<p>Towards Precision Medicine in Systemic Lupus Erythematosus</p>

Abstract

Systemic lupus erythematosus (SLE) is a remarkable condition characterised by diversity amongst its clinical features and immunological abnormalities. In this review, we attempt to capture the major immunological changes linked to the pathophysiology of lupus and discuss the challenge it presents in moving towards the concept of precision medicine. Currently broadly similar types of drugs, e.g., steroids, immunosuppressives, hydroxychloroquine are used to treat many of the diverse clinical features of SLE. We suspect that, as the precise immunopathological abnormalities differ between the various organs/systems in lupus patients, it will be some time before precision medicine can be fully applied to SLE.

Hydroxychloroquine: A Potential Ethical Dilemma for Rheumatologists during the COVID-19 Pandemic

“…Thereafter, both CQ and HCQ were identified as disease-modifying antirheumatic drugs (DMARD), with use continuing into the 21st century. With the emergence of additional synthetic DMARD, and in recent times biological DMARD, there has likely been a reduction in use of HCQ for patients with RA in particular; but HCQ remains a mainstay of treatment for an array of rheumatic autoimmune diseases, with the most important use in SLE 10,11 . In a first discontinuation study, the Canadian Hydroxychloroquine risk of having a disease flare 12 .…”

Precision Medicine of Autoimmune Diseases

“…An association has been established between SLE and human leukocyte antigen (HLA) haplotypes (HLA-DR3; DR9; DR15; DQA1*0101 especially). The extensive association has also been found between vitamin D matching up with serum concentrations and vitamin D-receptor genomic binding domains [49].…”

Aberrant Non-Coding RNA Expression in Patients with Systemic Lupus Erythematosus: Consequences for Immune Dysfunctions and Tissue Damage

“…More interestingly, a significant proportion of risk alleles demonstrated in the GWAS play essential roles in B cell activation [48,50] and signaling relevant to the induction of IFN-1s [51]. Accordingly, the pathogenesis of SLE can be further accounted for by the big data with regard to its molecular basis [52,53].…”

“…In addition to the above IC processing and HLA-associated genetic loci, many genes are related to the immune signal transduction. For example, Toll-like receptor (TLR)/IFN-1 and other pathways are relevant to lupus pathogenesis [43][44][45][46][47][48][49][50][51][52][53]. Besides, genes specific for B cell activation and signaling implicated in the induction of IFN-1 have also been discovered [46,47,50,51].…”

“…[I] Advances in genome-wide association studies on SLE [43][44][45][46][47][48][49][50][51][52][53].…”