Chapters authored
T Regulatory Cells in Systemic Lupus Erythematosus: Current Knowledge and Future Prospects
Systemic lupus erythematosus (SLE) is one of the most diverse autoimmune diseases, regarding clinical manifestations and therapeutic management. Visceral involvement is often and is generally associated with increased mortality and/or permanent disability. Thus, a reliable assessment of disease activity is required in order to follow‐up disease activity and apply appropriate therapy. Several serological indexes have been studied due to their competence in assessing disease activity in SLE. Apart from conventional and currently assessed serological indexes, regulatory T cells (Tregs), a CD4+ cellular population of the acquired immune compartment with homeostatic phenotype, are currently under intense investigation in SLE. In this chapter, Tregs ontogenesis and subpopulations are discussed focusing on their implications in immunopathophysiology of SLE. The authors present data indicating that this CD4+ population is highly associated with disease activity and response to treatment, concluding that Tregs are a promising biomarker in SLE. Future prospective includes Tregs implication in SLE therapeutic interventions.
Part of the book: Lupus
Accelerated Atherosclerosis in SLE: Mechanisms, Consequences, and Future Directions
The bimodal mortality rate in systemic lupus erythematosus (SLE) has been well documented, with atherosclerosis identified as a leading cause of late-stage death. Multiple mechanisms are responsible for accelerated atherosclerosis in SLE, ultimately resulting in endothelial dysfunction, arterial stiffness, arterial wall thickening, and plaque formation. This leads to an increased risk of coronary artery disease, cardiovascular events, cerebrovascular accidents, and peripheral arterial disease. SLE patients are not only impacted by traditional risk factors for cardiovascular disease (age, smoking, dyslipidemia, diabetes), but additionally nontraditional risk factors (prolonged corticosteroid use, disease activity and chronic inflammation). Identifying the impact of traditional risk factors and mediating nontraditional risk factors in SLE are vital to reduce morbidity and mortality related to atherosclerosis. SLE-specific screening methods should be established in the routine care of these patients, including the use of validated modified risk scores and imaging modalities. Furthermore, the utility of disease-specific biomarkers and anti-atherosclerotic therapies should be elicited. This chapter will provide an overview of considerations for the mechanisms, impact, and prevention of atherosclerosis in SLE patients.
Part of the book: Systemic Lupus Erythematosus