Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by dysregulated autoantibody production and complement activation leading to multi-organ damage. The disease is associated with increased intestinal permeability. In this study, we tested the hypothesis that SLE subjects have increased systemic exposure to bacteria. Since bacteria induce the expression of antimicrobial response factors (ARFs), we measured the levels of a series of clinically relevant ARFs in the plasma of SLE subjects. We found that levels of sCD14, lysozyme, and CXCL16 were significantly elevated in SLE subjects. A strong positive correlation was also observed between sCD14 and SELENA-SLEDAI score. Interestingly, the ratio of EndoCAb IgM:total IgM was significantly decreased in SLE and this ratio was negatively correlated with sCD14 levels. Although, there were no significant differences in the levels of lipopolysaccharide binding protein (LBP) and fatty acid binding protein 2 (FABP2), we observed significant positive correlations between lysozyme levels and sCD14, LBP, and FABP2. Moreover, galectin-3 levels also positively correlate with lysozyme, sCD14, and LBP. Since our SLE cohort comprised 43.33% males, we were able to identify gender-specific changes in the levels of ARFs. Overall, these changes in the levels and relationships between ARFs link microbial exposure and SLE. Approaches to reduce microbial exposure or to improve barrier function may provide therapeutic strategies for SLE patients.

/pdf/coordinated-induction-of-antimicrobial-response-factors-in-4ygn5dlkeh.pdf

Coordinated Induction of Antimicrobial Response Factors in Systemic Lupus Erythematosus.

To evaluate autoimmune hepatitis (AIH) in a multicenter cohort of childhood-onset systemic lupus erythematosus (cSLE) patients. This retrospective multicenter study included 847 patients with cSLE, performed in 10 Pediatric Rheumatology services of Sao Paulo state, Brazil. AIH was defined according to the International Autoimmune Hepatitis Group criteria (IAHGC). The statistical analysis was performed using the Bonferroni’s correction (p   0.0033). Overlap of AIH and cSLE was rarely observed in this large multicenter study and hepatomegaly was the distinctive clinical feature of these patients. AIH occurred during adolescence, mainly at the first years of lupus and it was associated with mild liver manifestations.

/pdf/autoimmune-hepatitis-in-847-childhood-onset-systemic-lupus-40o7trdxv5.pdf

Autoimmune hepatitis in 847 childhood-onset systemic lupus erythematosus population: a multicentric cohort study.

/pdf/kasl-clinical-practice-guidelines-for-management-of-2ltfgl41.pdf

KASL Clinical Practice Guidelines for Management of Autoimmune Hepatitis 2022.

Background and Aim: Serum immunoglobulins were reported to be associated with clinical characteristics of inflammatory bowel disease. However, whether a difference exists in the serum immunoglobulins levels in patients with Crohn's disease (CD) with different disease location and behavior phenotypes remains unclear. Therefore, this study aimed to explore the associations of serum immunoglobulins levels with specific CD phenotypes. Methods: Patients with CD having recorded serum immunoglobulins levels were recruited through multicenter collaborative efforts. The associations between serum immunoglobulins levels and distinct phenotypes of CD were evaluated using multiple logistic regression models. Results: A total of 608 patients with CD were included in the study. Elevated (above the upper limit of normal) serum immunoglobulin G (IgG), IgA, IgM, and IgG4 were identified in 24.5, 17.4, 2.1, and 8.2% of patients, respectively. Elevated serum IgG4 levels negatively correlated with complicated disease behavior [odds ratio (OR) 0.49, 95% confidence interval (CI) 0.26-0.92]. Elevated serum IgG was linked to isolated ileal disease with an OR of 0.37 (95% CI 0.23-0.61). The ORs of isolated ileal disease progressively reduced across increasing quartiles of IgG (P for trend < 0.001). The adjusted ORs of isolated ileal disease for increasing quartiles of IgM were 1.82 (1.07-3.1), 1.92 (1.14-3.24), 1.17 (0.69-1.98), and 1 (P for trend = 0.008). Besides, serum IgA and IgG levels significantly correlated with several disease activity indices. Conclusions: These results suggested that certain serum immunoglobulins were associated with specific disease phenotypes of CD. Further investigations to account for the associations are warranted.

/pdf/association-of-serum-immunoglobulins-levels-with-specific-1kakw6elhx.pdf

Association of Serum Immunoglobulins Levels With Specific Disease Phenotypes of Crohn's Disease: A Multicenter Analysis in China.

Abnormal liver function tests are frequently observed during follow-up of patients with systemic lupus erythematosus (SLE) but data on co-existence with autoimmune liver diseases (AILD) are scarce. This retrospective study aimed to describe the prevalence of autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) among well-characterized subjects with SLE. We also evaluated whether the presence of autoantibodies to complement protein 1q (C1q) and/or ribosomal P protein (anti-ribP) are, directly or inversely, associated with AIH, as proposed in some reports. The number of screened patients was 287 (86% females), and all cases were included in a regional Swedish cohort. Each subject of the study population met the 1982 American College of Rheumatology classification criteria and/or the Fries’ diagnostic principle. By applying the simplified diagnostic AIH criteria combined with persistent transaminasemia, 40 (13.9%) cases reached at least “probable AIH”. However, merely 8 of these had been diagnosed with AIH (overall AIH prevalence 2.8%). Neither anti-C1q nor anti-ribP associated significantly with AIH. By applying the recent PBC guidelines, 6 (2.1%) cases were found, but only 3 of them had actually been diagnosed with PBC and one additional subject was not identified by the guidelines (overall PBC prevalence 1.4%). Compared to prevalence data from the general Swedish population, both AIH and PBC were highly overrepresented in our study population. The sensitivity of the diagnostic AIH criteria was impeccable but the specificity was less impressive, mainly due to positive ANA and hypergammaglobulinemia. Based on our findings, among subjects with SLE, the AIH criteria are less useful and liver biopsy combined with detection of other AILD-associated autoantibodies should be performed.

Usefulness of Clinical and Laboratory Criteria for Diagnosing Autoimmune Liver Disease among Patients with Systemic Lupus Erythematosus: An Observational Study.

Objective
Autoimmune hepatitis (AIH) is a chronic progressive liver disease characterized by circulating autoantibodies and hyperglobulinemia. This study was conducted to identify the features of AIH accompanied by systemic lupus erythematosus (SLE-AIH) that differ from those of primary AIH (P-AIH), and to evaluate factors that affect the outcome for SLE-AIH patients.

Methods
From May 1995 to April 2014, clinical data (including liver pathology) from 164 patients with P-AIH and 23 patients with SLE-AIH were collected from an electronic database at a tertiary referral center. AIH was diagnosed according to the diagnostic scoring system for AIH (revised in 1999). SLE patients fulfilled at least 4 of the 1997 revised American College of Rheumatology criteria. Progression was defined as occurrence of cirrhosis, hepatocellular carcinoma, liver transplantation, or death from hepatic failure.

Results
The age at the time of AIH diagnosis was lower and initial levels of serum IgG were higher in SLE-AIH than in P-AIH patients. Progression was more common in P-AIH, and hepatocellular carcinoma, liver transplantation, or death occurred only in P-AIH patients. Among 23 patients with SLE-AIH, 8 with cirrhosis had higher levels of serum IgG than 15 patients without cirrhosis (mean ± SD 4,077.4 ± 1,641.0 mg/dl and 2,560.7 ± 932.2 mg/dl, respectively; P = 0.017). Moreover, a serum IgG level more than 2-fold the upper normal limit was associated with a high risk of cirrhosis in SLE-AIH (odds ratio 11.00 [95% confidence interval 1.420–85.201]; P = 0.026).

Conclusion
Initially high levels of serum IgG are a poor prognostic factor for SLE-AIH. Additionally, the long-term outcome for SLE-AIH might be better than for P-AIH.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/acr.22800

Immunoglobulin G Levels as a Prognostic Factor for Autoimmune Hepatitis Combined With Systemic Lupus Erythematosus

Sirs, Antiviral agents are generally prescribed in hepatitis B virus (HBV) carriers in addition to biologic agents (1). However, the antiviral prophylaxis cannot be sustained in some patients because of economic cost or adverse events. In this study, the outcome of reducing or discontinuing antiviral agents in HBV carriers during treatment with biologic agents was assessed. The medical records of 27 HBV carriers treated with biologic agents in a tertiary hospital between January 2005 and December 2016 were reviewed with the approval of the Asan Medical Center Institutional Review Board (IRB number: 2016-1034). Laboratory data were collected to evaluate liver function and serum HBV DNA along with assessment of HBV hepatitis flare. The HBV carriers had been diagnosed with rheumatoid arthritis (n=8), Crohn’s disease (n=11), ankylosing spondylitis (n=6), ulcerative colitis (n=1), and psoriatic arthritis (n=1). The biologic agents were given for a median of 39 months (interquartile range (IQR), 26–66). Three of the 12 HBV carriers not receiving HBV prophylaxis experienced hepatitis flare at 3, 3, and 66 months, respectively, after initiation of biologic agents. On the other hand, there were no flares for 39 months (IQR, 27 to 62) among the 15 patients receiving HBV prophylaxis. Among the HBV carriers receiving biologics and HBV prophylaxis concomitantly, one CD patient treated with infliximab received standard tenofovir prophylaxis for 9 months. HBV DNA titres of the patient was reduced from 530 IU/mL (at starting administration of biologics) to undetected level (<15 IU/mL, after 9 months). After that, the patient had the dose of the HBV regimen (tenofovir) reduced to alternate days because of an adverse drug reaction (diarrhoea), and since the dosereduction, there has been no hepatitis flare, and no HBV DNA has been detected for 21 months. In another 2 HBV carriers (an AS patient treated with etanercept and a RA patient with etanercept, adalimumab, and rituximab), standard HBV prophylaxis (lamivudine) was stopped after 37 and 5 months, respectively. No hepatitis flares occurred in these patients for over 87 and 119 months, respectively, of follow-up and their HBV DNA titres have remained low (Table I). In contrast, in the group without any HBV prophylaxis, 2 of 3 HBV carriers experienced hepatitis flares within 3 months of starting treatment of biologics. Several studies reported that low-dose entecavir (a tenth or a fifth part of the standard dose) and tenofovir (a quarter of the standard dose) suppressed viral replication (2-4). It is therefore possible that no flares occurred after reduction of HBV prophylaxis in the patients in the present study for these reasons. Considering that a high titre of HBV DNA is an important risk factor for HBV reactivation in immunocompromised patients (5), reduction of the HBV regimen may be safe after negative conversion of HBV DNA by standard prophylaxis. Previous studies suggested that the risk of infection is high at the beginning of TNF-α inhibitor treatment (6, 7), while the risk of infection is lower than that of conventional disease-modifying anti-rheumatic drugs by the third year of dosing (7, 8). Based on such findings, it seems that the administration of lamivudine for 37 and 5 months, respectively, was responsible for the absence of hepatitis flare during the critical period in our cases. In conclusion, it is important to administer HBV regimens continuously and monitor them regularly in HBV carriers treated with biologic agents. However, there was no hepatitis flares when HBV prophylaxis was stopped or reduced to half in the present study. If the titre of HBV DNA decreases or negative conversion occurs during standard HBV prophylaxis in HBV carriers who have to be treated with biologics, reducing or stopping HBV prophylaxis might be considered in certain circumstances.

Reduction or cessation of antiviral agents in hepatitis B virus carriers treated with biologic agents

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Danbi Lee

Author Tools

Chat about Author

Papers

Immunoglobulin G Levels as a Prognostic Factor for Autoimmune Hepatitis Combined With Systemic Lupus Erythematosus

Reduction or cessation of antiviral agents in hepatitis B virus carriers treated with biologic agents