Suzan Abou-Raya, Egypt
Faculty of Medicine, University of Alexandria Internal MedicinePresenter of 2 Presentations
HIGH MOBILITY GROUP B1 (HMGB1) AND SOLUBLE RECEPTOR FOR ADVANCED GLYCATION END PRODUCTS (SRAGE) IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS: TOWARDS A POTENTIAL TREATMENT STRATEGY?
Abstract
Background and Aims
SLE is a multifaceted autoimmune disease characterized by immune-complex mediated organ damage caused by the breakdown in innate tolerance to self-nucleic acids. HMGB1 supports the inflammatory clearance of apoptotic cells by binding to molecules released from apoptotic cells and may act as a proinflammatory mediator through ligation to its receptors, in particular, RAGE, one of the main receptor system responsible for HMGB1 activity. This study aimed to address the presence of HMGB1 and the soluble receptor for advanced glycation end products (sRAGE) in SLE patients and to correlate it with clinical and laboratory features of disease activity and severity,
Methods
A total of 35 patients with SLE and 20 age and gender matched healthy controls were recruited. Demographic and clinical data were recorded. Disease activity was assessed using the SLE disease activity index (SLEDAI). Blood samples were collected and levels of HMGB1 and sRAGE were measured using ELISA. Correlations between HMGB1, sRAGE levels and clinical and laboratory characteristics were assessed.
Results
SLE patients had significantly higher plasma levels of HMGB1 and significantly lower sRAGE levels compared to controls. HMGB1 and sRAGE levels correlated with SLE disease activity and severity and correlated with the levels of TNF-α and IL-6, hsCRP, C3, C4, white blood cell count and urine albumin creatinine ratio.
Conclusions
HMGB1/sRAGE is associated with the inflammation process in SLE and may be a risk factor for SLE. Furthermore, HMGB1 is a potential biomarker of disease severity and activity. Manipulation of HMGB1/sRAGE signalling is a potential therapeutic strategy for SLE.
HYDROXYCHLOROQUINE (HCQ) IN PRIMARY OBSTETRICAL ANTI-PHOSPHOLIPID SYNDROME (OAPS): PROSPECTIVE STUDY OF THE EFFICACY OF HCQ IN PRIMARY OAPS
Abstract
Background and Aims
Antimalarials have pleiotropic functions including anti-inflammatory, anti-aggrecant and immunoregulatory properties. Adverse pregnancy outcomes in primary OAPS despite anticoagulation, dictates the need for further measures. Experimental evidence exists that HCQ might decrease the incidence of thrombosis. The aim of the present study was to determine the effectiveness and to assess safety of HCQ during OAPS pregnancy (maternal and foetal outcome).
Methods
A total of 34 pregnant patients, (mean age 36.2 years and mean disease duration 4.2 years) with similar characteristics (age, sex, body mass index, ethnicity, disease duration) diagnosed according to the revised international criteria were recruited. All patients were prescribed low dose aspirin and low molecular weight heparin as well as HCQ 200 mg bid throughout the pregnancy. Thrombotic incidence before, during and after the pregnancy was analysed. Lupus anticoagulant was positive in 33(97%) cases, anticardiolipin antibodies were positive in 31(91%) cases; IgG was positive in 32(94 %), IgM positive in 31(91%) and anti-b2 glycoprotein antibodies were positive in 32 (94%) of cases.
Results
Thirty-two cases (94%) had successful pregnancy. Two patients (5.9%) had premature delivery. No fatal cases were recorded. No congenital abnormalities were observed and mean follow up of 24 months revealed no abnormalities in the infants. No new thrombi (arterial and venous) were recorded throughout the pregnancy. Previous events of vascular thrombosis (arterial and/or venous) were recorded at diagnosis in 42% of patients, previous obstetrical event in 38%, both venous and arterial thrombosis in 26% of cases.
Conclusions
The “immunomodulatory” approach of HCQ is effective in improving pregnancy outcome in primary OAPS.