الفهرس 
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune
disease characterized by the production of autoantibodies and the
deposition of immune complexes, affecting a wide range of organs.
Genetic factors, environmental factors and hormonal factors are believed
to contribute to the occurrence of SLE. However, the pathogenesis of SLE
is complex and remains unknown. Innate and adaptive immune responses
against self-antigen induce the production of autoantibodies and the
deposition of immune complexes in tissues.
The involvement of the interleukin 17 (IL-17) axis in many
inflammatory and autoimmune diseases is now well established, and this
has led to the development of successful targeted therapies. Its role in
systemic lupus erythematosus (SLE) is less described, since SLE is
characterized by the impairment of many other immune actors. Circulating
levels of IL-17 are increased in lupus, and tissue staining shows the
presence of IL-17-producing cells in organ lesions. Through different
mechanisms, the IL-17 axis promotes autoantibody production, immune
complex deposition, complement activation and then tissue damage which
account for the broad spectrum of clinical manifestations and disease
heterogeneity.
Although the pathogenesis of SLE remains elusive, from the point
of view of the etiology of the occurrence and development of SLE on the
molecular level, it can be seen that the imbalance of the immune regulation
mechanism plays a key role, especially the imbalance of proinflammatory
and anti-inflammatory cytokines.
Fcγ receptors (FcɣRs) are expressed in different hematopoietic cells
and play a critical role in the regulation of the immune system through
immune complex-mediated effector mechanisms. They provide
communication between humoral and cellular immune responses and are
crucial for regulation of the immune system. Upon interaction with IgG,
the activating FcɣR initiate phagocytosis, antibody-dependent cellular
cytotoxicity (ADCC), transcription of cytokines genes, and release of
inflammatory mediators and are also important in the opsonization of
antigens, and in the antigen presentation process.
This prospective study included 100 SLE patients, all of them
fulfilling the September 2019 European League Against Rheumatism
(EULAR) and American College of Rheumatology (ACR) diagnosis of
SLE, attending the outpatient clinic or the inpatient section at Sohag
University Hospital.
This study aimed at studying the serum level interleukin-17 (IL-17)
levels and Fc gamma receptor (FcγR) in lupus erythematosus patients and
to evaluate the association with different clinical presentation, disease
activity and laboratory findings.
Participants were recruited from the Internal Medicine Department
and outpatient clinics of Internal Medicine Department of Sohag
University Hospitals. All patients will be subjected to:
▪ Detailed history& clinical examination.
▪ Assessment of disease activity index (SLEDAI):
Disease activity will be assessed by using a combination of clinical
history, physical examination, organ specific functional tests, and serologic
studies. Total SLEDAI score will be measured on the day of serum sample
collection. Often it is divided into three categories of scoring: no or mild
flare (0 to 3), moderate flare (4-12) and severe (12).
▪ Laboratory investigations:
1. C-reactive protein, Erythrocyte sedimentation rate and Complete blood
picture.
2. Blood urea and s.cereatinine.
3. Urine analysis, 24 hrs. protein and urine albumin cereatinine
ratio(uACR)
4. Anti-Nuclear Antibody (ANA) and Anti-double stranded DNA (antidsDNA).
5. Abdominal ultrasound.
6. Electrocardiogram (ECG) & echocardiography (Echo).
7. Renal biopsy. Renal biopsies from lupus nephritis (LN) patients will
be evaluated according to the revised International Society of
Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus
nephritis.
8. IL 17 assay by ELISA.
9. FcγR assay by ELISA.
The current study included 100 SLE patients with mean age of
systemic lupus erythematous was 31.5±6.9 years ranging from 21 to 53
years. With higher percentage of females (87%) among SLE patients.
Regarding clinical presentation, severe cases were significantly
associated with fever (88.9%), oral ulcer (83.3%), pleural effusion
(69.4%), and NPSLE (52.8%), while mild cases were significantly
associated with arthralgia (77.8%) (P.<0.05).
IL-17 was significantly different between mild, moderate and severe
SLE with (p <0.05).Summary
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FC gamma receptor had significant positive correlation with
SLEDAI score (R +ve, P.<0.05). Significant positive correlation between
FC gamma receptor and SLEDAI score in all group, as correlation
coefficient (r) was positive and P. value <0.05.
IL17 had significant positive correlation with ESR, alb/creat ratio,
FC gamma receptor (R +ve, P.<0.05).
FC gamma receptor had significant positive correlation with ESR,
serum creatinine, alb/creat ratio, C3, and AntidsDNA (R +ve, P.<0.05).
within all group, IL17 had significant positive correlation with
SLEDAI score (R +ve, P.<0.05).).
FC gamma receptor had significant positive correlation with
SLEDAI score (R +ve, P.<0.05). Significant positive correlation between
FC gamma receptor and SLEDAI score in all group, as correlation
coefficient (r) was positive and P. value <0.05.
The results of this study showing that the IL17 level in discerning
moderate/severe from mild cases of SLE are highly significant and
indicative of a strong discriminatory power.
The results of this study showing that the FC gamma receptor in
discerning moderate/severe from mild cases of SLE are highly significant,
suggesting a strong discriminatory power.
The results of the analysis for the predicted probability of combined
biomarkers in discerning moderate/severe from mild cases of SLE are
highly significant, suggesting a very strong discriminatory power. indicates
that the combined biomarkers have a very high level of accuracy in
distinguishing between these two groups.
In conclusion, we find association between IL-17 and Fc gamma
receptor and SLE which suggests that they have a role in the SLE
pathogenesis.
Also, IL17 and FC gamma receptor had significant positive
correlation with SLE activity indicating their role in activity of SLE.
IL-17 was higher in severe cases suggesting that it had also a role in
increasing severity of SLE.ConclusionConclusion
Conclusion
In conclusion, we find that IL17 and FC gamma receptor had significant
positive correlation with SLE activity indicating their role in activity of SLE.
IL-17 was higher in severe cases sugge.