sle pathogenesis

SLE 发病机制
  • 文章类型: Case Reports
    系统性红斑狼疮(SLE)是一种自身免疫性疾病,其特征是靶向细胞核和细胞质抗原的抗体。它可以表现出不同的临床症状,包括全血细胞减少症.我们介绍了一个20多岁的非洲裔美国妇女的案例,有SLE病史,身上有瘀伤。她一直在接受羟氯喹治疗,霉酚酸酯,泼尼松,还有赖诺普利.在后续访问中,她的检查显示全血细胞减少症,促使调查原因。潜在的SLE或霉酚酸酯毒性的爆发可能是罪魁祸首。然而,临床表现与两者均不一致.骨髓活检最终诊断为急性早幼粒细胞白血病。SLE后急性早幼粒细胞白血病的发生率极为罕见。因此,在全血细胞减少症和潜在的SLE患者中,它可能存在重大的诊断困境。
    Systemic lupus erythematosus (SLE) is an autoimmune condition characterized by antibodies targeting nuclear and cytoplasmic antigens. It can present with diverse clinical symptoms, including pancytopenia. We present the case of an African American woman in her 20s, with a history of SLE who presented with bruising on her body. She had been receiving treatment with hydroxychloroquine, mycophenolate, prednisone, and lisinopril. During a follow-up visit, her workup revealed pancytopenia, prompting an investigation for causes. A flare-up of underlying SLE or mycophenolate toxicity was the likely culprit. However, the clinical picture was not aligned with either. A bone marrow biopsy ultimately led to the diagnosis of acute promyelocytic leukemia. The incidence of acute promyelocytic leukemia following SLE is exceedingly rare. Hence, it could present a significant diagnostic dilemma in patients with pancytopenia and underlying SLE.
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  • 文章类型: Journal Article
    系统性红斑狼疮(SLE)是一种慢性自身免疫性疾病,影响身体的多个系统。最近对与SLE患者相关的肠道菌群失调的研究已经获得了关注,值得进一步探索。尚未确定肠道微生物群的变化是SLE的原因还是SLE的症状。然而,基于细菌在肠道微生物组中的生理和病理生理作用,随着细菌水平的上升或下降,SLE患者的症状可能会受到影响。这篇综述分析了最近的研究,这些研究检查了SLE患者肠道菌群的变化,并强调了肠道菌群失调与SLE临床表现之间的相关性。通过结合术语“SLE,系统性红斑狼疮,“和”肠道微生物组。“生物医学参考收藏,CINAHL,MedlineProQuest,和PubMedCentral数据库通过将适当的关键字与\"AND结合起来进行搜索。\"只有全文,搜索了英语文章。这些文章从2013年到2023年受到限制。本范围审查仅包括同行评审的人体和动物试验的对照研究。评论文章,非英语文章,社论,案例研究,四个数据库中的重复文章被排除在外。发现各种细菌与SLE肠道微生物群落呈正相关或负相关。在增加的细菌种类中,梭状芽孢杆菌,乳酸杆菌,链球菌,肠杆菌,还有克雷伯菌.减少的细菌种类是双歧杆菌,普雷沃氏菌,和Firmicutes/拟杆菌比率。文献表明,梭菌属是发现数量丰富的几种细菌之一,从疾病前到SLE的患病状态。Lachnospileaceae和Ruminococaceae都是产生丁酸的厌氧菌家族的一部分,以其在增强皮肤屏障功能方面的作用而闻名,因此,可以解释SLE患者的皮肤表现。研究还表明,Firmicutes/拟杆菌比率显着降低,这可能导致SLE患者的食欲变化和体重减轻。基于这些细菌在肠道微生物组中的作用,肠道生态系统的破坏可以解释SLE患者常见的症状。通过解决这些变化,我们的范围审查鼓励进一步研究,以建立SLE患者细菌变化之间的真实因果关系,并进一步了解其他系统和自身免疫性疾病中微生物群变化的范围.
    Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple systems of the body. Recent research on the gut microbiota dysbiosis associated with SLE patients has gained traction and warranted further exploration. It has not been determined whether the change in the gut microbiota is a cause of SLE or a symptom of SLE. However, based on the physiological and pathophysiological role of the bacteria in the gut microbiome, as levels of the bacteria rise or fall, symptomatology in SLE patients could be affected. This review analyzes the recent studies that examined the changes in the gut microbiota of SLE patients and highlights the correlations between gut dysbiosis and the clinical manifestations of SLE. A systematic search strategy was developed by combining the terms \"SLE,\" \"systemic lupus erythematosus,\" and \"gut microbiome.\" Biomedical Reference Collection, CINAHL, Medline ProQuest, and PubMed Central databases were searched by combining the appropriate keywords with \"AND.\" Only full-text, English-language articles were searched. The articles were restricted from 2013 to 2023. Only peer-reviewed controlled studies with both human and animal trials were included in this scoping review. Review articles, non-English articles, editorials, case studies, and duplicate articles from the four databases were excluded. Various species of bacteria were found to be positively or negatively associated with SLE gut microbiomes. Among the bacterial species increased were Clostridium, Lactobacilli, Streptococcus, Enterobacter, and Klebsiella. The bacterial species that decreased were Bifidobacteria, Prevotella, and the Firmicutes/Bacteroidetes ratio. Literature shows that Clostridium is one of several bacteria found in abundance, from pre-disease to the diseased state of SLE. Lachnospiraceae and Ruminococcaceae are both part of the family of butyrate-producing anaerobes that are known for their role in strengthening the skin barrier function and, therefore, may explain the cutaneous manifestations of SLE patients. Studies have also shown that the Firmicutes/Bacteroidetes ratio is significantly depressed, which may lead to appetite changes and weight loss seen in SLE patients. Based on the established role of these bacteria within the gut microbiome, the disruption in the gut ecosystem could explain the symptomatology common in SLE patients. By addressing these changes, our scoping review encourages further research to establish a true causal relationship between the bacterial changes in SLE patients as well as furthering the scope of microbiota changes in other systems and autoimmune diseases.
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  • 文章类型: Case Reports
    我们描述了一名27岁男性并发嗜酸性肉芽肿合并多血管炎和混合性结缔组织疾病的罕见病例,肾,心脏,和皮肤表现。我们根据临床证实了诊断,组织病理学,和血清学标准。我们用皮质类固醇治疗了病人,甲氨蝶呤,环磷酰胺,和羟氯喹,实现早期缓解。同一患者中两种情况的共存极为罕见,并且仅在世界范围内的少数病例中报道。我们还回顾了关于这两种罕见的自身免疫性疾病共存的文献,发病机制,诊断,和管理。我们的案例强调识别具有复杂临床特征的患者的重叠自身免疫状况,并采用全面的诊断方法和量身定制的治疗策略。需要进一步的研究来了解这些患者的流行病学,预后,和最佳治疗。早期诊断和积极的免疫抑制对于实现缓解和预防器官损伤至关重要。我们还确定了该领域的知识差距和研究需求。
    We describe a rare case of concurrent eosinophilic granulomatosis with polyangiitis and mixed connective tissue disease in a 27-year-old man who presented with pulmonary, renal, cardiac, and skin manifestations. We confirmed the diagnosis based on clinical, histopathological, and serological criteria. We treated the patient with corticosteroids, methotrexate, cyclophosphamide, and hydroxychloroquine, achieving early remission. The coexistence of both conditions in the same patient is extremely rare and has only been reported in a few cases worldwide. We also review the literature on these two rare autoimmune diseases\' coexistence, pathogenesis, diagnosis, and management. Our case emphasizes recognizing overlapping autoimmune conditions in patients with complex clinical features and employing a comprehensive diagnostic approach and tailored treatment strategies. Further research is needed to understand these patients\' epidemiology, prognosis, and optimal therapy. Early diagnosis and aggressive immunosuppression are crucial for achieving remission and preventing organ damage. We also identified the knowledge gaps and research needs in this field.
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  • 文章类型: Journal Article
    系统性红斑狼疮(SLE)是一种自身免疫性疾病,其特征是由于免疫细胞暴露于过量的细胞外DNA而产生抗DNA自身抗体。小鼠中缺乏P-选择素诱导狼疮样综合征的发展,皮肤狼疮患者皮肤血管中P-选择素的表达降低。使用流式细胞术,我们分析了健康供体和患者中P-选择素糖蛋白配体-1(PSGL-1)在循环中性粒细胞中的表达以及PSGL-1/P-选择素相互作用在中性粒细胞胞外陷阱(NETs)生成中的意义。我们发现了一个统计学意义,即活动性SLE患者的中性粒细胞在SLE患者的中性粒细胞中PSGL-1的表达减少和PSGL-1的低水平与抗dsDNA抗体的存在有关,临床肺部受累,雷诺现象,狼疮抗凝物阳性.PSGL-1沿着NET中的DNA存在。在健康的捐赠者中,中性粒细胞与固定的P-选择素的相互作用触发Syk激活,增加NETs百分比并减少NETs中挤出的DNA量。在活动性SLE患者中,中性粒细胞与P-选择素的相互作用不会激活Syk或减少NETs中挤出的DNA量,这可能有助于增加DNA的细胞外水平,疾病的发病机理。
    Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by the generation of anti-DNA autoantibodies due to exposure of immune cells to excessive amounts of extracellular DNA. Lack of P-selectin in mice induces the development of a lupus-like syndrome and patients with cutaneous lupus have reduced P-selectin expression in skin vessels. Using flow cytometry we analyzed in healthy donors and patients the expression of P-selectin Glycoprotein Ligand-1 (PSGL-1) in circulating neutrophils and the implication of PSGL-1/P-selectin interaction in neutrophil extracellular traps (NETs) generation. We found a statistical significance that neutrophils from active SLE patients have a reduced expression of PSGL-1 and low levels of PSGL-1 in neutrophils from SLE patients associated with the presence of anti-dsDNA antibodies, clinical lung involvement, Raynaud\'s phenomenon, and positive lupus anticoagulant. PSGL-1 is present along the DNA in the NET. In healthy donors, neutrophil interaction with immobilized P-selectin triggers Syk activation, increases the NETs percentage and reduces the amount of DNA extruded in the NETs. In active SLE patients, neutrophil interaction with P-selectin does not activate Syk or reduce the amount of DNA extruded in the NETs, that might contribute to increase the extracellular level of DNA and hence, to disease pathogenesis.
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  • 文章类型: Journal Article
    近年来,许多有记录的系统性红斑狼疮(SLE)病例正在增加。该疾病的复杂病理生理学使得管理具有挑战性。两个数据库,PubMed和谷歌学者,使用关键字和医学主题标题(MeSH)组合进行详细的筛选。单词是“系统性红斑狼疮或SLE或狼疮,\"\"谷胱甘肽,\"和\"姜黄素。“文章有一个详细的筛选和质量评估过程。使用英语作为主要筛选参数,过去20年的论文,从2002年到2022年,是这次审查的基础。我们回顾了所有可能的人体研究,这些研究记录了姜黄素和谷胱甘肽治疗SLE的用途。本系统综述共15篇。姜黄素和谷胱甘肽可以作为治疗狼疮的有效药物。姜黄素可以是更有前途的替代品,因为它在各种途径上起作用,并且是更容易获得的来源。
    In recent years, many documented cases of systemic lupus erythematosus (SLE) have been on the rise. The complicated pathophysiology of the disease makes it challenging to manage. Two databases, PubMed and Google Scholar, have a detailed screening using keywords and Medical Subject Heading (MeSH) combinations. The words are \"Systemic Lupus Erythematosus OR SLE OR Lupus,\" \"Glutathione,\" and \"Curcumin.\" Articles had a detailed process of screening and quality appraisal. Using the English language as a primary filtering parameter, papers over the last 20 years, dating from 2002 to 2022, are the basis of this review. We reviewed all possible human studies documenting the use of curcumin and glutathione for treating SLE. A total of 15 articles are part of this systematic review. Curcumin and glutathione can act as potent drugs for treating lupus. Curcumin can be a more promising alternative since it operates on various pathways and is a more easily accessible source.
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  • 文章类型: Journal Article
    系统性红斑狼疮(SLE),通常被认为是自身免疫性疾病的原型,其特征在于自身免疫系统的过度活化,具有先天和适应性免疫细胞的异常功能,并且产生大量针对核组分的自身抗体。鉴于SLE的高度复杂性和异质性,这种疾病的发病机制尚不完全清楚,推测与遗传和环境因素有关。目前,肠道微生物群的紊乱已经成为SLE发病机制中的一种新的参与者。随着深入研究,对SLE中肠道细菌-宿主相互作用的理解更加全面。近年来,SLE的代谢组学研究也有所增加,试图确定诊断或疾病活动监测的潜在生物标志物。肠道微生物组变化和代谢改变之间的复杂关系可以帮助解释肠道细菌在SLE发病机理中发挥作用的机制。这里,我们综述了微生物群失调在SLE病因中的作用,以及肠道微生物群如何与宿主代谢轴相互作用.本文还讨论了基于肠道微生物组(GM)调节的SLE治疗策略。增加我们对肠道微生物群及其在狼疮中的功能的了解将为我们提供新的机会,以开发有效和精确的诊断策略,并探索针对狼疮患者的潜在基于微生物群的治疗方法。
    Systemic lupus erythematosus (SLE), often considered the prototype of autoimmune diseases, is characterized by over-activation of the autoimmune system with abnormal functions of innate and adaptive immune cells and the production of a large number of autoantibodies against nuclear components. Given the highly complex and heterogeneous nature of SLE, the pathogenesis of this disease remains incompletely understood and is presumed to involve both genetic and environmental factors. Currently, disturbance of the gut microbiota has emerged as a novel player involved in the pathogenesis of SLE. With in-depth research, the understanding of the intestinal bacteria-host interaction in SLE is much more comprehensive. Recent years have also seen an increase in metabolomics studies in SLE with the attempt to identify potential biomarkers for diagnosis or disease activity monitoring. An intricate relationship between gut microbiome changes and metabolic alterations could help explain the mechanisms by which gut bacteria play roles in the pathogenesis of SLE. Here, we review the role of microbiota dysbiosis in the aetiology of SLE and how intestinal microbiota interact with the host metabolism axis. A proposed treatment strategy for SLE based on gut microbiome (GM) regulation is also discussed in this review. Increasing our understanding of gut microbiota and their function in lupus will provide us with novel opportunities to develop effective and precise diagnostic strategies and to explore potential microbiota-based treatments for patients with lupus.
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  • 文章类型: Journal Article
    SLE is a chronic autoimmune disease caused by perturbations of the immune system. The clinical presentation is heterogeneous, largely because of the multiple genetic and environmental factors that contribute to disease initiation and progression. Over the last 60 years, there have been a number of significant leaps in our understanding of the immunological mechanisms driving disease processes. We now know that multiple leucocyte subsets, together with inflammatory cytokines, chemokines and regulatory mediators that are normally involved in host protection from invading pathogens, contribute to the inflammatory events leading to tissue destruction and organ failure. In this broad overview, we discuss the main pathways involved in SLE and highlight new findings. We describe the immunological changes that characterize this form of autoimmunity. The major leucocytes that are essential for disease progression are discussed, together with key mediators that propagate the immune response and drive the inflammatory response in SLE.
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  • 文章类型: Journal Article
    Oxidative stress is elevated in systemic lupus erythematosus (SLE) patients, and associated extensively with SLE pathogenesis. However, no common indicators of oxidative stress are yet in routine clinical use because of their instability, nonspecificity, and non-representation of all SLE symptoms. Moreover, the method for reproducible analysis of reactive oxygen species is still lacking. Lipids and their metabolites are essential components of biological systems, many of which serve as molecular targets of oxidative stress and play crucial roles in signaling, inflammation, and immune responses. Thus, determining the changed levels of lipids and their metabolites may serve the needs for SLE research. In the pilot study, shotgun lipidomics of sera from 30 SLE patients and 30 controls was performed and revealed a marked reduction of ethanolamine plasmalogen (pPE) species from 85.03±3.06 to 62.39±4.34 nmol/mL serum in controls and patients, respectively, accompanying significant increases in lysoPE (LPE) content (~46mol%) and 4-hydroxynonenal (an indictor of oxidative stress) in patients. Representative proinflammatory cytokines were also determined, revealing significant elevation of IL-6, IL-10, and TNF-α in SLE patients. Multivariate and multiple regression analyses showed for the first time that significant correlation among the SLE disease activity index, IL-10 levels, and pPE content exists, providing insights into SLE pathogenesis. The study also indicates that the changes of pPE (molecular targets of oxidative stress) and their peroxidation products may serve as novel biomarkers for diagnosis of SLE.
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