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Delimitreva S, Boneva G, Chakarova I, Hadzhinesheva V, Zhivkova R, Markova M, Nikolova V, Kolarov A, Mladenov N, Bradyanova S, Prechl J, Mihaylova N, Tchorbanov A. Lupus progression deteriorates oogenesis quality in MRL/lpr mice. Immunol Res 2024:10.1007/s12026-024-09489-2. [PMID: 38771487 DOI: 10.1007/s12026-024-09489-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the activation of the immune response against self antigens. Numerous reproductive complications, including reduced birth rate and complications for the mother and the fetus during pregnancy, have been observed in women with SLE. In the present study, we aimed to investigate the effect of SLE development on oocyte meiosis in lupus-prone mice. Lupus-prone MRL/lpr mice were used for the experiments: disease-free (4 weeks of age) and sick (20 weeks of age, virgin and postpartum). The immune response was monitored by flow cytometry, ELISpot, ELISA, and histology. Oocytes were analyzed by fluorescence microscopy based on chromatin, tubulin, and actin structures. The lupus-prone MRL/lpr mice developed age-dependent symptoms of SLE with increased levels of various autoantibodies, proteinuria, and renal infiltrates and a tendency for the immune response to worsen with changes in cell populations and the cytokine profile. The number and quality of oocytes were also affected, and the successful pregnancy rate of MRL/lpr mice was limited to only 60%. Isolated oocytes showed severe structural changes in all studied groups. Systemic alterations in immune homeostasis in SLE affect the quality of developing oocytes, which is evident from a young age. The data obtained is in line with the trend of reduced fertility in lupus-prone MRL/lpr mice. The phenomenon can be explained by changes in the microenvironment of the relevant organs and close connection between ovulation and inflammatory processes.
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Affiliation(s)
- Stefka Delimitreva
- Department of Biology, Medical University of Sofia, 2, Zdrave Str., 1431, Sofia, Bulgaria.
| | - Gabriela Boneva
- Department of Immunology, Stefan Angelov Institute of Microbiology, Bulgarian Academy of Sciences, Acad. G. Bonchev Street, Block 26, 1113, Sofia, Bulgaria
| | - Irina Chakarova
- Department of Biology, Medical University of Sofia, 2, Zdrave Str., 1431, Sofia, Bulgaria
| | | | - Ralitsa Zhivkova
- Department of Biology, Medical University of Sofia, 2, Zdrave Str., 1431, Sofia, Bulgaria
| | - Maya Markova
- Department of Biology, Medical University of Sofia, 2, Zdrave Str., 1431, Sofia, Bulgaria
| | - Venera Nikolova
- Department of Biology, Medical University of Sofia, 2, Zdrave Str., 1431, Sofia, Bulgaria
| | - Anton Kolarov
- Department of Biology, Medical University of Sofia, 2, Zdrave Str., 1431, Sofia, Bulgaria
| | - Nikola Mladenov
- Department of Biology, Medical University of Sofia, 2, Zdrave Str., 1431, Sofia, Bulgaria
| | - Silviya Bradyanova
- Department of Immunology, Stefan Angelov Institute of Microbiology, Bulgarian Academy of Sciences, Acad. G. Bonchev Street, Block 26, 1113, Sofia, Bulgaria
| | | | - Nikolina Mihaylova
- Department of Immunology, Stefan Angelov Institute of Microbiology, Bulgarian Academy of Sciences, Acad. G. Bonchev Street, Block 26, 1113, Sofia, Bulgaria
| | - Andrey Tchorbanov
- Department of Immunology, Stefan Angelov Institute of Microbiology, Bulgarian Academy of Sciences, Acad. G. Bonchev Street, Block 26, 1113, Sofia, Bulgaria.
- National Institute of Immunology, 1517, Sofia, Bulgaria.
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Farge D, Pugnet G, Allez M, Castilla-Llorente C, Chatelus E, Cintas P, Faucher-Barbey C, Labauge P, Labeyrie C, Lioure B, Maria A, Michonneau D, Puyade M, Talouarn M, Terriou L, Treton X, Wojtasik G, Zephir H, Marjanovic Z. French protocol for the diagnosis and management of hematopoietic stem cell transplantation in autoimmune diseases. Rev Med Interne 2024; 45:79-99. [PMID: 38220493 DOI: 10.1016/j.revmed.2023.12.008] [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] [Received: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
Hematopoietic stem cell transplantation (HSCT) for severe ADs was developed over the past 25years and is now validated by national and international medical societies for severe early systemic sclerosis (SSc) and relapsing-remitting multiple sclerosis (MS) and available as part of routine care in accredited center. HSCT is also recommended, with varying levels of evidence, as an alternative treatment for several ADs, when refractory to conventional therapy, including specific cases of connective tissue diseases or vasculitis, inflammatory neurological diseases, and more rarely severe refractory Crohn's disease. The aim of this document was to provide guidelines for the current indications, procedures and follow-up of HSCT in ADs. Patient safety considerations are central to guidance on patient selection and conditioning, always validated at the national MATHEC multidisciplinary team meeting (MDTM) based on recent (less than 3months) thorough patient evaluation. HSCT procedural aspects and follow-up are then carried out within appropriately experienced and Joint Accreditation Committee of International Society for Cellular Therapy and SFGM-TC accredited centres in close collaboration with the ADs specialist. These French recommendations were performed according to HAS/FAI2R standard operating procedures and coordinated by the Île-de-France MATHEC Reference Centre for Rare Systemic Autoimmune Diseases (CRMR MATHEC) within the Filière FAI2R and in association with the Filière MaRIH. The task force consisted of 3 patients and 64 clinical experts from various specialties and French centres. These data-derived and consensus-derived recommendations will help clinicians to propose HSCT for their severe ADs patients in an evidence-based way. These recommendations also give directions for future clinical research in this area. These recommendations will be updated according to newly emerging data. Of note, other cell therapies that have not yet been approved for clinical practice or are the subject of ongoing clinical research will not be addressed in this document.
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Affiliation(s)
- D Farge
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de Médecine Interne (UF 04) : CRMR MATHEC, maladies auto-immunes et thérapie cellulaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France; Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, URP-3518, 75010 Paris, France; Department of Medicine, McGill University, H3A 1A1, Montreal, Canada.
| | - G Pugnet
- Service de médecine interne et immunologie clinique, pôle hospitalo-universitaire des maladies digestives, CHU Rangueil, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex 9, France
| | - M Allez
- AP-HP, hôpital Saint-Louis, service d'hépato-gastro-entérologie, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Castilla-Llorente
- Gustave-Roussy cancer center, département d'hématologie, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - E Chatelus
- Département de rhumatologie, hôpitaux universitaires de Strasbourg, Strasbourg, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, Strasbourg, France
| | - P Cintas
- CHU Toulouse Purpan, service de neurologie, place du Dr-Baylac, 31059 Toulouse cedex 9, France
| | - C Faucher-Barbey
- Direction prélèvements et greffes de CSH, Direction médicale et scientifique, Agence de la biomédecine, 93212 St-Denis/La Plaine, France
| | - P Labauge
- CRC SEP, service de neurologie, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - C Labeyrie
- AP-HP, CHU de Bicêtre, service de neurologie, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - B Lioure
- Département d'onco-hématologie, université de Strasbourg, ICANS, Strasbourg, France
| | - A Maria
- Médecine interne & immuno-oncologie (MedI2O), Institute for Regenerative Medicine & Biotherapy (IRMB), hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, Montpellier, France; IRMB, Inserm U1183, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier, France
| | - D Michonneau
- Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, URP-3518, 75010 Paris, France; Service d'hématologie-greffe, AP-HP, hôpital Saint-Louis, institut de recherche Saint-Louis, Paris, France
| | - M Puyade
- CHU de Poitiers, service de médecine interne, 2, rue de La-Miletrie, 86021 Poitiers, France
| | - M Talouarn
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - L Terriou
- CHU de Lille, département de médecine interne et immunologie clinique, 59000 Lille, France; Centre de référence des maladies auto-immunes et auto-inflammatoires rares (CERAINO), 59000 Lille, France
| | - X Treton
- Université de Paris, hôpital Beaujon, service de gastro-entérologie, MICI et assistance nutritive, DMU DIGEST, 100, boulevard Leclerc, 92110 Clichy, France
| | - G Wojtasik
- Université de Lille, Inserm, CHU de Lille, service de médecine interne et immunologie clinique, Centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institut de recherche translationnelle sur l'inflammation, Lille, France
| | - H Zephir
- CHU de Lille, université de Lille, pôle des neurosciences et de l'appareil locomoteur, Lille Inflammation Research International Center (LIRIC), UMR 995, rue Émile-Laine, 59000 Lille, France
| | - Z Marjanovic
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Roberts WN, Lew ER, Liang MH. Hal Holman of Stanford. Rheum Dis Clin North Am 2024; 50:133-146. [PMID: 37973281 DOI: 10.1016/j.rdc.2023.08.011] [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: 11/19/2023]
Abstract
Before age 35, Holman hit over 0.500 at the University of California Los Angeles (UCLA); was recruited by professional baseball; led the Association of Interns and Medical Students and the International Union of Students in Denmark; had his passport confiscated; was stripped of a prestigious internship; shadowed by the Federal Bureau of Investigation ; grilled before a Senate committee on subversive activities; made a major medical discovery; and was recruited to be the new Chief of Medicine at Stanford. Holman was involved in building a leading academic institution. He expanded what medical students and graduates learned and what they researched. Holman saw the collision course between the technological capacity to do more and the growing expectations of the public. Moreover, he anticipated the monetization of health care and how it would widen the gap between what we know and what we practice in health care. He reinvented himself in population health. In contrast to reductionist laboratory-based research, his work embraced complexity and made action researchable and research action-oriented. Some innovations did not survive as originally conceived, but their ethos became mainstream. These included evidence-based management, shared physician-patient decision-making, self-management, critical evaluation of medical technology and diagnostics, and chronic disease management. Through the rise of the twentieth century American biomedical medicine, medical education, and slow-motion health care delivery crises that still occur, Holman changed the debate in a time when the funding, the people, the technology, and the need made all things seem possible.
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Affiliation(s)
- William Neal Roberts
- Division of Rheumatology, University of Kentucky Medical Center, Lexington, KY, USA.
| | - Edward R Lew
- Department of Political Science and Legal Studies, University of Massachusetts Amherst, 150 South Huntington Avenue, Boston, MA 02130, USA
| | - Matthew H Liang
- Rheumatology Section, Jamaica Plain VA Medical Center, 150 South Huntington Avenue, Boston, MA 02130, USA; Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
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Abdelsalam M, Zaki MES, Abo El-Kheir NY, Foda Salama M, Osman AOBS. Study of MicroRNA-124 in Patients with Lupus Nephritis. Endocr Metab Immune Disord Drug Targets 2024; 24:EMIDDT-EPUB-137379. [PMID: 38317459 DOI: 10.2174/0118715303250919231010073608] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/24/2023] [Accepted: 08/06/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Lupus nephritis is associated with a six-fold increase in mortality compared with the general population. MicroRNAs studies revealed that increased MicroRNA -21 and MicroRNA -155 levels represent risk factors for active LN patients. MicroRNAs can be used as biomarkers in the diagnosis of clinical stages of LN. OBJECTIVES The present study aimed to determine the level of miR-124 in patients with lupus nephritis by reverse transcriptase real-time polymerase chain reaction compared to healthy control and correlate its levels with biochemical findings in those patients. METHODS The study was a case-control study that included fifty patients with lupus nephritis in addition to fifty healthy controls. Blood samples from the participants were subjected to the determination of serological markers of SLE. Moreover, real-time PCR was used for the determination of miR-124. RESULTS The comparison of Micro-RNA124 between patients and control subjects revealed a statistically significant decrease in Micro-RNA124 in patients (1.193 ± 0.56) compared to the control (3.36 ± 0.50, p <0.001); the comparison of the level of MicroRNA 124 in the patients with different clinical and serological findings of SLE revealed a significant decrease in the level of MicroRNA 124 in patients with muscular findings (1.02 ± 0.5) compared to the patients with negative manifestations (1.47 ± 0.5, p =0.005) Conclusion: In the present study, a comparison of MicroRNA-124 in LN patients with different stages compared to normal control showed a statistically significant decrease in Micro-RNA124 in patients with lupus nephritis p <0.001 with significant correlation to the patients' different clinical and serological findings of SLE. Therefore, it may be used as a new noninvasive therapeutic approach to monitor response to therapy, predict relapses, and identify the degree of the activity of the disease or the progression to the chronic stage.
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Affiliation(s)
- Mostafa Abdelsalam
- Department of Internal Medicine, Mansoura Faculty of Medicine, Mansoura University, Egypt Nephrology and Dialysis Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt
| | | | | | - Mona Foda Salama
- Department of Medical Microbiology and Immunology-Mansoura Faculty of Medicine, Egypt
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Gibson S, Johnson N, Simpson Brown S, Hartley S, Maloney K, Gossell-Williams M, Hunter T. Pregnancy outcomes in systemic lupus erythematosus: experience from a Caribbean center. J Matern Fetal Neonatal Med 2023; 36:2204392. [PMID: 37127567 DOI: 10.1080/14767058.2023.2204392] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a chronic autoimmune multi-system disorder frequently affecting black women of childbearing age. No published data exist on the obstetric outcomes in a Caribbean population. OBJECTIVE We analyzed pregnancy outcomes in an Afro-Caribbean cohort of women with SLE at a tertiary university hospital. METHODS A retrospective cohort study was performed of all pregnant women with SLE prior to pregnancy from January 1990 to December 2021 at the University Hospital of the West Indies (UHWI), Jamaica. Maternal rheumatologic, obstetric, fetal/neonatal data were analyzed. Descriptive statistical analyses were performed. To determine if outcomes were associated with various factors, Spearman's rho was followed by logistic regression analysis to estimate unadjusted odds ratios with statistical significance at p < 0.05. RESULTS A total of 56 pregnancies in 47 women were identified with SLE. Live births were 87.5%, with 10.7% spontaneous miscarriages and no neonatal deaths. Prednisone was the most used drug in 67.9% of patients. 85% of women had an adverse outcome with an adverse fetal outcome occurring in 55% of cases. Prednisone was associated with an adverse fetal/neonatal outcome (Spearman's rho = 0.38; p = .004). CONCLUSION In this first Caribbean series on SLE in pregnancy, reasonably successful pregnancy outcomes are achievable in Afro-Caribbean women managed in multidisciplinary centers.
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Affiliation(s)
- Shanea Gibson
- Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston
| | - Nadine Johnson
- Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston
| | - Simone Simpson Brown
- Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston
| | - Shwantay Hartley
- Department of Basic Medical Sciences, University of the West Indies, Mona, Kingston
| | - Keisha Maloney
- Department of Medicine, University of the West Indies, Mona, Kingston
| | | | - Tiffany Hunter
- Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston
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Hajji M, Gorsane I, Badrouchi S, Litaiem N, Rammeh S, Ben Hamida F, Abderrahim E. Systemic lupus erythematosus presenting as lupus erythematosus tumidus and lupus nephritis: a case report. J Med Case Rep 2023; 17:242. [PMID: 37312164 DOI: 10.1186/s13256-023-03981-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Lupus nephritis and lupus erythematosus tumidus (LET) are uncommon manifestations of systemic lupus erythematosus (SLE), and their coexistence as the initial presentation of SLE is exceedingly rare. Here, we report such a case, emphasizing the diagnostic challenges and therapeutic implications of this unusual association. CASE REPORT A 38-year-old North African woman presented in Nephrology department with a history of lower extremity edema, fatigue, and weight loss of 3 kg in 4 weeks. Physical examination revealed LET lesions on the chest and the Neck. Laboratory investigations showed lymphopenia, low C3 and C4 complement levels, positive antinuclear antibodies, anti-dsDNA antibodies, and anti-SSA/Ro antibodies. Renal function tests showed normal serum creatinine and nephrotic proteinuria. Renal biopsy revealed Class V lupus nephritis. Skin biopsy confirmed the diagnosis of LET, with the presence of lymphohistiocytic infiltrates and dermal mucin. The patient was diagnosed with SLE based on the 2019 EULAR/ACR criteria and treated with prednisone (1 mg/kg/day) and hydroxychloroquine. She showed significant improvement in her cutaneous and renal symptoms at 6 and 12 months follow-up. CONCLUSION The rarity of the coexistence of LET and lupus nephritis as the initial manifestation of SLE, especially in the North African population, underscores the need for further research to elucidate the immunopathogenic mechanisms and prognostic factors associated with this association.
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Affiliation(s)
- Meriam Hajji
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia.
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia.
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia.
| | - Imen Gorsane
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Samaraa Badrouchi
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Noureddine Litaiem
- Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Soumaya Rammeh
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Fethi Ben Hamida
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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Scherlinger M, Sibilia J, Tsokos GC, Gottenberg JE. Chronic stimulation with SARS-CoV-2 spike protein does not trigger autoimmunity. Clin Immunol 2023; 248:109264. [PMID: 36804225 PMCID: PMC9931423 DOI: 10.1016/j.clim.2023.109264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023]
Abstract
Autoimmune manifestations were reported in people infected with SARS-CoV-2. Repetitive exposure of mice to foreign antigen may lead to the onset of autoimmunity. We therefore investigated whether repetitive exposure to the SARS-CoV-2 spike protein could result in autoimmunity. To address this hypothesis, we repeatedly immunized C57Bl/6 mice with spike protein injected intraperitoneally. At the end of the immunization, mice which received spike protein produced anti-spike IgG but none of them developed anti-dsDNA antibodies or proteinuria. In conclusion, repetitive immunization with SARS-CoV-2 spike protein does not induce autoimmunity in the present mice model. Albeit reassuring, these results need to be confirmed by large epidemiological study evaluating the incidence of autoimmune diseases in individuals with repetitive SARS-CoV-2 antigen exposure.
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Affiliation(s)
- Marc Scherlinger
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Rheumatology department, Centre national de référence maladie auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg University Hospital, Strasbourg University, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut national de la santé et de la recherche médicale (INSERM) UMR_S 1109, Strasbourg, France.
| | - Jean Sibilia
- Rheumatology department, Centre national de référence maladie auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg University Hospital, Strasbourg University, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut national de la santé et de la recherche médicale (INSERM) UMR_S 1109, Strasbourg, France
| | - George C Tsokos
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jacques-Eric Gottenberg
- Rheumatology department, Centre national de référence maladie auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg University Hospital, Strasbourg University, France; Immunologie, Immunopathologie et Chimie Thérapeutique (I2CT)-UPR3572 CNRS, Institut de Biologie Moléculaire et Cellulaire (IBMC), 67084 Strasbourg, France
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Ferreira De Matos C, De Almeida Chaves S, Potin P, Syrykh C, Piel-Julian ML, Sailler L, Moulis G. [Castleman-like presentation of systemic lupus: About a case report]. Rev Med Interne 2023; 44:85-8. [PMID: 36055947 DOI: 10.1016/j.revmed.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/29/2022] [Accepted: 08/21/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Castleman disease is a rare lymphoproliferation, which may mimic systemic lupus. Conversely, systemic lupus sometimes presents like an hematological malignancy. In these cases, a "Castleman-like" histology has been exceptionally described. OBSERVATION A 55-year-old female treated by methotrexate for systemic lupus with skin and joint involvement presented weight loss, polyadenopathy and clinical signs of lupus flare. Biology showed pancytopenia, complement activation, and positive anti-DNA antibodies. PET/CT showed hypermetabolic polyadenopathy. The lymph node biopsy showed "Castleman-like" features. Treatment with corticosteroids and azathioprine resulted in complete remission. CONCLUSION Systemic lupus and Castleman disease may share common clinical, biological, and histological features. The presence of specific elements of systemic lupus flare and the remission obtained by low-dose corticosteroids results in considering the diagnosis of Castleman-like systemic lupus and avoiding treatment intensification.
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Ferri C, Gragnani L, Raimondo V, Visentini M, Giuggioli D, Lorini S, Foti R, Cacciapaglia F, Caminiti M, Olivo D, Cuomo G, Pellegrini R, Pigatto E, Urraro T, Naclerio C, Tavoni A, Puccetti L, Cavazzana I, Ruscitti P, Vadacca M, La Gualana F, Cozzi F, Spinella A, Visalli E, Bosco YD, Amato G, Masini F, Mariano GP, Brittelli R, Aiello V, Scorpiniti D, Rechichi G, Varcasia G, Monti M, Elia G, Franceschini F, Casato M, Ursini F, Giacomelli R, Fallahi P, Santini SA, Iannone F, Salvarani C, Zignego AL, Antonelli A. Absent or suboptimal response to booster dose of COVID-19 vaccine in patients with autoimmune systemic diseases. J Autoimmun 2022; 131:102866. [PMID: 35841684 PMCID: PMC9271490 DOI: 10.1016/j.jaut.2022.102866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022]
Abstract
Autoimmune systemic diseases (ASD) show impaired immunogenicity to COVID-19 vaccines. Our prospective observational multicenter study aimed at evaluating the seroconversion elicited by COVID-19 vaccine over the entire vaccination cycle including the booster dose. Among 478 unselected ASD patients originally evaluated at the end of the first vaccination cycle (time 1), 344 individuals were re-evaluated after a 6-month period (time 2), and 244 after the booster vaccine dose (time 3). The immunogenicity of mRNA COVID-19 vaccines (BNT162b2 and mRNA-1273) was assessed by measuring serum IgG-neutralizing antibody (NAb) on samples obtained at the three time points in both patients and 502 age-matched controls. In the 244 ASD group that received booster vaccine and monitored over the entire follow-up, the mean serum NAb levels (time 1, 2, and 3: 696.8 ± 52.68, 370.8 ± 41.92, and 1527 ± 74.16SD BAU/mL, respectively; p < 0.0001) were constantly lower compared to controls (p < 0.0001), but they significantly increased after the booster dose compared to the first two measurements (p < 0.0001). The percentage of patients with absent/suboptimal response to vaccine significantly decreased after the booster dose compared to the first and second evaluations (time 1, 2, and 3: from 28.2% to 46.3%, and to 7.8%, respectively; p < 0.0001). Of note, the percentage of patients with absent/suboptimal response after the booster dose was significantly higher compared to controls (19/244, 7.8% vs 1/502, 0.2%; p < 0.0001). Similarly, treatment with immune-modifiers increased the percentage of patients exhibiting absent/suboptimal response (16/122, 13.1% vs 3/122, 2.46%; p = 0.0031). Overall, the above findings indicate the usefulness of booster vaccine administration in ASD patients. Moreover, the persistence of a significantly higher percentage of individuals without effective seroconversion (7.8%), even after the booster dose, warrants for careful monitoring of NAb levels in all ASD patients to identify those with increased risk of infection. In this particularly frail patients’ setting, tailored vaccination and/or therapeutic strategy are highly advisable.
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Affiliation(s)
- Clodoveo Ferri
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy; Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy.
| | - Laura Gragnani
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence Center, Center for Research and Innovation CRIA-MASVE, Firenze, Italy
| | - Vincenzo Raimondo
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | - Serena Lorini
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence Center, Center for Research and Innovation CRIA-MASVE, Firenze, Italy
| | - Rosario Foti
- AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Maurizio Caminiti
- UOD Reumatologia- Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Domenico Olivo
- Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy
| | | | | | | | - Teresa Urraro
- Rheumatology Unit, "M. Scarlato" Hospital, Scafati (SA), Italy
| | | | | | | | | | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marta Vadacca
- Unità Operativa di Immunoreumatologia-Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Italy
| | - Francesca La Gualana
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Amelia Spinella
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | | | | | | | | | | | | | - Vincenzo Aiello
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | | | - Giovanni Rechichi
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | | | - Monica Monti
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence Center, Center for Research and Innovation CRIA-MASVE, Firenze, Italy
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | | | - Milvia Casato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Ursini
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto Giacomelli
- Unità Operativa di Immunoreumatologia-Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Italy
| | - Poupak Fallahi
- Department of Translational Research & New Technologies in Medicine and Surgery, University of Pisa, School of Medicine, Pisa, Italy
| | - Stefano Angelo Santini
- Department of Basic, Clinical, Intensive and Perioperative Biotechnological Sciences, Catholic University School of Medicine, Rome, Italy; Synlab Italia, Monza (MB), Italy
| | | | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | - Anna Linda Zignego
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence Center, Center for Research and Innovation CRIA-MASVE, Firenze, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
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10
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Ferri C, Ursini F, Gragnani L, Raimondo V, Giuggioli D, Foti R, Caminiti M, Olivo D, Cuomo G, Visentini M, Cacciapaglia F, Pellegrini R, Pigatto E, Urraro T, Naclerio C, Tavoni A, Puccetti L, Varcasia G, Cavazzana I, L'Andolina M, Ruscitti P, Vadacca M, Gigliotti P, La Gualana F, Cozzi F, Spinella A, Visalli E, Dal Bosco Y, Amato G, Masini F, Pagano Mariano G, Brittelli R, Aiello V, Caminiti R, Scorpiniti D, Rechichi G, Ferrari T, Monti M, Elia G, Franceschini F, Meliconi R, Casato M, Iannone F, Giacomelli R, Fallahi P, Santini SA, Zignego AL, Antonelli A. Impaired immunogenicity to COVID-19 vaccines in autoimmune systemic diseases. High prevalence of non-response in different patients' subgroups. J Autoimmun 2021; 125:102744. [PMID: 34781162 PMCID: PMC8577991 DOI: 10.1016/j.jaut.2021.102744] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 02/02/2023]
Abstract
Autoimmune systemic diseases (ASD) may show impaired immunogenicity to COVID-19 vaccines. Our prospective observational multicenter study aimed to evaluate the seroconversion after the vaccination cycle and at 6-12-month follow-up, as well the safety and efficacy of vaccines in preventing COVID-19. The study included 478 unselected ASD patients (mean age 59 ± 15 years), namely 101 rheumatoid arthritis (RA), 38 systemic lupus erythematosus (SLE), 265 systemic sclerosis (SSc), 61 cryoglobulinemic vasculitis (CV), and a miscellanea of 13 systemic vasculitis. The control group included 502 individuals from the general population (mean age 59 ± 14SD years). The immunogenicity of mRNA COVID-19 vaccines (BNT162b2 and mRNA-1273) was evaluated by measuring serum IgG-neutralizing antibody (NAb) (SARS-CoV-2 IgG II Quant antibody test kit; Abbott Laboratories, Chicago, IL) on samples obtained within 3 weeks after vaccination cycle. The short-term results of our prospective study revealed significantly lower NAb levels in ASD series compared to controls [286 (53–1203) vs 825 (451–1542) BAU/mL, p < 0.0001], as well as between single ASD subgroups and controls. More interestingly, higher percentage of non-responders to vaccine was recorded in ASD patients compared to controls [13.2% (63/478), vs 2.8% (14/502); p < 0.0001]. Increased prevalence of non-response to vaccine was also observed in different ASD subgroups, in patients with ASD-related interstitial lung disease (p = 0.009), and in those treated with glucocorticoids (p = 0.002), mycophenolate-mofetil (p < 0.0001), or rituximab (p < 0.0001). Comparable percentages of vaccine-related adverse effects were recorded among responder and non-responder ASD patients. Patients with weak/absent seroconversion, believed to be immune to SARS-CoV-2 infection, are at high risk to develop COVID-19. Early determination of serum NAb after vaccination cycle may allow to identify three main groups of ASD patients: responders, subjects with suboptimal response, non-responders. Patients with suboptimal response should be prioritized for a booster-dose of vaccine, while a different type of vaccine could be administered to non-responder individuals.
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Affiliation(s)
- Clodoveo Ferri
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy; Rheumatology Clinic 'Madonna Dello Scoglio' Cotronei, Crotone, Italy.
| | - Francesco Ursini
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Gragnani
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence Center, Center for Research and Innovation CRIA-MASVE, Firenze, Italy
| | - Vincenzo Raimondo
- Rheumatology Clinic 'Madonna Dello Scoglio' Cotronei, Crotone, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | - Rosario Foti
- Rheumatology Unit AOU Policlinico G. Rodolico - S. Marco, Catania. Italy
| | - Maurizio Caminiti
- UOD Reumatologia- Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Domenico Olivo
- Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy
| | - Giovanna Cuomo
- University of Campania Luigi Vanvitelli, Department of Precision Medicine, Napoli, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Teresa Urraro
- Rheumatology Unit, "M. Scarlato" Hospital, Scafati, SA, Italy
| | | | | | | | | | | | - Massimo L'Andolina
- Rheumatology Outpatient Clinic, ASP- Vibo Valentia-Tropea Hospital, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marta Vadacca
- Unità Operativa di Immunoreumatologia-Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Italy
| | | | - Francesca La Gualana
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Amelia Spinella
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | - Elisa Visalli
- Rheumatology Unit AOU Policlinico G. Rodolico - S. Marco, Catania. Italy
| | - Ylenia Dal Bosco
- Rheumatology Unit AOU Policlinico G. Rodolico - S. Marco, Catania. Italy
| | - Giorgio Amato
- Rheumatology Unit AOU Policlinico G. Rodolico - S. Marco, Catania. Italy
| | - Francesco Masini
- University of Campania Luigi Vanvitelli, Department of Precision Medicine, Napoli, Italy
| | | | | | - Vincenzo Aiello
- Rheumatology Clinic 'Madonna Dello Scoglio' Cotronei, Crotone, Italy
| | - Rodolfo Caminiti
- Rheumatology Clinic 'Madonna Dello Scoglio' Cotronei, Crotone, Italy
| | | | - Giovanni Rechichi
- Rheumatology Clinic 'Madonna Dello Scoglio' Cotronei, Crotone, Italy
| | | | - Monica Monti
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence Center, Center for Research and Innovation CRIA-MASVE, Firenze, Italy
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | | | - Riccardo Meliconi
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milvia Casato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Giacomelli
- Unità Operativa di Immunoreumatologia-Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Italy
| | - Poupak Fallahi
- Department of Translational Research & New Technologies in Medicine and Surgery, University of Pisa, School of Medicine, Pisa, Italy
| | - Stefano Angelo Santini
- Department of Basic, Clinical, Intensive and Perioperative Biotechnological Sciences, Catholic University School of Medicine, Rome, Italy; Synlab Italia, Monza, MB, Italy
| | - Anna Linda Zignego
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence Center, Center for Research and Innovation CRIA-MASVE, Firenze, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
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Aldhahi MI, Wooten LC, Hasni S, Mikdashi J, Keyser RE. The association of breathing pattern with exercise tolerance and perceived fatigue in women with systemic lupus erythematosus: an exploratory case-control study. Rheumatol Int 2021. [PMID: 34727196 DOI: 10.1007/s00296-021-05005-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/19/2021] [Indexed: 10/19/2022]
Abstract
The aims of the study were to (1) to characterize the breathing pattern and work of breathing during peak exercise in patients with SLE; (2) to examine the extent to which the breathing pattern and work of breathing impact the exercise capacity and fatigue. Forty-one women participated in the study (SLE: n = 23, median = 35, range = 21-57 years, control: n = 18, median = 38, range = 22-45 years). Each subject performed a treadmill cardiopulmonary exercise test (a modified Bruce treadmill protocol) ending with volitional exhaustion. Breathing mechanic was characterized by measures of expired minute volume (VE), tidal volume (Vt), respiratory rate (f), work of breathing, and cardiorespiratory fitness was quantified by measures of peak oxygen consumption (VO2) and time to exhaustion. Data presented as median and interquartile range (IQR). Women with SLE had lower Vt {1221 [488.8] mL/min vs. 1716 [453.1] mL; p = .006}, VE {58.9 [18.9] L/min vs 70 [28.1] L/min, p = 0.04} and increased breathing frequency {51.5 [10.8] vs 43.6 [37.8] bpm, p = 0.01} compared to the control group. The time to exhaustion and peak VO2 during the CPET were significantly reduced in those with SLE compared to controls {13.3 [10.2] vs 16.1 [2.2] min; p = 0.004}, {20 [6.1] mL/kg/min vs 26.6 [7] mL/kg/min p < 0.001}, respectively. Differences remained when the analyses were controlled for the observed differences in peak VO2. When the regression model adjusted for the peak VO2, it had been shown that Vt, WOB and f were explained variances in the fatigue severity by 64% [p < 0.001]. The decline in VE and Vt coupled with a decreased peak VO2, and work of breathing may have contributed to low cardiorespiratory fitness and fatigue in patients with systemic lupus erythematosus.
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Martis N, Jamme M, Bagnis-Isnard C, Pouteil-Noble C, Presne C, Vigneau C, Grangé S, Burtey S, Coindre JP, Wynckel A, Hamidou MA, Kanouni T, Azoulay E, Hié M, Chauveau D, Veyradier A, Rondeau E, Coppo P. Systemic autoimmune disorders associated with thrombotic microangiopathy: A cross-sectional analysis from the French National TMA registry: Systemic autoimmune disease-associated TMA. Eur J Intern Med 2021; 93:78-86. [PMID: 34175183 DOI: 10.1016/j.ejim.2021.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
CONTEXT The management of systemic auto-immune diseases (SAID) -associated thrombotic microangiopathies (TMA) [SAID-TMA] remains debated. OBJECTIVES To provide a demographic, clinical and therapeutic picture of SAID-TMA. METHODS A cross-sectional analysis was conducted on adult patients presenting with SAID and TMA from the French National TMA Registry over a 20-year period. Clinical features were extracted and compared to those from a historical cohort of atypical haemolytic and uremic syndrome (aHUS) patients. RESULTS Forty-one patients with SAID-TMA were compared to 78 patients with aHUS from a historical cohort. Connective tissue diseases (CTD) were systemic lupus erythematosus (n=18), primary Sjögren's syndrome (n=7), systemic sclerosis (n=11), mixed CTD (n=2) and 2 cases of vasculitides, including 7 overlapping forms and 8 cases of primary antiphospholipid syndromes (APLS). Patients with SAID-TMA generally had pre-existing chronic kidney failure (OR= 3.17, 95%CI: 1.204 to 7.923; p= 0.016) compared to aHUS patients, though creatinine levels were significantly lower (216 [IQR, 108-334] µmol/L vs. 368 [IQR, 170-722] µmol/L; p= 0.002). Patients were less likely to recover if renal replacement therapy was needed at onset (OR= 0.07; 0.02 to 0.34; p <0.0005). Two patients died. Thirty patients responded to immunosuppressive treatment and complete remission was achieved in 25 cases. By contrast, therapeutic plasma exchange (TPE) did not have an early effect on TMA features at Day-7 nor Day-15 (p >0.05). CONCLUSION The management of SAID-TMA implies an early initiation of immunosuppressive drugs for flares of the associated SAID, whereas TPE seem ineffective. KEY MESSAGES.
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Affiliation(s)
- Nihal Martis
- Internal Medicine Department, University Hospital of Nice; Côte d'Azur University, Nice, France; French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France.
| | - Matthieu Jamme
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, C.H. Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France
| | | | - Claire Pouteil-Noble
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Édouard Herriot Hospital, Lyon, France
| | - Claire Presne
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Hôpital Sud, Amiens, France
| | - Cécile Vigneau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; University of Rennes, University Hospital of Rennes - Inserm, EHESP, Institut de recherche en santé, Environnement et Travail - UMR_S 1085, F-35000 Rennes, France
| | - Steven Grangé
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Intensive Care Unit, C.H.U Rouen, Rouen, France
| | - Stéphane Burtey
- Nephrology Department, C.H.U. de la Conception, Marseille, France
| | | | - Alain Wynckel
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Hôpital Maison Blanche, Reims Cedex, France
| | - Mohamed A Hamidou
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Internal Medicine Department, Hôtel Dieu Hospital, Nantes, France
| | - Tarik Kanouni
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Therapeutic Apheresis Department, C.H.U de Montpellier, Montpellier, France
| | - Elie Azoulay
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Medical Intensive Care Unit, Saint-Louis Hospital, Paris, France
| | - Miguel Hié
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Internal Medicine Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Dominique Chauveau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology and Kidney transplant Unit, Rangueil Hospital, Toulouse, France
| | - Agnès Veyradier
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Haemostasis Department, Lariboisière Hospital, Paris, France
| | - Eric Rondeau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology and Kidney transplant Unit, Tenon Hospital, Paris, France
| | - Paul Coppo
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Haematology Department, Saint-Antoine Hospital, Paris, France; Sorbonne University, Paris, France.
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Popper H, Stacher-Priehse E, Brcic L, Nerlich A. Lung fibrosis in autoimmune diseases and hypersensitivity: how to separate these from idiopathic pulmonary fibrosis. Rheumatol Int 2021; 42:1321-1330. [PMID: 34605934 PMCID: PMC9287245 DOI: 10.1007/s00296-021-05002-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
Lung involvement in autoimmune diseases (AID) is uncommon, but may precede other organ manifestations. A diagnostic problem is chronicity presenting with lung fibrosis. A new category of interstitial pneumonia with autoimmune features for patients with clinical symptoms of AID and presenting with usual interstitial pneumonia (UIP) enables antifibrotic treatment for these patients. Hypersensitivity pneumonia (HP) and other forms of lung fibrosis were not included into this category. As these diseases based on adverse immune reactions often present with unspecific clinical symptoms, a specified pathological diagnosis will assist the clinical evaluation. We aimed to establish etiology-relevant differences of patterns associated with AID or HP combined with lung fibrosis. We retrospectively evaluated 51 cases of AID, and 29 cases of HP with lung fibrosis, and compared these to 24 cases of idiopathic pulmonary fibrosis (UIP/IPF). Subacute AID and HP most often presented with organizing pneumonia (OP), whereas chronicity was associated with UIP. Unspecified fibrosis was seen in a few cases, whereas NSIP pattern was rare. In 9 cases, the underlying etiology could not be defined. Statistically significant features differentiating chronic AID or HP from UIP/IPF are lymphocytic infiltrations into myofibroblastic/fibroblastic foci. Other features significantly associated with AID and HP were granulomas, isolated Langhans giant cells, and protein deposits, but seen in only a minority of cases. A combination of UIP with one of these features enabled a specific etiology-based diagnosis. Besides the antifibrotic drug regimen, additional therapies might be considered.
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Affiliation(s)
- Helmut Popper
- Medical University Graz, Diagnostic and Research Institute of Pathology, Neue Stiftingtalstr. 6, 8036, Graz, Austria.
| | | | - Luka Brcic
- Medical University Graz, Diagnostic and Research Institute of Pathology, Neue Stiftingtalstr. 6, 8036, Graz, Austria
| | - Andreas Nerlich
- Department of Pathology, Teaching Hospital Munich-Bogenhausen, Munich, Germany
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14
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Dima A, Abida R, Sadovici-Bobeica V, Delcea C. Systemic lupus erythematosus on social networking sites: Friends or foes? Lupus 2021; 30:1873-1878. [PMID: 34455855 DOI: 10.1177/09612033211038053] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is one of the most studied autoimmune diseases. The interest shown for this pathology is translated into international scientific journals, congresses, meetings and, recently, in large data available online. Social networking sites (SNS) have gradually advanced from ways to facilitate interpersonal relations to important sources of information, including medical data regarding SLE, with sites largely accessed by both doctors and patients. Albeit the use of SNS can be valuable in providing education and promoting development of public health, it can be misleading if unprofessional sources of information are used; therefore, both "friends and foes" of the data accessed on large scale should always be considered. This viewpoint is a discussion of the potential benefits and harms related to the SNS use for SLE patients as well as for their physicians.
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Affiliation(s)
- Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Rym Abida
- Department of Internal Medicine, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Victoria Sadovici-Bobeica
- Department of Internal Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova
| | - Caterina Delcea
- Department of Cardiology, Colentina Clinical Hospital, Bucharest, Romania.,Department of Internal Medicine, 87267Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Bradyanova S, Mihaylova N, Chipinski P, Manassiev Y, Herbáth M, Kyurkchiev D, Prechl J, Tchorbanov AI. Anti-ANX A1 Antibody Therapy in MRL/lpr Murine Model of Systemic Lupus Erythematosus. Arch Immunol Ther Exp (Warsz) 2021; 69:19. [PMID: 34322760 DOI: 10.1007/s00005-021-00624-7] [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] [Received: 02/01/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
Systemic lupus erythematosus (SLE) is a severe autoimmune disease characterized by dysfunction of immune regulation, overproduction of inflammatory cytokines and attack on normal tissues by self-reactive cells and antibodies. The main role in the pathogenesis plays the autoreactive tandem of B-T cells, responsible for lupus progression and acceleration. Both activated B and T cells express a phospholipid binding protein Annexin A1 and abnormal levels of the protein were found in murine and human autoimmune syndromes, potentiating its role as a therapeutic target. Here, using anti-annexin A1 antibody we explore its property to modulate the autoimmune response in MRL/lpr mouse model of lupus. Anti-ANX A1 antibody was tested in vitro using spleen cells from MRL/lpr mice to determine the effect on lymphocyte activation, plasma cells differentiation, apoptosis and proliferation by flow cytometry and ELISpot assays. Subsequently, several groups of young (disease-free) and old (sick) MRL/lpr mice were treated with the antibody to determine the levels of panel auto-antibodies and cytokines, T cell arrest and migration. Treatment of splenocytes with anti-ANX A1 antibody inhibited T-cell activation and proliferation, suppressed anti-dsDNA antibody-producing plasma cells and affected B cell apoptosis. Administration of the antibody to MRL/lpr mice resulted to decreased autoantibody levels to various lupus antigens, suppressed T cell migration from lymph nodes and increased the levels of IL4 mRNA compared to the control group. Anti-ANX A1 antibody therapy suppresses B and T cell over-activation and down- modulates disease activity.
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Affiliation(s)
- Silvya Bradyanova
- Laboratory of Experimental Immunology, Stefan Angelov Institute of Microbiology, Bulgarian Academy of Sciences, Acad. G. Bonchev Street, Block 26, 1113, Sofia, Bulgaria
| | - Nikolina Mihaylova
- Laboratory of Experimental Immunology, Stefan Angelov Institute of Microbiology, Bulgarian Academy of Sciences, Acad. G. Bonchev Street, Block 26, 1113, Sofia, Bulgaria
| | - Petroslav Chipinski
- Laboratory of Experimental Immunology, Stefan Angelov Institute of Microbiology, Bulgarian Academy of Sciences, Acad. G. Bonchev Street, Block 26, 1113, Sofia, Bulgaria
| | - Yordan Manassiev
- Department of General Microbiology, Institute of Microbiology, Bulgarian Academy of Sciences, 1113, Sofia, Bulgaria
| | - Melinda Herbáth
- MTA-ELTE Immunology Research Group, Hungarian Academy of Sciences, Budapest, Hungary
| | - Dobroslav Kyurkchiev
- Laboratory of Clinical Immunology, Department of Clinical Laboratory and Clinical Immunology, University Hospital 'Sv. I. Rilski', Medical University Sofia, Sofia, Bulgaria
| | - József Prechl
- MTA-ELTE Immunology Research Group, Hungarian Academy of Sciences, Budapest, Hungary
- R & D Laboratory, Diagnosticum Zrt, Budapest, Hungary
| | - Andrey I Tchorbanov
- Laboratory of Experimental Immunology, Stefan Angelov Institute of Microbiology, Bulgarian Academy of Sciences, Acad. G. Bonchev Street, Block 26, 1113, Sofia, Bulgaria.
- National Institute of Immunology, 1517, Sofia, Bulgaria.
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Tofighi T, Morand EF, Touma Z. Systemic Lupus Erythematosus Outcome Measures for Systemic Lupus Erythematosus Clinical Trials. Rheum Dis Clin North Am 2021; 47:415-26. [PMID: 34215371 DOI: 10.1016/j.rdc.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The assessment of systemic lupus erythematosus (SLE) disease activity in clinical trials has been challenging. This is related to the wide spectrum of SLE manifestations and the heterogeneity of the disease trajectory. Currently, composite outcome measures are most commonly used as a primary endpoint while organ-specific measures are often used as secondary outcomes. In this article, we review the outcome measures and endpoints used in most recent clinical trials and explore potential avenues for further development of new measures and the refinement of existing tools.
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Abstract
Secondary forms of immune thrombocytopenia (ITP) represent approximately 20% of all ITP cases in adulthood and this rate increases with age. Since some causes may influence both the prognosis and outcome but also the management of ITP, a minimal workup must be performed at ITP diagnosis to look for an associated or underlying cause. Among adults, B-cell lymphomas and mainly chronic lymphocytic leukemia, systemic auto-immune diseases such as systemic lupus or primary immunodeficiencies mainly represented by common variable immunodeficiency are the most frequent causes of secondary ITP. Whereas first-line therapy used for secondary ITP is usually similar to the one commonly used in primary ITP and relies mostly on corticosteroids±intravenous immunoglobulin according to the severity of bleeding, second and third-line treatments must take into account the type and degree of activity of the underlying disease.
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Affiliation(s)
- M Michel
- Service de médecine interne, centre de référence pour les cytopénies auto-immunes de l'adulte, CHU Henri-Mondor, université Paris Est Créteil, Assistance publique-Hôpitaux de Paris, Créteil, France.
| | - J-C Lega
- Service de médecine interne et vasculaire, centre de compétences cytopénies auto-immunes, hôpital Lyon Sud, Lyon, France
| | - L Terriou
- Département de médecine interne et immunologie clinique, CHU de Lille, Lille, France
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18
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Wolf SJ, Estadt SN, Theros J, Moore T, Ellis J, Liu J, Reed TJ, Jacob CO, Gudjonsson JE, Kahlenberg JM. Ultraviolet light induces increased T cell activation in lupus-prone mice via type I IFN-dependent inhibition of T regulatory cells. J Autoimmun 2019; 103:102291. [PMID: 31248690 DOI: 10.1016/j.jaut.2019.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
Ultraviolet (UV) light is a known trigger of skin and possibly systemic inflammation in systemic lupus erythematosus (SLE) patients. Although type I interferons (IFN) are upregulated in SLE skin after UV exposure, the mechanisms to explain increased UVB-induced inflammation remain unclear. This paper compares the role of type I IFNs in regulating immune cell activation between wild-type and lupus-prone mice following UVB exposure. 10-week old female lupus-prone (NZM2328), wild-type (BALB/c) and iNZM mice (lack a functional type I IFN receptor on NZM2328 background) were treated on their dorsal skin with 100 mJ/cm2 of UVB for 5 consecutive days. Following UVB treatment, draining lymph node cell populations were characterized via flow cytometry and suppression assays; treated skin was examined for changes in expression of type I IFN genes. Only NZM2328 mice showed an increase in T cell numbers and activation 2 weeks post UVB exposure. This was preceded by a significant increase in UVB-induced type I IFN expression in NZM2328 mice compared to BALB/c mice. Following UVB exposure, both BALB/c and iNZM mice demonstrated an increase in functional T regulatory (TReg) cells; however, this was not seen in NZM2328 mice. These data suggest a skewed UVB-mediated T cell response in lupus-prone mice where activation of T cells is enhanced secondary to a type I IFN-dependent suppression of TReg cells. Thus, we propose type I IFNs are important for UVB-induced inflammation in lupus-prone mice and may be an effective target for prevention of UVB-mediated flares.
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Affiliation(s)
- Sonya J Wolf
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Immunology Program, University of Michigan, Ann Arbor, MI, USA
| | - Shannon N Estadt
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Immunology Program, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Theros
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tyson Moore
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jason Ellis
- Immunology Program, University of Michigan, Ann Arbor, MI, USA; Div. of Allergy and Immunology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jianhua Liu
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tamra J Reed
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chaim O Jacob
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - J Michelle Kahlenberg
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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19
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Abstract
Experimental immune tolerance induction, enabling tissues to be transplanted across animal strains, was first demonstrated in the 1950s. Therapeutic tolerance induction, whereby immune tolerance is used to treat or prevent transplant rejection, and as a treatment for autoimmunity, followed in the 1980s. Clinical translation has been slow but the pace of change is accelerating. Numerous strategies are now being tested clinically, ranging from monoclonal antibodies against T-cells, to peptide therapies, cellular therapies and microbiome manipulation. Furthermore, technology has advanced to the stage where we can start to monitor serological and cellular autoreactivity as biomarkers of response. In terms of autoimmunity, recognition of the prolonged phase of preclinical autoimmunity in several conditions, is leading to debate around treatment of at risk individuals, and trials in patients with prodromal clinical symptoms, such as seropositive arthralgia. Additionally, potent immunomodulatory drugs are achieving a substantial track record of safety. Putting these various factors together suggests that we can soon expect to see more trials of tolerogenic strategies in pre-clinical disease, with intensive immune monitoring to guide therapy.
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Affiliation(s)
- Fiona Rayner
- Institute of Cellular Medicine, Newcastle University and Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John D Isaacs
- Institute of Cellular Medicine, Newcastle University and Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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20
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Bernatsky S, Velásquez García HA, Spinelli JJ, Gaffney P, Smedby KE, Ramsey-Goldman R, Wang SS, Adami HO, Albanes D, Angelucci E, Ansell SM, Asmann YW, Becker N, Benavente Y, Berndt SI, Bertrand KA, Birmann BM, Boeing H, Boffetta P, Bracci PM, Brennan P, Brooks-Wilson AR, Cerhan JR, Chanock SJ, Clavel J, Conde L, Cotenbader KH, Cox DG, Cozen W, Crouch S, De Roos AJ, de Sanjose S, Di Lollo S, Diver WR, Dogan A, Foretova L, Ghesquières H, Giles GG, Glimelius B, Habermann TM, Haioun C, Hartge P, Hjalgrim H, Holford TR, Holly EA, Jackson RD, Kaaks R, Kane E, Kelly RS, Klein RJ, Kraft P, Kricker A, Lan Q, Lawrence C, Liebow M, Lightfoot T, Link BK, Maynadie M, McKay J, Melbye M, Molina TJ, Monnereau A, Morton LM, Nieters A, North KE, Novak AJ, Offit K, Purdue MP, Rais M, Riby J, Roman E, Rothman N, Salles G, Severi G, Severson RK, Skibola CF, Slager SL, Smith A, Smith MT, Southey MC, Staines A, Teras LR, Thompson CA, Tilly H, Tinker LF, Tjonneland A, Turner J, Vajdic CM, Vermeulen RCH, Vijai J, Vineis P, Virtamo J, Wang Z, Weinstein S, Witzig TE, Zelenetz A, Zeleniuch-Jacquotte A, Zhang Y, Zheng T, Zucca M, Clarke AE. Lupus-related single nucleotide polymorphisms and risk of diffuse large B-cell lymphoma. Lupus Sci Med 2017; 4:e000187. [PMID: 29214033 PMCID: PMC5715504 DOI: 10.1136/lupus-2016-000187] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/18/2016] [Accepted: 11/30/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Determinants of the increased risk of diffuse large B-cell lymphoma (DLBCL) in SLE are unclear. Using data from a recent lymphoma genome-wide association study (GWAS), we assessed whether certain lupus-related single nucleotide polymorphisms (SNPs) were also associated with DLBCL. METHODS GWAS data on European Caucasians from the International Lymphoma Epidemiology Consortium (InterLymph) provided a total of 3857 DLBCL cases and 7666 general-population controls. Data were pooled in a random-effects meta-analysis. RESULTS Among the 28 SLE-related SNPs investigated, the two most convincingly associated with risk of DLBCL included the CD40 SLE risk allele rs4810485 on chromosome 20q13 (OR per risk allele=1.09, 95% CI 1.02 to 1.16, p=0.0134), and the HLA SLE risk allele rs1270942 on chromosome 6p21.33 (OR per risk allele=1.17, 95% CI 1.01 to 1.36, p=0.0362). Of additional possible interest were rs2205960 and rs12537284. The rs2205960 SNP, related to a cytokine of the tumour necrosis factor superfamily TNFSF4, was associated with an OR per risk allele of 1.07, 95% CI 1.00 to 1.16, p=0.0549. The OR for the rs12537284 (chromosome 7q32, IRF5 gene) risk allele was 1.08, 95% CI 0.99 to 1.18, p=0.0765. CONCLUSIONS These data suggest several plausible genetic links between DLBCL and SLE.
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Affiliation(s)
- Sasha Bernatsky
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Héctor A Velásquez García
- BC Cancer Research Centre and School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - John J Spinelli
- BC Cancer Research Centre and School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Patrick Gaffney
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Karin E Smedby
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, and Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | | | - Sophia S Wang
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute, Duarte, USA
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Emanuele Angelucci
- Hematology Unit, Ospedale Oncologico di Riferimento Regionale ‘A. Businco’, Cagliari, Italy
| | | | - Yan W Asmann
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Jacksonville, USA
| | - Nikolaus Becker
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | | | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Heiner Boeing
- Department of Epidemiology, German Institute for Human Nutrition, Potsdam, Germany
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Paul Brennan
- International Agency for Research on Cancer (IARC), Lyon, France
| | | | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Jacqueline Clavel
- Epidemiology of childhood and adolescent cancers Group, Inserm, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Lucia Conde
- Department of Epidemiology, School of Public Health and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, USA
| | - Karen H Cotenbader
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, USA
| | - David G Cox
- INSERM U1052, Cancer Research Center of Lyon, Centre Léon Bérard, Lyon, France
| | - Wendy Cozen
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Simon Crouch
- Department of Health Sciences, University of York, York, UK
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health at Drexel University, Philadelphia, USA
| | - Silvia de Sanjose
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Simonetta Di Lollo
- Department of Surgery and Translational Medicine, Section of Anatomo-Pathology, University of Florence, Florence, Italy
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, USA
| | - Ahmet Dogan
- Departments of Laboratory Medicine and Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute and MF MU, Brno, Czech Republic
| | | | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Thomas M Habermann
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, USA
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Henri Mondor Hospital and University Paris Est, Créteil, France
| | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Henrik Hjalgrim
- Division ofHealth Surveillance and Research, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, USA
| | - Elizabeth A Holly
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Rebecca D Jackson
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Columbus, USA
| | - Rudolph Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eleanor Kane
- Department of Health Sciences, University of York, York, UK
| | - Rachel S Kelly
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Robert J Klein
- Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Anne Kricker
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | | | - Mark Liebow
- Department of Medicine, Mayo Clinic, Rochester, USA
| | | | - Brian K Link
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, USA
| | - Marc Maynadie
- Registre des Hémopathies Malignes de Côte d'Or, EA 4184, Univ. Bourgogne Franche-Comté and Dijon University Hospital, Dijon, France
| | - James McKay
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Mads Melbye
- Division ofHealth Surveillance and Research, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Thierry J Molina
- Department of Pathology, AP-HP, Necker Enfants malades, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Alain Monnereau
- Epidemiology of childhood and adolescent cancers Group, Inserm, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Alexandra Nieters
- Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - Kari E North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Anne J Novak
- Department of Medicine, Mayo Clinic, Rochester, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Marco Rais
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Monserrato, Italy
| | - Jacques Riby
- Department of Epidemiology, School of Public Health and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, USA
| | - Eve Roman
- Department of Health Sciences, University of York, York, UK
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Gilles Salles
- Department of Hematology, Hospices Civils de Lyon, Pierre benite Cedex, France
| | | | - Richard K Severson
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, USA
| | - Christine F Skibola
- Department of Epidemiology, School of Public Health and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, USA
| | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - Alex Smith
- Department of Health Sciences, University of York, York, UK
| | - Martyn T Smith
- Division of Environmental Health Sciences, University of California Berkeley School of Public Health, Berkeley, USA
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Lauren R Teras
- Epidemiology Research Program, American Cancer Society, Atlanta, USA
| | | | - Hervé Tilly
- Centre Heni Becquerel, Université de Rouen, Rouen, France
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA
| | | | - Jenny Turner
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Joseph Vijai
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Jarmo Virtamo
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Zhaoming Wang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephanie Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | | | - Andrew Zelenetz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, USA
| | - Tongzhang Zheng
- Department of Epidemiology, Brown School of Public Health, Providence, USA
| | - Mariagrazia Zucca
- Department of Biomedical Science, University of Cagliari, Monserrato, Italy
| | - Ann E Clarke
- Division of Rheumatology, University of Calgary, Calgary, Canada
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21
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Abstract
Significant advances in the understanding of the molecular basis of innate immunity have led to the identification of interferons (IFNs), particularly IFN-α, as central mediators in the pathogenesis of Systemic Lupus Erythematosus. Therefore, targeting of IFNs and of their downstream pathways has emerged as important developments for novel drug research in SLE. Based on this, several specific interferon blocking strategies using anti-IFN-α antibodies, anti-type I interferon receptor antibodies, Interferon-α-kinoid, or anti-IFN-γ antibodies have all been assessed in recent clinical trials. Alternative strategies targeting the plasmacytoid dendritic cells (pDCs), Toll-Like Receptors (TLRs)-7/9 or their downstream pathways such as the myeloid differentiation primary-response protein 88 (MYD88), spleen tyrosine kinase (Syk), Janus-kinases (JAKs), interleukin-1 receptor-associated kinase 4 (IRAK4), or the Tyrosine Kinase 2 (TYK2) are also investigated actively in SLE, at more preliminary clinical development stages, except for JAK inhibitors which have reached phase 2 studies. In a near future, in-depth and personalized functional characterization of IFN pathways may provide further guidance for the selection of the most relevant therapeutic strategy in SLE, tailored at the patient-level.
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Affiliation(s)
- François Chasset
- AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, F-75020, Paris, France
| | - Laurent Arnaud
- Service de rhumatologie, Centre National de Référence des Maladies Autoimmunes et Systémiques Rares, Université de Strasbourg, INSERM UMR-S 1109, F-67000 Strasbourg, France.
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22
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Ha-Ou-Nou FZ, Zahlane M, Benjilali L, Essaadouni L. [Extensive digital gangrene revealing late-onset systemic lupus erythematosus]. J Med Vasc 2017; 42:50-53. [PMID: 28705448 DOI: 10.1016/j.jdmv.2017.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/30/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Late-onset systemic lupus erythematosus represents a specific sub-group of the disorder, beginning after 50 years of age. The incidence is rarer and the course of the disease is considered to be more benign. Digital gangrene is an uncommon complication of systemic lupus erythematosus reported especially among middle-aged patients with long disease duration. OBSERVATION We report a 53-year-old man, who presented with systemic lupus erythematosus revealed by an extensive digital gangrene. CONCLUSION Digital gangrene is a rare complication of late onset systemic lupus erythematosus. Clinicians should be aware of this complication in order to initiate early and aggressive treatment.
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Affiliation(s)
- F Z Ha-Ou-Nou
- Service de médecine interne, hôpital ARRAZI, centre hospitalier universitaire Mohammed VI, avenue Ibn Sina Amerchich, 2360 Marrakech, Maroc.
| | - M Zahlane
- Service de médecine interne, hôpital ARRAZI, centre hospitalier universitaire Mohammed VI, avenue Ibn Sina Amerchich, 2360 Marrakech, Maroc
| | - L Benjilali
- Service de médecine interne, hôpital ARRAZI, centre hospitalier universitaire Mohammed VI, avenue Ibn Sina Amerchich, 2360 Marrakech, Maroc
| | - L Essaadouni
- Service de médecine interne, hôpital ARRAZI, centre hospitalier universitaire Mohammed VI, avenue Ibn Sina Amerchich, 2360 Marrakech, Maroc
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23
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Jamilloux Y, Frih H, Bernard C, Broussolle C, Petiot P, Girard N, Sève P. [Thymoma and autoimmune diseases]. Rev Med Interne 2018; 39:17-26. [PMID: 28365191 DOI: 10.1016/j.revmed.2017.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/04/2017] [Indexed: 12/28/2022]
Abstract
The association between thymoma and autoimmunity is well known. Besides myasthenia gravis, which is found in 15 to 20% of patients with thymoma, other autoimmune diseases have been reported: erythroblastopenia, systemic lupus erythematosus, inflammatory myopathies, thyroid disorders, Isaac's syndrome or Good's syndrome. More anecdotally, Morvan's syndrome, limbic encephalitis, other autoimmune cytopenias, autoimmune hepatitis, and bullous skin diseases (pemphigus, lichen) have been reported. Autoimmune diseases occur most often before thymectomy, but they can be discovered at the time of surgery or later. Two situations require the systematic investigation of a thymoma: the occurrence of myasthenia gravis or autoimmune erythroblastopenia. Nevertheless, the late onset of systemic lupus erythematosus or the association of several autoimmune manifestations should lead to look for a thymoma. Neither the characteristics of the patients nor the pathological data can predict the occurrence of an autoimmune disease after thymectomy. Thus, thymectomy usefulness in the course of the autoimmune disease, except myasthenia gravis, has not been demonstrated. This seems to indicate the preponderant role of self-reactive T lymphocytes distributed in the peripheral immune system prior to surgery. Given the high infectious morbidity in patients with thymoma, immunoglobulin replacement therapy should be considered in patients with hypogammaglobulinemia who receive immunosuppressive therapy, even in the absence of prior infection.
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24
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Angeletti A, Baraldi O, Chiocchini AL, Comai G, Cravedi P, La Manna G. Rituximab as First-Line Therapy in Severe Lupus Erythematosus with Neuropsychiatric and Renal Involvement: A Case-Report and Review of the Literature. ACTA ACUST UNITED AC 2017; 7. [PMID: 29888753 PMCID: PMC5991483 DOI: 10.4172/2165-7920.10001033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Neuropsychiatric and renal involvement are common in systemic lupus erythematosus with negative impact on patient survival. Glucocorticoids, antiproliferative and cytotoxic agents represent first-line therapies, but are often ineffective and are burdened by significant toxicities. Despite the negative results of two randomized controlled trials, rituximab is still widely used as second- or third-line therapy in similar cases. No case has been reported so far where rituximab has been used as first-line therapy. We report the case of a 60-year-old cCaucasian woman with concurrent neuropsychiatric and renal lupus erythematous treated with one cycle of rituximab therapy at disease onset. Treatment was well tolerated and at 24 months the patient is in complete remission and free of immunosuppression. To the best of our knowledge, this is the first case of neuropsychiatric and renal lupus erythematosus successfully treated with rituximab as first-line therapy.
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Affiliation(s)
- Andrea Angeletti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy.,Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, USA
| | - Olga Baraldi
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | - Anna Laura Chiocchini
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
| | - Paolo Cravedi
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, USA
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St Orsola Hospital, University of Bologna, Bologna, Italy
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25
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Kalunian KC, Kim M, Xie X, Baskaran A, Daly RP, Merrill JT. Impact of standard of care treatments and disease variables on outcomes in systemic lupus erythematosus trials: analysis from the Lupus Foundation of America Collective Data Analysis Initiative. Eur J Rheumatol 2016; 3:13-19. [PMID: 27708963 DOI: 10.5152/eurjrheum.2015.0048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/18/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Most clinical trials for systemic lupus erythematosus (SLE) study the efficacy and safety of investigational agents added to variable background immunosuppressants, which has resulted in high response rates in patients treated with placebo plus standard of care (SOC) plus rescue measures. This project compared the impact of different SOC treatments and disease variables on the outcomes of SLE trials. MATERIAL AND METHODS Data were obtained from 981 patients receiving only SOC treatments in three nephritis and three general SLE trials to compare response and flare rates on the basis of the British Isles Lupus Assessment Group (BILAG) index, a measure common to all trials. RESULTS For subjects enrolled in general SLE trials (n=173), those receiving mycophenolate mofetil (MMF) had more severe baseline disease, included more patients of African descent, and were administered higher baseline steroid doses compared with those receiving azathioprine (AZA) or methotrexate (MTX). BILAG responses at week 12 were MMF 35%, AZA 49%, MTX 34%, and no immunosuppressant (NIS) 65%. At week 52, MMF response rates increased to 41% despite reducing the steroid doses, but fell in all others (p=0.07, adjusted for steroids). Patients with severe disease activity at baseline (SDAB) who were defined as ≥1 BILAG A (severe) organ score had lower response rates to AZA or MTX but higher rates to MMF or NIS. Interim flares were highest with MMF [flares/patient-year (pt-yr)]. For all flares, rates were as follows: AZA 1.24, MMF 1.87, MTX 1.42, and NIS 0.81 and severe flares were as follows: AZA 0.66, MMF 1.29, MTX: 1.20, and NIS 0.55. Interim flares occurred in 71% of MMF-endpoint responders, 54% of AZA, 50% of MTX, and 22% of NIS. Patients with SDAB had more flares than moderate patients in the MMF and MTX groups: MMF: 2.39 vs. 1.03 flares/pt-yr (p=0.01), MTX: 2.33 vs. 0.63 (p=0.0002), severe flares: 1.87 vs. 0.34 for MMF (p=0.0013), 2.13 vs. 0.40 for MTX (p<0.0001). In nephritis trials (n=808), MMF subjects received less steroids than intravenous cyclophosphamide and response rates were similar, but MMF-treated patients had fewer severe flares (p=0.03). CONCLUSION Compared with MMF, AZA and MTX were associated with lower response rates at week 52. AZA-treated subjects had fewer flares and remained more stable in trials while engendering lower placebo plus SOC responses. MMF-treated subjects had frequent responses but more flares, suggesting that flares should be included in endpoint definitions. Given the likelihood of treatment selection bias, these data do not provide conclusions regarding efficacy but may help future trial designs by distinguishing factors definable at entry that are predictive of outcomes.
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Affiliation(s)
| | - Mimi Kim
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xianhong Xie
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amrutha Baskaran
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Rossi Paola Daly
- Department of Education and Research, Lupus Foundation of America, Washington, District of Columbia, USA
| | - Joan Tenenbaum Merrill
- Clinical Pharmacology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
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Abstract
Treat-to-target is a therapeutic strategy aimed at improving disease outcome through the achievement of shared treatment goals, which has dramatically ameliorated the prognosis of widespread disorders, such as hypertension or diabetes. Conversely, efforts to delineate treat-to-target in systemic lupus erythematosus (SLE) have failed in pinpointing common goals and treatment strategies, probably because of disease heterogeneity and lack of measurable biomarkers predicting disease course and ensuring a safe treatment tapering during quiescence. Given the detrimental effects of persistent disease activity and protracted corticosteroid therapy on patients' outcome in lupus, disease remission should be pursued whenever possible. Fortunately, clinical remission is currently realistic for a greater number of patients than it was in the past, yet tight monitoring is required in order for patients to benefit from disease- and corticosteroid-free intervals, while minimizing the risk of disease flares. In everyday practice, patients should be brought to the lowest level of disease activity ensuring a significant benefit over a persistently active disease, being either clinical remission or low disease activity.
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Affiliation(s)
- A Doria
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - M Gatto
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - L Iaccarino
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - L Punzi
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
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Wilhelm TR, Taddeo A, Winter O, Schulz AR, Mälzer JN, Domingo C, Biesen R, Alexander T, Thiel A, Radbruch A, Hiepe F, Gerl V. Siglec-1-positive plasmacytoid dendritic cells (pDCs) in human peripheral blood: A semi-mature and myeloid-like subset imbalanced during protective and autoimmune responses. Clin Immunol 2015; 163:42-51. [PMID: 26674280 DOI: 10.1016/j.clim.2015.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/27/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
Plasmacytoid dendritic cells (pDCs) play a central role in the pathogenesis of systemic lupus erythematosus (SLE) as IFN-α producers and promoters of T-cell activation or tolerance. Here, we demonstrated by flow-cytometry and confocal microscopy that Siglec-1, a molecule involved in the regulation of adaptive immunoresponses, is expressed in a subset of semi-mature, myeloid-like pDCs in human blood. These pDCs express lower BDCA-2 and CD123 and higher HLA-DR and CD11c than Siglec-1-negative pDCs and do not produce IFN-α via TLR7/TLR9 engagement. In vitro, Siglec-1 expression was induced in Siglec-1-negative pDCs by influenza virus. Proportions of Siglec-1-positive/Siglec-1-negative pDCs were higher in SLE than in healthy controls and correlated with disease activity. Healthy donors immunized with yellow fever vaccine YFV-17D displayed different kinetics of the two pDC subsets during protective immune response. PDCs can be subdivided into two subsets according to Siglec-1 expression. These subsets may play specific roles in (auto)immune responses.
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Affiliation(s)
| | - Adriano Taddeo
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany; German Rheumatism Research Centre (DRFZ) - a Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany
| | - Oliver Winter
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany; German Rheumatism Research Centre (DRFZ) - a Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany
| | - Axel Ronald Schulz
- Regenerative Immunology and Aging, Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine CVK, Augustenburger Platz 1, 13353, Berlin, Germany; German Rheumatism Research Centre (DRFZ) - a Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany
| | - Julia-Nora Mälzer
- Regenerative Immunology and Aging, Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine CVK, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Cristina Domingo
- Center for Biological Threats and Special Pathogens 1, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Thiel
- Regenerative Immunology and Aging, Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine CVK, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Radbruch
- German Rheumatism Research Centre (DRFZ) - a Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany
| | - Falk Hiepe
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany; German Rheumatism Research Centre (DRFZ) - a Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany
| | - Velia Gerl
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany; German Rheumatism Research Centre (DRFZ) - a Leibniz Institute, Charitéplatz 1, 10117, Berlin, Germany.
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Abstract
A broad spectrum of inflammatory disorders have the capacity to target the skeleton and to de-regulate the processes of physiological bone remodeling. This review will focus on the systemic inflammatory rheumatologic disorders, which target articular and peri-articular bone tissues. Many of these disorders also affect extra-articular tissues and organs, and in addition, have the capacity to produce systemic bone loss and increased risk of osteoporotic fractures. Attention will focus on rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and the seronegative spondyloarthropathies (SpAs), which include ankylosing spondylitis (AS), reactive arthritis (formerly designated as Reiter's syndrome), the arthritis of inflammatory bowel disease, juvenile onset spondyloarthropathy and psoriatic arthritis. The discussion will principally focus on RA, which is a prototypical model of an inflammatory disorder that de-regulates bone remodeling, but also will review the other forms of inflammatory joint disease to highlight the differential effects of inflammation on bone remodeling in these conditions. This article is part of a Special Issue entitled "Muscle Bone Interactions".
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Affiliation(s)
- Steven R Goldring
- Research Division, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.
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Al-Emadi S, Abutiban F, El Zorkany B, Ziade N, Al-Herz A, Al-Maini M, Khan B, Ghanem A, Al Rayes H, Al Saleh J, Al-Osaimi H, Østensen M. Enhancing the care of women with rheumatic diseases during pregnancy: challenges and unmet needs in the Middle East. Clin Rheumatol 2016; 35:25-31. [PMID: 26304021 DOI: 10.1007/s10067-015-3052-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/21/2015] [Accepted: 07/26/2015] [Indexed: 12/16/2022]
Abstract
Pregnancy in women with rheumatic disorders is known to be associated with risks for both the mother and fetus; however, these risks can be minimized with proper planning and careful management of the disease. In the Middle East, there are specific cultural challenges that may have a negative impact on the care that women with rheumatic disorders receive. There is a need for cross-collaboration between specialist physicians, improved awareness of rheumatic disorders among the general public and more open discussion with patients about the potential complications of pregnancy. Women in the region are often unwilling to discuss their disease with their partner and are even less likely to seek advice regarding family planning from their physician. The objective of this review is to highlight the specific challenges of pregnancy management and to discuss why establishing specialist pregnancy clinics for women with rheumatic disorders could be an effective solution. Such clinics can provide high quality care before, during and after pregnancy as shown in several European and US centers. Additionally, such clinics could be useful for the collection of pregnancy outcomes data from the Middle East, which may currently be lacking in the region, in order to highlight where further improvements can be made. With specialist care and analysis of pregnancy outcomes, the standard of care for women with rheumatic disorders in this area could be significantly improved.
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Abstract
Although a role of EBV in autoimmunity is biologically plausible and evidence of altered immune responses to EBV is abundant in several autoimmune diseases, inference on causality requires the determination that disease risk is higher in individuals infected with EBV than in those uninfected and that in the latter it increases following EBV infection. This determination has so far been possible only for multiple sclerosis (MS) and, to some extent, for systemic lupus erythematosus (SLE), whereas evidence is either lacking or not supportive for other autoimmune conditions. In this chapter, we present the main epidemiological findings that justify the conclusion that EBV is a component cause of MS and SLE and possible mechanisms underlying these effects.
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Abstract
We report a rare case of fulminant congestive heart failure with fatal outcome in a 21-year-old girl with systemic lupus erythematosus (SLE). A young woman was admitted in the intensive care unit for pericardial tamponade associated with disseminated coagulopathy and refractory shock secondary to multiple coronary aneurysms. Post-mortem examination revealed significant multiple coronary lesions with aneurysms of the interventricular and right coronary arteries, responsible of muscular necrosis, thrombosis of the coronary sinus, and significant pericardial infiltration with hemorrhagic fluid. We describe a refractory cardiac failure with extensive coronary artery involvements, which is very uncommon in young patients with SLE: few cases have been previously described in the literature. We report a rare case of fulminant congestive heart failure with fatal outcome in a young woman with SLE related to extensive coronary involvements.
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Sam R, Joshi A, James S, Jen KY, Amani F, Hart P, Schwartz MM. Lupus-like membranous nephropathy: Is it lupus or not? Clin Exp Nephrol 2014; 19:395-402. [PMID: 24993947 DOI: 10.1007/s10157-014-1002-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Membranous glomerulonephritis is typically classified as idiopathic or secondary to systemic lupus erythematosus (SLE), hepatitis B, drugs, toxins, other infections, or malignancy. Not infrequently in some patients without a definite diagnosis of SLE, pathologic features of secondary membranous nephropathy are seen e.g., mesangial and/or subendothelial deposits, tubuloreticular inclusions, and full house immunofluorescence. In these patients, there is uncertainty about the etiology, response to therapy, and prognosis of membranous GN. METHODS We retrospectively reviewed the charts of 98 patients with membranous GN at San Francisco General Hospital and John Stroger Hospital of Cook County over a 10-year period. Data were collected and analyzed using SPSS.18. RESULTS Thirty-nine (40 %) had idiopathic membranous GN (Group 1), thirty-six (37 %) had lupus membranous GN (Group 2) and twenty-three (23 %) had some pathological features of secondary membranous GN, but no definite etiology of membranous GN (Group 3). At baseline (at time of renal biopsy) and after mean follow-up of 3.5 years, the average serum creatinine (in mg/dL) in Group 1 was (1.6 ± 1.0 versus 1.6 ± 1.7), Group 2 was (1.8 ± 2.5 versus 1.2 ± 0.9) and Group 3 was (1.1 ± 0.4 versus 1.27 ± 0.83), respectively. For the same time points, the average urine protein to creatinine ratio (g/g) in Group 1 was (9.8 ± 7.1 versus 5.7 ± 6.7), Group 2 was (4.2 ± 3.9 versus 1.7 ± 2.2), and Group 3 was (7.4 ± 5.7 versus 3.1 ± 3.8). In addition, during the follow-up period, eleven of 39 (28 %) in Group 1, two of 36 (6 %) in Group 2, and three of 23 (13 %) in Group 3 progressed to end-stage renal disease and were started on dialysis. CONCLUSIONS It appears that patients with lupus membranous GN have better renal prognosis than patients with idiopathic membranous GN. The renal prognosis for patients with pathological features of lupus membranous but no diagnosis of systemic lupus (lupus-like membranous GN) falls in between. Further studies are needed to determine if Group 3 patients can (a) definitively be classified as true idiopathic membranous GN or lupus membranous GN or (b) they have a separate disease from either M-type phospholipase A2 receptor membranous nephropathy or systemic lupus-induced membranous nephropathy.
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Affiliation(s)
- Ramin Sam
- Division of Nephrology, San Francisco General Hospital and the University of California, 1001 Potrero Ave, Building 100, Rm 342, San Francisco, CA, 94110-1341, USA.
| | - Amit Joshi
- Division of Nephrology, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Sam James
- Division of Nephrology, San Francisco General Hospital and the University of California, 1001 Potrero Ave, Building 100, Rm 342, San Francisco, CA, 94110-1341, USA
| | - Kuang-Yu Jen
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Firouz Amani
- Department of Biostatistics, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Peter Hart
- Division of Nephrology, Stroger Hospital of Cook County, Chicago, IL, USA
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Hié M, Costedoat-Chalumeau N, Saadoun D, Azoulay E. [The pulmonary-renal syndrome: a diagnostic and therapeutic emergency for the internist and the intensivist]. Rev Med Interne 2013; 34:679-86. [PMID: 24140181 DOI: 10.1016/j.revmed.2013.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 12/24/2012] [Accepted: 02/04/2013] [Indexed: 12/11/2022]
Abstract
The pulmonary-renal syndrome is a rare and life-threatening condition. It is defined as the association of a diffuse alveolar hemorrhage and a rapidly progressive glomerulonephritis. The characteristic histological lesion common to all underlying diseases is a necrotizing and crescentic glomerulonephritis. The pulmonary-renal syndrome is a diagnostic and therapeutic emergency: any delay in its management will lead to death or serious functional damage as pulmonary and renal impairment. ANCA-associated vasculitis and Goodpasture's disease are the main disorders associated to pulmonary-renal syndrome. More rarely systemic lupus, cryoglobulinaemia, Henoch-Schonlein purpura or subacute endocarditis may induce a pulmonary-renal syndrome. Differential diagnosis can sometimes be difficult, highlighting some ambiguity in the definition of the syndrome. Initial treatment usually associates systemic corticosteroid, cyclophosphamide and plasma exchange. The role of biotherapy as first line therapy remains to be determined.
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Affiliation(s)
- M Hié
- Service de médecine interne 2, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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