biopsy worsening was associated with a significantly greater 15-year risk of ESRD (Hazard Ratio 4.2, p=0.0001) and death (Hazard Ratio 4.3, p=0.022), adjusting for age, gender, race, biopsy class, and treatment. Time between first and second biopsies was <1year in 32 patients, 1-5years in 81, and >5years in 28. Over a 15-year period, those with <1year between first and second biopsies (presumably enriched for patients with early clinical signs of progression) had a significantly greater risk of ESRD (Hazard Ratio 13.7, p<0.0001) and death (Hazard Ratio 16.9, p=0.0022) after adjusting for age, gender, race, biopsy class, and treatment. CONCLUSION A repeat renal biopsy demonstrating worsening pathology increases the risk of ESRD and death more than four-fold compared to non-worsening patients. Given known potential mismatch between biopsy and clinical data, repeat biopsies may add important information and justify changes in treatment not considered on clinical grounds. Earlier detection of poor prognostic signs in those without early clinical deterioration might improve outcomes in enough patients to reconsider cost effectiveness of routine repeat biopsy.
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Affiliation(s)
- Cristina Arriens
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, United States.
| | - Sixia Chen
- University of Oklahoma Health Sciences Center, 801 NE 13th Street, Oklahoma City, OK 73104, United States.
| | - David R Karp
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
| | - Ramesh Saxena
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
| | - Kamalanathan Sambandam
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
| | - Eliza Chakravarty
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, United States.
| | - Judith A James
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, United States.
| | - Joan T Merrill
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, United States.
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Pamuk ON, Gurkan H, Pamuk GE, Tozkır H, Duymaz J, Yazar M. BLK pathway-associated rs13277113 GA genotype is more frequent in SLE patients and associated with low gene expression and increased flares. Clin Rheumatol 2016; 36:103-109. [PMID: 27864698 DOI: 10.1007/s10067-016-3475-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/28/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023]
Abstract
We aimed to evaluate the relationship between some important genetic variations and expressions of these genes in our SLE population. We also determined their association with clinical parameters. Eighty-four SLE patients (79 F, 5 M) and 105 healthy controls (98 F, 7 M) were included in the study. rs13277113, rs2736340, rs7829816, rs6983130, rs2613310, and rs704853 polymorphisms, gene expressions of Src family kinases (Blk, Hck, Lck, and Lyn), and Syk kinases (Syk, ZAP70) were studied by real-time PCR. The heterozygous genotypic pattern (GA) for rs13277113 polymorphism was more frequent in patients with SLE when compared to that in controls (48.8 vs. 31.4%, p = 0.035). Other genotype variants were similar in SLE patients and controls. In the SLE group, the heterozygous genotype for rs13277113 was significantly less frequent in active SLE patients (58.8 vs. 26.7%, p = 0.01). SLE flares according to the SELENA-SLEDAI flare index were significantly more frequent in GA (rs13277113) (70 vs. 37%) and CT (rs2736340) genotypes (66.7 vs. 35.2%) than those in other genotypes (p values <0.01). The relative expression of Blk gene was significantly decreased in the SLE group as compared to that in controls (0.52 times, 95%CI 0.19-0.85). The gene expressions of Blk and ZAP70 were significantly lower in SLE patients who had flares according to the SELENA-SLEDAI flare index when compared to those in others (p values 0.01 and 0.017). We observed more frequent heterozygous GA genotypic pattern (rs13277113) in our SLE patients compared to that in controls; and it was associated with disease flares. Blk gene expression in SLE was lower, especially in relapsing patients.
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Affiliation(s)
- Omer Nuri Pamuk
- Department of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey.
- , Eski Yildiz Cad. Park Apt. No:22 Daire:18 Besiktas, 34349, Istanbul, Turkey.
| | - Hakan Gurkan
- Department of Medical Genetics, Trakya University Medical Faculty, Edirne, Turkey
| | - Gulsum Emel Pamuk
- Department of Hematology, Trakya University Medical Faculty, Edirne, Turkey
| | - Hilmi Tozkır
- Department of Medical Genetics, Trakya University Medical Faculty, Edirne, Turkey
| | - Julide Duymaz
- Trakya University Health Services Vocational College, Edirne, Turkey
| | - Metin Yazar
- Department of Medical Genetics, Trakya University Medical Faculty, Edirne, Turkey
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27
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Abstract
Systemic lupus erythematosus is a heterogeneous autoimmune disease marked by the presence of pathogenic autoantibodies, immune dysregulation, and chronic inflammation that may lead to increased morbidity and early mortality from end-organ damage. More than half of all systemic lupus erythematosus patients will develop lupus nephritis. Genetic-association studies have identified more than 50 polymorphisms that contribute to lupus nephritis pathogenesis, including genetic variants associated with altered programmed cell death and defective immune clearance of programmed cell death debris. These variants may support the generation of autoantibody-containing immune complexes that contribute to lupus nephritis. Genetic variants associated with lupus nephritis also affect the initial phase of innate immunity and the amplifying, adaptive phase of the immune response. Finally, genetic variants associated with the kidney-specific effector response may influence end-organ damage and the progression to end-stage renal disease and death. This review discusses genetic insights of key pathogenic processes and pathways that may lead to lupus nephritis, as well as the clinical implications of these findings as they apply to recent advances in biologic therapies.
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Alarcón-Riquelme ME, Ziegler JT, Molineros J, Howard TD, Moreno-Estrada A, Sánchez-Rodríguez E, Ainsworth HC, Ortiz-Tello P, Comeau ME, Rasmussen A, Kelly JA, Adler A, Acevedo-Vázquez EM, Cucho-Venegas JM, García-De la Torre I, Cardiel MH, Miranda P, Catoggio LJ, Maradiaga-Ceceña M, Gaffney PM, Vyse TJ, Criswell LA, Tsao BP, Sivils KL, Bae SC, James JA, Kimberly RP, Kaufman KM, Harley JB, Esquivel-Valerio JA, Moctezuma JF, García MA, Berbotto GA, Babini AM, Scherbarth H, Toloza S, Baca V, Nath SK, Aguilar Salinas C, Orozco L, Tusié-Luna T, Zidovetzki R, Pons-Estel BA, Langefeld CD, Jacob CO. Genome-Wide Association Study in an Amerindian Ancestry Population Reveals Novel Systemic Lupus Erythematosus Risk Loci and the Role of European Admixture. Arthritis Rheumatol 2016; 68:932-43. [PMID: 26606652 DOI: 10.1002/art.39504] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 11/03/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a strong genetic component. We undertook the present work to perform the first genome-wide association study on individuals from the Americas who are enriched for Native American heritage. METHODS We analyzed 3,710 individuals from the US and 4 countries of Latin America who were diagnosed as having SLE, and healthy controls. Samples were genotyped with HumanOmni1 BeadChip. Data on out-of-study controls genotyped with HumanOmni2.5 were also included. Statistical analyses were performed using SNPtest and SNPGWA. Data were adjusted for genomic control and false discovery rate. Imputation was performed using Impute2 and, for classic HLA alleles, HiBag. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS The IRF5-TNPO3 region showed the strongest association and largest OR for SLE (rs10488631: genomic control-adjusted P [Pgcadj ] = 2.61 × 10(-29), OR 2.12 [95% CI 1.88-2.39]), followed by HLA class II on the DQA2-DQB1 loci (rs9275572: Pgcadj = 1.11 × 10(-16), OR 1.62 [95% CI 1.46-1.80] and rs9271366: Pgcadj = 6.46 × 10(-12), OR 2.06 [95% CI 1.71-2.50]). Other known SLE loci found to be associated in this population were ITGAM, STAT4, TNIP1, NCF2, and IRAK1. We identified a novel locus on 10q24.33 (rs4917385: Pgcadj = 1.39 × 10(-8)) with an expression quantitative trait locus (eQTL) effect (Peqtl = 8.0 × 10(-37) at USMG5/miR1307), and several new suggestive loci. SLE risk loci previously identified in Europeans and Asians were corroborated. Local ancestry estimation showed that the HLA allele risk contribution is of European ancestral origin. Imputation of HLA alleles suggested that autochthonous Native American haplotypes provide protection against development of SLE. CONCLUSION Our results demonstrate that studying admixed populations provides new insights in the delineation of the genetic architecture that underlies autoimmune and complex diseases.
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Affiliation(s)
| | - Julie T Ziegler
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Andrés Moreno-Estrada
- Stanford University School of Medicine, Stanford, California, and Laboratorio Nacional de Genómica para la Biodiversidad, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Irapuato, Mexico
| | | | | | - Patricia Ortiz-Tello
- Stanford University School of Medicine, Stanford, California, and Laboratorio Nacional de Genómica para la Biodiversidad, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Irapuato, Mexico
| | - Mary E Comeau
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Adam Adler
- Oklahoma Medical Research Foundation, Oklahoma City
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Judith A James
- Oklahoma Medical Research Foundation and University of Oklahoma Health Sciences Center, Oklahoma City
| | | | | | - John B Harley
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jorge A Esquivel-Valerio
- Hospital Universitario Dr. José Eleuterio González Universidad Autonoma de Nuevo León, Monterrey, Mexico
| | | | - Mercedes A García
- Hospital Interzonal General de Agudos General San Martin, La Plata, Argentina
| | | | | | - Hugo Scherbarth
- Hospital Interzonal General de Agudos Oscar E. Alende, Mar del Plata, Argentina
| | - Sergio Toloza
- Hospital Interzonal San Juan Bautista, San Fernando del Valle de Catamarca, Argentina
| | - Vicente Baca
- Hospital de Peditaria, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Carlos Aguilar Salinas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lorena Orozco
- Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Teresa Tusié-Luna
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Instituto de Investigaciones Biomédicas de la Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | | | - Chaim O Jacob
- University of Southern California School of Medicine, Los Angeles
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The diagnosis and clinical management of the neuropsychiatric manifestations of lupus. J Autoimmun 2016; 74:41-72. [PMID: 27427403 DOI: 10.1016/j.jaut.2016.06.013] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 06/21/2016] [Indexed: 01/03/2023]
Abstract
Neuropsychiatric (NP) involvement in Systemic Lupus Erythematosus (SLE), can be a severe and troubling manifestation of the disease that heavily impacts patient's health, quality of life and disease outcome. It is one of the most complex expressions of SLE which can affect central, peripheral and autonomous nervous system. Complex interrelated pathogenetic mechanisms, including genetic factors, vasculopathy, vascular occlusion, neuroendocrine-immune imbalance, tissue and neuronal damage mediated by autoantibodies, inflammatory mediators, blood brain barrier dysfunction and direct neuronal cell death can be all involved. About NPSLE a number of issues are still matter of debate: from classification and burden of NPSLE to attribution and diagnosis. The role of neuroimaging and new methods of investigation still remain pivotal and rapidly evolving as well as is the increasing knowledge in the pathogenesis. Overall, two main pathogenetic pathways have been recognized yielding different clinical phenotypes: a predominant ischemic-vascular one involving large and small blood vessels, mediated by aPL, immune complexes and leuko-agglutination which it is manifested with more frequent focal NP clinical pictures and a predominantly inflammatory-neurotoxic one mediated by complement activation, increased permeability of the BBB, intrathecal migration of autoantibodies, local production of immune complexes and pro-inflammatory cytokines and other inflammatory mediators usually appearing as diffuse NP manifestations. In the attempt to depict a journey throughout NPSLE from diagnosis to a reasoned therapeutic approach, classification, epidemiology, attribution, risk factors, diagnostic challenges, neuroimaging techniques and pathogenesis will be considered in this narrative review based on the most relevant and recent published data.
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Sex-specific effects of LiCl treatment on preservation of renal function and extended life-span in murine models of SLE: perspective on insights into the potential basis for survivorship in NZB/W female mice. Biol Sex Differ 2016; 7:31. [PMID: 27354902 PMCID: PMC4924261 DOI: 10.1186/s13293-016-0085-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/22/2016] [Indexed: 11/10/2022] Open
Abstract
Considerable research effort has been invested in attempting to understand immune dysregulation leading to autoimmunity and target organ damage. In systemic lupus erythematosus (SLE), patients can develop a systemic disease with a number of organs involved. One of the major target organs is the kidney, but patients vary in the progression of the end-organ targeting of this organ. Some patients develop glomerulonephritis only, while others develop rapidly progressive end organ failure. In murine models of SLE, renal involvement can also occur. Studies performed over the past several years have indicated that treatment with LiCl of females, but not males of the NZB/W model, at an early age during the onset of disease, can prevent development of end-stage renal disease in a significant percentage of the animals. While on Li treatment, up to 80 % of the females can exhibit long-term survival with evidence of mild glomerulonephritis which does not progress to renal failure in spite of on-going autoimmunity. Stopping the treatment led to a reactivation of the disease and renal failure. Li treatment of other murine models of SLE was less effective and decreased survivorship in male BxSB mice, exhibited little effect on male MRL-lpr mice, and only modestly improved survivorship in female MRL-lpr mice. This perspective piece discusses the findings of several related studies which support the concept that protecting target organs such as the kidney, even in the face of continued immune insults and some inflammation, can lead to prolonged survival with retention of organ function. Some possible mechanisms for the effectiveness of Li treatment in this context are also discussed. However, the detailed mechanistic basis for the sex-specific effects of LiCl treatment particularly in the NZB/W model remains to be elucidated. Elucidating such details may provide important clues for development of effective treatment for patients with SLE, ~90 % of which are females.
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Murugapandian S, Mansour I, Hudeeb M, Hamed K, Hammode E, Bijin B, Daheshpour S, Thajudeen B, Kadambi P. Epidemiology of Glomerular Disease in Southern Arizona: Review of 10-Year Renal Biopsy Data. Medicine (Baltimore) 2016; 95:e3633. [PMID: 27149502 PMCID: PMC4863819 DOI: 10.1097/md.0000000000003633] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Glomerulonephritis stands third in terms of the etiologies for end-stage kidney disease in the USA. The aim of this study was to look at the patterns of biopsy-proven glomerulonephritis based on data from a single center.Kidney biopsy specimens of all patients above the age of 18 years, over a 10-year period, who had diagnosis of nondiabetic glomerular disease, were selected for the study.The most common histopathological diagnosis was focal and segmental glomerulosclerosis (FSGS) (22.25%, 158/710) followed by membranous nephropathy (20.28%, 144/710) and immunoglobulin (Ig)A nephropathy (19.71%, 140/710). There was male preponderance in all histological variants except IgA nephropathy, lupus nephritis, and pauci-immune glomerulonephritis. The race distribution was uneven, and all histological variants, except minimal change disease and lupus nephritis, were more commonly seen in whites. In a separate analysis of the histological pattern in Hispanics, lupus nephritis was the most common pathology (28.70%, 62/216) followed by FSGS (18.05%, 39/216). In American Indian population, the most common pathology was IgA nephropathy (33.33%, 8/24) followed by FSGS (16.67%, 4/24).This study highlights the histopathological patterns of glomerular disease in southern Arizona. The data suggest regional and ethnic variations in glomerular disease that may point towards genetic or environmental influence in the pathogenesis of glomerular diseases.
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MESH Headings
- Adult
- Black or African American/statistics & numerical data
- Aged
- Arizona/epidemiology
- Biopsy
- Female
- Glomerulonephritis/epidemiology
- Glomerulonephritis/ethnology
- Glomerulonephritis/pathology
- Glomerulonephritis, IGA/epidemiology
- Glomerulonephritis, IGA/pathology
- Glomerulonephritis, Membranoproliferative/epidemiology
- Glomerulonephritis, Membranoproliferative/pathology
- Glomerulonephritis, Membranous/epidemiology
- Glomerulonephritis, Membranous/pathology
- Glomerulosclerosis, Focal Segmental/epidemiology
- Glomerulosclerosis, Focal Segmental/pathology
- Hispanic or Latino/statistics & numerical data
- Humans
- Indians, North American/statistics & numerical data
- Kidney/pathology
- Lupus Nephritis/epidemiology
- Lupus Nephritis/pathology
- Male
- Middle Aged
- Nephrosis, Lipoid/epidemiology
- Nephrosis, Lipoid/pathology
- Sex Factors
- White People/statistics & numerical data
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Affiliation(s)
- Sangeetha Murugapandian
- From the Department of Nephrology (SM, BB, BT, PK); and Department of Medicine (IM, MH, KH, EH, SD), University of Arizona Medical Center, Tucson, AZ
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Genetic ancestry as an effect modifier of naltrexone in smoking cessation among African Americans: an analysis of a randomized controlled trial. Pharmacogenet Genomics 2016; 25:305-12. [PMID: 25918964 DOI: 10.1097/fpc.0000000000000138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether there were differential quit rates between African Americans (AA) and European Americans with the experimental treatment naltrexone, and examine the role of genetic ancestry on these outcomes among AAs. METHODS Data from a previous randomized trial of 315 smokers to naltrexone versus placebo were reanalyzed using West African (WA) genetic ancestry to define subpopulations. Logistic regression models were used to estimate treatment effects on early and end of treatment quit rates, by race and WA ancestry. RESULTS Among European Americans (n=136), naltrexone significantly increased quit rates at 4 weeks (62 vs. 43%, P=0.03) with directional, but not statistically significant effects at 12 weeks (30 vs. 18%, P=0.12). In contrast, among the AAs (n=95), quit rates did not differ between naltrexone and placebo groups at either interval (4 weeks: 43 vs. 32%, P=0.27; 12 weeks: 22 vs. 18%, P=0.60). A median split was conducted in AAs for WA ancestry. Among AAs with low WA ancestry, quit rates were significantly higher with naltrexone compared with placebo (60 vs. 27%, P=0.03). There was no advantage in quit rates with naltrexone for the high WA ancestry group. CONCLUSION Naltrexone efficacy for smoking cessation varies across AA individuals with different levels of WA ancestry. These results suggest that genetic background may partially explain racial differences in drug response.
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Seldin MF. The genetics of human autoimmune disease: A perspective on progress in the field and future directions. J Autoimmun 2015; 64:1-12. [PMID: 26343334 PMCID: PMC4628839 DOI: 10.1016/j.jaut.2015.08.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/23/2015] [Indexed: 12/18/2022]
Abstract
Progress in defining the genetics of autoimmune disease has been dramatically enhanced by large scale genetic studies. Genome-wide approaches, examining hundreds or for some diseases thousands of cases and controls, have been implemented using high throughput genotyping and appropriate algorithms to provide a wealth of data over the last decade. These studies have identified hundreds of non-HLA loci as well as further defining HLA variations that predispose to different autoimmune diseases. These studies to identify genetic risk loci are also complemented by progress in gene expression studies including definition of expression quantitative trait loci (eQTL), various alterations in chromatin structure including histone marks, DNase I sensitivity, repressed chromatin regions as well as transcript factor binding sites. Integration of this information can partially explain why particular variations can alter proclivity to autoimmune phenotypes. Despite our incomplete knowledge base with only partial definition of hereditary factors and possible functional connections, this progress has and will continue to facilitate a better understanding of critical pathways and critical changes in immunoregulation. Advances in defining and understanding functional variants potentially can lead to both novel therapeutics and personalized medicine in which therapeutic approaches are chosen based on particular molecular phenotypes and genomic alterations.
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Affiliation(s)
- Michael F Seldin
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Tupper Hall Room 4453, Davis, CA 95616, USA; Division of Rheumatology and Allergy, Department of Medicine, University of California, Davis, Tupper Hall Room 4453, Davis, CA 95616, USA.
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Tesar V, Hruskova Z. Lupus Nephritis: A Different Disease in European Patients? KIDNEY DISEASES 2015; 1:110-8. [PMID: 27536671 DOI: 10.1159/000438844] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 07/17/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lupus nephritis (LN) is still associated with significant mortality and substantial risk of progression to end-stage renal failure. Its outcome is related to the class and severity of LN and response to treatment, and it is poorer in patients with renal relapses. Ethnicity has a relatively well-defined impact on the outcome of the patients and their response to treatment and must always be taken into consideration in treatment decisions. SUMMARY In this article, we provide a review of the impact of ethnicity on the prevalence of systemic lupus erythematosus (SLE), the proportion of patients with SLE developing LN, outcomes of SLE and LN and response of LN to treatment. In European patients, the prevalence of SLE and the proportion of SLE patients with LN are lower and the outcome of LN is better than in nonwhite populations. European patients may respond better to some modes of treatment [e.g. cyclophosphamide (CYC) or rituximab] and may be less frequently refractory to treatment compared to black patients with LN. Although these differences may be largely genetically driven, socioeconomic factors (poverty, education, insurance, access to health care and adherence to treatment) may also play a significant role in some disadvantaged patients. KEY MESSAGE Treatment of LN may be different in patients with different ethnicity. Less aggressive disease in European patients may better respond to less aggressive treatment. Treatment of LN in nonwhite patients may require newer (more effective) therapeutic approaches, but targeting negative socioeconomic factors might be even more effective. FACTS FROM EAST AND WEST (1) The prevalence of SLE is lower among Caucasians than other ethnicities. A higher prevalence is observed among Asians and African Americans, while the highest prevalence is found in Caribbean people. The prevalence of LN in Asian SLE patients is much higher than in Caucasians as well. However, the 10-year renal outcome and renal survival rate appear to be better in Asians. (2) Polymorphisms of genes involved in the immune response, such as Fcγ receptor, integrin alpha M, TNF superfamily 4, myotubularin-related protein 3 and many others, might be partly responsible for the differences in prevalence between the different ethnic groups. European ancestry was shown to be associated with a decrease in the risk of LN even after adjustment for genes most associated with renal disease. (3) Access to health care is a key determinant of disease progression, treatment outcome and the management of complications such as infections, particularly in South Asia, and might also explain disparities between clinical outcomes. (4) The efficacy of low-dose CYC combined with corticosteroids for induction treatment of LN was proved in European Caucasian patients. This treatment is also used in Asia, although no formal evaluation of efficacy and safety in comparison with other treatment regimens exists in this population. The efficacy of mycophenolate mofetil (MMF) is similar to that of CYC, and similar between Asians and Caucasians. MMF may be more effective than CYC in inducing response in high-risk populations such as African American or Hispanic patients. MMF might cause less infection-related events in Asians, but its high cost prevents broader usage at present. (5) For maintenance therapy, corticosteroid combined with azathioprine (AZA) or MMF is used worldwide, with a broadly similar efficacy of both treatments, although there are data suggesting that in high-risk populations (e.g. African Americans) MMF may be more effective in preventing renal flares. AZA is often preferred in Asia due to economic constraints and because of its safety in pregnancy. (6) Alternative therapies under investigation include rituximab, which might be more efficient in Caucasians, as well as belimumab. Recent Japanese and Chinese studies have indicated a potential benefit of tacrolimus as a substitute for or in addition to CYC or MMF (dual or triple immunosuppression). Mizoribine is used in Japan exclusively.
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Affiliation(s)
- Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zdenka Hruskova
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Choi JH, Park DJ, Kang JH, Yim YR, Lee KE, Lee JW, Wen L, Kim TJ, Park YW, Lee JK, Lee SS. Comparison of clinical and serological differences among juvenile-, adult-, and late-onset systemic lupus erythematosus in Korean patients. Lupus 2015; 24:1342-9. [PMID: 26085595 DOI: 10.1177/0961203315591024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 05/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We investigated whether systemic lupus erythematosus (SLE) patients could be distinguished based on the time of disease onset and, if so, whether the groups differed in their clinical and laboratory features in ethnically homogeneous Korean patients. METHODS We enrolled 201 SLE patients with available clinical data at the time of onset of SLE from the lupus cohort at Chonnam National University Hospital. Sociodemographic, clinical, and laboratory data, including autoantibodies, and concomitant diseases were found at the time of diagnosis of SLE by reviewing patient charts. We divided SLE patients according to age at SLE diagnosis into three groups: juvenile-onset SLE (JSLE, diagnosed at ≤ 18 years), adult-onset SLE (ASLE, diagnosed at 19-50 years), and late-onset SLE (LSLE, diagnosed at >50 years), and compared baseline demographic, clinical, and relevant laboratory findings. RESULTS Of the 201 patients, 27 (14.4%), 149 (74.1%), and 25 (12.4%) were JSLE, ASLE, and LSLE patients, respectively. Fever, oral ulcers, nephritis, anemia, and thrombocytopenia were more common in JSLE patients than ASLE or LSLE patients (p < 0.05, < 0.05, 0.001, < 0.05, and < 0.05, respectively). However, Sjögren's syndrome was more frequent in LSLE patients than JSLE or ASLE patients (p < 0.05). Disease activity was significantly higher in JSLE patients than in ASLE or LSLE patients (p < 0.001). Anti-dsDNA and anti-nucleosome antibodies were found more frequently in JSLE patients and less frequently in LSLE patients (p < 0.05 and 0.005, respectively) and decreased complement levels were more common in JSLE patients and less common in LSLE patients (p < 0.001, 0.001, and < 0.05, respectively). CONCLUSIONS Our results indicate that SLE patients present with different clinical and serological manifestations according to age at disease onset. JSLE patients have more severe disease activity and more frequent renal involvement and LSLE patients have milder disease activity, more commonly accompanied by Sjögren's syndrome, at disease onset.
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Affiliation(s)
- J H Choi
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - D J Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - J H Kang
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Y R Yim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - K E Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - J W Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - L Wen
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - T J Kim
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Y W Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - J K Lee
- Department of Neurosurgery, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - S S Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
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Wu YY, Georg I, Díaz-Barreiro A, Varela N, Lauwerys B, Kumar R, Bagavant H, Castillo-Martín M, El Salem F, Marañón C, Alarcón-Riquelme ME. Concordance of increased B1 cell subset and lupus phenotypes in mice and humans is dependent on BLK expression levels. THE JOURNAL OF IMMUNOLOGY 2015; 194:5692-702. [PMID: 25972485 DOI: 10.4049/jimmunol.1402736] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/13/2015] [Indexed: 01/20/2023]
Abstract
Polymorphisms in the B lymphoid tyrosine kinase (BLK) gene have been associated with autoimmune diseases, including systemic lupus erythematosus, with risk correlating with reduced expression of BLK. How reduced expression of BLK causes autoimmunity is unknown. Using Blk(+/+) , Blk(+/-) , and Blk(-/-) mice, we show that aged female Blk(+/-) and Blk(-/-) mice produced higher anti-dsDNA IgG Abs and developed immune complex-mediated glomerulonephritis, compared with Blk(+/+) mice. Starting at young age, Blk(+/-) and Blk(-/-) mice accumulated increased numbers of splenic B1a cells, which differentiated into class-switched CD138(+) IgG-secreting B1a cells. Increased infiltration of B1a-like cells into the kidneys was also observed in aged Blk(+/-) and Blk(-/-) mice. In humans, we found that healthy individuals had BLK genotype-dependent levels of anti-dsDNA IgG Abs as well as increased numbers of a B1-like cell population, CD19(+)CD3(-)CD20(+)CD43(+)CD27(+), in peripheral blood. Furthermore, we describe the presence of B1-like cells in the tubulointerstitial space of human lupus kidney biopsies. Taken together, our study reveals a previously unappreciated role of reduced BLK expression on extraperitoneal accumulation of B1a cells in mice, as well as the presence of IgG autoantibodies and B1-like cells in humans.
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Affiliation(s)
- Ying-Yu Wu
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104;
| | - Ina Georg
- Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Andalusian Regional Government, Health Sciences Technology Park, Granada 18016, Spain
| | - Alejandro Díaz-Barreiro
- Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Andalusian Regional Government, Health Sciences Technology Park, Granada 18016, Spain
| | - Nieves Varela
- Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Andalusian Regional Government, Health Sciences Technology Park, Granada 18016, Spain
| | - Bernard Lauwerys
- Pôle de Pathologies Rhumatismales, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; and
| | - Ramesh Kumar
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104
| | - Harini Bagavant
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104
| | | | - Fadi El Salem
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Concepción Marañón
- Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Andalusian Regional Government, Health Sciences Technology Park, Granada 18016, Spain
| | - Marta E Alarcón-Riquelme
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104; Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Andalusian Regional Government, Health Sciences Technology Park, Granada 18016, Spain;
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Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that has a broad spectrum of effects on the majority of organs, including the kidneys. Approximately 40-70% of patients with SLE will develop lupus nephritis. Renal assault during SLE is initiated by genes that breach immune tolerance and promote autoantibody production. These genes might act in concert with other genetic factors that augment innate immune signalling and IFN-I production, which in turn can generate an influx of effector leucocytes, inflammatory mediators and autoantibodies into end organs, such as the kidneys. The presence of cognate antigens in the glomerular matrix, together with intrinsic molecular abnormalities in resident renal cells, might further accentuate disease progression. This Review discusses the genetic insights and molecular mechanisms for key pathogenic contributors in SLE and lupus nephritis. We have categorized the genes identified in human studies of SLE into one of four pathogenic events that lead to lupus nephritis. We selected these categories on the basis of the cell types in which these genes are expressed, and the emerging paradigms of SLE pathogenesis arising from murine models. Deciphering the molecular basis of SLE and/or lupus nephritis in each patient will help physicians to tailor specific therapies.
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Treatment of lupus nephritis with abatacept: the Abatacept and Cyclophosphamide Combination Efficacy and Safety Study. Arthritis Rheumatol 2015; 66:3096-104. [PMID: 25403681 DOI: 10.1002/art.38790] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/15/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of a 24-week course of abatacept in the treatment of active lupus nephritis and to assess the potential of abatacept to induce "clinical tolerance," defined as sustained clinical quiescence of lupus nephritis after discontinuation of immunosuppressive therapy. METHODS Patients with active lupus nephritis (n = 134) were enrolled in a randomized, double-blind phase II add-on trial in which they received either abatacept or placebo in conjunction with the Euro-Lupus Nephritis Trial regimen of low-dose cyclophosphamide (CYC) followed by azathioprine (AZA). The primary efficacy outcome was the frequency of complete response at week 24. Thereafter, patients who met either complete or partial response criteria continued blinded treatment through week 52. During this phase of the study, subjects in the abatacept treatment group in whom a complete response was achieved at week 24 discontinued immunosuppressive therapy other than prednisone (10 mg/day). RESULTS There were no statistically significant differences between groups with respect to the primary outcome or any of the secondary outcomes, including measures of safety. A complete response was achieved in 33% of the subjects in the treatment group and in 31% of the subjects in the control group at week 24. Fifty percent of the subjects in the treatment group who met complete response criteria and therefore discontinued immunosuppressive therapy at week 24 maintained their complete response status through week 52. CONCLUSION The addition of abatacept to a regimen of CYC followed by AZA did not improve the outcome of lupus nephritis at either 24 or 52 weeks. No worrisome safety signals were encountered.
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Impact of race and ethnicity in the course and outcome of systemic lupus erythematosus. Rheum Dis Clin North Am 2014; 40:433-54, vii-viii. [PMID: 25034155 DOI: 10.1016/j.rdc.2014.04.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genetic factors seem to play a more important role early in the course of systemic lupus erythematosus (SLE), whereas nongenetic factors seem to play a more important role over the course of the disease. SLE is more frequent with less favorable outcomes in nonwhite populations. To overcome these differences and reduce the immediate-term, mediate-term, and long-term impact of SLE among disadvantaged populations, it is essential to increase disease awareness, to improve access to health care and to provide care to these patients in a consistent manner regardless of the severity of their disease.
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González LA, Toloza SMA, McGwin G, Alarcón GS. Ethnicity in systemic lupus erythematosus (SLE): its influence on susceptibility and outcomes. Lupus 2014; 22:1214-24. [PMID: 24097993 DOI: 10.1177/0961203313502571] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ethnicity is a biological and a social construct which encompasses ancestral genes, cultural, geographic and socioeconomic characteristics shared within a population. It is clear that no homogeneous racial groups exist within the human race as demonstrated when examining ancestry informative markers. Both the genetic and non-genetic components of ethnicity exert influence in the expression and outcome of systemic lupus erythematosus (SLE), including disease activity, damage accrual, work disability and mortality. Although it is difficult to determine the extent to which the differences observed in these parameters are caused by genetic or non-genetic factors, early in the disease genetic factors seem to play a more important role as determinants of the differences observed between SLE patients from various ethnic groups. Over the course of the disease, non-genetic factors seem to play a more important role. By and large, SLE is more frequent and more severe with higher disease activity and more damage accrual in non-Caucasian populations (Hispanics, African descendants and Asians) than in Caucasians. To overcome these differences it is necessary to optimize health care access to disadvantaged populations and use innovative tools to increase disease awareness and improve treatment adherence.
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Affiliation(s)
- L A González
- 1Division of Rheumatology, Universidad de Antioquia, Medellín, Colombia; Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Argentina; Departments of Epidemiology and Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA; and Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Freedman BI, Langefeld CD, Andringa KK, Croker JA, Williams AH, Garner NE, Birmingham DJ, Hebert LA, Hicks PJ, Segal MS, Edberg JC, Brown EE, Alarcón GS, Costenbader KH, Comeau ME, Criswell LA, Harley JB, James JA, Kamen DL, Lim SS, Merrill JT, Sivils KL, Niewold TB, Patel NM, Petri M, Ramsey-Goldman R, Reveille JD, Salmon JE, Tsao BP, Gibson KL, Byers JR, Vinnikova AK, Lea JP, Julian BA, Kimberly RP. End-stage renal disease in African Americans with lupus nephritis is associated with APOL1. Arthritis Rheumatol 2014; 66:390-6. [PMID: 24504811 DOI: 10.1002/art.38220] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 10/01/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE) that exhibits familial aggregation and may progress to end-stage renal disease (ESRD). LN is more prevalent among African Americans than among European Americans. This study was undertaken to investigate the hypothesis that the apolipoprotein L1 gene (APOL1) nephropathy risk alleles G1/G2, common in African Americans and rare in European Americans, contribute to the ethnic disparity in risk. METHODS APOL1 G1 and G2 nephropathy alleles were genotyped in 855 African American SLE patients with LN-ESRD (cases) and 534 African American SLE patients without nephropathy (controls) and tested for association under a recessive genetic model, by logistic regression. RESULTS Ninety percent of the SLE patients were female. The mean ± SD age at SLE diagnosis was significantly lower in LN-ESRD cases than in SLE non-nephropathy controls (27.3 ± 10.9 years versus 39.5 ± 12.2 years). The mean ± SD time from SLE diagnosis to development of LN-ESRD in cases was 7.3 ± 7.2 years. The G1/G2 risk alleles were strongly associated with SLE-ESRD, with 25% of cases and 12% of controls having 2 nephropathy alleles (odds ratio [OR] 2.57, recessive model P = 1.49 × 10(-9)), and after adjustment for age, sex, and ancestry admixture (OR 2.72, P = 6.23 × 10(-6)). The age-, sex-, and admixture-adjusted population attributable risk for ESRD among patients with G1/G2 polymorphisms was 0.26, compared to 0.003 among European American patients. The mean time from SLE diagnosis to ESRD development was ∼2 years earlier among individuals with APOL1 risk genotypes (P = 0.01). CONCLUSION APOL1 G1/G2 alleles strongly impact the risk of LN-ESRD in African Americans, as well as the time to progression to ESRD. The high frequency of these alleles in African Americans with near absence in European Americans explains an important proportion of the increased risk of LN-ESRD in African Americans.
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Zhao JJ, Wang XB, Luan Y, Liu JL, Liu L, Jia HY. Association of human leukocyte antigen gene polymorphism and mesangial proliferative glomerulonephritis in a large population-based study. Biomed Rep 2014; 1:751-756. [PMID: 24649023 DOI: 10.3892/br.2013.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/16/2013] [Indexed: 01/25/2023] Open
Abstract
The aim of the present study was to investigate the association of human leukocyte antigen (HLA) gene polymorphism and clinical phenotypes of patients with mesangial proliferative glomerulonephritis (MsPGN). The genotyping of HLA-A, HLA-B and HLA-DRB1 alleles was detected in 1,536 consecutive MsPGN patients during the previous five years and 2,027 age- and gender-matched healthy individuals by using the polymerase chain reaction-sequence-specific primers method. The clinical and pathological data of the patients were collected and the genotype frequencies (GF) and odds ratio (OR) were analyzed. The allele frequencies of HLA-A*23, A*25, B*15, B*40, B*53 and DRB1*18 were significantly higher in MsPGN patients than in the controls (P<0.05). These alleles were considered as the suspected susceptibility genes (SSG) for MsPGN. Of note, results of the follow-up survey study demonstrated poorer prognosis of patients with SSG than those without SSG. On the other hand, the frequencies of A*32, A*33, B*50, B*58, B*60, B*71, DRB1*16 were lower in MsPGN patients than in the controls (P<0.05). However, the alleles A*20, A*22, A*35, A*36, A*38, B*21, B*73 and B*78 were not expressed in MsPGN patients. HLA gene polymorphism is associated with hereditary susceptibility to MsPGN. Therefore, there might be corresponding susceptibility and protective genes associated with MsPGN.
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Affiliation(s)
- Jing-Jie Zhao
- Clinical Molecular Biology Laboratory, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Xi-Bing Wang
- Department of Gynaecology and Obstetrics, Maternal and Child Health Care Service Center of Zaozhuang, Shandong 277102, P.R. China
| | - Yun Luan
- Central Laboratory, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Jun-Li Liu
- Clinical Molecular Biology Laboratory, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Ling Liu
- Clinical Molecular Biology Laboratory, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Hong-Ying Jia
- Department of Scientific Research, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
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Socioeconomic status. The relationship with health and autoimmune diseases. Autoimmun Rev 2014; 13:641-54. [PMID: 24418307 DOI: 10.1016/j.autrev.2013.12.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/24/2013] [Indexed: 12/15/2022]
Abstract
Socioeconomic status (SES) is a hierarchical social classification associated with different outcomes in health and disease. The most important factors influencing SES are income, educational level, occupational class, social class, and ancestry. These factors are closely related to each other as they present certain dependent interactions. Since there is a need to improve the understanding of the concept of SES and the ways it affects health and disease, we review herein the tools currently available to evaluate SES and its relationship with health and autoimmune diseases.
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Tabatabai MA, Li H, Eby WM, Kengwoung-Keumo JJ, Manne U, Bae S, Fouad M, Singh KP. Robust Logistic and Probit Methods for Binary and Multinomial Regression. ACTA ACUST UNITED AC 2014; 5. [PMID: 26078914 DOI: 10.4172/2155-6180.1000202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this paper we introduce new robust estimators for the logistic and probit regressions for binary, multinomial, nominal and ordinal data and apply these models to estimate the parameters when outliers or inluential observations are present. Maximum likelihood estimates don't behave well when outliers or inluential observations are present. One remedy is to remove inluential observations from the data and then apply the maximum likelihood technique on the deleted data. Another approach is to employ a robust technique that can handle outliers and inluential observations without removing any observations from the data sets. The robustness of the method is tested using real and simulated data sets.
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Affiliation(s)
- M A Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN 37208, USA
| | - H Li
- Department of Mathematical Sciences, Cameron University, Lawton, OK 73505, USA
| | - W M Eby
- Department of Mathematics, New Jersey City University, Jersey City, NJ 07305, USA
| | - J J Kengwoung-Keumo
- Department of Mathematical Sciences, Cameron University, Lawton, OK 73505, USA
| | - U Manne
- Department of Pathology and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - S Bae
- Department of Medicine Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - M Fouad
- Department of Medicine Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - K P Singh
- Department of Medicine Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Pons-Estel GJ, Alarcón GS, Burgos PI, Hachuel L, Boggio G, Wojdyla D, Nieto R, Alvarellos A, Catoggio LJ, Guibert-Toledano M, Sarano J, Massardo L, Vásquez GM, Iglesias-Gamarra A, Lavras Costallat LT, Da Silva NA, Alfaro JL, Abadi I, Segami MI, Huerta G, Cardiel MH, Pons-Estel BA. Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance: data from a Latin American cohort. Lupus 2013; 22:899-907. [PMID: 23857989 DOI: 10.1177/0961203313496339] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this paper is to assess the predictors of time-to-lupus renal disease in Latin American patients. METHODS Systemic lupus erythematosus (SLE) patients (n = 1480) from Grupo Latino Americano De Estudio de Lupus (GLADEL's) longitudinal inception cohort were studied. Endpoint was ACR renal criterion development after SLE diagnosis (prevalent cases excluded). Renal disease predictors were examined by univariable and multivariable Cox proportional hazards regression analyses. Antimalarials were considered time dependent in alternative analyses. RESULTS Of the entire cohort, 265 patients (17.9%) developed renal disease after entering the cohort. Of them, 88 (33.2%) developed persistent proteinuria, 44 (16.6%) cellular casts and 133 (50.2%) both; 233 patients (87.9%) were women; mean (± SD) age at diagnosis was 28.0 (11.9) years; 12.2% were African-Latin Americans, 42.5% Mestizos, and 45.3% Caucasians (p = 0.0016). Mestizo ethnicity (HR 1.61, 95% CI 1.19-2.17), hypertension (HR 3.99, 95% CI 3.02-5.26) and SLEDAI at diagnosis (HR 1.04, 95% CI 1.01-1.06) were associated with a shorter time-to-renal disease occurrence; antimalarial use (HR 0.57, 95% CI 0.43-0.77), older age at onset (HR 0.90, 95% CI 0.85-0.95, for every five years) and photosensitivity (HR 0.74, 95% CI 0.56-0.98) were associated with a longer time. Alternative model results were consistent with the antimalarial protective effect (HR 0.70, 95% CI 0.50-0.99). CONCLUSIONS Our data strongly support the fact that Mestizo patients are at increased risk of developing renal disease early while antimalarials seem to delay the appearance of this SLE manifestation. These data have important implications for the treatment of these patients regardless of their geographic location.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Villarroel 170, Barcelona, Catalonia, Spain.
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