Activity of Lupus Nepheritis Clinical Trial
Official title:
Role of Estrogen in the Flarring up of Lupus Nepheritis
Role of estrogen in the flarring up of lupus nepheritis
Systemic lupus erythematosus SLE is an autoimmune disease that affects ∼5.5 per 100,000
individuals worldwide . SLE is characterized by loss of tolerance against nuclear
autoantigens, lymphoproliferation, polyclonal autoantibody production, immune complex
disease, and multiorgan tissue inflammation. Up to 50% of SLE patients develop some degree of
renal involvement, with up to 20% progressing to end-stage renal disease, depending on racial
background . Lupus nephritis LN is characterized by anti-nuclear Ab production, immune
complex deposition, and immune-mediated kidney damage. Development of LN remains a sign of
poor prognosis and is a significant cause of morbidity and mortality . Because 9 of 10 SLE
patients are women, the role of the sex hormones estrogens in this disease is of key
interest. Estrogens signal through two receptors: estrogen receptor a ERa and estrogen
receptor b ERb. In contrast to estrogen receptor b, ERa is found in female reproductive
organs, yet is robustly expressed in kidney, liver, heart, and lungs in males and females,as
well as on most immune cells however the kidney is considered the most estrogenic
nonreproductive organ. The overwhelming female predominance for SLE begins at puberty and
extends to menopause , supporting the concept that estrogens or other reproductive factors
stimulate lupus development. This concept is further evidenced by reports of menstrual cycle
flares of SLE , disease exacerbations by oral contraceptives or estrogen administration , and
induction of lupus by ovulation regimens . Ultraviolet rays has arole in the flarring up SLE.
There is evidence that fibroblasts and blood lymphocytes from SLE patients are hypersensitive
to the cytotoxic effects of UV light radiation
. RNA and protein synthesis is also affected by UV light 18. A study from 1986 found that
people were more likely to menstruate during a new moon, which occurs during the opposite
half of the lunar cycle than the full moon . There are different evolutionary theories
speculating why the human menstrual cycle length evolved to be so close to the lunar cycle in
length. Stories and beliefs connecting the two are also found in various cultures and
mythologies . The terms menstruation and menses even come from Latin and Greek words meaning
month mensis and moon mene
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