RESUMEN
OBJECTIVES: We sought to determine the effect of statin therapy on the levels of proinflammatory/prothrombotic markers and disease activity scores in patients with SLE in a multi-ethnic, multi-centre cohort (LUMINA). METHODS: Plasma/serum samples from SLE patients placed on statins (n=21) therapy taken before and after at least 6 months of treatment were tested. Disease activity was assessed using SLAM-R scores. Interleukin (IL)-1ß, IL-6, IL-8, tumour necrosis factor (TNF)-α, vascular endothelial growth factor (VEGF) and soluble CD40 ligand (sCD40L) levels were determined by a multiplex immunoassay. Soluble intercellular cell adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 and anticardiolipin (aCL) antibodies were evaluated using ELISA assays while high sensitivity C-reactive protein (hsCRP) was assessed by nephelometry. Plasma/serum samples from frequency- matched healthy donors were used as controls. RESULTS: Levels of IL-6, VEGF, sCD40L and TNF-α were significantly elevated in SLE patients versus controls. Statin therapy resulted in a significant decrease in SLAM-R scores (p=0.0199) but no significant changes in biomarker levels were observed. There was no significant association of biomarkers with SLAM-R scores. CONCLUSIONS: Statin therapy resulted in significant clinical improvement in SLE patients, underscoring the use of statins in the treatment of SLE.
Asunto(s)
Biomarcadores/sangre , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Lupus Eritematoso Sistémico , Adulto , Proteína C-Reactiva/análisis , Ligando de CD40/sangre , Etnicidad , Femenino , Humanos , Molécula 1 de Adhesión Intercelular/sangre , Interleucinas/sangre , Estudios Longitudinales , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Gravedad del Paciente , Puerto Rico/epidemiología , Proyectos de Investigación , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/sangre , Estados Unidos/epidemiología , Molécula 1 de Adhesión Celular Vascular/sangreRESUMEN
The antiphospholipid syndrome (APS) is an acquired thombophilia, which is characterized by one or more thrombotic episodes and obstetric complications in the presence of antiphospholipid (aPL) antibodies (Abs). APL Abs are detected by laboratory tests such as lupus anticoagulant (LAC), anticardiolipin (aCL) and anti-Beta2-glycoprotein I (Beta2GPI) Abs. This article reviews the most current aspects of APS with emphasis on the pathophysiology of the disease, clinical manifestations, laboratory tests, and current modalities of treatment.
Asunto(s)
Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/fisiopatología , Aborto Habitual/etiología , Adulto , Animales , Anticuerpos Anticardiolipina , Anticuerpos Antifosfolípidos/análisis , Anticoagulantes/uso terapéutico , Síndrome Antifosfolípido/terapia , Modelos Animales de Enfermedad , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Intercambio Plasmático , Embarazo , Complicaciones Hematológicas del Embarazo , Trombosis/etiología , Trombosis/terapia , beta 2 Glicoproteína I/inmunologíaRESUMEN
OBJECTIVE: Reports have shown that anticardiolipin (aCL) antibodies present in patients with autoimmune diseases are dependent on the cofactor,beta2 glycoprotein I (beta2 GPI), as opposed to aCL antibodies seen in infectious diseases such as syphilis, HIV hepatitis C, etc. The assay for anti-beta2GPI antibodies has been reported to be more specific for antiphospholipid syndrome (APS). However, the prevalence of these antibodies in diseases such as leishmaniasis and leptospirosis remains unknown. The aim of the present study was determine the prevalence of antibodies to cardiolipin and to beta2GPI in patients with different infectious diseases, including leptospirosis, syphilis and leishmaniasis. METHODS: Samples from patients with Kala-azar (visceral leishmaniasis), syphilis or leptospirosis were tested for IgG and IgM anticardiolipin and IgG anti-beta2GPI antibodies by ELISA. RESULTS: In patients with Kala-azar the prevalence of IgG aCL, IgM aCL and anti-beta2GPI was 6% (2/30), 3% (1/30) and 53% (16/30), respectively. In syphilis the prevalence was 18% (14/74), 13% (10/74) and 10% (8/70), respectively. In leptospirosis the frequency of these antibodies was 23% (9/39), 10% (4/39) and 17% (6/34), respectively. There was no statistical correlation between aCL and anti-beta2GPI antibodies in these diseases. DISCUSSION: This study clearly shows a significant prevalence of anti-beta2GPI antibodies in leptospirosis and leishmaniasis and syphilis. This indicates that the assay for antibeta2GPI antibodies should be thoroughly validated before it is introduced as a definitive tool for the diagnosis of APS, testing a larger number of sera from patients with a wider range of clinical conditions.
Asunto(s)
Anticuerpos Anticardiolipina/análisis , Glicoproteínas/inmunología , Leishmaniasis Visceral/inmunología , Leptospirosis/inmunología , Sífilis/inmunología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Lactante , Masculino , Persona de Mediana Edad , beta 2 Glicoproteína IRESUMEN
Antiphospholipid antibodies (aPL) have been associated with different diseases. They are defined as a large family of immunoglobulins (Ig) of either alloantibodies or autoantibodies. The autoimmune antibodies are associated with venous and/or arterial thrombosis, thrombocytopenia and recurrent fetal loss in the so-called antiphospholipid syndrome or in systemic lupus erythematosus. These antibodies are directed against proteins or phospholipid-protein complexes. On the contrary, antiphospholipid antibodies (alloantibodies) which are found in infectious diseases sera (syphilis, HIV, and other viral diseases), disappear with illness remission and are directed to phospholipids alone (particularly cardiolipin) and are not associated with thrombosis or recurrent fetal loss. However, the role and type of aPL found during hepatic diseases is still unclear. To investigate the prevalence of autoimmune aPL (IgG and IgM) during different hepatic diseases, we have studied 128 patients with hepatitis C virus, hepatitis B virus and hepatic autoimmune diseases without treatment as well as 40 healthy control subjects. We have used a specific ELISA kit, that uses a mixture of phospholipid instead of cardiolipin alone, and allows a better detection of aPL of the autoimmune type. Our results show that autoimmune aPL are not significantly increased in viral hepatic diseases (2%) or autoimmune diseases of the liver (3%) when compared to the control group (0%).
Asunto(s)
Anticuerpos Antifosfolípidos/sangre , Hepatitis B/sangre , Hepatitis C/sangre , Hepatitis Autoinmune/sangre , Autoanticuerpos/sangre , Estudios de Casos y Controles , Enfermedad Crónica , Ensayo de Inmunoadsorción Enzimática , Hepatitis B/inmunología , Hepatitis C/inmunología , Hepatitis Autoinmune/inmunología , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , PrevalenciaRESUMEN
Antiphospholipid antibodies (aPL) have been associated with different diseases. They are defined as a large family of immunoglobulins (Ig) of either alloantibodies or autoantibodies. The autoimmune antibodies are associated with venous and/or arterial thrombosis, thrombocytopenia and recurrent fetal loss in the so-called antiphospholipid syndrome or in systemic lupus erythematosus. These antibodies are directed against proteins or phospholipid-protein complexes. On the contrary, antiphospholipid antibodies (alloantibodies) which are found in infectious diseases sera (syphilis, HIV, and other viral diseases), disappear with illness remission and are directed to phospholipids alone (particularly cardiolipin) and are not associated with thrombosis or recurrent fetal loss. However, the role and type of aPL found during hepatic diseases is still unclear. To investigate the prevalence of autoimmune aPL (IgG and IgM) during different hepatic diseases, we have studied 128 patients with hepatitis C virus, hepatitis B virus and hepatic autoimmune diseases without treatment as well as 40 healthy control subjects. We have used a specific ELISA kit, that uses a mixture of phospholipid instead of cardiolipin alone, and allows a better detection of aPL of the autoimmune type. Our results show that autoimmune aPL are not significantly increased in viral hepatic diseases (2
) or autoimmune diseases of the liver (3
) when compared to the control group (0
).