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Nikolopoulos D, Nakos-Bimpos M, Manolakou T, Polissidis A, Boumpas DT. Impaired serotonin synthesis in hippocampus of murine lupus represents an early neuropsychiatric event. Lupus 2024; 33:166-171. [PMID: 38073556 DOI: 10.1177/09612033231221651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Despite significant progress in understanding the mechanisms underlying hippocampal involvement in neuropsychiatric systemic lupus erythematosus (NPSLE), our understanding of how neuroinflammation affects the brain neurotransmitter systems is limited. To date, few studies have investigated the role of neurotransmitters in pathogenesis of NPSLE with contradictory results. METHODS Hippocampal tissue from NZB/W-F1 lupus-prone mice and age-matched control strains were dissected in both pre-nephritic (3-month-old) and nephritic (6-month-old) stages. High-Performance Liquid Chromatography (HPLC) was used to evaluate the level of serotonin (5-HT), dopamine (DA), and their metabolites 5-HIAA and DOPAC, respectively, in mouse hippocampi. RESULTS Lupus mice exhibit decreased levels of serotonin at the early stages of the disease, along with intact levels of its metabolite 5-HIAA. The 5-HT turnover ratio (5-HIAA/5-HT ratio) was increased in the hippocampus of lupus mice at pre-nephritic stage suggesting that low hippocampal serotonin levels in lupus are attributed to decreased serotonin synthesis. Both DA and DOPAC levels remained unaffected in lupus hippocampus at both early and late stages. CONCLUSION Impaired hippocampal serotonin synthesis in the hippocampus of lupus-prone mice represents an early neuropsychiatric event. These findings may have important implications for the use of symptomatic therapy in diffuse NPSLE.
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Affiliation(s)
- Dionysis Nikolopoulos
- Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Modestos Nakos-Bimpos
- Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Theodora Manolakou
- Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexia Polissidis
- Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Dimitrios T Boumpas
- Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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2
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Nagata W, Koizumi A, Nakagawa K, Takahashi S, Gotoh M, Satoh Y, Ishizuka T. Treatment with lysophosphatidic acid prevents microglial activation and depression-like behaviours in a murine model of neuropsychiatric systemic lupus erythematosus. Clin Exp Immunol 2023; 212:81-92. [PMID: 36718978 PMCID: PMC10128163 DOI: 10.1093/cei/uxad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/05/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
Neuropsychiatric systemic lupus erythematosus (NPSLE) is an incurable disease characterised by neuropsychiatric symptoms, particularly depression. Novel therapeutic options for NPSLE are urgently needed. Several previous reports have suggested that both microglial activation and impaired neurogenesis may be involved in the progression of depression. In contrast, the administration of lysophosphatidic acid (LPA) ameliorates depression and anxiety. Therefore, in the present study, we determined whether treatment with LPA affects microglial activation, impaired neurogenesis, and abnormal behaviour in MRL/lpr mice. In both tail suspension test and forced swim test, the MRL/lpr mice exhibited a significant increase in total immobility time compared with MRL/+ mice. Treatment with LPA significantly suppressed the prolonged immobility time in MRL/lpr mice. In contrast, pretreatment with ki16425 (a specific antagonist of LPA receptor 1 and 3) significantly reversed the effects of LPA. Furthermore, MRL/lpr mice exhibited impairments in spatial working memory and visual cognitive memory, which were suppressed by LPA treatment. The expression levels of TMEM119, CD68, GFAP, and caspase-3 in the hippocampus and prefrontal cortex of MRL/lpr mice were significantly higher than those in MRL/+ mice. Treatment with LPA inhibited these increases in MRL/lpr mice. Pretreatment with ki16425 reversed LPA-mediated inhibition of microglial activation. The quantity of sodium fluorescein that leaked into the brain tissues in MRL/lpr mice were significantly higher than that in MRL/+ mice. Treatment with LPA tended to decrease the sodium fluorescein leakage. These findings suggest that treatment with LPA may regulate microglial activation, which is important in the pathogenesis of NPSLE, as well as blood-brain-barrier weakening and abnormal behaviour.
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Affiliation(s)
- Wataru Nagata
- Department of Pharmacology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Akiho Koizumi
- Department of Pharmacology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Keiichi Nakagawa
- Department of Pharmacology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Sayaka Takahashi
- Department of Pharmacology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Mari Gotoh
- Department of Clinical Laboratory Medicine, Faculty of Medical Technology, Teikyo University, Itabashi, Tokyo, Japan
- Institute for Human Life Science, Ochanomizu University, Bunkyo, Tokyo, Japan
| | - Yasushi Satoh
- Department of Biochemistry, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toshiaki Ishizuka
- Department of Pharmacology, National Defense Medical College, Tokorozawa, Saitama, Japan
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3
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Tan G, Huang B, Cui Z, Dou H, Zheng S, Zhou T. A noise-immune reinforcement learning method for early diagnosis of neuropsychiatric systemic lupus erythematosus. Math Biosci Eng 2022; 19:2219-2239. [PMID: 35240783 DOI: 10.3934/mbe.2022104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The neuropsychiatric systemic lupus erythematosus (NPSLE), a severe disease that can damage the heart, liver, kidney, and other vital organs, often involves the central nervous system and even leads to death. Magnetic resonance spectroscopy (MRS) is a brain functional imaging technology that can detect the concentration of metabolites in organs and tissues non-invasively. However, the performance of early diagnosis of NPSLE through conventional MRS analysis is still unsatisfactory. In this paper, we propose a novel method based on genetic algorithm (GA) and multi-agent reinforcement learning (MARL) to improve the performance of the NPSLE diagnosis model. Firstly, the proton magnetic resonance spectroscopy (1H-MRS) data from 23 NPSLE patients and 16 age-matched healthy controls (HC) were standardized before training. Secondly, we adopt MARL by assigning an agent to each feature to select the optimal feature subset. Thirdly, the parameter of SVM is optimized by GA. Our experiment shows that the SVM classifier optimized by feature selection and parameter optimization achieves 94.9% accuracy, 91.3% sensitivity, 100% specificity and 0.87 cross-validation score, which is the best score compared with other state-of-the-art machine learning algorithms. Furthermore, our method is even better than other dimension reduction ones, such as SVM based on principal component analysis (PCA) and variational autoencoder (VAE). By analyzing the metabolites obtained by MRS, we believe that this method can provide a reliable classification result for doctors and can be effectively used for the early diagnosis of this disease.
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Affiliation(s)
- Guanru Tan
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Boyu Huang
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Zhihan Cui
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Haowen Dou
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Shiqiang Zheng
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Teng Zhou
- Department of Computer Science, Shantou University, Shantou 515063, China
- Key Laboratory of Intelligent Manufacturing Technology, Shantou University, Ministry of Education, Shantou 515063, China
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4
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Wollmuth LP, Chan K, Groc L. The diverse and complex modes of action of anti-NMDA receptor autoantibodies. Neuropharmacology 2021; 194:108624. [PMID: 34081993 PMCID: PMC8693782 DOI: 10.1016/j.neuropharm.2021.108624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 12/21/2022]
Abstract
NMDA receptors are ligand-gated ion channels that are found throughout the brain and are required for both brain development and many higher order functions. A variety of human patients with diverse clinical phenotypes have been identified that carry autoantibodies directed against NMDA receptor subunits. Here we focus on two general classes of autoantibodies, anti-GluN1 antibodies associated with anti-NMDA receptor encephalitis and anti-GluN2 antibodies associated with systemic lupus erythematosus (SLE). These two general classes of anti-NMDA receptor autoantibodies display a wide range of pathophysiological mechanisms from altering synaptic composition to gating of NMDARs. While we have made progress in understanding how these autoantibodies work at the molecular and cellular level, many unanswered questions remain including their long-term actions on brain function, the significance of clonal variations, and their effects on different NMDA receptor-expressing cell types in local circuits. This information will be needed to define fully the transition from anti-NMDA receptor autoantibodies to a clinical phenotype.
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Affiliation(s)
- Lonnie P Wollmuth
- Department of Neurobiology & Behavior, USA; Department of Biochemistry & Cell Biology, USA; Center for Nervous System Disorders. Stony Brook University, Stony Brook, NY, 11794-5230, USA.
| | - Kelvin Chan
- Graduate Program in Neuroscience, USA; Medical Scientist Training Program (MSTP), USA; Department of Neurobiology & Behavior, USA
| | - Laurent Groc
- Univ. de Bordeaux, Interdisciplinary Institute for Neuroscience, UMR 5297, F-33000, Bordeaux, France; CNRS, IINS UMR, 5297, Bordeaux, France
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5
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Iacobas D, Wen J, Iacobas S, Schwartz N, Putterman C. Remodeling of Neurotransmission, Chemokine, and PI3K-AKT Signaling Genomic Fabrics in Neuropsychiatric Systemic Lupus Erythematosus. Genes (Basel) 2021; 12:251. [PMID: 33578738 PMCID: PMC7916450 DOI: 10.3390/genes12020251] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022] Open
Abstract
Cognitive dysfunction and mood changes are prevalent and especially taxing issues for patients with systemic lupus erythematosus (SLE). Tumor necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) and its cognate receptor Fn14 have been shown to play an important role in neurocognitive dysfunction in murine lupus. We profiled and compared gene expression in the cortices of MRL/+, MRL/lpr (that manifest lupus-like phenotype) and MRL/lpr-Fn14 knockout (Fn14ko) adult female mice to determine the transcriptomic impact of TWEAK/Fn14 on cortical gene expression in lupus. We found that the TWEAK/Fn14 pathway strongly affects the expression level, variability and coordination of the genomic fabrics responsible for neurotransmission and chemokine signaling. Dysregulation of the Phosphoinositide 3-kinase (PI3K)-AKT pathway in the MRL/lpr lupus strain compared with the MRL/+ control and Fn14ko mice was particularly prominent and, therefore, promising as a potential therapeutic target, although the complexity of the transcriptomic fabric highlights important considerations in in vivo experimental models.
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Affiliation(s)
- Dumitru Iacobas
- Center for Computational Systems Biology, Personalized Genomics Laboratory, Roy G. Perry College of Engineering, Prairie View A & M University, Prairie View, TX 77446, USA;
- DP Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jing Wen
- Department of Medicine (Rheumatology), Albert Einstein College of Medicine, Bronx, NY 10461, USA; (J.W.); (N.S.)
| | - Sanda Iacobas
- Department of Pathology, New York Medical College, Valhalla, NY 10595, USA;
| | - Noa Schwartz
- Department of Medicine (Rheumatology), Albert Einstein College of Medicine, Bronx, NY 10461, USA; (J.W.); (N.S.)
| | - Chaim Putterman
- Department of Medicine (Rheumatology), Albert Einstein College of Medicine, Bronx, NY 10461, USA; (J.W.); (N.S.)
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat 52100, Israel
- Galilee Medical Center, Research Institute, Nahariya 22100, Israel
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6
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Nocito C, Lubinsky C, Hand M, Khan S, Patel T, Seliga A, Winfield M, Zuluaga-Ramirez V, Fernandes N, Shi X, Unterwald EM, Persidsky Y, Sriram U. Centrally Acting Angiotensin-Converting Enzyme Inhibitor Suppresses Type I Interferon Responses and Decreases Inflammation in the Periphery and the CNS in Lupus-Prone Mice. Front Immunol 2020; 11:573677. [PMID: 33042154 PMCID: PMC7522287 DOI: 10.3389/fimmu.2020.573677] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multi-organ damage. Neuropsychiatric lupus (NPSLE) is one of the most common manifestations of human SLE, often causing depression. Interferon-α (IFNα) is a central mediator in disease pathogenesis. Administration of IFNα to patients with chronic viral infections or cancers causes depressive symptoms. Angiotensin-converting enzyme (ACE) is part of the kallikrein-kinin/renin-angiotensin (KKS/RAS) system that regulates many physiological processes, including inflammation, and brain functions. It is known that ACE degrades bradykinin (BK) into inactive peptides. We have previously shown in an in vitro model of mouse bone-marrow-derived dendritic cells (BMDC) and human peripheral blood mononuclear cells that captopril (a centrally acting ACE inhibitor-ACEi) suppressed Type I IFN responsive gene (IRG) expression. In this report, we used the MRL/lpr lupus-prone mouse model, an established model to study NPSLE, to determine the in vivo effects of captopril on Type I IFN and associated immune responses in the periphery and brain and effects on behavior. Administering captopril to MRL/lpr mice decreased expression of IRGs in brain, spleen and kidney, decreased circulating and tissue IFNα levels, decreased microglial activation (IBA-1 expression) and reduced depressive-like behavior. Serotonin levels that are decreased in depression were increased by captopril treatment. Captopril also reduced autoantibody levels in plasma and immune complex deposition in kidney and brain. Thus, ACEi's may have potential for therapeutic use for systemic and NPSLE.
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Affiliation(s)
- Cassandra Nocito
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Cody Lubinsky
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Michelle Hand
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Sabeeya Khan
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Tulsi Patel
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Alecia Seliga
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Malika Winfield
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Viviana Zuluaga-Ramirez
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Nicole Fernandes
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Xiangdang Shi
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Ellen M Unterwald
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Yuri Persidsky
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
| | - Uma Sriram
- Department of Pathology and Laboratory Medicine, Temple University, Philadelphia, PA, United States
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7
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Li Y, Ge Z, Zhang Z, Shen Z, Wang Y, Zhou T, Wu R. Broad Learning Enhanced 1H-MRS for Early Diagnosis of Neuropsychiatric Systemic Lupus Erythematosus. Comput Math Methods Med 2020; 2020:8874521. [PMID: 33299467 PMCID: PMC7704182 DOI: 10.1155/2020/8874521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 02/05/2023]
Abstract
In this paper, we explore the potential of using the multivoxel proton magnetic resonance spectroscopy (1H-MRS) to diagnose neuropsychiatric systemic lupus erythematosus (NPSLE) with the assistance of a support vector machine broad learning system (BL-SVM). We retrospectively analysed 23 confirmed patients and 16 healthy controls, who underwent a 3.0 T magnetic resonance imaging (MRI) sequence with multivoxel 1H-MRS in our hospitals. One hundred and seventeen metabolic features were extracted from the multivoxel 1H-MRS image. Thirty-three metabolic features selected by the Mann-Whitney U test were considered to have a statistically significant difference (p < 0.05). However, the best accuracy achieved by conventional statistical methods using these 33 metabolic features was only 77%. We turned to develop a support vector machine broad learning system (BL-SVM) to quantitatively analyse the metabolic features from 1H-MRS. Although not all the individual features manifested statistics significantly, the BL-SVM could still learn to distinguish the NPSLE from the healthy controls. The area under the receiver operating characteristic curve (AUC), the sensitivity, and the specificity of our BL-SVM in predicting NPSLE were 95%, 95.8%, and 93%, respectively, by 3-fold cross-validation. We consequently conclude that the proposed system effectively and efficiently working on limited and noisy samples may brighten a noinvasive in vivo instrument for early diagnosis of NPSLE.
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Affiliation(s)
- Yan Li
- Department of Medical Imaging, The 2nd Affiliated Hospital, Shantou University Medical College, Shantou 515041, China
| | - Zuhao Ge
- Department of Computer Science, Shantou University, Shantou 515041, China
| | - Zhiyan Zhang
- Department of Medical Imaging, Huizhou Central Hospital, Huizhou 516000, China
| | - Zhiwei Shen
- Department of Medical Imaging, The 2nd Affiliated Hospital, Shantou University Medical College, Shantou 515041, China
| | - Yukai Wang
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou 515041, China
| | - Teng Zhou
- Department of Computer Science, Shantou University, Shantou 515041, China
- Key Laboratory of Intelligent Manufacturing Technology (Shantou University), Ministry of Education, Shantou 515063, China
| | - Renhua Wu
- Department of Medical Imaging, The 2nd Affiliated Hospital, Shantou University Medical College, Shantou 515041, China
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Stock AD, Der E, Gelb S, Huang M, Weidenheim K, Ben-Zvi A, Putterman C. Tertiary lymphoid structures in the choroid plexus in neuropsychiatric lupus. JCI Insight 2019; 4:124203. [PMID: 31167973 PMCID: PMC6629135 DOI: 10.1172/jci.insight.124203] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/23/2019] [Indexed: 12/20/2022] Open
Abstract
The central nervous system manifestations of systemic lupus erythematosus (SLE) remain poorly understood. Given the well-defined role of autoantibodies in other lupus manifestations, extensive work has gone into the identification of neuropathic autoantibodies. However, attempts to translate these findings to patients with SLE have yielded mixed results. We used the MRL/MpJ-Faslpr/lpr mouse, a well-established, spontaneous model of SLE, to establish the immune effectors responsible for brain disease. Transcriptomic analysis of the MRL/MpJ-Faslpr/lpr choroid plexus revealed an expression signature driving tertiary lymphoid structure formation, including chemokines related to stromal reorganization and lymphocyte compartmentalization. Additionally, transcriptional profiles indicated various stages of lymphocyte activation and germinal center formation. The extensive choroid plexus infiltrate present in MRL/MpJ-Faslpr/lpr mice with overt neurobehavioral deficits included locally proliferating B and T cells, intercellular interactions between lymphocytes and antigen-presenting cells, as well as evidence for in situ somatic hypermutation and class switch recombination. Furthermore, the choroid plexus was a site for trafficking lymphocytes into the brain. Finally, histological evaluation in human lupus patients with neuropsychiatric manifestations revealed increased leukocyte migration through the choroid plexus. These studies identify a potential new pathway underlying neuropsychiatric lupus and support tertiary lymphoid structure formation in the choroid plexus as a novel mechanism of brain-immune interfacing.
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Affiliation(s)
- Ariel D. Stock
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, New York, USA
| | - Evan Der
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, New York, USA
| | - Sivan Gelb
- Department of Developmental Biology and Cancer Research, Faculty of Medicine, The Hebrew University, Ein-Kerem, Jerusalem, Israel
| | - Michelle Huang
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, New York, USA
| | | | - Ayal Ben-Zvi
- Department of Developmental Biology and Cancer Research, Faculty of Medicine, The Hebrew University, Ein-Kerem, Jerusalem, Israel
| | - Chaim Putterman
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, New York, USA
- Division of Rheumatology, Albert Einstein College of Medicine, New York, New York, USA
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Bendorius M, Po C, Muller S, Jeltsch-David H. From Systemic Inflammation to Neuroinflammation: The Case of Neurolupus. Int J Mol Sci 2018; 19:E3588. [PMID: 30428632 PMCID: PMC6274746 DOI: 10.3390/ijms19113588] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 12/17/2022] Open
Abstract
It took decades to arrive at the general consensus dismissing the notion that the immune system is independent of the central nervous system. In the case of uncontrolled systemic inflammation, the relationship between the two systems is thrown off balance and results in cognitive and emotional impairment. It is specifically true for autoimmune pathologies where the central nervous system is affected as a result of systemic inflammation. Along with boosting circulating cytokine levels, systemic inflammation can lead to aberrant brain-resident immune cell activation, leakage of the blood⁻brain barrier, and the production of circulating antibodies that cross-react with brain antigens. One of the most disabling autoimmune pathologies known to have an effect on the central nervous system secondary to the systemic disease is systemic lupus erythematosus. Its neuropsychiatric expression has been extensively studied in lupus-like disease murine models that develop an autoimmunity-associated behavioral syndrome. These models are very useful for studying how the peripheral immune system and systemic inflammation can influence brain functions. In this review, we summarize the experimental data reported on murine models developing autoimmune diseases and systemic inflammation, and we explore the underlying mechanisms explaining how systemic inflammation can result in behavioral deficits, with a special focus on in vivo neuroimaging techniques.
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Affiliation(s)
- Mykolas Bendorius
- UMR 7242 Biotechnologie et Signalisation Cellulaire, École Supérieure de Biotechnologie de Strasbourg (ESBS), Laboratoire d'Excellence Médalis, Université de Strasbourg/CNRS, 67412 Illkirch, France.
| | - Chrystelle Po
- ICube UMR 7357, Université de Strasbourg/CNRS, Fédération de Médecine Translationnelle de Strasbourg, 67000 Strasbourg, France.
| | - Sylviane Muller
- UMR 7242 Biotechnologie et Signalisation Cellulaire, École Supérieure de Biotechnologie de Strasbourg (ESBS), Laboratoire d'Excellence Médalis, Université de Strasbourg/CNRS, 67412 Illkirch, France.
- University of Strasbourg Institute for Advanced Study (USIAS), 67000 Strasbourg, France.
| | - Hélène Jeltsch-David
- UMR 7242 Biotechnologie et Signalisation Cellulaire, École Supérieure de Biotechnologie de Strasbourg (ESBS), Laboratoire d'Excellence Médalis, Université de Strasbourg/CNRS, 67412 Illkirch, France.
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10
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Shimizu F, Kanda T. [Disruption of the blood-brain barrier in inflammatory neurological diseases]. Brain Nerve 2013; 65:165-176. [PMID: 23399674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The blood-brain barrier (BBB) restricts the exchange of humoral factors and cells between the blood and brain and thus plays a crucial role in maintaining cerebral homeostasis. Disruption of the BBB has been considered the initial key step of the disease process in some inflammatory neurological diseases, including multiple sclerosis (MS), neuromyelitis optica (NMO), and neuropsychiatric systemic lupus erythematosus (NPSLE). In MS, the BBB may be impaired before the formation of demyelinating foci or T-cell infiltration around small vessels; however, once the BBB is disrupted, massive infiltration of T cells, augmented expression of adhesion molecules on the endothelial cell surface, and leakage of inflammatory cytokines and antibodies aggravate the MS lesions. Recently, the disease-specific and pathogenic autoantibody "anti-AQP4" was detected in the sera of NMO patients. Thus, the destruction of the BBB is an important step in the development of NMO because the circulating anti-AQP4 antibodies have to pass through the BBB to reach the astrocytic endfeet, where AQP4 is localized. Several studies have shown an association between anti-NR2 antibodies in the serum or cerebrospinal fluid of NPSLE patients and neuropsychological manifestations. These antibodies may be involved in the pathogenesis of NPSLE, and the leaky BBB that allows the intrusion of circulating anti-NR2 antibodies is considered to play a crucial role in the disease process. Although some medications, including glucocorticoids and type 1 interferons, are known to repair the integrity of the BBB in an additive manner, the development of a novel disease-specific therapy, which focuses on repairing the integrity of the BBB, is awaited.
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Affiliation(s)
- Fumitaka Shimizu
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Japan
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11
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Reshef T, Mekori YA, Mor A. Differential antinuclear antibodies pattern. Isr Med Assoc J 2009; 11:123-124. [PMID: 19432046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Tamar Reshef
- Laboratory of Allergy and Clinical Immunology, Meir Medical Center, Kfar Saba, Israel
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12
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Honda K, Matsumoto M, Kaneko T, Kamei I, Tatsumi H, Murai N, Mineharu Y, Oita J. Linear deposition of immunoglobulins and complement components on the dura in normal pressure hydrocephalus complicating systemic lupus erythematosus. J Clin Neurosci 2008; 11:561-3. [PMID: 15177414 DOI: 10.1016/j.jocn.2003.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2003] [Accepted: 06/02/2003] [Indexed: 11/29/2022]
Abstract
We present a case of normal pressure hydrocephalus in a 70-year-old man with previously diagnosed systemic lupus erythematosus. Histological examination demonstrated the linear deposition of IgG, IgA, IgM, C(3) and C(1q) on the dura in the absence of inflammation or thrombosis that has previously been implicated in the aetiology of elevated pressure hydrocephalus in systemic lupus erythematosus. Our results suggest that the deposition of immunoglobulins and complement may play a pivotal role in an insidious manner in the pathogenesis of normal pressure hydrocephalus in systemic lupus erythematosus.
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Affiliation(s)
- Kazuhiro Honda
- Department of Neurology, Hikone Municipal Hospital, Japan.
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13
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Stojanovich L, Zandman-Goddard G, Pavlovich S, Sikanich N. Psychiatric manifestations in systemic lupus erythematosus. Autoimmun Rev 2007; 6:421-6. [PMID: 17537389 DOI: 10.1016/j.autrev.2007.02.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 02/14/2007] [Indexed: 11/24/2022]
Abstract
Psychiatric abnormalities are common in systemic lupus erythematosus (SLE) with a prevalence of 17% to 75%, reflecting different methods of patient selection and assessment, the different professional orientation of clinicians, and lack of an accepted consensus for diagnosing active neuropsychiatric lupus (NPSLE). The psychiatric syndromes included in the ACR Neuropsychiatric Lupus Nomenclature Committee criteria are cognitive dysfunction, acute confusional state (delirium), anxiety disorder, mood disorder, and psychosis. In SLE patients, identification of psychiatric phenomena and the generation of a differential diagnosis are crucial. Possible mechanisms include vascular injury and pathogenic antibodies. Treatment strategies are based on small case studies. The purpose of this review is to discuss clinical manifestations, pathogenesis and the present therapeutic options in psychiatric lupus.
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Affiliation(s)
- Ljudmila Stojanovich
- Department of Internal Medicine, Bezhanijska Kosa University Medical Center, Belgrade University, Serbia and Montenegro.
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14
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Qing X, Zavadil J, Crosby MB, Hogarth MP, Hahn BH, Mohan C, Gilkeson GS, Bottinger EP, Putterman C. Nephritogenic anti-DNA antibodies regulate gene expression in MRL/lpr mouse glomerular mesangial cells. ACTA ACUST UNITED AC 2006; 54:2198-210. [PMID: 16804897 DOI: 10.1002/art.21934] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Lupus-associated IgG anti-double-stranded DNA antibodies are thought to be pathogenic in the kidney due to cross-reaction with glomerular antigens, leading subsequently to immune complex formation in situ and complement activation. We undertook this study to determine if pathogenic anti-DNA antibodies may also contribute to renal damage by directly influencing mesangial gene expression. METHODS Complementary DNA microarray gene profiling was performed in primary mesangial cells (derived from lupus-prone MRL/lpr mice) treated with pathogenic, noncomplexed anti-DNA antibodies. Significant gene up-regulation induced by anti-DNA antibodies as determined by microarray analysis was further investigated by real-time polymerase chain reaction and methods to detect the relevant proteins. Induction of proinflammatory genes by pathogenic antibodies was confirmed by comparing gene expression in glomeruli of old versus young MRL/lpr mice, and by antibody injection in vivo. RESULTS Pathogenic, but not nonpathogenic, antibodies significantly induced a number of transcripts, including CXCL1/KC, LCN2, iNOS, CX3CL1/fractalkine, SERPINA3G, and IkappaBalpha ("marker genes"). Blocking of Fcgamma receptors or using Fcgamma chain-knockout mesangial cells had no effect on the gene regulation effect of the pathogenic antibody R4A, indicating a non-Fc-dependent mechanism. The glomerular expression of these marker genes increased over time with the development of glomerular antibody deposition and active nephritis in MRL/lpr mice. Moreover, injection of R4A into SCID mice in vivo significantly up-regulated glomerular marker gene expression. CONCLUSION These findings indicate that the renal pathogenicity of anti-DNA antibodies may be attributed in part to their ability to directly modulate gene expression in kidney mesangial cells through both Fc-dependent and non-Fc-dependent mechanisms.
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MESH Headings
- Acute-Phase Proteins/genetics
- Acute-Phase Proteins/metabolism
- Animals
- Antibodies, Antinuclear/adverse effects
- Antibodies, Antinuclear/pharmacology
- Cells, Cultured
- Chemokine CX3CL1
- Chemokine CXCL1
- Chemokines, CX3C/genetics
- Chemokines, CX3C/metabolism
- Chemokines, CXC/genetics
- Chemokines, CXC/metabolism
- Female
- I-kappa B Proteins/genetics
- I-kappa B Proteins/metabolism
- Intercellular Signaling Peptides and Proteins/genetics
- Intercellular Signaling Peptides and Proteins/metabolism
- Kidney Diseases/chemically induced
- Kidney Diseases/physiopathology
- Lipocalin-2
- Lipocalins
- Lupus Vasculitis, Central Nervous System/genetics
- Lupus Vasculitis, Central Nervous System/metabolism
- Lupus Vasculitis, Central Nervous System/pathology
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Mesangial Cells/drug effects
- Mesangial Cells/metabolism
- Mesangial Cells/pathology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred MRL lpr/genetics
- Mice, Knockout
- Mice, SCID
- NF-KappaB Inhibitor alpha
- Nitric Oxide Synthase Type II/genetics
- Nitric Oxide Synthase Type II/metabolism
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Serpins/genetics
- Serpins/metabolism
- Up-Regulation/drug effects
- Up-Regulation/physiology
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Affiliation(s)
- Xiaoping Qing
- Division of Rheumatology, Forchheimer 701N, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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15
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Appenzeller S, Costallat LTL, Li LM, Cendes F. Magnetic resonance spectroscopy in the evaluation of central nervous system manifestations of systemic lupus erythematosus. ACTA ACUST UNITED AC 2006; 55:807-11. [PMID: 17013841 DOI: 10.1002/art.22228] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Pullmann R, Skerenová M, Hybenová J, Lukác J, Rovenský J, Pullmann R. Apolipoprotein E polymorphism in patients with neuropsychiatric SLE. Clin Rheumatol 2004; 23:97-101. [PMID: 15045621 DOI: 10.1007/s10067-003-0796-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2003] [Accepted: 07/28/2003] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate a relationship between neuropsychiatric SLE (NPSLE), characterized by many different neurological and psychiatric disorders, and the polymorphism of apoE as a neurobiologically important molecule conferring increased risk and a worse prognosis of a variety of CNS diseases. One hundred and forty-six SLE patients and 93 healthy controls were studied. Out of the SLE cohort, 48 patients (32.8%) were diagnosed with NPSLE and further classified according to criteria of onset, extent, relapsing tendency and type of neuropsychiatric impairment. Apolipoprotein E (apoE) polymorphism was determined by PCR-RFLP and confirmed by isoelectrofocusing. The frequency of the epsilon4 allele was significantly higher in the NPSLE group than in the non-NPSLE group (17.7% vs. 3.1%, chi(2)=19.05, p<0.0001). Distribution of apoE genotypes was significantly different between NPSLE and non-NPSLE groups (chi(2)=80.95, p<0.0001). Both epsilon4 allele frequency (17.7% vs 8.6%, chi(2)=5.082, p<0.024) and genotype distribution (chi(2)=7.202, p<0.027) were significantly different between NPSLE group and the controls. The allele epsilon4 was also associated with earlier disease onset (Fisher's test, p<0.036) and peripheral nervous system involvement (chi(2)=8.242, p<0.0041), but not with relapse frequency ( p<0.37) or major/minor subtype of the disease ( p<0.90). The epsilon4 allele carriers did not develop significantly more neuropsychiatric syndromes than non- carriers (1.75+/-0.23 sy (mean +/- SD) in epsilon4 vs 1.85+/-0.19 sy (mean +/- SD) in non-epsilon4 carriers, Mann-Whitney test, p<0.78). In conclusion, the data suggest an association between apoE polymorphism and NPSLE.
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Affiliation(s)
- Rudolf Pullmann
- Medical Clinic II, Martin Faculty Hospital, Jessenius Medical Faculty, Kollárova 2, 036 59, Martin, Slovakia
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17
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Kurup RK, Kurup PA. Hypothalamic-mediated model for systemic lupus erythematosis: relation to hemispheric chemical dominance. Int J Neurosci 2003; 113:1561-77. [PMID: 14585754 DOI: 10.1080/00207450390240022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The isoprenoid pathway including endogenous digoxin was assessed in systemic lupus erythematosis (SLE). All the patients with SLE were right-handed/left hemispheric dominant by the dichotic listening test. This was also studied for comparison in patients with right hemispheric and left hemispheric dominance. The isoprenoid pathway was upregulated with increased digoxin synthesis in patients with SLE and in those with right hemispheric dominance. In this group of patients (i) the tryptophan catabolites were increased and the tyrosine catabolites reduced, (ii) the dolichol and glycoconjugate levels were elevated, (iii) lysosomal stability was reduced, (iv) ubiquinone levels were low and free radical levels increased, and (v) the membrane cholesterol:phospholipid ratios were increased and membrane glycoconjugates reduced. On the other hand, in patients with left hemispheric dominance the reverse patterns were obtained. The biochemical patterns obtained in SLE is similar to those obtained in left-handed/right hemispheric chemically dominant individuals. But all the patients with SLE were right-handed/left hemispheric dominant by the dichotic listening test. Hemispheric chemical dominance has no correlation with handedness or the dichotic listening test. SLE occurs in right hemispheric chemically dominant individuals, and is a reflection of altered brain function. The role of the isoprenoid pathway in the pathogenesis of SLE and its relation to hemispheric dominance is discussed.
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Affiliation(s)
- Ravi Kumar Kurup
- Department of Neurology, Medical College Hospital, Trivandrum, Kerala, India
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18
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Abstract
Brain-reactive autoantibodies (BRAA) are thought to play an important role in central nervous system (CNS) manifestations of systemic lupus erythematosus (SLE). Previous studies have shown the existence of BRAA in human and murine SLE. This study was undertaken to establish and characterize the presence of autoantibody binding to brain of autoimmune mice. Laser confocal microscopy was performed on frozen brain sections to detect the presence of immunoglobulin (Ig) in the brain of MRL/lpr and BXSB mice and compare that to control strains of MRL/mp and C57BL/6 mice. There was a dramatic increase in fluorescence in the brains of MRL/lpr and BXSB at 4 months of age. There was little or no Ig detected in the brains of control mice. This increase in presence of Ig in the autoimmune mouse brain was paralleled by an increase in the serum titers of BRAA and anti-DNA autoantibodies as determined by ELISA. These studies provide another link between the existence of brain-reactive autoantibodies and altered CNS functioning.
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Affiliation(s)
- A Zameer
- Department of Microbiology and the Molecular and Cell Biology Program, Arizona State University, Tempe, AZ 85287-2701, USA
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19
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Villarreal J, Crosdale D, Ollier W, Hajeer A, Thomson W, Ordi J, Balada E, Villardell M, Teh LS, Poulton K. Mannose binding lectin and FcgammaRIIa (CD32) polymorphism in Spanish systemic lupus erythematosus patients. Rheumatology (Oxford) 2001; 40:1009-12. [PMID: 11561111 DOI: 10.1093/rheumatology/40.9.1009] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Mannose binding lectin (MBL) and FcgammaRII (CD32) polymorphisms have both been implicated as candidate susceptibility genes in systemic lupus erythematosus (SLE). The aim of this study was to evaluate the relationship of these polymorphisms with SLE. METHODS We studied a cohort of 125 SLE patients from Barcelona, Spain and 138 geographically matched controls. Sequence-specific primer-polymerase chain reaction (SSP-PCR) amplification was used to determine CD32 and MBL structural polymorphisms. MBL haplotypes were established using sequence-specific oligonucleotide probing techniques. RESULTS Patients carried the MBL codon 54 mutant allele more frequently than controls [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.2-4.0; P=0.007] and the haplotype HY W52 W54 W57 was found to be significantly lower in cases compared with controls (OR 0.6; 95% CI 0.4-0.9; P=0.016). CONCLUSION The MBL gene codon 54 mutant allele appears to be a risk factor for SLE, whilst haplotypes encoding for high levels of MBL are protective against the disease. Differences between controls and patients were not significant when considering the FcgammaRIIa polymorphisms; similar results were observed for renal affectation.
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MESH Headings
- Acute-Phase Proteins/genetics
- Acute-Phase Proteins/metabolism
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- DNA/analysis
- Gene Frequency
- Haplotypes
- Humans
- Lectins/genetics
- Lectins/metabolism
- Lupus Erythematosus, Cutaneous/genetics
- Lupus Erythematosus, Cutaneous/metabolism
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/genetics
- Lupus Erythematosus, Systemic/metabolism
- Lupus Nephritis/genetics
- Lupus Nephritis/metabolism
- Lupus Vasculitis, Central Nervous System/genetics
- Lupus Vasculitis, Central Nervous System/metabolism
- Mannose-Binding Lectins
- Mutation
- Polymerase Chain Reaction
- Polymorphism, Genetic
- Receptors, IgG/genetics
- Receptors, IgG/metabolism
- Spain
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Affiliation(s)
- J Villarreal
- Hospital General Vall d'Hebron, Passieg Vall d'Hebron 119-129, Barcelona, Spain
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20
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Svenungsson E, Andersson M, Brundin L, van Vollenhoven R, Khademi M, Tarkowski A, Greitz D, Dahlström M, Lundberg I, Klareskog L, Olsson T. Increased levels of proinflammatory cytokines and nitric oxide metabolites in neuropsychiatric lupus erythematosus. Ann Rheum Dis 2001; 60:372-9. [PMID: 11247868 PMCID: PMC1753603 DOI: 10.1136/ard.60.4.372] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate systemic and intrathecal production of proinflammatory cytokines in relation to cerebrospinal fluid (CSF) nitric oxide (NO) release in patients with neuropsychiatric lupus erythematosus (NPLE). METHODS Thirty patients with NPLE rated as mild, moderate, or severe were studied and CSF was obtained from 21 of these. Cytokine mRNA expressing cells were detected by in situ hybridisation. Soluble cytokines were assessed by enzyme linked immunosorbent assay (ELISA). Nitrite and nitrate were determined by capillary electrophoresis. RESULTS Patients with NPLE had high numbers of lymphocytes expressing mRNA for tumour necrosis factor alpha (TNFalpha), interferon gamma, and interleukin 10 in blood. The number of peripheral blood TNFalpha mRNA positive cells correlated strongly with the level of NO metabolites in the CSF (r(2)=0.69). Both the number of peripheral blood mononuclear cells expressing mRNA for TNFalpha as well as the CSF level of NO metabolites correlated with NPLE disease severity. CONCLUSION These data suggest that increased peripheral production of proinflammatory cytokines such as TNFalpha may contribute both to an increased production of NO in the central nervous system and to generation of clinical NPLE. The data also support the possibility that measurements of NO metabolites in CSF may be of value in the diagnosis of neurological symptoms related to SLE.
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Affiliation(s)
- E Svenungsson
- Department of Medicine, Rheumatology Unit, Karolinska Hospital, S-171 76 Stockholm, Sweden.
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21
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Weiner SM, Otte A, Schumacher M, Brink I, Juengling FD, Sobanksi T, Nitzsche EU, Peter HH. Alterations of cerebral glucose metabolism indicate progress to severe morphological brain lesions in neuropsychiatric systemic lupus erythematosus. Lupus 2000; 9:386-9. [PMID: 10878734 DOI: 10.1191/096120300678828370] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Neuropsychiatric systemic lupus erythematosus (SLE) is frequently associated with deficits in brain glucose metabolism, even if morphological imaging by magnetic resonance imaging (MRI) shows no abnormalities. In these patients it is unclear whether or not the changes of brain metabolism measured by F-18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) may progress to lesions of cerebral structure. We describe a 20-year-old woman with SLE who presented with depression, headache and impairment of memory. Initially, a cranial MRI was negative, but FDG-PET revealed significant hypometabolism in the frontal and parieto-temporo-occipital regions on both sides as well as hypermetabolism in the nuclei caudati. Within two months the patient developed an acute confusional state, seizures, visual disturbances and cranial MRI became positive showing hyperintensities at the basal ganglia and the temporo-occipital regions. Focal cerebral symptoms responded to treatment with high dose corticosteroids and brain lesions in MRI disappeared. However, a second FDG-PET showed persistent hypometabolism at frontal regions in accordance with the persistence of subclinical depression. To our knowledge, this is the first SLE case report showing that functional brain lesions visualized by FDG-PET may be a risk factor for subsequent structural brain damage seen in MRI. Thus, FDG-PET may help to verify cerebral involvement of SLE earlier than MRI.
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Affiliation(s)
- S M Weiner
- Department of Rheumatology and Clinical Immunology, University Hospital, Freiburg, Germany.
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22
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Baraczka K, Pozsonyi T, Nékám K, Virányi M, Seszták M, Szongoth M, Jakab L. Soluble L-selectin levels in serum and cerebrospinal fluid in patients with multiple sclerosis and systemic lupus erythematosus. Acta Neurol Scand 2000; 102:114-7. [PMID: 10949528 DOI: 10.1034/j.1600-0404.2000.102002114.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Soluble L-selectin (sL-selectin) concentrations were measured in paired samples of serum and cerebrospinal fluid by an ELISA method. Patients with several forms of multiple sclerosis (MS) and systemic lupus erythematosus with central nervous system involvement (SLE-CNS) were investigated. Elevated CSF sL-selectin concentrations were found in patients with SLE-CNS (7.62 +/- 3.31 ng/ml) and with relapsing-remitting form of MS (6.99 +/- 4.72 ng/ml) compared to the control group (4.00 +/- 0.95 ng/ml). The data presented suggest some similarities between inflammatory/immunological events in the central nervous system in patients with SLE-CNS and relapsing-remitting form of MS. Immunological heterogeneity in MS is suspected.
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Affiliation(s)
- K Baraczka
- National Institute of Rheumatology and Physiotherapy, III, Clinic of Internal Medicine, Budapest, Hungary
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