Studies on Lupus Nephritis

摘要: Systemic Lupus Erythematosus (SLE) is a chronic inflammatory autoimmune disease characterized by multiple organ involvement, production of autoantibodies to nuclear components and local formation or deposition immune complexes in different organs. nephritis (LN) common severe manifestation SLE. A renal biopsy the “gold standard” for diagnosis LN basis treatment strategies. However there no consensus whether repeat should be performed define response treatment. Biomarkers available activity are insufficient patients may have lesions tissue despite clinical quiescent disease. The aim this thesis was study clinical, laboratory histopathological findings LN-patients with repeated biopsies after immunosuppressive I aimed investigate role second evaluation response, identify novel biomarkers activity. We also studied long-term outcome predictors subset who were treated B-cell depletion therapy (rituximab). In paper we expression serum levels High Mobility Group Box 1 protein (HMGB1), that can act as proinflammatory mediator proposed involved diseases. found high increased HMGB1 at both active indicates supports previous persistent inflammation II compared induction substantial proportion had an apparent good response. Repeated thus add important information not captured routine markers which turn impact on outcome. III cytokines association LN. baseline interleukin (IL)-17 poor IL-23 non-responding patients. Immunostainings revealed IL-17 areas CD3+ T-cell infiltrates tissue. Th-17 phenotype IV (mean 36 months) 25 patients, previously refractory relapsing LN, been rituximab (RTX). majority achieved complete remission. long time associated faster use RTX conclusion, persisting many clinically inactive Consistently, biomarkers. standard overall term follow-up depleting therapy. LIST OF PUBLICATIONS This based following papers, will referred text their Roman numerals. I. Zickert A, Palmblad K, Sundelin B, Chavan S, Tracey KJ, Bruchfeld Gunnarsson Renal mobility group box lupus nephritis. Arthritis Res Ther. 2012 Feb 20;14(1):R36 II. Svenungsson E, Role early Submitted. III. Amoudruz P, Sundstrom Y, Ronnelid J, Malmstrom V, histopathology IV. Jonsdottir T, Welin Henriksson van Vollenhoven R, Long-term rituximabclinical Rheumatology (Oxford). 2013 Jan 3. (Epub ahead print) Related publication patient cohort, included Sjowall C, Skogh Wettero Serum against C-reactive correlate 2009;11(6):R188.