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Rodrigues de Almeida A, Jaime Bezerra Mendonça Junior F, Tavares Dantas A, Eduarda de Oliveira Gonçalves M, Chêne C, Jeljeli M, Chouzenoux S, Thomas M, David de Azevedo Valadares L, Andreza Bezerra Correia M, Ângela da Silva Alves W, Carvalho Lira E, Doridot L, Jesus Barreto de Melo Rêgo M, Cristiny Pereira M, Luzia Branco Pinto Duarte A, Saes Parra Abdalla D, Nicco C, Batteux F, Galdino da Rocha Pitta M. IBPA a mutual prodrug of ibuprofen and acetaminophen alleviates inflammation, immune dysregulation and fibrosis in preclinical models of systemic sclerosis. Int Immunopharmacol 2024; 136:112344. [PMID: 38833846 DOI: 10.1016/j.intimp.2024.112344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
Systemic sclerosis (SSc) is a devastating autoimmune illness with a wide range of clinical symptoms, including vascular abnormalities, inflammation, and persistent and progressive fibrosis. The disease's complicated pathophysiology makes it difficult to develop effective therapies, necessitating research into novel therapeutic options. Molecular hybridization is a strategy that can be used to develop new drugs that act on two or multiple targets and represents an interesting option to be explored for the treatment of complex diseases. We aimed to evaluate the effects of a hybrid mutual prodrug of ibuprofen and acetaminophen (IBPA) in peripheral blood mononuclear cells (PBMC) isolated from SSc patients, and in an in vivo model of SSc induced in BALB/c mice by intradermal injections of hypochlorous acid (HOCl) for 6 weeks. The mice were treated at the same time with daily intraperitoneal injections of IBPA (40 mg/kg). Pulmonary and skin fibrosis as well as immune responses were evaluated. IBPA significantly decreased the release of cytokines in PBMC culture supernatants from SSc patients after stimulation with phytohemagglutinin-M (IL-2, IL-4, IL-6, IL-10, IL-13, IL-17A, TNF and IFN-γ).In HOCl-induced SSc, IBPA treatment prevented dermal and pulmonary fibrosis, in addition to reducing CD4 + T and B cells activation and reversing the M2 polarization of macrophages in spleen cells, and inhibiting IFN-γ secretion in splenocyte cultures. These results show the anti-inflammatory and antifibrotic effects of IBPA in SSc and highlight the therapeutic potential of this mutual prodrug, providing support for future studies.
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Affiliation(s)
- Anderson Rodrigues de Almeida
- Laboratório de Imunomodulação e Novas Abordagens Terapêuticas, Núcleo de Pesquisa em Inovação Terapêutica, Universidade Federal de Pernambuco, Recife, PE, Brazil; Université Paris Cité, Institut Cochin, Inserm, CNRS, Paris, France
| | - Francisco Jaime Bezerra Mendonça Junior
- Laboratório de Síntese e Vetorização de Moléculas, Departamento de Ciências Biológicas, Centro de Ciências Biológicas e Sociais Aplicadas, Universidade Estadual da Paraíba, João Pessoa, PB, Brazil
| | - Andréa Tavares Dantas
- Serviço de Reumatologia, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Maria Eduarda de Oliveira Gonçalves
- Laboratório de Imunomodulação e Novas Abordagens Terapêuticas, Núcleo de Pesquisa em Inovação Terapêutica, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Charlotte Chêne
- Université Paris Cité, Institut Cochin, Inserm, CNRS, Paris, France
| | - Mohamed Jeljeli
- Université Paris Cité, Institut Cochin, Inserm, CNRS, Paris, France
| | | | - Marine Thomas
- Université Paris Cité, Institut Cochin, Inserm, CNRS, Paris, France
| | | | - Maria Andreza Bezerra Correia
- Laboratório de Imunomodulação e Novas Abordagens Terapêuticas, Núcleo de Pesquisa em Inovação Terapêutica, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | - Eduardo Carvalho Lira
- Departamento de Fisiologia e Farmacologia, Centro de Biociências, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Ludivine Doridot
- Université Paris Cité, Institut Cochin, Inserm, CNRS, Paris, France
| | - Moacyr Jesus Barreto de Melo Rêgo
- Laboratório de Imunomodulação e Novas Abordagens Terapêuticas, Núcleo de Pesquisa em Inovação Terapêutica, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Michelly Cristiny Pereira
- Laboratório de Imunomodulação e Novas Abordagens Terapêuticas, Núcleo de Pesquisa em Inovação Terapêutica, Universidade Federal de Pernambuco, Recife, PE, Brazil; Departamento de Fisiologia e Farmacologia, Centro de Biociências, Universidade Federal de Pernambuco, Recife, PE, Brazil.
| | | | - Dulcineia Saes Parra Abdalla
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carole Nicco
- Université Paris Cité, Institut Cochin, Inserm, CNRS, Paris, France
| | - Frédéric Batteux
- Université Paris Cité, Institut Cochin, Inserm, CNRS, Paris, France
| | - Maira Galdino da Rocha Pitta
- Laboratório de Imunomodulação e Novas Abordagens Terapêuticas, Núcleo de Pesquisa em Inovação Terapêutica, Universidade Federal de Pernambuco, Recife, PE, Brazil
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De Múgica AD, Bailey E, Loughlin A. Scleroderma: oral, maxillofacial and radiographic manifestations for dental practitioners. Br Dent J 2024; 236:881-886. [PMID: 38877249 DOI: 10.1038/s41415-024-7453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 06/16/2024]
Abstract
Scleroderma is an autoimmune condition of unknown aetiology with a range of manifestations, which can be limited to the skin or can extend to be multisystemic. It is characterised by fibrosis, microangiopathy and dysregulation of the immune system and commonly affects the oral cavity. Frequent oral and maxillofacial features include fibrosis of the face, circumoral furrows and reduced oral aperture. Radiographic findings are often incidental, including uniform, asymptomatic periodontal ligament space widening of teeth and osteolysis of bone at muscular attachments. The oral and maxillofacial manifestations significantly contribute to its disease burden and are often overlooked and undertreated as their treatment can be limited due to their challenging rheumatological care. Given the complexity of the condition and its multisystemic impacts, better co-operation between dentists and rheumatologists may help improve this patient cohort's quality of life. This clinical article aims to better equip dentists to identify features of scleroderma and manage the day-to-day oro-facial manifestations.
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Affiliation(s)
- Alexander Davies De Múgica
- Department of Dental and Maxillofacial Radiology, Royal London Dental Hospital, Turner Street, London, E1 1FR, UK; Department of Dental and Maxillofacial Radiology, Eastman Dental Hospital, 47-49 Huntley St, London, WC1E 6DG, UK.
| | - Edmund Bailey
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 1FR, UK
| | - Amanda Loughlin
- Department of Dental and Maxillofacial Radiology, Royal London Dental Hospital, Turner Street, London, E1 1FR, UK
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Ohno R, Nakamura A. Advancing autoimmune Rheumatic disease treatment: CAR-T Cell Therapies - Evidence, Safety, and future directions. Semin Arthritis Rheum 2024; 67:152479. [PMID: 38810569 DOI: 10.1016/j.semarthrit.2024.152479] [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: 03/09/2024] [Revised: 04/20/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Despite advancements in managing autoimmune rheumatic diseases (ARDs) with existing treatments, many patients still encounter challenges such as inadequate responses, difficulty in maintaining remission, and side effects. Chimeric Antigen Receptor (CAR) T-cell therapy, originally developed for cancer, has now emerged as a promising option for cases of refractory ARDs. METHODS A search of the literature was conducted to compose a narrative review exploring the current evidence, potential safety, limitations, potential modifications, and future directions of CAR-T cells in ARDs. RESULTS CAR-T cell therapy has been administered to patients with refractory ARDs, including systemic lupus erythematosus, antisynthetase syndrome, and systemic sclerosis, demonstrating significant improvement. Notable responses include enhanced clinical symptoms, reduced serum autoantibody titers, and sustained remissions in disease activity. Preclinical and in vitro studies using both animal and human samples also support the efficacy and elaborate on potential mechanisms of CAR-T cells against antineutrophil cytoplasmic antibody-associated vasculitis and rheumatoid arthritis. While cautious monitoring of adverse events, such as cytokine release syndrome, is crucial, the therapy appears to be highly tolerable. Nevertheless, challenges persist, including cost, durability due to potential CAR-T cell exhaustion, and manufacturing complexities, urging the development of innovative solutions to further enhance CAR-T cell therapy accessibility in ARDs. CONCLUSIONS CAR-T cell therapy for refractory ARDs has demonstrated high effectiveness. While no significant warning signs are currently reported, achieving a balance between therapeutic efficacy and safety is vital in adapting CAR-T cell therapy for ARDs. Moreover, there is significant potential for technological advancements to enhance the delivery of this treatment to patients, thereby ensuring safer and more effective disease control for patients.
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Affiliation(s)
- Ryunosuke Ohno
- Department of Medicine, Division of Rheumatology, Queen's University, Kingston, Ontario, Canada; Department of Medicine, Okayama University, Okayama, Japan
| | - Akihiro Nakamura
- Department of Medicine, Division of Rheumatology, Queen's University, Kingston, Ontario, Canada; Translational Institute of Medicine, School of Medicine, Queen's University, Ontario, Canada; Rheumatology Clinic, Kingston Health Science Centre, Kingston, Ontario, Canada.
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Foti R, Zeppieri M, Foti R, Visalli E, Amato G, Amato R, Dammino E, D’Esposito F, Gagliano C. Retinal Vascular Abnormalities and Clinical Parameters in Systemic Sclerosis. J Clin Med 2024; 13:2738. [PMID: 38792282 PMCID: PMC11122651 DOI: 10.3390/jcm13102738] [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: 03/19/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Systemic sclerosis is a complex autoimmune disease characterized by vasculopathy, fibrosis, and immune dysregulation. Ocular manifestations in these patients are increasingly recognized, suggesting potential correlations between systemic vascular abnormalities and ocular microvascular changes. Advancements in molecular immunology and imaging technology using ocular coherence tomography (OCT) have unveiled intricate pathways underlying possible disease pathogenesis. Understanding the interplay between retinal vascular abnormalities and molecular immunology parameters could provide insights into disease mechanisms and potential biomarkers. Purpose: The aim of this study was to investigate vascular abnormalities, detected with optical coherence tomography angiography (OCT-A), in systemic sclerosis patients and to find correlations between the severity of the disease detected with molecular immunology findings and OCT-A parameters. Methods: A group of 32 systemic sclerosis patients were compared with 9 healthy controls. Ganglion cell complex thickness (GCC), retina thickness of the fovea and parafovea, nerve fiber layer thickness (RNFL) and cup/disc area ratio were investigated using OCT. Vessel density (VD) of the superficial (SCP) and deep capillary plexus (DCP) of the whole macular area and ETDRS grid, size of the foveal avascular zone (FAZ) and vessel density of the radial peripapillary capillary plexus (RPCP) were evaluated using OCT-A. Modified Rodnan skin score (mRSS), capillaroscopy and disease duration were used to stage disease severity. Results: There was a statistically significant reduction in retina thickness of the fovea and parafovea, VD of the whole DCP, VD of the SCP and DCP in ETDRS grid in the patient group compared to controls (p < 0.001). The patients presented a significant enlargement of the FAZ (p 0.005). No significant correlation between OCT and OCT-A parameters and disease severity scores was found. Conclusions: OCT-A could represent a non-invasive tool to detect retinal microvascular damage in systemic sclerosis.
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Affiliation(s)
- Rosario Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (R.F.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Roberta Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (R.F.)
| | - Elisa Visalli
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (R.F.)
| | - Giorgio Amato
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (R.F.)
| | - Roberta Amato
- Eye Clinic, Catania University, San Marco Hospital, Viale Carlo Azeglio Ciampi, 95121 Catania, Italy (C.G.)
| | - Edoardo Dammino
- Eye Clinic, Catania University, San Marco Hospital, Viale Carlo Azeglio Ciampi, 95121 Catania, Italy (C.G.)
| | - Fabiana D’Esposito
- Imperial College Ophthalmic Research Group (ICORG) Unit, Imperial College, London NW1 5QH, UK
| | - Caterina Gagliano
- Eye Clinic, Catania University, San Marco Hospital, Viale Carlo Azeglio Ciampi, 95121 Catania, Italy (C.G.)
- Department of Medicine and Surgery, University of Enna “Kore”, Piazza dell’Università, 94100 Enna, Italy
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Swain HN, Boyce PD, Bromet BA, Barozinksy K, Hance L, Shields D, Olbricht GR, Semon JA. Mesenchymal stem cells in autoimmune disease: A systematic review and meta-analysis of pre-clinical studies. Biochimie 2024; 223:54-73. [PMID: 38657832 DOI: 10.1016/j.biochi.2024.04.009] [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: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024]
Abstract
Mesenchymal Stem Cells (MSCs) are of interest in the clinic because of their immunomodulation capabilities, capacity to act upstream of inflammation, and ability to sense metabolic environments. In standard physiologic conditions, they play a role in maintaining the homeostasis of tissues and organs; however, there is evidence that they can contribute to some autoimmune diseases. Gaining a deeper understanding of the factors that transition MSCs from their physiological function to a pathological role in their native environment, and elucidating mechanisms that reduce their therapeutic relevance in regenerative medicine, is essential. We conducted a Systematic Review and Meta-Analysis of human MSCs in preclinical studies of autoimmune disease, evaluating 60 studies that included 845 patient samples and 571 control samples. MSCs from any tissue source were included, and the study was limited to four autoimmune diseases: multiple sclerosis, rheumatoid arthritis, systemic sclerosis, and lupus. We developed a novel Risk of Bias tool to determine study quality for in vitro studies. Using the International Society for Cell & Gene Therapy's criteria to define an MSC, most studies reported no difference in morphology, adhesion, cell surface markers, or differentiation into bone, fat, or cartilage when comparing control and autoimmune MSCs. However, there were reported differences in proliferation. Additionally, 308 biomolecules were differentially expressed, and the abilities to migrate, invade, and form capillaries were decreased. The findings from this study could help to explain the pathogenic mechanisms of autoimmune disease and potentially lead to improved MSC-based therapeutic applications.
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Affiliation(s)
- Hailey N Swain
- Department of Biological Sciences, Missouri University of Science and Technology, USA
| | - Parker D Boyce
- Department of Biological Sciences, Missouri University of Science and Technology, USA
| | - Bradley A Bromet
- Department of Biological Sciences, Missouri University of Science and Technology, USA
| | - Kaiden Barozinksy
- Department of Biological Sciences, Missouri University of Science and Technology, USA
| | - Lacy Hance
- Department of Biological Sciences, Missouri University of Science and Technology, USA
| | - Dakota Shields
- Department of Mathematics and Statistics, Missouri University of Science and Technology, USA
| | - Gayla R Olbricht
- Department of Mathematics and Statistics, Missouri University of Science and Technology, USA
| | - Julie A Semon
- Department of Biological Sciences, Missouri University of Science and Technology, USA.
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Doskaliuk B, Kreminska I, Fedorchenko Y, Zaiats L, Yatsyshyn R. Systemic sclerosis associated respiratory involvement: Scopus-based analysis of articles in 2013-2022. Rheumatol Int 2024; 44:693-702. [PMID: 38319374 DOI: 10.1007/s00296-024-05535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Systemic sclerosis (SSc), a complex autoimmune disorder, manifests as a convergence of rheumatologic, dermatologic, and pulmonary challenges. Among the severe complications contributing to morbidity and mortality are SSc Associated Interstitial Lung Disease (SSc-ILD) and pulmonary hypertension. Over the past decade, research on pulmonary involvement in SSc has intensified, leading to a heightened understanding of its pathogenesis, diagnostic methods, and therapeutic strategies. AIM This study aims to provide a data-driven overview of the current state of systemic sclerosis research, identifying emerging trends and fostering informed decisions regarding resource allocation and research priorities. METHODS A literature search was conducted in the Scopus database, using MESH keywords such as "systemic sclerosis" AND "lungs" OR "pulmonary hypertension" OR "interstitial lung disease". After applying exclusion criteria, a thorough analysis was performed, considering factors such as document category, authorship, journal source, citation frequency, country of publication, language, and keywords. The bibliometric analysis utilized Scopus as the preferred database, leveraging its extensive coverage, user-friendly interface, and commitment to data accuracy. Visual networks were constructed using VOSviewer software to map the relationships between keywords, countries, and authors. Altmetric Attention Scores (AAS) were employed to assess the social impact of articles. RESULTS The analysis revealed a total of 2538 scholarly items, with 55.7% identified as open access. The USA (n = 532), Italy (n = 458), France (n = 304), Japan (n = 271), and the UK (n = 236) emerged as primary contributors, with English being the predominant language. A notable upward tendency in annual publication and citation scores indicated sustained interest and relevance in SSc-ILD research. The top journals, including Rheumatology United Kingdom, Clinical and Experimental Rheumatology, Clinical Rheumatology, Arthritis and Rheumatology, and Journal of Rheumatology, played a pivotal role in scholarly output. Original Articles (n = 1795; 70.7%) constituted the majority of publications, followed by Reviews, Letters, Notes, and Editorials. The analysis of publication impact within different scholarly formats revealed varying citation patterns, with Original Articles and Reviews leading in influence. The identification of influential research hubs and key contributors provided insights into collaborative efforts and geographic distribution. A strong correlation (rho = 0.612, p < 0.001) was observed between the quantity of Mendeley readers and the citations received by scholarly articles. CONCLUSION This bibliometric analysis offers a comprehensive overview of SSc-ILD research, highlighting its dynamic and interdisciplinary nature. The surge in publications, citation scores, and the identification of key contributors underscore the continued relevance and impact of this field. The nuanced relationships between social attention and scientific recognition, as revealed by Mendeley readership and AAS, contribute to a deeper understanding of the multifaceted nature of scholarly impact.
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Affiliation(s)
- Bohdana Doskaliuk
- Department of Patophysiology, Ivano-Frankivsk National Medical University, Halytska Str. 2, Ivano-Frankivsk, 76000, Ukraine.
| | - Iryna Kreminska
- Department of Patophysiology, Ivano-Frankivsk National Medical University, Halytska Str. 2, Ivano-Frankivsk, 76000, Ukraine
| | - Yulia Fedorchenko
- Department of Patophysiology, Ivano-Frankivsk National Medical University, Halytska Str. 2, Ivano-Frankivsk, 76000, Ukraine
| | - Liubomyr Zaiats
- Department of Patophysiology, Ivano-Frankivsk National Medical University, Halytska Str. 2, Ivano-Frankivsk, 76000, Ukraine
| | - Roman Yatsyshyn
- Academician Ye. M. Neiko Department of Internal Medicine #1, Clinical immunology and allergology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
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Prajjwal P, Marsool MDM, Yadav V, Kanagala RSD, Reddy YB, John J, Lam JR, Karra N, Amiri B, Islam MU, Nithya V, Marsool ADM, Gadam S, Vora N, Hussin OA. Neurological, cardiac, musculoskeletal, and renal manifestations of scleroderma along with insights into its genetics, pathophysiology, diagnostic, and therapeutic updates. Health Sci Rep 2024; 7:e2072. [PMID: 38660003 PMCID: PMC11040569 DOI: 10.1002/hsr2.2072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Background Scleroderma, also referred to as systemic sclerosis, is a multifaceted autoimmune condition characterized by abnormal fibrosis and impaired vascular function. Pathologically, it encompasses the persistent presence of inflammation, abnormal collagen buildup, and restructuring of blood vessels in various organs, resulting in a wide range of clinical symptoms. This review incorporates the most recent scientific literature on scleroderma, with a particular emphasis on its pathophysiology, clinical manifestations, diagnostic approaches, and treatment options. Methodology A comprehensive investigation was carried out on numerous databases, such as PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar, to collect pertinent studies covering diverse facets of scleroderma research. Results Scleroderma presents with a range of systemic manifestations, such as interstitial lung disease, gastrointestinal dysmotility, Raynaud's phenomenon, pulmonary arterial hypertension, renal complications, neurological symptoms, and cardiac abnormalities. Serological markers, such as antinuclear antibodies, anti-centromere antibodies, and anti-topoisomerase antibodies, are important for classifying diseases and predicting their outcomes. Discussion The precise identification of scleroderma is crucial for promptly and correctly implementing effective treatment plans. Treatment approaches aim to improve symptoms, reduce complications, and slow down the progression of the disease. An integrated approach that combines pharmacological agents, including immunosuppressants, endothelin receptor antagonists, and prostanoids, with nonpharmacological interventions such as physical and occupational therapy is essential for maximizing patient care. Conclusion Through the clarification of existing gaps in knowledge and identification of emerging trends, our goal is to improve the accuracy of diagnosis, enhance the effectiveness of therapeutic interventions, and ultimately enhance the overall quality of life for individuals suffering from scleroderma. Ongoing cooperation and creative research are necessary to advance the field and achieve improved patient outcomes and new therapeutic discoveries.
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Affiliation(s)
| | | | - Vikas Yadav
- Department of Internal MedicinePt. B. D. S. Postgraduate Institute of Medical SciencesRohtakIndia
| | | | | | - Jobby John
- Department of Internal MedicineDr. Somervell Memorial CSI Medical College and HospitalNeyyāttinkaraIndia
| | - Justin Riley Lam
- Department of Internal MedicineCebu Institute of MedicineCebuPhilippines
| | - Nanditha Karra
- Department of Internal MedicineOsmania Medical CollegeHyderabadTelanganaIndia
| | - Bita Amiri
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Moiz Ul Islam
- Department of Internal MedicinePunjab Medical CollegeFaisalabadPakistan
| | - Venkatesh Nithya
- Department of Internal MedicineS. D. Asfendiyarov Kazakh National Medical UniversityAlmatyKazakhstan
| | | | | | | | - Omniat Amir Hussin
- Department of MedicineAlmanhal University Academy of ScienceKhartoumSudan
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Martínez-Díaz G, Cruz-Domínguez MP, López Zamora B, Ramirez-Facio J, Medina G, Munguía-Cruz RX, Saavedra-Salinas MA, Arrucha-Cozaya M, Vera-Lastra OL, Peralta-Amaro AL, Florez-Durante ÓI, Gil-Galindo KA. Influence of visceral adiposity on cardiovascular risk in patients with systemic sclerosis. Rheumatol Int 2024; 44:621-630. [PMID: 37684492 DOI: 10.1007/s00296-023-05421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023]
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterized by systemic inflammation, endothelial dysfunction, generalized fibrosis and high cardiovascular mortality. The evaluation of cardiovascular risk through the visceral adiposity index (VAI) has been helpful due to its direct relationship to the body and visceral fat percentage. We evaluated the influence of body composition and anthropometrics on cardiovascular risk as measured by VAI in healthy controls (HC) and SSc. An analytical cross-sectional study of 66 participants (33 SSc and 33 HC), mean age 52.7 ± 10, 95% women, was conducted from August 2020 to January 2021. Inclusion criteria in cases were consecutive patients with SSc (ACR/EULAR 2013), 63.6% were diffuse cutaneous (dcSS) subtype, and 36.4 were limited cutaneous (lcSS) subtype. HC was matched by age and gender. Serum lipid profiles and InBody anthropometrics were analyzed and compared. We performed descriptive statistics, bivariate analysis with Student's t, or Mann-Whitney U, correlation and chi-square according to the variable type and distribution. Total cholesterol was significantly higher in SSc than HC (345 vs 194, p = < 0.001). The BMI was higher in HC (26.2 vs 28.9, p < 0.001). Kilograms of muscle (19.8 vs 28.9, p < 0.001) and total fat (23.4 vs 28.9, p < 0.001) were lower in SSc patients compared to HC. VAI was similar when BMI < 25, but significantly higher when BMI > 25 in SSc than in HC (3 vs 1.9, p = 0.030). The increase in BMI at overweight or obese in SSc is associated with a significant increase in cardiovascular risk.
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Affiliation(s)
- Gabriela Martínez-Díaz
- Faculty of Medicine, Benemérita Universidad Autónoma de Puebla, Campus Puebla, Puebla, Puebla, Mexico
| | - María Pilar Cruz-Domínguez
- Direction of Education and Research, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico.
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Berenice López Zamora
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
- Postgraduate studies section and research, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Jordan Ramirez-Facio
- Internal Medicine Resident, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
| | - Gabriela Medina
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS; Universidad Nacional Autónoma de México, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Miguel Angel Saavedra-Salinas
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Michelle Arrucha-Cozaya
- Faculty of Medicine, Benemérita Universidad Autónoma de Puebla, Campus Puebla, Puebla, Puebla, Mexico
| | - Olga Lidia Vera-Lastra
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Internal Medicine Department, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
| | - Ana Lilia Peralta-Amaro
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Internal Medicine Department, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
| | - Óscar Iván Florez-Durante
- Laboratory Department, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Mexico City, Mexico
| | - Kybaná Aurora Gil-Galindo
- Postgraduate studies section and research, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
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Kasprzak-Drozd K, Niziński P, Hawrył A, Gancarz M, Hawrył D, Oliwa W, Pałka M, Markowska J, Oniszczuk A. Potential of Curcumin in the Management of Skin Diseases. Int J Mol Sci 2024; 25:3617. [PMID: 38612433 PMCID: PMC11012053 DOI: 10.3390/ijms25073617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Curcumin is a polyphenolic molecule derived from the rhizoma of Curcuma longa L. This compound has been used for centuries due to its anti-inflammatory, antioxidant, and antimicrobial properties. These make it ideal for preventing and treating skin inflammation, premature skin ageing, psoriasis, and acne. Additionally, it exhibits antiviral, antimutagenic, and antifungal effects. Curcumin provides protection against skin damage caused by prolonged exposure to UVB radiation. It reduces wound healing times and improves collagen deposition. Moreover, it increases fibroblast and vascular density in wounds. This review summarizes the available information on the therapeutic effect of curcumin in treating skin diseases. The results suggest that curcumin may be an inexpensive, well-tolerated, and effective agent for treating skin diseases. However, larger clinical trials are needed to confirm these observations due to limitations in its in vivo use, such as low bioavailability after oral administration and metabolism.
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Affiliation(s)
- Kamila Kasprzak-Drozd
- Department of Inorganic Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland; (K.K.-D.); (A.H.)
| | - Przemysław Niziński
- Department of Pharmacology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland;
| | - Anna Hawrył
- Department of Inorganic Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland; (K.K.-D.); (A.H.)
| | - Marek Gancarz
- Institute of Agrophysics, Polish Academy of Sciences, Doświadczalna 4, 20-290 Lublin, Poland;
- Faculty of Production and Power Engineering, University of Agriculture in Krakow, Balicka 116B, 30-149 Krakow, Poland
| | | | - Weronika Oliwa
- Science Circle of the Department of Inorganic Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland; (W.O.); (M.P.); (J.M.)
| | - Magdalena Pałka
- Science Circle of the Department of Inorganic Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland; (W.O.); (M.P.); (J.M.)
| | - Julia Markowska
- Science Circle of the Department of Inorganic Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland; (W.O.); (M.P.); (J.M.)
| | - Anna Oniszczuk
- Department of Inorganic Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland; (K.K.-D.); (A.H.)
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Che Rahim MJ, Lim JA, Wan Ghazali WS. Raynaud's phenomenon associated with psoriatic arthritis. BMJ Case Rep 2024; 17:e258215. [PMID: 38442964 PMCID: PMC10916094 DOI: 10.1136/bcr-2023-258215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
We report a case of Raynaud's phenomenon in a patient with psoriatic arthritis (PsA). A middle-aged right-handed housewife presented with complaints of severely painful hand discolouration for 1 week, which usually worsened with cold exposure. She was diagnosed with PsA 6 months earlier. Her PsA was well controlled with weekly methotrexate. Physical examination showed no features of scleroderma or skin necrosis of her right hand. Both radial pulses were strong and symmetrical. Her nailfolds were visibly normal. The extractable nuclear antigen panel and other blood investigations were negative for scleroderma and other possible causes of secondary Raynaud's phenomenon. Occupational or environmental factors were also excluded. Dermatoscope examination of the nailfolds revealed some areas of dilated capillary loops, areas of vascular sparing and proximal nail fold telangiectasia. The diagnosis of secondary Raynaud's phenomenon was made, and an oral calcium channel blocker was started. The patient had significant improvement in symptoms shortly afterwards.
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Affiliation(s)
- Mohd Jazman Che Rahim
- Internal Medicine, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
- Universiti Sains Malaysia - Kampus Kesihatan, Kota Bharu, Kelantan, Malaysia
| | - Jo Anne Lim
- Internal Medicine, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
- Universiti Sains Malaysia - Kampus Kesihatan, Kota Bharu, Kelantan, Malaysia
| | - Wan Syamimee Wan Ghazali
- Internal Medicine, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
- Universiti Sains Malaysia - Kampus Kesihatan, Kota Bharu, Kelantan, Malaysia
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11
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Quteineh M, Obeid SN, Al-Shami K, Hanifa H. Vesicovaginal and vesicorectal fistula in a patient with systemic sclerosis: A case report. Clin Case Rep 2024; 12:e8550. [PMID: 38389964 PMCID: PMC10883344 DOI: 10.1002/ccr3.8550] [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: 10/30/2023] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Key Clinical Message This case highlights the need for further research to explore a potential link between systemic sclerosis and fistula development, and the importance of raising awareness among clinicians about this possibility for timely appropriate management. Abstract The primary diagnosis in this case is systemic sclerosis (scleroderma) in a 47-year-old female patient with various clinical manifestations, including vesicovaginal and vesicorectal fistulas. The medical interventions and diagnostic workup involved an electrocardiogram, cardiac echocardiogram, pulmonary function tests, beta blockers, aspirin, inhaled corticosteroids, albuterol, endoscopy, biopsy, treatment for Helicobacter pylori infection, fluconazole for candida esophagitis, endoscopic dilation for achalasia, anticholinergic therapy for mixed urinary incontinence, gabapentin for neuropathic symptoms, analgesia for knee pain, and psychiatric treatment with selective serotonin reuptake inhibitors. The outcomes described in the case report include the diagnosis of systemic sclerosis, the identification of vesicovaginal and vesicorectal fistulas, the patient's medical history and symptoms over the years, and various treatments and management strategies.
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Affiliation(s)
- Mohammad Quteineh
- Department of Clinical Medical Sciences, Faculty of Medicine Yarmouk University Irbid Jordan
| | - Sajedah N Obeid
- Department of Clinical Medical Sciences, Faculty of Medicine Yarmouk University Irbid Jordan
| | - Khayry Al-Shami
- Department of Clinical Medical Sciences, Faculty of Medicine Yarmouk University Irbid Jordan
| | - Hamdah Hanifa
- Faculty of Medicine University of Kalamoon Al-Nabk Syria
- Al-Dandashi National Group Yaafour Damascus Syria
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12
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Radić M, Kolak E, Đogaš H, Gelemanović A, Bučan Nenadić D, Vučković M, Radić J. Body composition parameters in systemic sclerosis-a systematic review and meta-analysis. Rheumatology (Oxford) 2024; 63:16-25. [PMID: 37647631 DOI: 10.1093/rheumatology/kead418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to summarize current evidence regarding body composition (BC) in SSc in order to gain new insights and improve clinical care in the context of the nutritional status of SSc patients. METHODS The databases Web of Science, PubMed, Scopus and Cochrane Library were searched on 4 January 2023. Studies were included if they provided data regarding BC obtained by dual-energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) in patients with SSc and healthy controls (HC). The study design criteria for inclusion were cohort and observational studies. The risk of bias assessment was performed using the Newcastle-Ottawa scale. For meta-analysis, mean difference with a 95% confidence interval was obtained and all results were depicted as forest plots. RESULTS The number of retrieved publications was 593, of which nine were included in a random-effects meta-analysis totalling 489 SSc patients and 404 HC. Overall, significantly lower body mass index, lean mass (LM), fat mass (FM) and phase angle values were found in SSc patients when compared with HC. Furthermore, FM and LM were significantly lower in SSc patients when the DXA method was applied, whereas the same parameters were comparable between two groups of participants when BIA was applied. CONCLUSION Altered BC is characteristic of SSc patients indicating the need for regular nutritional status assessment in order to improve the quality of life and clinical care of patients with SSc.
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Affiliation(s)
- Mislav Radić
- Internal Medicine Department, Rheumatology, Allergology and Clinical Immunology Division, University Hospital of Split, Split, Croatia
- Department of Internal Medicine, University of Split, Split, Croatia
| | - Ela Kolak
- Nutrition and Dietetics Department, University Hospital of Split, Split, Croatia
| | - Hana Đogaš
- Internal Medicine Department, Nephrology and Hemodialysis Division, University Hospital of Split, Split, Croatia
| | | | - Dora Bučan Nenadić
- Nutrition and Dietetics Department, University Hospital of Split, Split, Croatia
| | - Marijana Vučković
- Internal Medicine Department, Nephrology and Hemodialysis Division, University Hospital of Split, Split, Croatia
| | - Josipa Radić
- Department of Internal Medicine, University of Split, Split, Croatia
- Internal Medicine Department, Nephrology and Hemodialysis Division, University Hospital of Split, Split, Croatia
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Ebrahimi A, Panahi P, Tekantapeh ST. Concomitant uterus agenesia and Marfan syndrome with systemic sclerosis: A rare case report. Clin Case Rep 2024; 12:e8408. [PMID: 38173886 PMCID: PMC10762330 DOI: 10.1002/ccr3.8408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
It seems that the association of two connective tissue disorders, including Marfan syndrome and systemic sclerosis, the first is associated with the loosening of the subcutaneous tissue and the second with its tightening, is a very interesting and controversial paradox at the same time and need finding possible genetic etiologies.
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Affiliation(s)
- Aliasghar Ebrahimi
- Connective Tissue Diseases Research CenterTabriz University of Medical Sciences, Imam Reza HospitalTabrizIran
| | - Padideh Panahi
- Student Research CommitteeTabriz University of Medical ScienceTabrizIran
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14
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Sehgal S, Agrawal S, Khedkar C. Spared Supravenous Pigmentation in a Patient of Systemic Sclerosis: A Sign of Progressive Disease with Systemic Involvement. Indian Dermatol Online J 2024; 15:153-155. [PMID: 38282992 PMCID: PMC10810410 DOI: 10.4103/idoj.idoj_103_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Sumit Sehgal
- Department of Dermatology, Ananta Institute of Medical Sciences and Research Center, Udaipur, Rajasthan, India
| | - Srishti Agrawal
- Department of Dermatology, Pacific Medical College, Udaipur, Rajasthan, India
| | - Chaitali Khedkar
- Department of Dermatology, Ananta Institute of Medical Sciences and Research Center, Udaipur, Rajasthan, India
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15
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Shir-az O, Berl A, Mann D, Bilal BS, Levy Y, Shalom A. Treatment of Scleroderma-Related Microstomia Using Hyaluronic Acid: An Interventional Study. Life (Basel) 2023; 13:2176. [PMID: 38004316 PMCID: PMC10671914 DOI: 10.3390/life13112176] [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: 10/06/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Systemic sclerosis (SSc) or scleroderma is a rare, systemic, autoimmune connective tissue disease. It causes increased collagen synthesis, leading to multi-organ sclerosis, including the skin and joints. Patients' overall health and quality of life are harmed dramatically. Involvement of the face and, especially, the oral opening can limit patients' ability to speak and eat, oral hygiene, and cosmetic appearance. Profhilo® (NAHYCO®) is an over-the-counter product consisting of pure hyaluronic acid. It is used to improve skin quality by increasing collagen production and adipocyte vitality. This interventional study evaluated the results of perioral injections of hyaluronic acid in terms of improved skin quality, elasticity, and increased oral opening. Patients diagnosed with SSc received an injection of one syringe of Profhilo® (2 mL of hyaluronic acid) at each of two clinic visits at one-month intervals. The oral opening was measured between the upper and lower central incisors before and after treatment. Quality of life was assessed using the modified Rodnan Skin Score and Health Assessment Questionnaire-Disability Index. A total of 14 patients received the first treatment, and 11 received the second treatment. The mean oral opening increased from 31.6 mm (range 17-50 mm) prior to therapy to 35.8 mm (range 21-56) 2 months following the second injection. Statistical analysis showed that there was a significant increase in the oral opening as observed one week (36.2 mm, p = 0.011), one month (36.2 mm, p = 0.007), and three months (31.6 mm, p = 0.023) after the second injection, at the 5-month follow-up. Treatment of SSc patients' perioral area with Profhilo® can result in significant improvements in oral opening and quality of life.
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Affiliation(s)
- Ofir Shir-az
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Ariel Berl
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Din Mann
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Biader Samih Bilal
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Yair Levy
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Avshalom Shalom
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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Khalayli N, Ibrahim R, Ibrahim R, Kudsi M. Antineutrophil cytoplasmic antibody-associated vasculitis with systemic sclerosis: a fatal case report. Ann Med Surg (Lond) 2023; 85:5770-5775. [PMID: 37915665 PMCID: PMC10617915 DOI: 10.1097/ms9.0000000000001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/16/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction and importance Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a rare co-occurrence with systemic sclerosis, in around 2.5-9% of patients. The clinical manifestations and prognosis of vasculitis in systemic sclerosis depend on organ involvement. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers get along with purpuric vasculitis in some cases reports. Reports had found that survival in those with pulmonary-renal syndrome is poor. However, high-dose corticosteroids and cyclophosphamide increase the survival percent in those patients. Case presentation An 81-year-old female was admitted for newly diagnosed acute renal failure and highly elevated C-reactive protein levels. She was diagnosed with systemic sclerosis 8 years previously, with a 3-year history of interstitial lung disease, and a 2-year history of pulmonary hypertension. Treatment included home oxygen on demand, prednisone 5 mg/day, and azathioprine 75 mg daily. On physical examination, she had sclerodactyly, both extremities ulcers, severe livedo reticularis, and hyperpigmented papules on her hand and feet. Laboratory findings included a markedly positive MPO (p-ANCA), and anti-Scl-70. She was treated with pulse methylprednisolone without any improvement. After a day, she developed anuria and became comatose. Then, she developed cardiac arrest, leading to death. Clinical discussion The presence of ANCA in systemic sclerosis patients ranges from 2.5 to 9% of systemic sclerosis patients. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers. The treatment with high-dose corticosteroids and cyclophosphamide is benefit. Survival in those with pulmonary-renal syndrome is poor. Conclusion The presence of ANCA-associated vasculitis is rarely reported with scleroderma. It occurs most commonly in women with limited or Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) variants of scleroderma, as well as those with overlap features. Severe manifestations including pulmonary-renal syndrome and death may occur.
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17
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Samm DAA, Macoustra AR, Crane RK, McWilliams LM, Proudman SM, Chapple LAS. A survey of Australian rheumatologists' perspectives of nutrition needs in systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:203-209. [PMID: 37744049 PMCID: PMC10515988 DOI: 10.1177/23971983231185465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/09/2023] [Indexed: 09/26/2023]
Abstract
Aim Systemic sclerosis (scleroderma) is an incurable inflammatory condition synonymous with unique nutrition needs. As rheumatologists are frequently responsible for managing the various organ manifestations, this study aimed to understand the service needs and nutritional concerns of rheumatologists involved in the care of adults with systemic sclerosis. Methods A 13-item online qualitative and quantitative survey was distributed via REDCap® from January to March 2022 to rheumatologists who are members of the Australian Scleroderma Interest Group and consult patients with systemic sclerosis. Data were collected on rheumatologists' demographics, and their views on symptoms observed, nutrition concerns and priorities, and preferred dietetic service provision for their patients. Data are reported as number (%). Results Of 27 eligible rheumatologists, 17 (63%) completed the survey. All rheumatologists reported gastrointestinal symptoms in their patients (n = 17, 100%); predominantly reflux (n = 17, 100%) and dysphagia (n = 17, 100%). Weight loss was observed by the majority of rheumatologists (n = 15, 88%). Rheumatologists reported patients used food avoidance/special diets to manage symptoms (n = 12, 71%). Dietetic consultation was reported as potentially beneficial by all rheumatologists, with the preferred time being when symptoms increase or change (n = 15, 88%), and the preferred approaches being written resources (n = 15, 88%), face-to-face (n = 14, 82%) and telephone consultation (n = 14, 82%). Advice on gaining weight (n = 14, 82%) and systemic sclerosis symptom management (n = 13, 77%) were the most desired education topics reported. Conclusion Rheumatologists commonly observe gastrointestinal symptoms in patients with systemic sclerosis and report dietetics services would be advantageous in supporting their patients to gain weight and better manage their symptoms.
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Affiliation(s)
- De-arne A Samm
- Department of Nutrition and Dietetics, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Aimee R Macoustra
- Department of Nutrition and Dietetics, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Rhiannon K Crane
- Department of Nutrition and Dietetics, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Susanna M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Lee-anne S Chapple
- Department of Nutrition and Dietetics, Royal Adelaide Hospital, Adelaide, SA, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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18
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Williams KA, Wondimu B, Ajayi AM, Sokumbi O. Skin of color in dermatopathology: does color matter? Hum Pathol 2023; 140:240-266. [PMID: 37146946 DOI: 10.1016/j.humpath.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
Skin of color (SoC) remains an understudied and under taught area of dermatology despite its rising importance. Race and ethnicity play a particularly important role in dermatology as skin pigmentation can affect the manifestation and presentation of many common dermatoses. With this review, we seek to review pertinent differences in SoC histology, as well as highlight the histopathology of conditions more common in SoC and address inherent bias that may affect accurate dermatopathology sign out.
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Affiliation(s)
- Kyle A Williams
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Bitania Wondimu
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA, 98195, USA
| | - Ayodeji M Ajayi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, 32224, USA; Department of Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL, 32224, USA.
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Khanna D, Krieger N, Sullivan KM. Improving outcomes in scleroderma: recent progress of cell-based therapies. Rheumatology (Oxford) 2023; 62:2060-2069. [PMID: 36355455 PMCID: PMC10234204 DOI: 10.1093/rheumatology/keac628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/23/2022] [Indexed: 08/27/2023] Open
Abstract
Scleroderma is a rare, potentially fatal, clinically heterogeneous, systemic autoimmune connective tissue disorder that is characterized by progressive fibrosis of the skin and visceral organs, vasculopathy and immune dysregulation. The more severe form of the disease, diffuse cutaneous scleroderma (dcSSc), has no cure and limited treatment options. Haematopoietic stem cell transplantation has emerged as a potentially disease-modifying treatment but faces challenges such as toxicity associated with fully myeloablative conditioning and recurrence of autoimmunity. Novel cell therapies-such as mesenchymal stem cells, chimeric antigen receptor-based therapy, tolerogenic dendritic cells and facilitating cells-that may restore self-tolerance with more favourable safety and tolerability profiles are being explored for the treatment of dcSSc and other autoimmune diseases. This narrative review examines these evolving cell therapies.
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Affiliation(s)
- Dinesh Khanna
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nancy Krieger
- Talaris Therapeutics, Boston, MA and Louisville, KY, USA
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Elmatary A, Longridge N, Jarad F. IS EXTERNAL CERVICAL RESORPTION AN ESTABLISHED MANIFESTATION OF SYSTEMIC SCLEROSIS? A CASE REPORT. J Endod 2023:S0099-2399(23)00278-9. [PMID: 37211310 DOI: 10.1016/j.joen.2023.05.008] [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: 03/24/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
AIM Scleroderma, or systemic sclerosis, is a multisystem autoimmune disorder characterized by hardening and fibrosis of the skin. To date, only a small number of case reports have established a relationship between scleroderma and external cervical resorption (ECR). The aim of this case report is to document the case of a patient with multiple external cervical resorption lesions, who was referred to our unit. SUMMARY A 54-year-old female patient, with a 10-year history of systemic sclerosis diagnosed by her rheumatologist, was referred to our unit regarding extensive ECR. A total of 14 maxillary and mandibular teeth with ECR were detected by clinical examination and cone-beam computed tomography (CBCT). The characteristic vascularity of resorptive defects with profuse bleeding upon probing was not evident. The patient declined any active treatment owing to the desire to avoid lengthy and unpredictable treatment, which may hasten the loss of her teeth. CONCLUSIONS General practitioners should be aware of the relationship between connective tissue disorders and ECR. Although not well established in the literature, the vascular changes implicated in scleroderma may stimulate the odontoclastic processes involved in ECR.
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Affiliation(s)
- Ahmed Elmatary
- Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS.
| | - Nicholas Longridge
- Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS
| | - Fadi Jarad
- Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS
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Navas-Otero A, Gómez-De-Castro S, Ortiz-Rubio A, Heredia-Ciuró A, Martín-Núñez J, Calvache-Mateo A, Valenza MC. Effects of non-pharmacological therapies on hand function and the ability to perform daily activities in people with systemic sclerosis: A systematic review and meta-analysis of randomized control trials. Int J Rheum Dis 2023. [PMID: 37137818 DOI: 10.1111/1756-185x.14721] [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: 10/20/2022] [Revised: 03/03/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is an autoimmune rheumatic disease. Individuals with a diagnosis of SSc describe repercussions on their activities of daily living and instrumental activities of daily living that affect their everyday functional capacity. The objective of this systematic review was to explore the effectiveness of non-pharmacological interventions to improve hand function and the ability to perform activities of daily living. METHODS A systematic review was conducted on the Cochrane Library, Medline/PubMed, OTseeker, PEDro, Scopus, Web of Science up to September 10, 2022. Inclusion criteria were defined following PICOS recommendations (Populations, Intervention, Comparison and Outcome measures). Methodological quality was assessed with the Downs and Black Scale and risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). A meta-analysis of each outcome was performed. RESULTS A total of 8 studies met the inclusion criteria, providing data on 487 individuals with SSc. The non-pharmacological intervention applied the most was exercise. The effects of non-pharmacological interventions were better than those of the waiting list or no treatment control conditions in both outcomes - hand function (mean difference [MD] = -6.98; 95% CI [-11.45, - 2.50], P = 0.002, I2 = 0%) and performance of daily activities (MD = -0.19; 95% CI [-0.33, - 0.04], P = 0.01, I2 = 0%). Moderate risk of bias was found in the majority of the studies included. CONCLUSION There is emerging evidence that non-pharmacological interventions can improve hand function and performance of daily activities in individuals with a diagnosis of SSc. Given the moderate risk of bias found in the studies included, the results should be considered with caution.
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Affiliation(s)
- Alba Navas-Otero
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Sheila Gómez-De-Castro
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Javier Martín-Núñez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Andrés Calvache-Mateo
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Doskaliuk B, Zaiats L. Structural and functional characteristics of the pulmonary hemomicrocirculatory bed in induced systemic sclerosis: an experimental study. Rheumatol Int 2023; 43:1341-1347. [PMID: 37071178 DOI: 10.1007/s00296-023-05328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023]
Abstract
The objective of this study was to investigate the effects of prolonged exposure to the oxidative agent NaClO on histopathological changes in the lung tissues of laboratory animals. Specifically, the study aimed to examine morphological changes in the pulmonary microcirculation and the level of vascular cell adhesion molecule-1 (VCAM-1) as a functional activity indicator of endothelial cells in animals with induced systemic sclerosis (SSc). A laboratory animal model was used to assess the impact of long-term exposure to NaClO on lung tissues. The animals were divided into three groups: the experimental group (25 rats) was exposed to NaClO, while the control group (20 rats) received an isotonic solution, and the intact group (15 animals) was without any exposure. The concentration of VCAM-1 in the serum of the animals was measured using an enzyme-linked immunosorbent assay. Histopathological analysis of lung tissue specimens was performed using both light and electron microscopy. The concentration of VCAM-1 in the serum of the animals in the experimental group was significantly higher than that of the control group (91.25 [85.63-143.75] vs 19.50 [13.53-22.20], p < 0.05). The histopathological analysis revealed significant abnormalities in the lung tissue specimens from the experimental group, including disruption in the structure of the hemocapillaries of the lungs, narrowing of the microvessel lumen, and perivascular infiltration by polymorphonuclear cells. The electron microscopic analysis showed several ultrastructural changes in the endotheliocytes of the hemocapillaries, including uneven expansion of the perinuclear space, swollen mitochondria, and fragmentation of the membranes of the granular endoplasmic reticulum. Additionally, the basement membrane of hemocapillaries showed uneven thickening with indistinct contours, and the peripheral parts of endotheliocytes were marked by numerous micropinocytotic vesicles and vacuoles. Erythrocyte aggregates and leukocyte adhesion were identified in the lumen of many hemocapillaries, while adhesion and aggregation of platelets were also observed in several hemocapillaries. Long-term exposure to NaClO can cause significant histopathological changes in lung tissues, including damage to the hemocapillaries and disruption in the structure of endotheliocytes.
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Affiliation(s)
- Bohdana Doskaliuk
- Department of Patophysiology, Ivano-Frankivsk National Medical University, Halytska str. 2, Ivano-Frankivsk, 76000, Ukraine.
| | - Liubomyr Zaiats
- Department of Patophysiology, Ivano-Frankivsk National Medical University, Halytska str. 2, Ivano-Frankivsk, 76000, Ukraine
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Bagang N, Gupta K, Singh G, Kanuri SH, Mehan S. Protease-activated receptors in kidney diseases: A comprehensive review of pathological roles, therapeutic outcomes and challenges. Chem Biol Interact 2023; 377:110470. [PMID: 37011708 DOI: 10.1016/j.cbi.2023.110470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023]
Abstract
Studies have demonstrated that protease-activated receptors (PARs) with four subtypes (PAR1-4) are mainly expressed in the renal epithelial, endothelial, and podocyte cells. Some endogenous and urinary proteases, namely thrombin, trypsin, urokinase, and kallikrein released during diseased conditions, are responsible for activating different subtypes of PARs. Each PAR receptor subtype is involved in kidney disease of distinct aetiology. PAR1 and PAR2 have shown differential therapeutic outcomes in rodent models of type-1 and type-2 diabetic kidney diseases due to the distinct etiological basis of each disease type, however such findings need to be confirmed in other diabetic renal injury models. PAR1 and PAR2 blockers have been observed to abolish drug-induced nephrotoxicity in rodents by suppressing tubular inflammation and fibrosis and preventing mitochondrial dysfunction. Notably, PAR2 inhibition improved autophagy and prevented fibrosis, inflammation, and remodeling in the urethral obstruction model. Only the PAR1/4 subtypes have emerged as a therapeutic target for treating experimentally induced nephrotic syndrome, where their respective antibodies attenuated the podocyte apoptosis induced upon thrombin activation. Strikingly PAR2 and PAR4 subtypes involvement has been tested in sepsis-induced acute kidney injury (AKI) and renal ischemia-reperfusion injury models. Thus, more studies are required to delineate the role of other subtypes in the sepsis-AKI model. Evidence suggests that PARs regulate oxidative, inflammatory stress, immune cell activation, fibrosis, autophagic flux, and apoptosis during kidney diseases.
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Mosaddad SA, Abdollahi Namanloo R, Ghodsi R, Salimi Y, Taghva M, Naeimi Darestani M. Oral rehabilitation with dental implants in patients with systemic sclerosis: A systematic review. Immun Inflamm Dis 2023; 11:e812. [PMID: 36988245 PMCID: PMC10022424 DOI: 10.1002/iid3.812] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
Objective To assess the influence of systemic sclerosis (SSc) on the survival rate of dental implants in SSc patients receiving implant‐supported treatments. Methods The Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) Statement and the Cochrane Collaboration's guiding principles were followed during the study's execution. The data from three databases, PubMed, Google Scholar, and Scopus, available until January 2023, were used to compile the material for our research. Only English‐language publications were submitted for this research and evaluated based on their titles, abstracts, and full texts. For performing a quality assessment, quality scores were calculated. Results The total number of patients and implants studied were 37 and 153, respectively, all having had scleroderma. The patients’ ages ranged from 28 to 77 years old, with a mean (SD) age of 58.16 (12.88). All the patients in the case reports and most in the case series study were female. The range of follow‐up duration was from 1 to 10 years. In case report studies, the survival rate was 100%; in case series, it was 89.2%. Conclusion The SSc status had no discernible impact on the implant survival rate. Implant‐based treatments in SSc patients should not worsen the overall morbidity and should not conflict with systemic treatments. Before starting implant therapy, a thorough risk assessment is essential, though.
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Affiliation(s)
- Seyed Ali Mosaddad
- Student Research Committee, School of DentistryShiraz University of Medical SciencesShirazIran
| | | | - Raziye Ghodsi
- Department of Periodontics, Dental SchoolShiraz University of Medical SciencesShirazIran
| | - Yasaman Salimi
- Student Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Masumeh Taghva
- Department of Prosthodontics, School of DentistryShiraz University of Medical SciencesShirazIran
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Macklin M, Yadav S, Jan R, Reid P. Checkpoint Inhibitor-Associated Scleroderma and Scleroderma Mimics. Pharmaceuticals (Basel) 2023; 16:259. [PMID: 37259404 PMCID: PMC9962184 DOI: 10.3390/ph16020259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 10/28/2023] Open
Abstract
Immune checkpoint inhibitors (ICI) are the standard of care for various malignancies and have been associated with a wide spectrum of complications that are phenotypically akin to primary autoimmune diseases. While the literature on these toxicities is growing, there is a paucity of data regarding ICI-associated scleroderma which can carry significant morbidity and limit the ability to continue effective ICI therapy. Our review aimed to analyze the current literature on ICI-associated systemic scleroderma (ICI-SSc) and key scleroderma mimics. Cases of ICI-SSc had notable differences from primary SSc, such as fewer vascular features and less seropositivity (such as scleroderma-specific antibodies and antinuclear antibodies). We found that patients with a diagnosis of SSc prior to the start of ICI can also experience flares of pre-existing disease after ICI treatment used for their cancer. Regarding scleroderma mimics, several cases of ICI-eosinophilic fasciitis have also been described with variable clinical presentations and courses. We found no cases of scleroderma mimics: ICI-scleromyxedema or ICI-scleroedema. There is a critical need for multi-institutional efforts to collaborate on developing a patient database and conducting robust, prospective research on ICI-scleroderma. This will ultimately facilitate more effective clinical evaluations and management for ICI-scleroderma.
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Affiliation(s)
- Michael Macklin
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Sudeep Yadav
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Reem Jan
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Pankti Reid
- Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago Medical Center, Chicago, IL 60637, USA
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Lagziel T, Kawaji Q, Hultman CS. Incisional Release and Fat Grafting for the Surgical Management of Perioral Fibrosis in Scleroderma: A Technical Report and Institutional Review. Ann Plast Surg 2023:00000637-990000000-00145. [PMID: 36943019 DOI: 10.1097/sap.0000000000003475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Scleroderma (systemic sclerosis [SSc]) is a rare autoimmune, connective tissue disorder. Perioral fibrosis is a local cutaneous complication, negatively impacting functional capabilities and aesthetic satisfaction. Fat grafting has been postulated to aid in the management of SSc fibrosis thanks to stem cell enrichment. This technique's success has been demonstrated using different graft origin sites and different injection targets. We aim to demonstrate our SSc patients' success using abdominal fat and perioral target. METHODS We queried our records for patients with preexisting SSc who underwent incisional release and fat grafting for perioral fibrosis from 2018 to 2021. For perioral release, a semisharp cannula was tunneled under the vermilion border into the vermilion and along the skin. For grafting, cannulas were used to infiltrate the fat with a retrograde filling technique in a radial-fanning manner. Their autoimmune diagnosis, anesthetic risk assessment, systemic disease complications, and degree of presenting symptoms were reviewed along with their postoperative outcomes. RESULTS From 2018 to 2021, 16 patients diagnosed with SSc were treated with incisional release and fat grafting for the management of perioral fibrosis. Of the SSc patients, 8 presented with limited SSc, and 8 presented with diffuse SSc. The mean patient age was 54.31 years. All SSc patients presented with functional symptoms with the most common concern (n = 9) being "decreased mouth opening." Other common complaints were "difficulty eating" (n = 3) or "difficulty drinking" (n = 2). Some patients (n = 11) also presented with cosmetic concerns with "perioral rhytids" being the most common (n = 6). The mean number of systemic complications, at the time of presentation, was 3.06. The mean anesthetic risk assessment was 2.44. The average amount of fat grafted intraoperatively was 14.89 mL. Two patients with SSc required regrafting. For one patient, this was part of the original treatment plan and for the other due to fat resorption. Patients who followed up reported improved functionality and were pleased aesthetically. CONCLUSIONS Patients with perioral fibrosis due to SSc can benefit from autologous fat grafting. Incisional release in combination with fat grafting can enhance procedure outcomes. This technique provides beneficial functional and aesthetic outcomes. Patients with both diffuse and limited disease are appropriate candidates for this procedure.
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Affiliation(s)
| | - Qingwen Kawaji
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Scott Hultman
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Bayati P, Poormoghim H, Mojtabavi N. Aberrant expression of miR-138 as a novel diagnostic biomarker in systemic sclerosis. Biomark Insights 2022; 17:11772719221135442. [PMID: 36518749 PMCID: PMC9742580 DOI: 10.1177/11772719221135442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/11/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND MicroRNAs are short nucleotide sequences that contribute to the regulation of various biological functions and therefore their roles have been investigated in many pathologic conditions such as epithelial to mesenchymal transition in cancer and fibrosis; among them, miR-138 has been mostly studied in cancer biology and is well-known for its suppressing effect on cancer progression. Being able to suppress major pathways involved in EMT, miR-138 could be a good candidate to be investigated in fibrotic responses too. Based on our previous studies, and the capability of miR-138 to target and regulate several components of the EMT pathway; we hypothesized a role for miR-138 in systemic sclerosis. Accordingly, the gene expression of miR-138 was assessed to find any alterations in the whole blood of the SSc patients. METHODS Blood was collected from 70 patients with systemic sclerosis (equally divided between 2 groups of limited and diffuse categories) and 30 healthy individuals as controls. RNA was immediately isolated from the fresh whole blood; afterward, the resulting RNA was reverse transcribed into cDNA and then the relative expression of miR-138 was compared between the patients and the controls by the means of qPCR, and specific TaqMan primer and probes. RESULTS The relative expression of miR-138 was significantly lower in patients with systemic sclerosis compared to the controls. No significant difference was observed between the limited and diffuse patient groups. ROC curve analysis showed an appropriate diagnostic value of miR-138 in effectively differentiating SSc patients from the healthy controls. CONCLUSION miR-138 is likely involved in the pathogenesis of SSc and with further evaluations may be utilized as a diagnostic biomarker in SSc. Also, targeting miR-138 in future studies could be promising for finding a novel treatment option for patients with SSc.
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Affiliation(s)
- Paria Bayati
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
- Department of Immunology Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Poormoghim
- Scleroderma study group Firuzgar Hospital Iran University of medical sciences, Tehran, Iran
| | - Nazanin Mojtabavi
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
- Department of Immunology Iran University of Medical Sciences, Tehran, Iran
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MiR-27a as a diagnostic biomarker and potential therapeutic target in systemic sclerosis. Sci Rep 2022; 12:18932. [PMID: 36344812 PMCID: PMC9640682 DOI: 10.1038/s41598-022-23723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Systemic sclerosis (SSc) or scleroderma is a multiorgan rheumatoid disease characterized by skin tightening or organ dysfunction due to fibrosis, vascular damage, and autoimmunity. No specific cause has been discovered for this illness, and hence no effective treatment exists for it. On the other hand, due to the lack of diagnostic biomarkers capable of effectively and specifically differentiating the patients, early diagnosis has not been possible. Due to their potent regulatory roles in molecular pathways, microRNAs are among the novel candidates for the diagnosis and treatment of diseases like SSc. MiR-27a is a microRNA known for its role in the pathogenesis of fibrosis and cancer, both of which employ similar signaling pathways; hence we hypothesized that Mir-27a could be dysregulated in the blood of individuals affected by SSc and it might be useful in the diagnosis or treatment of this disease. Blood was collected from 60 SSc patients (30 limited and 30 diffuse) diagnosed by a rheumatologist according to ACR/AULAR criteria; following RNA isolation and cDNA synthesis; real-time qPCR was performed on the samples using Taq-Man probes and data were analyzed by the ΔΔCT method. Also, potential targets of miR-27a were evaluated using bioinformatics. It was revealed that miR-27a was significantly down-regulated in SSc patients in comparison to healthy individuals, but there was no difference in miR-27 expression between limited and diffused SSc patients. Besides, miR-27a was found to target several contributing factors to SSc. It seems that miR-27a has a protective role in SSc, and its downregulation could result in the disease's onset. Based on bioinformatics analyses, it is speculated that miR-27a likely targets factors contributing to the pathogenesis of SSc, which are elevated upon the downregulation of miR-27a; hence, miR-27a mimics could be considered as potential therapeutic agents for the treatment of SSc in future studies. Since no difference was observed between limited and diffuse patient groups, it is unlikely that this microRNA has a role in disease progression. According to ROC analysis of qPCR data, miR-27a could be employed as a valuable diagnostic biomarker for SSc.
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Bălănescu A, Băicuș C, Bălănescu E, Bălănescu P. Circulatory cytokeratin 17, marginal zone B1 protein and leucine-rich α2-glycoprotein-1 as biomarkers for disease severity and fibrosis in systemic sclerosis patients. Biochem Med (Zagreb) 2022; 32:030707. [PMID: 36277429 PMCID: PMC9562799 DOI: 10.11613/bm.2022.030707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Systemic sclerosis (Ssc) is a multiorgan debilitating autoimmune disease that associates the triad: vascular involvement, tissue fibrosis and profound immune response alterations. Numerous previous studies focused on identification of candidate proteomic Ssc biomarkers using mass-spectrometry techniques and a large number of candidate Ssc biomarkers emerged. These biomarkers must firstly be confirmed in independent patient groups. The aim of the present study was to investigate the association of cytokeratin 17 (CK17), marginal zone B1 protein (MZB1) and leucine-rich α2-glycoprotein-1 (LRG1) with clinical and biological Ssc characteristics. Material and methods Serum CK17, MZB1 and LRG1 were assessed in samples of the available Ssc biobank comprising of samples from 53 Ssc patients and 26 matched age and gender controls. Results Circulatory CK17, LRG1 and MZB1 concentrations were increased in Ssc patients. Cytokeratin 17 is independently associated with Ssc disease activity. Patients with pulmonary fibrosis expressed higher LRG1 and MZB1 concentrations. Serum MZB1 concentrations were also associated with extensive skin fibrosis. Conclusions Serum CK17, MZB1 and LRG1 were confirmed biomarkers for Ssc. LRG1 seems a good biomarker for pulmonary fibrosis, while MZB1 is a good biomarker for extensive skin fibrosis. CK17 proved to be independently associated with Ssc disease severity, higher CK17 values being protective for a more active disease.
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Affiliation(s)
- Anca Bălănescu
- Pediatrics Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cristian Băicuș
- Internal Medicine Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Eugenia Bălănescu
- Clinical Immunology Laboratory CDPC, Colentina Clinical Hospital, Bucharest, Romania
| | - Paul Bălănescu
- Internal Medicine Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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Association between systemic sclerosis, palmar fasciitis with polyarthritis, Raynaud's phenomenon and erythromelalgia with underlying malignancy. Reumatologia 2022; 60:275-280. [PMID: 36186832 PMCID: PMC9494792 DOI: 10.5114/reum.2022.119044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
The symptoms of a rheumatic disease may also be a sign of a proliferative process. These include conditions that present with skin and vascular changes such as systemic sclerosis and Raynaud's phenomenon with peripheral ischaemia and ulceration. Furthermore, the less common conditions - erythromelalgia or palmar fasciitis with polyarthritis may also accompany cancer. In this article, we discuss the association of diffuse systemic sclerosis with anorectal tumor, palmar fasciitis and polyarthritis with ovarian cancer, erythromelalgia with underlying ovarian malignancy and Raynaud's phenomenon and digital ischemia associated with renal carcinoma. Based on the literature review on this topic we highlighted the importance of recognizing paraneoplastic syndromes at an early stage. This is a crucial point in the adequate management of a patient. Many of the paraneoplastic symptoms of rheumatic and other described conditions may regress with the management of the underlying malignancy.
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31
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Król M, Kupnicka P, Bosiacki M, Chlubek D. Mechanisms Underlying Anti-Inflammatory and Anti-Cancer Properties of Stretching-A Review. Int J Mol Sci 2022; 23:ijms231710127. [PMID: 36077525 PMCID: PMC9456560 DOI: 10.3390/ijms231710127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023] Open
Abstract
Stretching is one of the popular elements in physiotherapy and rehabilitation. When correctly guided, it can help minimize or slow down the disabling effects of chronic health conditions. Most likely, the benefits are associated with reducing inflammation; recent studies demonstrate that this effect from stretching is not just systemic but also local. In this review, we present the current body of knowledge on the anti-inflammatory properties of stretching at a molecular level. A total of 22 papers, focusing on anti-inflammatory and anti-cancer properties of stretching, have been selected and reviewed. We show the regulation of oxidative stress, the expression of pro- and anti-inflammatory genes and mediators, and remodeling of the extracellular matrix, expressed by changes in collagen and matrix metalloproteinases levels, in tissues subjected to stretching. We point out that a better understanding of the anti-inflammatory properties of stretching may result in increasing its importance in treatment and recovery from diseases such as osteoarthritis, systemic sclerosis, and cancer.
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Affiliation(s)
- Małgorzata Król
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Patrycja Kupnicka
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
- Correspondence:
| | - Mateusz Bosiacki
- Chair and Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University, Żołnierska 54, 71-210 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
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Kim SJ, Bale S, Verma P, Wan Q, Ma F, Gudjonsson JE, Hazen SL, Harms PW, Tsou PS, Khanna D, Tsoi LC, Gupta N, Ho KJ, Varga J. Gut microbe-derived metabolite trimethylamine N-oxide activates PERK to drive fibrogenic mesenchymal differentiation. iScience 2022; 25:104669. [PMID: 35856022 PMCID: PMC9287188 DOI: 10.1016/j.isci.2022.104669] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/24/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
Intestinal dysbiosis is prominent in systemic sclerosis (SSc), but it remains unknown how it contributes to microvascular injury and fibrosis that are hallmarks of this disease. Trimethylamine (TMA) is generated by the gut microbiome and in the host converted by flavin-containing monooxygenase (FMO3) into trimethylamine N-oxide (TMAO), which has been implicated in chronic cardiovascular and metabolic diseases. Using cell culture systems and patient biopsies, we now show that TMAO reprograms skin fibroblasts, vascular endothelial cells, and adipocytic progenitor cells into myofibroblasts via the putative TMAO receptor protein R-like endoplasmic reticulum kinase (PERK). Remarkably, FMO3 was detected in skin fibroblasts and its expression stimulated by TGF-β1. Moreover, FMO3 was elevated in SSc skin biopsies and in SSc fibroblasts. A meta-organismal pathway thus might in SSc link gut microbiome to vascular remodeling and fibrosis via stromal cell reprogramming, implicating the FMO3-TMAO-PERK axis in pathogenesis, and as a promising target for therapy.
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Affiliation(s)
- Seok-Jo Kim
- Division of Rheumatology, Department of Internal Medicine, The University of Michigan, Suite 7C27, 300 North Ingalls Building, Ann Arbor, MI, USA
- SCM Lifescience Co. Ltd., Incheon, Republic of Korea
| | - Swarna Bale
- Division of Rheumatology, Department of Internal Medicine, The University of Michigan, Suite 7C27, 300 North Ingalls Building, Ann Arbor, MI, USA
| | - Priyanka Verma
- Division of Rheumatology, Department of Internal Medicine, The University of Michigan, Suite 7C27, 300 North Ingalls Building, Ann Arbor, MI, USA
| | - Qianqian Wan
- Division of Rheumatology, Department of Internal Medicine, The University of Michigan, Suite 7C27, 300 North Ingalls Building, Ann Arbor, MI, USA
| | - Feiyang Ma
- Department of Dermatology, The University of Michigan, 300 North Ingalls Building, Ann Arbor, MI, USA
- Department of Computational Medicine & Bioinformatics, The University of Michigan, Ann Arbor, MI, USA
| | - Johann E. Gudjonsson
- Division of Rheumatology, Department of Internal Medicine, The University of Michigan, Suite 7C27, 300 North Ingalls Building, Ann Arbor, MI, USA
- Department of Dermatology, The University of Michigan, 300 North Ingalls Building, Ann Arbor, MI, USA
| | - Stanley L. Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Microbiome & Human Health, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul W. Harms
- Department of Dermatology, The University of Michigan, 300 North Ingalls Building, Ann Arbor, MI, USA
- Department of Pathology, The University of Michigan, Ann Arbor, MI, USA
| | - Pei-Suen Tsou
- Division of Rheumatology, Department of Internal Medicine, The University of Michigan, Suite 7C27, 300 North Ingalls Building, Ann Arbor, MI, USA
| | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, The University of Michigan, Suite 7C27, 300 North Ingalls Building, Ann Arbor, MI, USA
- Michigan Scleroderma Program, The University of Michigan, 300 North Ingalls Building, Ann Arbor, MI, USA
| | - Lam C. Tsoi
- Department of Dermatology, The University of Michigan, 300 North Ingalls Building, Ann Arbor, MI, USA
- Department of Computational Medicine & Bioinformatics, The University of Michigan, Ann Arbor, MI, USA
| | - Nilaksh Gupta
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Microbiome & Human Health, Cleveland Clinic, Cleveland, OH, USA
| | - Karen J. Ho
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Varga
- Division of Rheumatology, Department of Internal Medicine, The University of Michigan, Suite 7C27, 300 North Ingalls Building, Ann Arbor, MI, USA
- Department of Dermatology, The University of Michigan, 300 North Ingalls Building, Ann Arbor, MI, USA
- Michigan Scleroderma Program, The University of Michigan, 300 North Ingalls Building, Ann Arbor, MI, USA
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Clinical and radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Insights Imaging 2022; 13:108. [PMID: 35767157 PMCID: PMC9243214 DOI: 10.1186/s13244-022-01243-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
Connective tissue diseases (CTDs) include a spectrum of disorders that affect the connective tissue of the human body; they include autoimmune disorders characterized by immune-mediated chronic inflammation and the development of fibrosis. Lung involvement can be misdiagnosed, since pulmonary alterations preceded osteo-articular manifestations only in 20% of cases and they have no clear clinical findings in the early phases. All pulmonary structures may be interested: pulmonary interstitium, airways, pleura and respiratory muscles. Among these autoimmune disorders, rheumatoid arthritis (RA) is characterized by usual interstitial pneumonia (UIP), pulmonary nodules and airway disease with air-trapping, whereas non-specific interstitial pneumonia (NSIP), pulmonary hypertension and esophageal dilatation are frequently revealed in systemic sclerosis (SSc). NSIP and organizing pneumonia (OP) may be found in patients having polymyositis (PM) and dermatomyositis (DM); in some cases, perilobular consolidations and reverse halo-sign areas may be observed. Systemic lupus erythematosus (SLE) is characterized by serositis, acute lupus pneumonitis and alveolar hemorrhage. In the Sjögren syndrome (SS), the most frequent pattern encountered on HRCT images is represented by NSIP; UIP and lymphocytic interstitial pneumonia (LIP) are reported with a lower frequency. Finally, fibrotic NSIP may be the interstitial disease observed in patients having mixed connective tissue diseases (MCTD). This pictorial review therefore aims to provide clinical features and imaging findings associated with autoimmune CTDs, in order to help radiologists, pneumologists and rheumatologists in their diagnoses and management.
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Medina-Bielski S, Mohan S, Makol A. 72-Year-Old Man With Puffy Fingers and Raynaud Phenomenon. Mayo Clin Proc 2022; 97:1014-1019. [PMID: 35512871 DOI: 10.1016/j.mayocp.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Sara Medina-Bielski
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Sneha Mohan
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Ashima Makol
- Advisor to residents and Consultant in Rheumatology, Mayo Clinic, Rochester, MN.
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Polunosika E, Pastare D, Jaunozoliņa L, Karelis G. Involvement of the Nervous System in Systemic Sclerosis. Open Neurol J 2022. [DOI: 10.2174/1874205x-v16-e2112241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Scleroderma is a rare heterogeneous multisystem autoimmune disease. The disease is characterized by structural abnormalities of the small blood vessels. Scleroderma affects all organs of the body. Skin manifestations are commonly reported, but peripheral nervous system (PNS) and central nervous system (CNS) involvement has been less frequently reported. Neurological manifestations are broad, and it is challenging for clinicians to confirm a diagnosis of scleroderma.
Case Presentation:
In our case, a 53-year-old white woman had extensive clinical presentations: skin rashes and symptoms from internal organs, CNS, and PNS during the previous 11 years. She had not undergone any specific treatment because diagnosis has not been made in the early stages.
Conclusion:
It is important to make the diagnosis as early as possible and start treatment with immunomodulatory and immunosuppressant medication, as it affects the patient's disease progression, quality of life, and mortality. A detailed medical history, physical examination, and laboratory and radiology findings help us to identify and diagnose scleroderma. But unfortunately, it was late, and the patient died. This case guides us to be more careful and make the diagnosis of scleroderma earlier in the future.
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Polunosika E, Pastare D, Jaunozoliņa L, Karelis G. Involvement of the Nervous System in Systemic Sclerosis. Open Neurol J 2022. [DOI: 10.2174/1874205x-v16-2112241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Scleroderma is a rare heterogeneous multisystem autoimmune disease. The disease is characterized by structural abnormalities of the small blood vessels. Scleroderma affects all organs of the body. Skin manifestations are commonly reported, but peripheral nervous system (PNS) and central nervous system (CNS) involvement has been less frequently reported. Neurological manifestations are broad, and it is challenging for clinicians to confirm a diagnosis of scleroderma.
Case Presentation:
In our case, a 53-year-old white woman had extensive clinical presentations: skin rashes and symptoms from internal organs, CNS, and PNS during the previous 11 years. She had not undergone any specific treatment because diagnosis has not been made in the early stages.
Conclusion:
It is important to make the diagnosis as early as possible and start treatment with immunomodulatory and immunosuppressant medication, as it affects the patient's disease progression, quality of life, and mortality. A detailed medical history, physical examination, and laboratory and radiology findings help us to identify and diagnose scleroderma. But unfortunately, it was late, and the patient died. This case guides us to be more careful and make the diagnosis of scleroderma earlier in the future.
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Affiliation(s)
- A Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata 700004, India
| | - A Sil
- Department of Dermatology, Venereology, and Leprosy, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata 700004, India
| | - A Hati
- , Department of Internal Medicine, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata, 700004, India
| | - K A Shah
- , Department of Internal Medicine, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata, 700004, India
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Redhu N, Thakur Z. Network biology and applications. Bioinformatics 2022. [DOI: 10.1016/b978-0-323-89775-4.00024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Knarborg M, Hyldgaard C, Bendstrup E, Davidsen JR, Løkke A, Shaker SB, Hilberg O. Incidence, prevalence and regional distribution of systemic sclerosis and related interstitial lung Disease: A nationwide retrospective cohort study. Chron Respir Dis 2022; 19:14799731221125559. [PMID: 36123773 PMCID: PMC9500307 DOI: 10.1177/14799731221125559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate incidence and prevalence of Systemic Sclerosis (SSc) and association with interstitial lung disease (SSc-ILD) in a nationwide population-based study. Methods Patients with an incident diagnosis of SSc in 2000–2016 were identified in the Danish National Patient Registry and categorised based on diagnosis of ILD. Incidence- and prevalence proportions were calculated based on the annual population estimates. A cox proportional hazards model was used to evaluate the association between age, sex, region and marital status and presence of ILD. Results In total, 1869 patients with SSc were identified; 275 patients (14.7%) had SSc-ILD. The majority of patients were females (75.5%). The percentage of males was higher in SSc-ILD than in SSc alone (30.9% and 23.4%, p = 0.008). Median time from SSc to ILD diagnosis was 1.4 years (range 0–14.2). ILD was diagnosed from ≤4 years before to ≥7 years after SSc. Development of ILD was associated with male gender (HR 1.75, 95% CI 1.15–2.66), age 41–50 (HR 1.81, 95% CI 1.07–3.05) and residency in the North Denmark Region (HR 1.95, 9 5% CI 1.12–3.40). Mean annual incidence proportion of SSc was 2.9/100,000 and mean annual prevalence proportion was 16.8/100,000. The incidence remained stable, but prevalence proportion increased from 14.1 – 16.5/100,000 in 2000–2008 to 17.9–19.2/100,000 in 2009–2016. Conclusion The prevalence of SSc increased during the study period, while the incidence remained stable. The prevalence of SSc-ILD was 14.7% and thus less frequent than expected. Male sex and age between 41 and 50 years were associated with ILD.
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Affiliation(s)
- Malene Knarborg
- Department of Medicine, 371420Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, 6174University of Southern Denmark, Odense, Denmark
| | - Charlotte Hyldgaard
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, 53179Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, 11297Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, 1006Aarhus University, Aarhus, Denmark
| | - Jesper R Davidsen
- South Danish Center for Interstitial Lung Diseases (SCILS), Department of Respiratory Medicine, 11286Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, 6174University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, 371420Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, 6174University of Southern Denmark, Odense, Denmark
| | - Saher B Shaker
- Department of Respiratory Medicine, 53147Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Ole Hilberg
- Department of Medicine, 371420Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, 6174University of Southern Denmark, Odense, Denmark
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Edigin E, Ojemolon PE, Eseaton PO, Shaka H, Akuna E, Asemota IR, Manadan A. Systemic Sclerosis Is Associated With Increased Inpatient Mortality in Patients Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample. J Clin Rheumatol 2021; 27:e477-e481. [PMID: 32947436 DOI: 10.1097/rhu.0000000000001543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to compare the outcomes of patients primarily admitted for atrial fibrillation (AFib) with and without a secondary diagnosis of systemic sclerosis (SSc). The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, and electrical cardioversion were secondary outcomes of interest. METHODS Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for adult hospitalizations with AFib as principal diagnosis with and without SSc as secondary diagnosis using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. RESULTS There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Of 821,630 AFib hospitalizations, 750 (0.09%) had SSc. The adjusted odds ratio for inpatient mortality for AFib with coexisting SSc compared with without coexisting SSc was 3.3 (95% confidence interval, 1.27-8.52; p = 0.014). Atrial fibrillation with coexisting SSc hospitalizations had similar LOS (4.2 vs 3.4 days; p = 0.767), mean total hospital charges ($40,809 vs $39,158; p = 0.266), odds of undergoing ablation (2.7% vs 4.2%; p = 0.461), and electrical cardioversion (12.0% vs 17.5%; p = 0.316) compared with without coexisting SSc. CONCLUSIONS Patients admitted primarily for AFib with a secondary diagnosis of SSc have more than 3 times the odds of inpatient death compared with those without coexisting SSc. Hospital LOS, total hospital charges, likelihood of undergoing ablation, and electrical cardioversion were similar in both groups.
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Affiliation(s)
- Ehizogie Edigin
- From the Department of Internal Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Pius Ehiremen Ojemolon
- Department of Anatomical Sciences, St George's University, St George's, Grenada, West Indies
| | - Precious Obehi Eseaton
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | - Hafeez Shaka
- From the Department of Internal Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Emmanuel Akuna
- From the Department of Internal Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | | | - Augustine Manadan
- Division of Rheumatology, Rush University Medical Center, Chicago, IL
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Conte E. Targeting monocytes/macrophages in fibrosis and cancer diseases: Therapeutic approaches. Pharmacol Ther 2021; 234:108031. [PMID: 34774879 DOI: 10.1016/j.pharmthera.2021.108031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 02/08/2023]
Abstract
Over almost 140 years since their identification, the knowledge about macrophages has unbelievably evolved. The 'big eaters' from being thought of as simple phagocytic cells have been recognized as master regulators in immunity, homeostasis, healing/repair and organ development. Long considered to originate exclusively from bone marrow-derived circulating monocytes, macrophages have been also demonstrated to be the first immune cells colonizing tissues in the developing embryo and persisting in adult life by self-renewal, as long-lived tissue resident macrophages. Therefore, heterogeneous populations of macrophages with different ontogeny and functions co-exist in tissues. Macrophages act as sentinels of homeostasis and are intrinsically programmed to lead the wound healing and repair processes that occur after injury. However, in certain pathological circumstances macrophages get dysfunctional, and impaired or aberrant macrophage activities become key features of diseases. For instance, in both fibrosis and cancer, that have been defined 'wounds that do not heal', dysfunctional monocyte-derived macrophages overall play a key detrimental role. On the other hand, due to their plasticity these cells can be 're-educated' and exert anti-fibrotic and anti-cancer functions. Therefore macrophages represent an important therapeutic target in both fibrosis and cancer diseases. The current review will illustrate new insights into the role of monocytes/macrophages in these devastating diseases and summarize new therapeutic strategies and applications of macrophage-targeted drug development in their clinical setting.
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Affiliation(s)
- Ilaria Galetti
- Gruppo Italiano per la Lotta alla Sclerodermia (GILS), Milan, Italy
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43
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Elessawi DF, Gabr H, Badawy MMM, Gheita TA. Therapeutic potential of mesenchymal stem cells for scleroderma induced in mouse model. Tissue Cell 2021; 73:101671. [PMID: 34742053 DOI: 10.1016/j.tice.2021.101671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the potential therapeutic effect of mesenchymal stem cells (MSCs) for experimental scleroderma. MATERIALS AND METHODS Fifty-four mice six-week-old (30-35 g) were studied. Hypochlorous acid (HOCl) induced scleroderma was considered. Mice were divided into 3 groups: (I) Control: Six mice did not receive any treatment and were sacrificed at the end of the experiment; (II) HOCl mice (induced scleroderma as a positive control): (III) MSCs-treated HOCl mice: Thirty six HOCl-induced mice were injected with MSCs (7.5 × 105) intravenous every week for 3 weeks. Skin pieces were taken from the backs of mice and lung tissue pieces. a smooth muscle actin (α-SMA) and transforming growth factor-β (TGF-β1) were analysed or fixed in 10 % formalin for skin and lung tissue histopathological analysis. Plasma nitric oxide (NO) was also assayed. RESULTS There was a significant rise in the NO level and of the cutaneous and lung tissue α-SMA and TGF-β1 in untreated scleroderma-induced mice. The values significantly normalized after MSC therapy over the 7 weeks duration of the study. The altered histopathology of the skin and lung tissues in the scleroderma-induced mice showed a remarkable tendency to normalization of the skin and lung parenchyma and vasculature. CONCLUSION There was a significant rise in the level of NO and skin and lung tissue α-SMA and TGF-β1 in untreated scleroderma-induced mice and values were significantly normalized after MSC therapy over the 7 weeks duration of the study. Altered histopathology of the skin and lung appeared nearly normal after MSC therapy.
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Affiliation(s)
- Dina Fathy Elessawi
- Department of Health Radiation Research - National Center for Radiation Research and Technology (NCRRT) - Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Hala Gabr
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Monda Mohamed Maher Badawy
- Department of Health Radiation Research - National Center for Radiation Research and Technology (NCRRT) - Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt.
| | - Tamer A Gheita
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Işık M, Kara M. Systemic sclerosis related interstitial lung disease: What is the recommended treatment? ACTA ACUST UNITED AC 2021; 17:490. [PMID: 34625155 DOI: 10.1016/j.reumae.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/27/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Metin Işık
- Internal Medicine and Rheumatology, Özel 100. Yıl Hospital, Çukurambar, Muhsin Yazıcıoğlu Caddesi No: 54, Çankaya, Ankara, Turkey.
| | - Murat Kara
- Physical Medicine and Rehabilitation, Hacettepe University Hospital, Sıhhiye, Ankara, Turkey
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Syed Gaggatur N, Sange AH, Srinivas N, Sarnaik MK, Modi S, Pisipati Y, Vaidya S, Sange I. Systemic Sclerosis: Highlighting Respiratory Complications and Significance of Early Screening. Cureus 2021; 13:e17291. [PMID: 34552830 PMCID: PMC8448757 DOI: 10.7759/cureus.17291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/30/2022] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune disease that leads the patient to have a diverse clinical presentation encompassing several systems and a worse prognosis, mainly when complications arise. Most SSc-related deaths are caused by pulmonary hypertension (PH) and interstitial lung disease (ILD). This article focuses on pulmonary artery hypertension (PAH) and ILD as pulmonary consequences of SSc. We examined the grave effects regarding SSc's respiratory complications, which are concealed by the disease's clinical heterogeneity. In this article, we briefly reviewed the discussion of clinical features and management and the mortality associated with the sequelae. We further addressed the benefits and significance of screening for the disease and associated respiratory complications in SSc patients in this study.
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Affiliation(s)
| | - Aliya H Sange
- Research, K. J. Somaiya Medical College, Mumbai, IND
| | - Natasha Srinivas
- Research, B. G. S. Global Institute of Medical Sciences, Bangalore, IND
| | | | - Srimy Modi
- Research, K. J. Somaiya Medical College, Mumbai, IND
| | - Yasaswi Pisipati
- Internal Medicine, M. S. Ramaiah Medical College, Bangalore, IND
| | - Sarayoo Vaidya
- Internal Medicine, M. S. Ramaiah Medical College, Bangalore, IND
| | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, K. J. Somaiya Medical College, Mumbai, IND
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Pipek LZ, Nascimento RFV, Acencio MMP, Teixeira LR. Comparison of SpO 2 and heart rate values on Apple Watch and conventional commercial oximeters devices in patients with lung disease. Sci Rep 2021; 11:18901. [PMID: 34556765 PMCID: PMC8460792 DOI: 10.1038/s41598-021-98453-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/06/2021] [Indexed: 11/09/2022] Open
Abstract
Lung diseases have high mortality and morbidity, with an important impact on quality of life. Hypoxemic patients are advised to use oxygen therapy to prolong their survival, but high oxygen saturation (SpO2) levels can also have negative effects. Pulse oximeters are the most common way to assess oxygen levels and guide medical treatment. This study aims to assess whether wearable devices can provide precise SpO2 measurements when compared to commercial pulse oximeters. This is a cross-section study with 100 patients with chronic obstructive pulmonary disease and interstitial lung disease from an outpatient pneumology clinic. SpO2 and heart rate data were collected with an Apple Watch Series 6 (Apple) and compared to two commercial pulse oximeters. The Bland-Altman method and interclass correlation coefficient were used to compare their values. We observed strong positive correlations between the Apple Watch device and commercial oximeters when evaluating heart rate measurements (r = 0.995, p < 0.001) and oximetry measurements (r = 0.81, p < 0.001). There was no statistical difference in the evaluation of skin color, wrist circumference, presence of wrist hair, and enamel nail for SpO2 and heart rate measurements in Apple Watch or commercial oximeter devices (p > 0.05). Apple Watch 6 is a reliable way to obtain heart rate and SpO2 in patients with lung diseases in a controlled environment.
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Affiliation(s)
| | | | - Milena Marques Pagliarelli Acencio
- Laboratorio de Pneumologia/LIM09-Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Lisete Ribeiro Teixeira
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Laboratorio de Pneumologia/LIM09-Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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Leong E, Bezuhly M, Marshall JS. Distinct Metalloproteinase Expression and Functions in Systemic Sclerosis and Fibrosis: What We Know and the Potential for Intervention. Front Physiol 2021; 12:727451. [PMID: 34512395 PMCID: PMC8432940 DOI: 10.3389/fphys.2021.727451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
Systemic sclerosis (SSc) is a chronic debilitating idiopathic disorder, characterized by deposition of excessive extracellular matrix (ECM) proteins such as collagen which leads to fibrosis of the skin and other internal organs. During normal tissue repair and remodeling, the accumulation and turnover of ECM proteins are tightly regulated by the interaction of matrix metalloproteinases (MMPs) and endogenous tissue inhibitors of metalloproteinases (TIMPs). SSc is associated with dysregulation of the activity of these proteolytic and inhibitory proteins within the tissue microenvironment, tipping the balance toward fibrosis. The resultant ECM accumulation further perpetuates tissue stiffness and decreased function, contributing to poor clinical outcomes. Understanding the expression and function of these endogenous enzymes and inhibitors within specific tissues is therefore critical to the development of therapies for SSc. This brief review describes recent advances in our understanding of the functions and mechanisms of ECM remodeling by metalloproteinases and their inhibitors in the skin and lungs affected in SSc. It highlights recent progress on potential candidates for intervention and therapeutic approaches for treating SSc fibrosis.
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Affiliation(s)
- Edwin Leong
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Michael Bezuhly
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada.,Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Jean S Marshall
- Department of Pathology, Dalhousie University, Halifax, NS, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
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Newe M, Kant TA, Hoffmann M, Rausch JSE, Winter L, Künzel K, Klapproth E, Günther C, Künzel SR. Systemic mesalazine treatment prevents spontaneous skin fibrosis in PLK2-deficient mice. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2021; 394:2233-2244. [PMID: 34410453 PMCID: PMC8514377 DOI: 10.1007/s00210-021-02135-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/30/2021] [Indexed: 11/27/2022]
Abstract
Skin fibrosis is a complex biological remodeling process occurring in disease like systemic sclerosis, morphea, or eosinophilic fasciitis. Since the knowledge about the underlying pathomechanisms is still incomplete, there is currently no therapy, which prevents or reverses skin fibrosis sufficiently. The present study investigates the role of polo-like kinase 2 (PLK2) and the pro-fibrotic cytokine osteopontin (OPN) in the pathogenesis of cutaneous fibrosis and demonstrates the antifibrotic effects of systemic mesalazine treatment in vivo. Isolated primary dermal fibroblasts of PLK2 wild-type (WT) and knockout (KO) mice were characterized invitro. Skin thickness and histoarchitecture were studied in paraffin-embedded skin sections. The effects of mesalazine treatment were examined in isolated fibroblasts and PLK2 KO mice, which were fed 100 µg/g mesalazine for 6 months via the drinking water. Compared to WT, PLK2 KO fibroblasts displayed higher spontaneous myofibroblast differentiation, reduced proliferation rates, and overexpression of the fibrotic cytokine OPN. Invitro, 72 h of treatment with 10 mmol/L mesalazine induced phenotype conversion in PLK2 KO fibroblasts and attenuated OPN expression by inhibiting ERK1/2. In vivo, dermal myofibroblast differentiation, collagen accumulation, and skin thickening were prevented by mesalazine in PLK2 KO. Plasma creatinine levels indicated good tolerability of systemic long-term mesalazine treatment. The current study reveals a spontaneous fibrotic skin phenotype and ERK1/2-dependent OPN overexpression in PLK2 KO mice. We provide experimental evidence for the antifibrotic effectiveness of systemic mesalazine treatment to prevent fibrosis of the skin, suggesting further investigation in experimental and clinical settings.
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Affiliation(s)
- Manja Newe
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Theresa A Kant
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Maximilian Hoffmann
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Johanna S E Rausch
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Luise Winter
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Karolina Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Erik Klapproth
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany
| | - Claudia Günther
- Department of Dermatology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan R Künzel
- Institute of Pharmacology and Toxicology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, 01309, Dresden, Germany.
- Department of Dermatology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Iloprost Attenuates Oxidative Stress-Dependent Activation of Collagen Synthesis Induced by Sera from Scleroderma Patients in Human Pulmonary Microvascular Endothelial Cells. Molecules 2021; 26:molecules26164729. [PMID: 34443317 PMCID: PMC8399120 DOI: 10.3390/molecules26164729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 12/17/2022] Open
Abstract
Endothelial cell injury is an early event in systemic sclerosis (SSc) pathogenesis and several studies indicate oxidative stress as the trigger of SSc-associated vasculopathy. Here, we show that circulating factors present in sera of SSc patients increased reactive oxygen species (ROS) production and collagen synthesis in human pulmonary microvascular endothelial cells (HPMECs). In addition, the possibility that iloprost, a drug commonly used in SSc therapy, might modulate the above-mentioned biological phenomena has been also investigated. In this regard, as compared to sera of SSc patients, sera of iloprost-treated SSc patients failed to increased ROS levels and collagen synthesis in HPMEC, suggesting a potential antioxidant mechanism of this drug.
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Kafle S, Thapa Magar M, Patel P, Poudel A, Cancarevic I. Systemic Sclerosis Associated Interstitial Lung Disease and Nintedanib: A Rare Disease and a Promising Drug. Cureus 2021; 13:e16404. [PMID: 34414042 PMCID: PMC8364831 DOI: 10.7759/cureus.16404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is a rare disease with a progressive nature, eventually leading to lung fibrosis. Nintedanib, a tyrosine kinase inhibitor, is a widely accepted drug for treating idiopathic pulmonary fibrosis (IPF), a disease that shares some similarities with SSc-ILD regarding pathological disease processes. In this review, we aim to discuss the pathogenesis of SSc-ILD and the overall role of nintedanib in the management of SSc-ILD. SSc-ILD involves multiple pathological mediators contributing to various pathways that ultimately cause lung fibrosis. The pathogenesis of SSc-ILD is a complex phenomenon and still needs further study. Nintedanib has demonstrated its efficacy in the treatment of SSc-ILD by reducing the progression of the pathological process. It has also proven its clinical significance in the management of SSc-ILD. However, the currently available literature does not have any evidence to compare the effectiveness of nintedanib with the already available treatment modalities such as cyclophosphamide (CYC), mycophenolate mofetil (MMF), and azathioprine (AZT). The current literature also lacks information about nintedanib's long-term consequences on patients with SSc-ILD. Therefore, to create better evidence-based treatment guidelines, we recommend that researchers conduct randomized clinical trials comparing nintedanib to MMF, CYC, AZT, etc., and continue surveillance to explore the long-term consequences of nintedanib.
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Affiliation(s)
- Sunam Kafle
- Internal Medicine, Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Manusha Thapa Magar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Priyanka Patel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Arisa Poudel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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