Hyaluronic acid in dermatomyositis and polymyositis: relationship with disease and cutaneous lesions

Abstract

BackgroundThere are scarce studies in the literature about hyaluronic acid in systemic autoimmune myopathies.ObjectivesTo analyze the serum level of hyaluronic acid in patients with dermatomyositis and polymyositis.MethodsCross-sectional study, single-center, that evaluated hyaluronic acid in 18 dermatomyositis and 15 polymyositis (Bohan and Peter criteria), newly diagnosed, with clinical and laboratory activity, with no previous drug treatment. The patients were also age-, gender- and ethnicity-matched to 36 healthy individuals. The hyaluronic acid was analyzed by ELISA/EIA kit anti-hyaluronic acid.ResultsThere was a higher serum level of hyaluronic acid in patients with autoimmune myopathies, in relation to control group (P<0.05). Moreover, the serum level of this glycosaminoglycan was higher in dermatomyositis, when compared to polymyositis. Both groups were comparable with regard to demographic, clinical and laboratory data, except for the presence of skin lesions in the first group.Study limitations.The presence of hyaluronic acid in cutaneous lesions, particularly of patients with dermatomyositis, was not analyzed neither quantified. In addition, due to disease rarity and the establishment of strict inclusion and exclusion criteria, there was a small sample in the present study.ConclusionsAs an example of others systemic autoimmune diseases, it is possible that the hyaluronic acid is involved in the pathogenesis of autoimmune myopathies, and particularly when associated with cutaneous lesions.

Hyaluronan primes the oxidative burst in human neutrophils

“…1 The nonenzymatic degradation can occur by the action of free radicals, most commonly NADPH-oxidase derived reactive oxygen species (ROS) that are produced by activated neutrophils. 4 Elevated circulating concentrations of HA have been reported in individuals with systemic inflammatory conditions, including, but not limited to, rheumatic arthritis, 5,6 myositis, 7 and sepsis, 8 as well as in patients with damage-induced neutrophil infiltration as seen in pulmonary disease, 9,10 liver fibrosis, 11 lupus nephritis, 12 and vasculitis. 13 The elevated metabolism of HA that is observed in various diseases is likely a natural response of the damaged tissues to replenish depleted HMM HA and restore homeostasis.…”

Hyaluronan promotes intracellular ROS production and apoptosis in TNFα-stimulated neutrophils

“…In homeostatic tissue, HA undergoes continuous synthesis and enzymatic degradation that is mediated by hyaluronan synthases and hyaluronidases, respectively. This basal rate of HA synthesis and corresponding degradation is increased during inflammation ( 2 ) and to an extent that circulating concentrations of HA are elevated in individuals with conditions characterized by systemic inflammation, such as rheumatoid arthritis ( 3 , 4 ), myositis ( 5 ), and sepsis ( 6 ). High circulating concentrations of HA have also been observed in other diseases where damage-induced neutrophil infiltration is prominent, such as pulmonary disease ( 7 – 9 ), liver fibrosis ( 10 ), lupus nephritis ( 11 ) and vasculitis ( 12 ).…”