Hematologic manifestations of juvenile systemic lupus erythematosus: An emphasis on anemia

Kısaoğlu, Hakan; Baba, Özge; Kalyoncu, Mukaddes

doi:10.1177/09612033221093508

Cited by 6 publications

(5 citation statements)

References 26 publications

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“…The intricate connection between nutrition and immunity is evident, especially in intensive care units, 4 and is crucial in infectious diseases and chronic illnesses. Micronutritional deficiencies are known to drive inflammation and are associated with increased morbidity and mortality 5–7 in various diseases including congestive heart failure, 8–10 chronic kidney diseases 11–13 autoimmune thyroid diseases, 14–18 inflammatory bowel disease, 19,20 cancer, 21–23 atopic diseases 24,25 and even in obesity 26–29 …”

Section: Introductionmentioning

confidence: 99%

Nutrition in chronic inflammatory conditions: Bypassing the mucosal block for micronutrients

Roth‐Walter,

Berni Canani,

O'Mahony

et al. 2023

Allergy

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Nutritional Immunity is one of the most ancient innate immune responses, during which the body can restrict nutrients availability to pathogens and restricts their uptake by the gut mucosa (mucosal block). Though this can be a beneficial strategy during infection, it also is associated with non‐communicable diseases—where the pathogen is missing; leading to increased morbidity and mortality as micronutritional uptake and distribution in the body is hindered. Here, we discuss the acute immune response in respect to nutrients, the opposing nutritional demands of regulatory and inflammatory cells and particularly focus on some nutrients linked with inflammation such as iron, vitamins A, Bs, C, and other antioxidants. We propose that while the absorption of certain micronutrients is hindered during inflammation, the dietary lymph path remains available. As such, several clinical trials investigated the role of the lymphatic system during protein absorption, following a ketogenic diet and an increased intake of antioxidants, vitamins, and minerals, in reducing inflammation and ameliorating disease.

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Section: Introductionmentioning

confidence: 99%

Nutrition in chronic inflammatory conditions: Bypassing the mucosal block for micronutrients

Roth‐Walter,

Berni Canani,

O'Mahony

et al. 2023

Allergy

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Section: Discussionmentioning

confidence: 99%

“…The significance of the complement status in hematological involvement of patients with juvenile onset SLE was previously reported and shown that low complement C3 was associated with hematological involvement and low complement C4 was more frequently encountered in patients with anemia. 22,23 Complement activation is generated by 3 main pathways. Classical pathway activation is a well known and main pathway involving in the SLE pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Significance of the weighted complement domain of the EULAR/ACR classification criteria in juvenile onset systemic lupus erythematosus

Kısaoğlu

Baba

Kalyoncu

2023

Lupus

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Objective We aimed to compare the clinical and laboratory characteristics of patients with SLE according to the weighted complement status of the EULAR/ACR criteria and investigate whether different weighting of the complement status at disease onset is associated with outcomes. Methods Patients diagnosed with juvenile onset SLE who fulfilled the 2019 EULAR/ACR classification criteria were retrospectively analyzed. Results Among 43 patients included, hypocomplementemia was observed in 37 (86%), mostly with a low level of both complement C3 (C3) and complement C4 (C4) (53.5%). In patients with low levels of both C3 and C4, more common cutaneous (65.2% vs 28.6%, p: 0.045), musculoskeletal involvement (78.3% vs 42.9%, p: 0.039), autoimmune hemolytic anemia (52.2% vs 14.3%, p: 0.035), positive anti-dsDNA (65.2% vs 21.4%, p: 0.017) and anti-Sm antibodies (60.9% vs 21.4%, p: 0.04) were observed. In addition these patients had higher scores from the 2019 EULAR/ACR classification criteria (26 vs 15.5, p: < 0.0001). Remission and flare rates, and SLE associated damage were not differed according to the complement status in patients with hypocomplementemia. Conclusion Observation of more frequent clinical and serological activity with higher total scores from the EULAR/ACR classification criteria supported the higher scoring of patients with low C3 and C4 in the weighted criteria. However, since significant number of patients did not exhibit low complement C4, and the frequency of kidney involvement did not differ according to the weighted complement status, complement C3 might be suggested as a more important diagnostic tool in patients with juvenile onset SLE. Also, weighted complement status at onset did not seem to affect the disease outcomes.

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“…By degrading ferroportin, which enables exporting iron into circulation, hepcidin decreases iron absorption from the gastrointestinal tract and decreases the accessibility of iron stored in macrophages. The blocking of iron absorption and mobilization is a critical clinical finding, which is associated with a worsened prognosis and outcome in chronic diseases such as congestive heart failure (30,31), chronic kidney diseases (32-34) (NCT03029208, NCT02940860, and NCT01864161), autoimmune diseases (35)(36)(37)(38)(39), inflammatory bowel disease (40,41), cancer (42)(43)(44), atopic diseases (45,46) (NCT03815981 and NCT03816800), and even in obesity (47-50) (NCT00030238). Importantly, in iron-deficient children who are not anemic, inflammation is a common finding (51).…”

Section: Iron Uptake Under Inflammation: a Real Problemmentioning

confidence: 99%

Lack of iron, zinc, and vitamins as a contributor to the etiology of atopic diseases

et al. 2023

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Micronutritional deficiencies are common in atopic children suffering from atopic dermatitis, food allergy, rhinitis, and asthma. A lack of iron, in particular, may impact immune activation with prolonged deficiencies of iron, zinc, vitamin A, and vitamin D associated with a Th2 signature, maturation of macrophages and dendritic cells (DCs), and the generation of IgE antibodies. In contrast, the sufficiency of these micronutrients establishes immune resilience, promotion of regulatory cells, and tolerance induction. As micronutritional deficiencies mimic an infection, the body’s innate response is to limit access to these nutrients and also impede their dietary uptake. Here, we summarize our current understanding of the physiological function of iron, zinc, and vitamins A and D in relation to immune cells and the clinical consequences of deficiencies in these important nutrients, especially in the perinatal period. Improved dietary uptake of iron is achieved by vitamin C, vitamin A, and whey compounds, whereas zinc bioavailability improves through citrates and proteins. The addition of oil is essential for the dietary uptake of beta-carotene and vitamin D. As for vitamin D, the major source comes via sun exposure and only a small amount is consumed via diet, which should be factored into clinical nutritional studies. We summarize the prevalence of micronutritional deficiencies of iron, zinc, and vitamins in the pediatric population as well as nutritional intervention studies on atopic diseases with whole food, food components, and micronutrients. Dietary uptake via the lymphatic route seems promising and is associated with a lower atopy risk and symptom amelioration. This review provides useful information for clinical studies and concludes/emphasizes that a healthy, varied diet containing dairy products, fish, nuts, fruits, and vegetables as well as supplementing foods or supplementation with micronutrients as needed is essential to combat the atopic march.

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Hematologic manifestations of juvenile systemic lupus erythematosus: An emphasis on anemia

Cited by 6 publications

References 26 publications

Nutrition in chronic inflammatory conditions: Bypassing the mucosal block for micronutrients

Nutrition in chronic inflammatory conditions: Bypassing the mucosal block for micronutrients

Significance of the weighted complement domain of the EULAR/ACR classification criteria in juvenile onset systemic lupus erythematosus

Lack of iron, zinc, and vitamins as a contributor to the etiology of atopic diseases

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