Active Systemic Lupus Erythematosus Group Research Articles

Association of Autoimmune Markers with the Disease Activity in Patients with Systemic Lupus Erythematosus

Abstract Background Systemic lupus erythematosus (SLE) is a multisystem chronic autoimmune disease with a relapsing and remitting course. Predicting changes in SLE disease activity could allow for closer monitoring and preemptive treatment. SLE is diagnosed using a combination of immunological markers, clinical symptoms. Aim of the Work To assess the relation between level of autoimmune markers in SLE patients with disease activity. Subjects and Methods Our study was a case control study, conducted on 60 patients of matched age and sex attending immunology & rheumatology outpatient clinics and wards at Ain Shams university hospital during the period from September 2023 to February 2024. 30 were medically free individuals and they made the control group. As regards the cases group it was divided into further 2 groups where 30 were SLE patients not in activity and the remaining 30 patients were SLE patients in activity. Results Markers of activity as C3, C4, Anti-dsDNA, ESR, CRP, PR/CR ratio was highly significant when compared between three studied groups, p-value <0.01. ESR and CRP was high in active group than inactive group than control group. C3 and C4 was high in control group than inactive group than active group. PR/CR ratio was high in active group than control group inactive group. Anti-dsDNA was significance in comparison between Active SLE and Inactive SLE groups, also between active SLE and control groups, being positive only in active group. Antiphospholipid antibodies (LAC IgG and IgM, ACL IgG and IgM, β2 glycoprotein IgG and IgM) was highly significant when compared between three studied groups, p-value <0.01, being higher in inactive group than active group than control group. Conclusion Autoimmune markers as markers of activity and antiphospholipid antibodies showed strong significance when compared between three studied groups, and in comparison between active and inactive SLE groups.

Serum and urine interferon-inducible protein 10, galectin-9, and SIGLEC-1 as biomarkers of disease activity in systemic lupus erythematosus.

In this prospective study, we aimed to investigate the association of serum (s) and urine (u) IP-10, galectin-9, and SIGLEC-1 with disease activity in patients with systemic lupus erythematosus (SLE). Sixty-three patients with active SLE (31 renal, 32 extrarenal) were included. Thirty patients with inactive SLE (15 renal, 15 extrarenal), 17 with renal active AAV, and 32 healthy volunteers were selected as control groups. Serum and urine IP-10, galectin-9, and SIGLEC-1 were tested using ELISA. Levels of sIP-10 (p = 0.046), uIP-10 (p < 0.001), sGalectin-9 (p = 0.03), and uSIGLEC-1 (p = 0.006) were significantly higher in active SLE group compared to the inactive SLE; however, no differences were detected in the comparison of uGalectin-9 (p = 0.18) and sSIGLEC-1 (p = 0.69) between two groups. None of the biomarkers discriminated patients with active renal SLE from active extrarenal SLE. ROC analyses revealed an AUC of 0.63 (0.52-0.73) for sIP-10, 0.78 (0.68-0.86) for uIP-10, 0.64 (0.53-0.74) for sGalectin-9, and 0.68 (0.57-0.77) for uSIGLEC-1 in discriminating disease activity in SLE, which did not outperform C3 (0.75, 0.64-0.84) and C4 (0.72, 0.61-0.82). sIP-10 (p = 0.001), uIP-10 (p = 0.042), and uGalectin-9 (p = 0.009) were significantly increased in patients with active renal SLE compared to active renal AAV. sGalectin-9 (p < 0.001) and sIP-10 levels (p = 0.06) were decreased after 8 (5-22.5) months of treatment. sIP-10, uIP-10, sGalectin-9, and uSIGLEC-1 reflect global disease activity in SLE but do not outperform C3 and C4. sIP-10 and uIP-10 may be specific for active SLE compared to active AAV. sIP-10 and sGalectin-9 might be valuable in monitoring response after treatment.

Assessment of anti-nucleosome antibody (ANuA) isotypes for the diagnosis and prediction of systemic lupus erythematosus and lupus nephritis activity.

Our study aims to investigate the serum levels of anti-nucleosome antibody (ANuA) isotypes in patients with systemic lupus erythematosus (SLE) and clarify ANuA isotypes that may diagnose and predict SLE. We detected anti-nucleosome antibodies (ANuA) in the serum from 120 patients with SLE, 99 patients suffering from other autoimmune diseases (OAD), and 50 healthy controls by performing IgG-, IgA-, and IgM-specific ELISAs. The serum levels of total anti-nuclear antibodies (ANA IgG), ANuA IgG subclasses (IgG1, IgG2, IgG3, and IgG4), anti-dsDNA antibodies, and the avidities of ANA IgG were also analysed using ELISAs. The levels of three ANuA isotypes (IgG, IgA, and IgM) were significantly higher in patients with SLE than in patients with OAD and healthy controls (p < 0.05). Moreover, the concentrations of ANuA isotypes increased in the active SLE and lupus nephritis (LN) groups and in patients with SLE presenting high-avidity IgG ANA (p < 0.05). Furthermore, ANuA isotype levels decreased significantly with drug therapy, while anti-dsDNA IgG levels decreased with the same trend. Additionally, ANuA isotypes were positively related to the SLEDAI (SLE Disease Activity Index) score, RAI (relative avidity index) of high-avidity IgG ANAs, and serum anti-dsDNA IgG levels. Last, the sensitivity and specificity values for SLE were 83.33 and 96.67% for ANuA IgG, 85.83 and 93.33% for ANuA IgA, and83.33 and 86.67% for ANuA IgM, respectively. The sensitivity and specificity values for LN were 61.67 and 96.67% for ANuA IgG, 49.17 and 96.67% for ANuA IgA, and 52.50 and 96.67% for ANuA IgM, respectively. In conclusion, we evaluated whether ANuA isotypes represent a diagnostic tool to predict SLE activity and define subsets of patients with LN.

Urine inter-alpha-trypsin inhibitor family-related proteins may serve as biomarkers for disease activity of lupus.

BackgroundSystemic lupus erythematosus (SLE) is a chronic inflammatory disease involving multiple tissues. Inter‐Alpha‐Trypsin Inhibitor (ITI) family proteins have a role in maintaining tissue homeostasis, but their possible clinical significance in the SLE patients has not been reported. The aim of this study was to analyze and verify the expression of ITI‐related proteins in the urine of SLE patients, further explore the features of these proteins in disease activity.MethodsBased on label‐free proteomics technology and bioinformatics technology, we analyzed the expression of ITI family‐related proteins in the urine of lupus. Subsequently, Western‐blot and targeted proteomics were used to qualitatively and quantitatively verify the expression of these proteins, respectively.ResultsA total of seven ITI family‐related proteins were screened and identified; and six of these proteins were differentially expressed in the urine of SLE patients. Further quantitative analysis showed that the expressions of ITIH2, ECM1, and ITIH5 in urine between active SLE group and stable SLE group were consistent with the preliminary screening results. The expression of ITIH2 and ECM1 in the renal damage group were also consistent with the screening results. Moreover, ITIH2 and ECM1 have a good correlation with disease activity and have a certain correlation with renal damage.ConclusionsIn this exploratory study, we evaluated the expression of ITI family‐related proteins in the urine of SLE and found that urine ITIH2 and ECM1 were closely related to SLE activity, especially kidney damage, providing an experimental basis for further exploration of the potential roles in monitoring lupus and lupus nephritis activity.

FC063: Serum and Urine Galectin-9, Ip-10 and Siglec-1 as Biomarkers of Disease Activity in Patients with Systemic Lupus Erythematosus Compared to Anca-Associated Vasculitis: A Longitudinal Study

Abstract BACKGROUND AND AIMS Galectin-9, interferon-inducible protein-10 (IP-10) and sialoadhesin (SIGLEC-1) are considered as potential biomarkers reflecting disease activity in patients with systemic lupus erythematosus (SLE). In this study, we aimed to investigate the association of serum and urine galectin-9, IP-10 and SIGLEC-1 with disease activity in patients with SLE. Also, we compared the results with ANCA-associated vasculitis (AAV) to test the specificity of the biomarkers. METHOD A total of 63 patients with active SLE (31 renal and 32 extrarenal) were included in the study. A total of 30 patients with inactive SLE (15 renal and 15 extrarenal), 17 with renal active AAV and 32 healthy volunteers were selected as control groups. Serum (s) and urine (u) levels of galectin-9, IP-10 and SIGLEC-1 were tested using ELISA. Urine levels of biomarkers were normalized by urine creatinine. RESULTS Of 142 participants, 109 (76.7%) were female and median age was 36 (28.75–48) years. Groups were comparable with regard to sex and age distribution except for AAV. In AAV group, seven patients (41.1%) were female and median age was 60 (48–65.5) years. Proliferative lupus nephritis (LN) (class III/III + V and IV/IV + V) were found in 22 patients with active renal SLE (70.9%), while 6 patients (19.3%) had pure class V and 3 (9.7%) had class II LN. Levels of sIP-10, uIP-10, sGalectin-9 and uSIGLEC-1 were significantly higher in the active SLE group compared to the inactive SLE group (sIP-10; P = 0.046, uIP-10; P &amp;lt; 0.001, sGalectin-9; P = 0.031 and uSIGLEC-1; P = 0.006); however, no differences were detected in the comparison of uGalectin-9 and sSIGLEC-1 between these two groups (uGalectin-9; P = 0.180 and sSIGLEC-1; P = 0.699). sIP-10 (P &amp;lt; 0.001), uIP-10 (P = 0.029) and uGalectin-9 (P &amp;lt; 0.001) were significantly higher in patients with active SLE compared to AAV (Table 1). Serum and urine galectin-9, IP-10 and SIGLEC-1 did not differ between patients with active renal and extrarenal SLE. Levels of sIP-10, uIP-10 and uSIGLEC-1 were correlated with SLE Disease Activity Index (SLEDAI). ROC analyses confirmed that sIP-10, uIP-10, sGalectin-9 and uSIGLEC-1 discriminated disease activity in SLE (Figure 1). Serum and urine levels of all biomarkers were retested in 41 of 63 patients (65%) with active SLE after a median treatment of 8 (5–22.5) months. At the time of the second tests, there was a significant decrease in disease activity as measured by SLEDAI [2 (0–4)] compared to the time of the first tests [10 (6–15.5)]. Comparison of sGalectin-9 levels between the sample at the time of active disease and remission showed a very significant decline (P &amp;lt; 0.001). uGalectin-9, sIP-10 and uSIGLEC-1 also decreased after treatment; however, the difference was not statistically significant. CONCLUSION sIP-10, uIP-10, sGalectin-9 and uSIGLEC-1 are associated with disease activity in SLE. None is able to discriminate active renal from active extrarenal disease. sIP-10 and uIP-10 are specific for active SLE compared to renal active AAV. sGalectin-9 may be a valuable biomarker to monitor response after treatment for active disease. Funded by Scientific Research Projects Coordination Unit of Istanbul University. Project number: TSA-2019–34 218.

Amount of dissipative energy loss when assessing left ventricular dysfunction in female patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is associated with an increased risk of cardiovascular disease. The purpose of the current study was to explore the amount of energy loss (EL) using vector flow mapping (VFM) in the detection of early stage left ventricular (LV) dysfunction among patients with SLE. Eighty-nine patients with SLE and fifty-six healthy controls were enrolled. SLE patients were further divided into inactive (SLEDAI ≤ 4, n = 43) and active (SLEDAI ≥ 5, n = 46) subgroups. A prosound F75 echocardiography machine was used for echocardiographic examination. Intra-cardiac flow images were analysed by a VFM workstation. Compared with the healthy group, the inactive SLE group had increased diastolic EL values (38.05 mW/m vs. 33.02 mW/m, p = 0.010). However, the systolic EL values were comparable between the inactive SLE group and the control group (26.07mW/m vs 23.15 mW/m, p = 0.105). The active SLE group exhibited significantly higher diastolic (104.13mW/m vs 33.02mW/m, p < 0.001) and systolic (48.83 mW/m vs 23.15mW/m, p < 0.001) EL values than the control group. The most notable correlation was observed between the values of the diastolic EL and SLEDAI in the inactive SLE group (r = 0.633, p < 0.001) and in the active SLE group (r = 0.824, p < 0.001). LV-dissipative EL assessed by using VFM is useful and feasible for estimating lesions of LV systolic and diastolic function in active SLE patients with preserved left ventricular ejection fraction. Increased disease activity may lead to increased risk of LV dysfunction.

Maternal and neonatal outcomes of pregnancy complicated with Systemic Lupus Erythematosus

To study the maternal and neonatal outcomes of pregnancy complicated with Systemic Lupus Erythematosus (SLE). Clinical data of 84 pregnant women complicated with SLE were collected. All patients were divided into the different groups based on the pregestational status of SLE, SLE status during pregnancy and the type of medicine administration respectively. The incidence rates of pregnancy loss and preterm labor in the pregestational and gestational stable SLE groups were significantly lower and the incidence rate of full-term labor was considerably higher than those in the active SLE groups. In the pregestational stable SLE group, the incidence of PIH was significantly lower than that in the active SLE group. The incidence of PIH and FGR in the gestational active SLE group was dramatically higher than that in the gestational stable SLE group. Among 84 women, 56 (66.7%) received cesarean section, 18 (21.4%) vaginal delivery and 10 (11.9%) labor induction. The status of SLE is intimately correlated with maternal and neonatal outcomes. PIH is a major complication of active SLE and associated with adverse pregnancy outcomes. SLE can cause congenital fetal injury, especially congenital heart block.

SİSTEMİK LUPUS ERİTEMATOZUSLU GEBE KADINLARIN MATERNAL VE FETAL SONUÇLARININ DEĞERLENDİRİLMESİ

Aim: To evaluate obstetrical and perinatal outcomes of pregnancies with systemic lupus erythematosus (SLE).&#x0D; Materials and Method: This was a retrospective study evaluating obstetric outcomes of 35 patients with SLE who were followed up between 2010 and 2020. Lupus activity was based on SLE Disease Activity Index (SLEDAI) criteria and pregnancy outcomes were evaluated by grouping as active and inactive SLE.&#x0D; Results: The mean maternal age was 29 (21-39). The rate of antiphospholipid syndrome and active disease was 5% and 40% respectively. There were 30 live births. Two elective abortions were reported, one with major cardiac anomaly and the other with renal agenesis. One spontaneous abortion and 2 stillbirths were observed in the active SLE group. Overall rates of intrauterine growth retardation, preeclampsia, and preterm delivery were 8%, 20%, and 26%, respectively. Fetal loss and preterm delivery were significantly higher in the active SLE group (p=0,018, p=0,023). A higher rate of neonatal intensive care unit (NICU) admission was observed in the active SLE group (p=0,034) but Apgar scores less than 0,05).&#x0D; Conclusion: Despite advances in the medical sciences, an active disease with SLE has an elevated risk of inducing adverse pregnancy outcomes. Close follow-up could helps reduce pregnancy complications, especially preterm deliveries.

Elevated levels of serum IL-36α in patients with systemic lupus erythematosus.

The present study aimed to investigate the levels of IL-36α and its association with disease activity in patients with systemic lupus erythematosus (SLE). A total of 60 patients with SLE and 29 healthy controls were enrolled in the present study. Disease activity was evaluated using the SLE disease activity index (SLEDAI). The serum levels of IL-36α, IL-36 receptor antagonist (IL-36Ra) and IL-17 were assessed using ELISA. The levels of IL-36α in patients with SLE were significantly higher compared with those of healthy controls. There was a significant increase in IL-36α in the active SLE group (SLEDAI score ≥5) compared with that of the healthy controls (P<0.001). The serum IL-36α levels were higher in patients with active SLE than in patients with quiescent disease (P=0.012). IL-36Ra was downregulated in patients with SLE (P=0.007). The serum IL-17 levels were elevated in patients with SLE (P=0.036), and a positive correlation was observed between the IL-36α and IL-17 levels (r=0.453, P=0.003). The serum IL-36α levels were associated with SLEDAI (r=0.374, P=0.003), proteinuria (r=0.329, P=0.010) and complement 3 (r=-0.336, P=0.009). Patients who were receiving glucocorticoid treatment had lower IL-36α levels than those who were not receiving glucocorticoid treatment (P=0.003). Patients with lupus nephritis had higher serum IL-36α levels compared with those found in patients without lupus nephritis (P=0.037). The serum IL-36α concentration was elevated in patients with SLE, and was correlated with disease activity and IL-17 levels. The aberrant serum IL-36α levels observed in the present study and its clinical association with SLE suggest the important role of IL-36α in onset and progression of SLE. In addition, the association of IL-36α with IL-17 level indicates its involvement in the regulation of T helper 17 cytokines.

The Comparison of Interleukin-17 and Interleukin-10 with Systemic Lupus Erythematosus Disease Activity

AIM: This study was conducted to compare means of interleukin-17 (IL-17) (Th17 cytokines) and interleukin-10 (IL-10) (T-regulatory cytokines) as pro-inflammatory and anti-inflammatory cytokine with disease activity of systemic lupus erythematosus (SLE) and to investigate correlation between IL-17 cytokine serums with IL-10 in SLE patients. METHODS: This study recruited total of 68 SLE patients which included 34 active and 34 inactive patients based on MEX-SLEDAI as disease activity tool measurement and subjects were selected using consecutive sampling method. Blood samples were taken from subjects and IL-17 and IL-10 were measured using ELISA method. Data were analyzed with SPSS 26 software. RESULTS: Mean IL-17 was 19.67 ± 1.299 pg/ml in active SLE group and 19.78 ± 1.187 pg/ml in inactive group. Median of IL-10 in active group was 3.63 pg/ml and in inactive group was 2.52 pg/ml, respectively. No significant mean differences were found of IL-17 and IL-10 between active and inactive SLE patients (p &gt; 0.005). We found significant positive correlation between IL-17 and IL-10 (p &lt; 0.005; r = 0.529). CONCLUSION: There were no significant mean differences of IL-17 and IL-10 between active and inactive SLE patients. However, we found elevated result of IL-10 in active SLE than inactive. There was positive correlation between IL-17 and IL-10.

Serum and urine TNF-like weak inducer of apoptosis, monocyte chemoattractant protein-1 and neutrophil gelatinase-associated lipocalin as biomarkers of disease activity in patients with systemic lupus erythematosus.

TNF-like weak inducer of apoptosis (TWEAK), monocyte chemoattractant protein-1 (MCP-1) and neutrophil gelatinase-associated lipocalin (NGAL) are proinflammatory cytokines/chemokines that are considered as potential biomarkers reflecting disease activity in systemic lupus erythematosus (SLE). In this study, we aimed to investigate the association of serum (s) and urine (u) levels of TWEAK, MCP-1 and NGAL with disease activity in both renal and extra-renal SLE. Thirty active patients with SLE (15 renal and 15 extra-renal) were recruited. Thirty-one inactive patients with SLE (16 renal and 15 extra-renal), 14 patients with ANCA-associated vasculitis (AAV) all of whom had active renal involvement and 20 healthy volunteers were selected as control groups. Serum and urine levels of TWEAK, MCP-1 and NGAL were tested using ELISA. Serum and urine levels of TWEAK and NGAL were significantly higher in the active SLE group compared to the inactive SLE group (sTWEAK p = 0.005; uTWEAK p = 0.026; sNGAL p < 0.001; uNGAL p = 0.002), whilst no significant differences regarding serum and urine MCP-1 levels were observed (p = 0.189 and p = 0.106, respectively). uTWEAK (p = 0.237), sMCP-1 (p = 0.141), uMCP-1 (p = 0.206), sNGAL (p = 0.419) and uNGAL (p = 0.443) levels did not differ between patients with active renal and extra-renal SLE. Serum TWEAK was higher in patients with active renal SLE (p = 0.006). There were no differences between active renal SLE and active renal AAV. Levels of all biomarkers were correlated with the SLE Disease Activity Index. sTWEAK, uTWEAK, sNGAL and uNGAL are biomarkers showing disease activity in SLE. However, our results implicate that these biomarkers may not be specific for SLE, and can be elevated in patients with active renal involvement of AAV.

THE LEVELS OF FERRITIN SERUM AS A BIOMARKER TO DISTINGUISH BETWEEN ACTIVE AND INACTIVE SYSTEMIC LUPUS ERYTHEMATOSUS

Introduction: The Characteristic recurrence of SLE (Systemic Lupus Erythematosus) patients cannot be predicted. Lack of a reliable parameter that can predict an active clinical phase precludes the way to explore effective preventive strategies for disease relapse, while clinicians should balance the toxicity effect of prolonged use of immunosuppressive therapy. Aim: Knowing the function of serum ferritin as a biomarker to distinguish between active and inactive SLE Methods: Cross-sectional research was conducted at the hospital general of Haji Adam Malik Medan from August to September 2019 in 65 SLE patients. Patients conducted a serum ferritin test and in value by using the MexSledai score. Data analysis using the Mann-Whitney test in SPSS 20th. Result: Median (Min-max) serum ferritin levels of active SLE group 1519 (18.6-2218) ng/mL while inactive SLE Group is 250 (10.5-2000) ng/mL. There are significant differences in serum ferritin levels between active and inactive SLE groups (p = 0,004). ROC curve plot on was found the value of the serum ferritin cutoff can be used to diagnose active SLE. Cutoff value for ferritin levels is (486.0 ng/mL) with a sensitivity value (100.0%) and specificity (90.5%). Conclusion: Serum ferritin levels can be used as a biomarker to distinguish active and inactive SLE.

Altered Olfactory Function in Patients with Systemic Lupus Erythematosus.

BackgroundThe objective of this study was to detect the level of olfactory function in patients with systemic lupus erythematosus (SLE) and to explore the relationship between impaired olfactory function and anti-ribosomal P protein antibody (ARPA), disease duration, and age.Material/MethodsThe level of olfactory function in 65 patients with SLE and 50 healthy participants was detected using the Connecticut Chemosensory Clinical Research Center (CCCRC) method; serum ARPA levels in SLE patients and the healthy control group were detected by enzyme-linked immunosorbent assay (ELISA).ResultsCCCRC scores in the active SLE group was lower than that in the inactive SLE and healthy control groups (P<0.01). In SLE patients, the CCCRC scores of ARPA-positive patients were lower than those of ARPA-negative patients (P<0.01). A negative correlation was discovered between CCCRC scores and ARPA serum levels in SLE patients. Multiple linear regression analyses showed a correlation among the CCCRC score, age, and ARPA.ConclusionsOlfactory dysfunction was found in patients with active SLE; which correlated with SLE disease activity and ARPA levels.

Peripheral blood brain-derived neurotrophic factor level and tyrosine kinase B expression on T lymphocytes in systemic lupus erythematosus: Implications for systemic involvement

Brain-derived neurotrophic factor (BDNF) has been reported to be involved in the pathogenesis of autoimmune diseases and tyrosine kinase B (TrkB) is the specific receptor for BDNF. Our aim in this study was to investigate serum BDNF level and TrkB expression on peripheral blood T cell surface in patients with systemic lupus erythematosus (SLE) and explore potential relationship between serum BDNF and SLE. Samples from fifty SLE patients and thirty healthy controls were evaluated. Serum BDNF level was measured by enzyme-linked immunosorbent assay (ELISA) and the percentages of TrkB expression on the surface of CD3 + CD4 + and CD3 + CD8 + T lymphocytes were measured by flow cytometry. The SLE patients were divided into subgroups according to whether they exhibited brain, kidney or lung involvement, and whether the disease was active or inactive. Serum BDNF levels in SLE patients were decreased when compared to the controls (p < 0.001). Comparing with the SLE individuals without systemic involvement, the BDNF levels were decreased in SLE patients with lupus nephritis (p = 0.042) and in SLE patients with neuropsychiatric manifestations (p = 0.04). On the other hand, the BDNF level was significantly increased in the inactive SLE group (p < 0.001) compared to the active SLE group. In addition, the percentages of TrkB expression on CD3 + CD4 + and CD3 + CD8 + T cell surface in SLE were significantly higher (p < 0.001; p < 0.001, respectively) than that in the controls. Serum BDNF level combined with TrkB expression on T cell surface can reflect SLE activity. It is possible that BDNF may be used as a potential serological biomarker for disease activity of SLE. In addition, the significant decrease in serum BDNF level may imply systemic involvement of SLE, as well as, possibly, differentiate neuropsychiatric SLE from hormone-induced mental disorders.

SAT0184 ASSOCIATION OF SERUM AND URINE LEVELS OF TWEAK, MCP-1 AND NGAL WITH DISEASE ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background: TWEAK, MCP-1 and NGAL, mediators in pathogenesis of systemic lupus erythematosus (SLE), are proinflammatory cytokines/chemokines that are thought as potential biomarkers reflecting disease activity (1). Objectives: In this study, we aimed to investigate the association of serum (s) and urine (u) levels of TWEAK, MCP-1 and NGAL with disease activity in both renal and non-renal SLE. Methods: Thirty active patients with SLE (15 renal and 15 non-renal) were recruited. Thirty-one inactive patients with SLE (16 renal and 15 non-renal), 14 patients with ANCA-associated vasculitis (AAV) all of whom had active renal involvement and 20 healthy volunteers were selected as control groups. Serum and urine levels of TWEAK, MCP-1 and NGAL were tested using ELISA. Results: Sixty-one SLE patients, 51 (83.6%) of whom were female, with a median disease duration of 83 (23.5-135) months and a median age of 35 (27-47.5) were included in the study. Serum and urine levels of TWEAK and NGAL were significantly higher in the active SLE group compared with the inactive SLE (n=31) group (sTWEAK: p=0.005; uTWEAK: p=0.026; sNGAL: p Conclusion: sTWEAK, uTWEAK, sNGAL and uNGAL are significant biomarkers showing disease activity in SLE. However, our results implicate that these biomarkers may not be specific for SLE, and can be elevated in patients with active renal involvement of AAV. sTWEAK may be of use for discriminating active nephritis from non-renal active disease in SLE. Further studies are awaited to confirm these results (This study was funded by Istanbul University with the project number TTU-2017-24738 and Turkish Society for Rheumatology). Reference [1] Mok CC. Biomarkers for lupus nephritis: a critical appraisal. J Biomed Biotechnol. 2010;2010:638413. Disclosure of Interests: None declared

Vitamin D receptor expression in peripheral blood mononuclear cells is inversely associated with disease activity and inflammation in lupus patients

Systemic lupus erythematosus (SLE) is characterized by uncontrolled production of pro-inflammatory cytokines. Vitamin D receptor (VDR) has potent anti-inflammatory activities. The aim of this study was to examine the correlation between VDR expression and inflammation and disease activity in patients with SLE. Ninety-five SLE patients were recruited and divided into two groups, active and inactive, according to their SLE disease activity index (SLEDAI)-2K, and 40 healthy individuals served as controls. The expression of VDR and NF-κB p65 in peripheral blood mononuclear cells (PBMCs) was determined by quantitative RT-PCR and Western blotting. VDR expression was correlated with inflammatory and diseases parameters in SLE patients. VDR regulation was also studied in THP-1 and Jurkat cell lines. PBMC VDR expression was downregulated in SLE patients, especially in the active SLE group. VDR mRNA levels were negatively correlated with SLEDAI-2K (r = - 0.348, P = 0.001), Systemic Lupus International Collaborating Clinics (SLICC) renal activity scores (r = - 0.346, P = 0.014), and proteinuria (r = - 0.309, P = 0.002) and positively associated with serum complement C3 levels (r = 0.316, P = 0.002). Multiple stepwise regression analysis indicated that PBMC VDR downregulation was an independent risk factor for SLEDAI-2K. VDR levels were also negatively correlated with NF-κB p65 (r = - 0.339, P = 0.001), TNF-α (r = - 0.268, P = 0.009), and IL-6 (r = - 0.313, P = 0.002) levels. In monocyte and T lymphocyte cell lines, TNF-α suppressed VDR expression, whereas 1,25-dihydroxyvitamin D blocked TNF-α-induced VDR downregulation. PBMC VDR expression is inversely associated with disease activity and inflammation in SLE patients, and VDR downregulation is likely driven by inflammation.

Significance of increased IL-17-producing Foxp3+ Treg in peripheral blood of patients with active systemic lupus erythematosus

Objective To investigate the expression of IL-17-producing regulatory T cells (Treg) in patients with systemic lupus erythematosus (SLE) and to analyze their clinical significance. Methods This study recruited 32 patients with SLE (including 14 with active SLE and 18 with inactive SLE) and 13 healthy subjects matched for age and sex. Flow cytometry was performed to detect the expression of Foxp3 and IL-17 in CD4 T lymphocytes and the phenotypic characteristics of IL-17-producing Treg. Correlations between these cells and clinical indicators of SLE were analyzed. Peripheral CD4+ CD25+ T cells were isolated from five healthy subjects and then stimulated with IL-6 and IL-1β alone or in combination. An in vitro T cell polarization assay was performed to investigate the role of cytokines in the polarization and regulation of IL-17-producing Treg. Results Compared with the healthy subjects and patients with inactive SLE, the patients with active SLE had a higher percentage of IL-17-producing Treg in peripheral blood. Moreover, the expression of Foxp3 and CD45RA by IL-17-producing Treg in the active SLE group was down-regulated, while that of IL-2, granzyme B (GramB), programmed cell death protein 1 (PD-1) and glucocorticoid-induced tumor necrosis factor receptor (GITR) was up-regulated. Inflammatory cytokines such as IL-6 and IL-1 could induce Treg to produce IL-17. Conclusions This study suggested that increased inflammatory cytokines might correlate with higher percentages of IL-17-producing Treg in patients with active SLE. These cells were a subset of pathogenic Treg failing to prevent autoimmune. Key words: Regulatory T cell; Interleukin-17; Inflammatory cytokine; Immunophenotype; T cell plasticity

Predictive values of dyslipidemia and B-type natriuretic peptide levels in juvenile systemic lupus erythematosus: A two center-experience.

B-type natriuretic peptide (BNP) is a biomarker that helps in determining the diagnosis and prognosis of heart failure (HF). There is an increased risk for cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) with high disease activity, demonstrated by the higher frequency of dyslipidemia and higher BNP concentrations than in healthy controls. The aim of the work was to evaluate the association between the levels of lipids and BNP in pediatric patients with SLE with HF. We classified our subjects into three groups as follows: Group 1 (active SLE group): included 38 patients who subgrouped into 16 with HF and 22 without HF; Group 2 (inactive SLE group): included 38 patients, and Group 3 (control group): included 38 apparently healthy children. All children were subjected to complete history taking, clinical examination, SLE disease activity index scoring and investigations included complete blood count, erythrocyte sedimentation rate, 24-h urinary protein, anti-double strand deoxy-ribonucleic acid and anti-nuclear antibody, lipid profile, serum albumin, protein, and BNP. There was a significantly elevated lipid level and decreased high-density lipoproteins in lupus patients than in healthy controls. The dyslipidemia was more prevalent in active SLE. There were significantly elevated BNP levels in lupus patients than in healthy controls. In this study, we found that BNP was a biomarker in determining the diagnosis and prognosis of HF. This study revealed that BNP levels were increased in SLE patients without cardiac symptoms as compared to healthy controls; furthermore, the BNP levels were higher in active SLE patients with HF. The data indicated that there is a high risk for CVD in SLE with high disease activity, as demonstrated by the higher frequency of dyslipidemia and higher BNP concentrations than in healthy controls.

Platelet distribution width as a novel indicator of disease activity in systemic lupus erythematosus

Background:Significance of platelet distribution width (PDW) and mean platelet volume (MPV) in assessing disease activity of systemic lupus erythematosus (SLE) remains unclear. This study was aimed to evaluate PDW and MPV as potential disease activity markers in adult SLE patients.Materials and Methods:A total of 204 study participants, including 91 SLE patients and 113 age- and gender-matched healthy controls, were selected in this cross-sectional study. They were classified into three groups: control group (n = 113), active SLE group (n = 54), and inactive SLE group (n = 37). Demographic, clinical, and laboratory data were analyzed.Results:In patient group, PDW was statistically higher than that in control group (13.54 ± 2.67 vs. 12.65 ± 2.34, P = 0.012), and in active group, PDW was significantly increased compared to inactive group (14.31 ± 2.90 vs. 12.25 ± 1.55, P < 0.001). However, MPV was significantly lower in SLE group than in control group (10.74 ± 0.94 vs. 11.09 ± 1.14, P = 0.016). PDW was positively correlated with SLE disease activity index (P < 0.001, r = 0.529) and erythrocyte sedimentation rate (P = 0.002, r = 0.321) and negatively correlated with C3 (P < 0.001, r = −0.419). However, there was no significant association between MPV and these study variables. A PDW level of 11.85% was determined as a predictive cutoff value of SLE diagnosis (sensitivity 76.9%, specificity 42.5%) and 13.65% as cutoff of active stage (sensitivity 52.6%, specificity 85.3%).Conclusion:This study first associates a higher PDW level with an increased SLE activity, suggesting PDW as a novel indicator to monitor the activity of SLE.

Serum leptin in systemic lupus erythematosus patients: Its correlation with disease activity and some disease parameters

Abstract Aim of the work To evaluate serum leptin levels in systemic lupus erythematosus (SLE) patients and correlate these levels with clinical and laboratory parameters as well as disease activity using systemic lupus disease activity index (SLEDAI). Patients and methods The study was conducted on sixty female subjects, forty SLE patients and twenty healthy controls. Patients were diagnosed according to the American College of Rheumatology (ACR) revised criteria for SLE. All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity using SLEDAI and laboratory investigations including serum leptin levels (pg/ml) assessed by Enzyme Linked Immunosorbent Assay (ELISA). Patients were divided into two groups; group I with active SLE and group II with inactive SLE. Patients with SLEDAI ≥3 were considered active. Results Significant statistical differences were found in serum leptin levels between SLE patients and controls (6229.65 vs. 2962.30 pg/ml, p Conclusions SLE patients had elevated serum leptin levels. Elevated leptin levels correlated significantly with BMI and total cholesterol. Serum leptin levels showed non-significant correlations with SLEDAI nor did they differentiate between active and inactive SLE patients.