Lupus related to the imbalances of the intestinal microbiome



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The disease called systemic lupus erythematosus (SLE) – characterized by damage to the joints, skin and kidneys by the body's immune system – is linked to an abnormal mix of bacteria in the gut. This is according to a new study conducted by scientists at the NYU School of Medicine.

While bacterial imbalances have been linked to many immune diseases, including inflammatory bowel disease, arthritis and some cancers, the authors of this study claim that their experiments are the first detailed evidence of a link between bacterial imbalances in the intestine and potentially life-long forms of SLE treatment

The new study, published in the Annals of Rheumatic Diseases online Feb. 19, found that 61 women diagnosed with SLE had about 5 times more intestinal bacteria known as Ruminococcus gnavus, compared to 17 women of the same age and breed were in good health. Lupus is more common in women than in men.

In addition, the results of the study showed that "flare-ups" of the disease, which can range from rash to skin and joint pain to severe kidney dysfunction requiring dialysis, follow closely. Significant increase in bacterial growth of R. gnavus in the gut immune proteins called antibodies, specifically formed to bind bacteria. Study participants with renal failure had particularly high levels of anti-R. gnavus.

The authors explain that the specific causes of lupus, which affects 1.5 million Americans, are unknown, although many suspect that genetic factors are partly responsible.

"Our study strongly suggests that, in some patients, bacterial imbalances could be at the origin of lupus and its relapses associated with the disease," says lead investigator and immunologist Gregg Silverman of the study, MD. "Our results also indicate that bacteria leaks into the intestine are a possible trigger of the disease by the immune system and suggest that the internal gut environment could therefore play a more important role than genetics in eruptions. this is a fatal disease, "says Dr. Silverman, a professor in the NYU Langone Health Departments of Medicine and Pathology. He also suspects that antibodies to R. gnavus cause a "continuous and relentless" immune attack on the organs involved in the outbreaks.

According to Dr. Silverman, the development of relatively simple blood tests to detect antibodies against fugitive bacteria could be used to diagnose and track the progression and treatment of lupus, even in the early stages of the disease. Current tests, he says, are often inconclusive and rely on signs and symptoms that only appear when the disease has already progressed.

Dr. Silverman, who is also associate director of rheumatology at NYU Langone, warns that more important studies are needed to confirm how this bacteria could cause lupus. But if future experiments yield similar positive results, this could lead to a change in current approaches to treating the disease, which focus on immunosuppressive anticancer drugs to alleviate kidney symptoms and lesions.

If the results of the study team are validated, some current treatments may actually cause harm if they alter the overall immune defenses against the infection.

According to Dr. Silverman, future treatments could include inexpensive probiotics or diets that hinder the growth of R. gnavus and prevent flare-ups. Fecal transplants of healthy subjects would also be possible.

According to Dr. Silverman, new treatments could also be used to promote the growth of Bacteroides uniformis, a bacterium that is believed to impede the growth of R. gnavus in the gut and has decreased by up to four times in study with lupus compared to those with lupus. without the disease. Experts say that more than 1000 different types of bacteria make up the human intestinal microbiome.

For this study, researchers analyzed blood and stool samples from participants. The researchers were surprised to find strong immune responses to R. gnavus in the blood because the intestinal lining prevents the bacteria from escaping to other parts of the body. The researchers say this suggests that small pieces of bacteria, called antigens, must have "penetrated" into the intestine to trigger the immune response.

This article has been republished from documents provided by Langone Health of New York University. Note: Content may have changed for length and content. For more information, please contact the cited source.

Reference
Lupus nephritis is related to expansions associated with disease activity and immunity to the intestinal commensal. Doua Azzouz, Aidana Omarbekova, Adriana Heguy, Dominik Schwudke, Nicolas Gisch, Brad H. Rovin, Roberto Caricchio, Jill Buyon P., Alexander V. Alekseyenko, Gregg J. Silverman. Ann Rheum Dis 2019; 0: 1-10. doi: 10.1136 / annrheumdis-2018-214856.

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