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found in SLE, but only few of them are associated with the SLE manifestations.
There are almost always autoantibodies against one or more cell components in the blood of
SLE patients. Hematologic complications of SLE are among the most common
manifestations of this disorder, and almost all patients have hematologic abnormality at some
stage of the disease. In 1971, American college of rheumatology established the SLE criteria
in which hemolytic anemia, leukopenia, and thrombocytopenia were the individual criterion.
Chapter VI - Interleukin-21 (IL-21) is a member of the chain-dependent cytokine family
and as such, its receptor (R) is made of the common chain associated to the IL-21R-specific
chain. This four -helical bundle type I cytokine was first discovered in 2000 and since
then, a large number of studies have evidenced its pleiotropic functions on the immune
system. IL-21 seems to be a critical regulator of T cells since it induces the development of
inflammatory Th17 cells while blocking the differentiation and counteracting the activity of
regulatory T cells. It also modulates CD8+ T cell, natural killer cells, as well as dendritic cell
functions. Moreover, IL-21 is involved in shaping the effector function and the fate of B cells
and especially their final differentiation step in plasma cells, which implies that it may be
central in immune diseases that have a major B cell component. Systemic lupus
erythematosus (SLE) is one of these B-cell mediated disease, and numerous B cell
abnormalities have been described, although T cells and many other immune mediators are
also known to be altered. Lupus disease is indeed characterized by the production of
autoantibodies (a lot of them being specific for nuclear components) and by the subsequent
formation of inflammatory immune complexes. Some of them play a crucial role in associated
cutaneous lesions and in glomerulonephritis, which can in turn be fatal. Therefore, B
lymphocytes are undoubtedly key players in lupus disease. As such, they constitute a
privileged objective for the development of new specific biologics and every molecule that
affects their function, such as IL-21, may be a valuable therapeutic target in SLE. In this
review, we will provide an overview of the role of IL-21 in B cell physiology and lupus
pathology, and we will discuss the possible targeting of this cytokine to treat SLE.
Chapter VII - Systemic lupus erythematosus (SLE) is a chronic, multisystemic
autoimmune disease predominantly affecting women of childbearing age. The impact of
coronary heart disease (CHD) on morbidity and mortality in patients with established SLE
has assumed increasing importance in their long-term management. Classic CHD risk factors
and lupus-specific factors, such as antiphospholipid antibodies and nephrotic proteinuria,
seem to be important in determining long-term cardiovascular risk, but the role of metabolic
derangement, specifically the metabolic syndrome (MetS), is gaining increasing prominence
in the literature. One very important aspects of classical cytokines derived from inflammatory
cells is their importance in the pathogenesis of the metabolic syndrome. A generally enhanced
adipose tissue-derived cytokine expression may be one plausible mechanism for the
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inflammationMetS relationship. MetS can be associated with increased risk of develop

autoimmune inflammatory diseases like SLE. The best treatment to MetS in SLE patients is
maximizing lifestyle therapies. Statins treatment are used to reduction levels of low-density
lipoprotein cholesterol (LDL-c) and one of the various immunomodulatory functions realized
by statins, is to be able to reduce atherosclerotic vascular disease in SLE by lowering immune
activation in the arterial wall and by attenuating SLE activity, but this result is not unanimous.
In this chapter the authors will review the prevalence and importance of Mets in SLE and its
implication in mortality in SLE.

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