Objetivo: Avaliar possíveis associações entre o polimorfismo Glu298Asp da região codificadora do gene da óxido nítrico sintetase endotelial (eNOS) e a suscetibilidade ao lúpus eritematoso sistêmico (LES) e manifestações clínicas relacionadas à doença. Métodos: Cento e treze pacientes de descendência européia com diagnóstico de LES, com 4 ou mais critérios do Colégio Americano de Reumatologia, que foram recrutados no ambulatório do Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, e 206 controles saudáveis, de mesma descendência européia que os pacientes, foram genotipados através de reação em cadeia da polimerase para o polimorfismo Glu298Asp da região codificadora do gene da eNOS. Dados clínicos, demográficos, laboratoriais dos pacientes foram coletados. Manifestações clínicas do LES e doenças relacionadas foram avaliadas quanto à associação com genótipos específicos.Resultados: A distribuição do genótipo Glu298Asp e alelos não teve diferença estatísticamente significativa entre os pacientes lúpicos e controles. Não houve também associação significativa do polimorfismo com glomerulonefrite lúpica, síndrome antifosfolipídeo (SAF), doença cardiovascular (DCV) e fatores de risco para DCV. Conclusão: Os achados apresentados não evidenciaram um papel importante do polimorfismo estudado na suscetibilidade para o LES nem para as manifestações clínicas avaliadas, fato este que pode ser devido à perda de poder estatístico nestas análises de subgrupo.

O Lúpus Eritematoso Sistêmico (LES) é uma doença inflamatória sistêmica autoimune caracterizada pela produção e deposição de imunocomplexos. Sua etiologia é pouco conhecida, mas há evidências da participação de fatores genéticos. Vários genes responsáveis pela síntese de proteínas do Sistema Complemento (SC) têm sido relacionados com LES. O gene MBL-2 responsável pela síntese da lectina ligadora da manose (MBL - mannose-binding lectin), uma proteína envolvida na ativação do SC, apresenta vários polimorfismos que se relacionam com a deficiência desta proteína e, conseqüentemente, estão associados com desenvolvimento de LES. Para verificar a possibilidade de alguns polimorfismos da MBL configurarem risco aumentado para LES e se há alguma interferência destes com as manifestações clínicas e laboratoriais da doença, foi conduzido um estudo de caso-controle, com 327 pacientes lúpicos e 165 controles saudáveis da mesma área geográfica, sendo avaliados os polimorfismos G57E (alelo C), G54D (alelo B), IVSnt5, R52C (alelo D) e R52H do gene MBL-2. A genotipagem foi realizada por Restriction Fragment Length Polymorphism-Polimerase Chain Reaction (RFLP-PCR) usando primers e enzimas de restrição específicas para cada polimorfismo. Os dados clínicos e laboratoriais foram coletados dos prontuários. Os resultados evidenciaram uma diferença estatisticamente significativa na freqüência do alelo D nos pacientes euro-descendentes quando comparados com os controles (9,6% versus 3,3%, P=0,001, odds ratio de 3,01, intervalo de confiança de 95%: 1,58- 6,06, P<0,05). As frequências dos alelos B e C não foram diferentes nos pacientes euro-descendentes e controles (alelo B: 15,9% versus 18,8%, P=0,317 e alelo C: 3,6% versus 3,0%, P=0,796). Os alelos IVSnt5 e R52H não foram encontrados nesta população. Achados clínicos e laboratoriais não tiveram diferença estatisticamente significativa em relação à presença ou ausência dos alelos mutantes. Os resultados apresentados apontam um aumento de cerca de três vezes no odds ratio para o desenvolvimento de LES em pessoas com a presença do alelo D. Nesta população estudada, não foi encontrada associação entre os alelos mutantes e a expressão fenotípica da doença.

A farmacocinética dos enantiômeros da ciclofosfamida (CPA) foi avaliada em pacientes portadores de nefrite lúpica distribuídos em dois grupos de acordo com o clearance da creatinina: Grupo 1 90,6-144,6mL/min/1,73m2 e Grupo 2 42,8-76,4mL/min/1,73m2. Os pacientes foram tratados com doses de 0,75 a 1,3g de ciclofosfamida racêmica sob forma de infusão com duração de 2h e com 1mg de midazolam (MDZ) administrado via endovenosa para a avaliação da atividade in vivo do CYP3A. As concentrações plasmáticas dos enantiômeros da CPA e do MDZ foram avaliadas por LC-MS/MS. Os enantiômeros da CPA foram resolvidos na coluna Chiralcel OD-R, com fase móvel constituída por mistura de acetonitrila e água (75:25, v/v) adicionada de 0,2% de ácido fórmico. Os enantiômeros da CPA foram extraídos do plasma com recuperações maiores que 95% e o limite de quantificação obtido foi de 2,5ng de cada enantiômero da CPA/mL plasma. As seguintes diferenças (teste de Wilcoxon, p<0,05) foram observadas nos parâmetros farmacocinéticos entre os enantiômeros (S)-(-)-CPA e (R)-(+)-CPA para os pacientes do Grupo 1: AUC do tempo 0 ao infinito 152,41 vs 129,25g.h/mL; Cl 3,28 vs 3,89L/h; Vd 31,38 vs 29,74L e t1/2 6,79 vs 5,56h e para os pacientes do Grupo 2: AUC do tempo 0 ao infinito 167,20 vs 139,08g.h/mL; Cl 2,99 vs 3,59L/h e t1/2 6,15 vs 4,99h. Não foi observada diferença (teste de Mann-Whitney, p<0,05) nos parâmetros farmacocinéticos de ambos os enantiômeros entre os grupos 1 e 2. Não foi observada corrrelação entre o clearance do MDZ (2,92-16,40ml/min.kg) e o clearance de cada enantiômero da CPA. Concluindo, a farmacocinética da CPA é enantiosseletiva em pacientes portadores de nefrite lúpica com acúmulo plasmático do enantiômero (S)-(-)-CPA e a farmacocinética de ambos os enantiômeros da CPA não é alterada pela agravamento da função renal. / The pharmacokinetics of cyclophosphamide (CYC) enantiomers was evaluated in patients with lupus nephritis distributed in two groups according to creatinine clearance; Group 1 - 90.6-144.6mL/min/1.73m2 and Group 2 - 42.8- 76.4mL/min/1.73m2. All patients were treated with 0.75 to 1.3g of racemic CYC as a 2-hour infusion and with 1mg intravenous midazolam as a drug marker. CYC enantiomers and midazolam concentrations in plasma were measured by LC-MS/MS. CYC enantiomers were separated on a Chiralcel OD-R column, with the mobile phase consisting of a mixture of acetonitrile and water (75:25, v/v) plus 0.2% formic acid. Recovery rates were higher than 95% and the quantification limit was 2.5ng/ml plasma for both enantiomers. The coefficients of variation and the relative errors obtained for the validation of intra- and interassay precision and accuracy were less than 10%. The following differences in the pharmacokinetic parameters (Wilcoxon test, p<0.05) were observed between the (S)-(-) and (R)-(+) enantiomers for Group 1 AUC from time 0 to infinity 152.41 vs 129.25g.h/mL, Cl 3.28 vs 3.89L/h, Vd 31.38 vs 29.74L and t1/2 6.79 vs 5.56h and for Group 2 AUC from time 0 to infinity 167.20 vs 139.08g.h/mL, Cl 2.99 vs 3.59 L/h and t1/2 6.15 vs 4.99 h. No differences (Mann-Whitney test, p<0.05) were observed between Groups 1 and 2 in the pharmacokinetics parameters of both enantiomers. No significant relationship was observed between midazolam clearance (2.92-16.40 ml/min.kg) and clearance of each CYC enantiomer. In conclusion, CYC kinetic disposition is enantioselective resulting in higher exposure of (S)-(-)-CYC in lupus nephritis patients and the pharmacokinetic parameters of both enantiomers are not altered by the worsening of renal condition.

Introdução: A prolactina (PRL) exerce efeitos imunoestimulatórios in vitro e in vivo, porém a literatura é controversa quanto ao papel deste hormônio na atividade do Lúpus Eritematoso Sistêmico (LES). A macroprolactina possui menor atividade biológica in vivo e poderia explicar os resultados díspares. Objetivos: avaliar a prevalência de hiperprolactinemia e macroprolactinemia em pacientes lúpicas; analisar a correlação entre a atividade do LES e PRL, e interferência da macroprolactina nesta associação. Casuística e Métodos: Em 73 mulheres com LES ativo foi dosada a PRL pelo Immulite 2000®, e a macroprolactina pelo método do Polietilenoglicol (momento 1); em 62 destas pacientes foi colhida uma segunda amostra com a menor atividade do LES ao longo do tratamento (momento 2). Os controles foram 29 mulheres hígidas no menacme (grupo C) e 34 gestantes no terceiro trimestre (grupo G). Resultados: Houve 15 casos (20,55%) de hiperprolactinemia nas lúpicas, e nenhum entre as mulheres hígidas (p = 0,005). Todas as gestantes apresentaram hiperprolactinemia. A concentração de PRL foi maior (Med = 11,70 ng/ml) (p = 0,01) no LES do que no grupo C (Med = 8,81ng/ml), e correlacionou-se com a atividade da doença pelo SLEDAI (r = 0,41; p = 0,0003) no momento 1. No LES muito ativo os níveis de PRL foram maiores do que na doença inativa (Med = 17,10 ng/ml vs. Med = 8,36 ng/ml) (p< 0,01), e moderadamente ativa (Med = 7,75 ng/ml) (p < 0,05). Dentre as lúpicas hiperprolactinêmicas, 04 casos (26,7%) foram devidos à macroprolactina, e nas gestantes, 02 casos (5,9%). O LES foi tão ativo na macroprolactinemia quanto nos casos pela forma monomérica, porém a correlação entre PRL e SLEDAI foi maior para a PRL livre (r = 0,44; p = 0,0001). O tratamento das pacientes lúpicas hiperprolactinêmicas resultou em diminuição da concentração de PRL (Me momento 1 = 56,71 ± 43,87 ng/ml vs. Me momento 2 = 18,68 ± 24,20 ng/ml) (p = 0,015). Conclusões: pacientes lúpicas apresentam hiperprolactinemia mais frequentemente do que mulheres hígidas, e a PRL correlaciona-se com a atividade do LES. A macroprolactinemia não é marcador de doença inativa/pouco ativa. / Introduction: Prolactin (PRL) is a hormone with widespread influences in the cells of the immune system, which have been demonstrated by several in vitro and in vivo studies. However, the role of this hormone in the pathogenesis of Systemic Lupus Erythematosus (SLE) is controversial within the medical literature. The potentially lower biological activity of macroprolactin could explain the disparity of the results. Methods: PRL levels were determined by chemo luminescence method (Immulite 2000®) in 73 women with active SLE (group L), while the screening for macroprolactinemia was determined by the polyethylene glycol precipitation method (first moment). Sixty two of these patients had their PRL levels determined in a second occasion, when the disease was inactive or with the lowest activity observed after treatment (second moment). The control groups were 29 healthy women (group C) and 34 third-trimester healthy pregnant (group P). The levels of PRL were correlated with the SLE Disease Activity Index (SLEDAI). Results: In the study group there were 15 (20.55%) cases of hyperprolactinemia, while in the group C there were none (p = 0,005). All pregnant women presented hyperprolactinemia. Prolactin levels were higher in group L (Med = 11,70 ng/ml) then in group C (Med = 8,81ng/ml) (p = 0,01) and correlated with the SLEDAI in the first moment (r = 0,41; p = 0,0003). We also detected that PRL levels were higher at highly active SLE (SLEDAI ¡Ý 11) than when the disease was inactive (SLEDAI = 0) (Med = 17,10 ng/ml vs. Med = 8,36 ng/ml) (p< 0,01) or moderately active SLE (6 ¡Ü SLEDAI ¡Ü 10) (Med = 7,75 ng/ml) (p<0,05). In the 15 patients of group L with hyperprolactinemia, there were 04 cases of macroprolactinemia (26.7%), while 02 subjects in group P presented it (5.9%). SLE was as active in the patients with hyperprolactinemia caused by the monomeric form of the hormone, as in the ones with macroprolactinemia. The correlation of the PRL levels and the SLEDAI was, nevertheless, stronger for free PRL (r = 0,44; p = 0,0001). The SLE treatment in the hyperprolactinemic patients reduced PRL levels from 56,71 ng/ml (sd = 43,87) to 18,68 ng/ml (± 24,20) (p = 0,015). Discussion: the frequency of hyperprolactinemia is higher in SLE than in the general population, and the levels of PRL correlate with the activity of the disease. Macroprolactin is also associated to active SLE.

By the discovery of the therapeutic properties of ultra-violet light, vast possibilities in the treatment of all tubercular lesions have been opened up. Not the least important of these lesions is lupus vulgaris, which until now has, in many cases, obstinately defied cure. The ultra-violet light universal bath, while still in its childhood regarding experience of technique, etc., has already proved itself the greatest curative agent yet discovered for lupus vulgaris, producing dramatic results in many an old-standing case which has resisted every other method of treatment. In this Thesis I shall endeavour to show the marvellous results of carbon arc-light baths in lupus vulgaris, and though the improvement may appear slow, we must allow for the amount of destruction of shin in the disease, and its many years' duration in most cases.

INTRODUCTION: Patients with systemic lupus erythematosus (SLE) are at increased risk of the metabolic syndrome (MetS) and its complications. In the absence of published studies from sub-Saharan Africa, we investigated the prevalence and associations of the MetS amongst recent-onset SLE patients. METHODS: A cross-sectional study of recent onset (<5 years disease duration) patients with SLE meeting the SLICC SLE classification criteria. The MetS was defined by Joint Interim Statement criteria. Clinical and demographic data and a Functional Assessment of Chronic Illness Therapy score and the 36-Item Short-Form Healthy Survey were completed. RESULTS: Of 75 patients, the mean age was 37.1 (11.7) years, disease duration was 30.8 (23.6) months, 65 (86.7%) were female, 68.0% were of mixed ethnic ancestry and 29.3% were Black Africans. The mean SLEDAI score was 0.9 (1.6). The prevalence of MetS was 40.0%, and age and body mass index were the only significant features associated with MetS (p = 0.003 and 0.001 respectively). Increased waist circumference (WC) was the most frequently observed feature, present in 92.9% of MetS patients. Patients with an elevated WC were 32.5 times more likely to have MetS. CONCLUSION: This study shows a high prevalence of MetS amongst South Africans with recently diagnosed SLE. This calls for aggressive strategies to reduce the prevalence of Mets and atherosclerotic cardiovascular disease. Waist circumference is a useful and costeffective screening tool to identify SLE patients at risk of MetS.

Background. Lupus nephritis (LN) can be complicated with requirement for kidney replacement therapy and death. Efficacy of induction therapies using mycophenolate mofetil (MMF) or intravenous cyclophosphamide (IVCYC) has been reported from studies, but there is limited data in Africans comparing both treatments in patients with proliferative LN. Methods. This was a retrospective study of patients with biopsy-proven proliferative LN diagnosed and treated with either MMF or IVCYC in a single centre in Cape Town, South Africa, over a 5-year period. *e primary outcome was attaining complete remission after completion of induction therapy. Results. Of the 84 patients included, mean age was 29.6 ± 10.4 years and there was a female preponderance (88.1%). At baseline, there were significant differences in estimated glomerular filtration rate (eGFR) and presence of glomerular crescents between both groups (p ≤ 0.05). After completion of induction therapy, there was no significant difference in remission status (76.0% versus 87.5%; p = 0.33) or relapse status (8.1% versus 10.3%; p = 0.22) for the IVCYC and MMF groups, respectively. Mortality rate for the IVCYC group was 5.5 per 10,000 person-days of follow-up compared to 1.5 per 10,000 person-days of follow-up for the MMF group (p = 0.11), and there was no significant difference in infection-related adverse events between both groups. Estimated GFR at baseline was the only predictor of death (OR: 1.0 [0.9–1.0]; p = 0.001). Conclusion. This study shows similar outcomes following induction treatment with MMF or IVCYC in patients with biopsy-proven proliferative LN in South Africa. However, a prospective and randomized study is needed to adequately assess these outcomes.

Systemic lupus erythematosus (SLE) develops when genetically susceptible individuals lose tolerance to autoantigens, likely as a result of an environmental insult. The list of identified genetic susceptibilities is expansive, however variants in the interferon regulatory factor 5 (IRF5) gene have consistently and convincingly been shown to be associated with an increased risk of developing SLE across all ethnic and racial groups examined. These genetic variants are hypothesized to produce a gain-of-function phenotype due to increased IRF5 mRNA and increased stability of the IRF5 protein; however, definitive functional studies examining these polymorphisms in primary human cells are not possible given the genetic variation from patient to patient. IRF5 is a transcription factor that is constitutively expressed in a number of immune cells including B cells and dendritic cells. IRF5 has cell type specific roles; in dendritic cells, it primarily controls a proinflammatory program which directs T cell polarization. Dysfunctional conventional dendritic cells (cDCs) have been implicated in the onset and development of SLE due to their high capacity to activate and interact with autoreactive lymphoid cells via a number of different pathways; the exact type of dysfunction and mechanisms underlying it are still debated. Study of primary cDCs either from SLE patients or healthy controls is complicated by the low frequency of cDCs in peripheral blood (<0.1%). To better evaluate the role IRF5 plays in cDC dysfunction in SLE, I developed a method for generating cDCs from induced pluripotent stem cells (iPSCs). The cDCs derived from this protocol are similar in many respects to primary human cDCs based on their gene expression profiles, cytokine production, and ability to act as antigen presenting cells to activate T cells. I also generated a library of iPSCs with and without the IRF5 risk haplotype to enable future studies to delineate the role of IRF5 polymorphisms in human cDCs. To facilitate these future studies, I also made an IRF5 deficient iPSC line which will be essential in discerning the role of IRF5 in cDC function. More broadly, we describe herein a platform to study gene function in an isogenic model of human conventional dendritic cells.

No description available.

No description available.