Letter to the Editor
Inflammation, systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome
Inflamação, lúpus eritematoso sistémico e síndrome de Kounis associada à ativação dos mastócitos
Nicholas G. Kounis
Department of Medical Sciences, Southwestern Greece Highest Institute of Education and Technology, Patras, Greece
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Kounis" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Nicholas G." "apellidos" => "Kounis" "email" => array:1 [ 0 => "ngkounis@otenet.gr" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Medical Sciences, Southwestern Greece Highest Institute of Education and Technology, Patras, Greece" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Inflamação, lúpus eritematoso sistémico e síndrome de Kounis associada à ativação dos mastócitos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease of unknown origin that affects many organ systems. It is characterized by chronic inflammation that can induce abnormal vasomotion by reducing nitric oxide production and increasing endothelin-1 release, leading to endothelial injury and consequently to coronary artery spasm, which can progress to acute myocardial infarction (MI). This could be the result of either increased C-reactive protein, which induces significant expression of molecules associated with endothelial damage such as ICAM-1, VCAM-1 and E-selectin, or expansion of CD4 CD28 T cells, which induce cytolysis in endothelial cells and/or activation of macrophages and other related interacting cells such as mast cells.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> Therefore an association with Kounis mast cell activation-associated syndrome, also known as coronary hypersensitivity disorder,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> cannot be excluded.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the very interesting paper by de Matos Soeiro et al. published in the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> concerning 11 patients with acute coronary syndromes, it was concluded that coronary artery disease in young people with SLE due to premature atherosclerosis should be always be borne in mind because of its high mortality rate.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Indeed, the following inflammatory substances and conditions that are associated with Kounis syndrome should be always considered in patients with lupus erythematosus, including:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0020" class="elsevierStylePara elsevierViewall">Interleukin-9, a T-cell derived factor preferentially expressed by CD4+ T cells that has been characterized in human and murine systems.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0025" class="elsevierStylePara elsevierViewall">Mast cell tryptase, which can be an indicator of type I hypersensitivity reaction and may serve as a surrogate marker of anaphylaxis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Macrophages and their polarization have been found to contribute to the initiation and perpetuation of SLE.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Hypereosinophilic syndrome, which is associated with SLE.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0040" class="elsevierStylePara elsevierViewall">Mast cells, macrophages and (very few) eosinophils are present in inflamed rheumatoid synovial tissue and sites of cartilage erosion in SLE and other autoimmune conditions, including rheumatoid arthritis.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Patients with SLE have higher risk of acute MI compared with non-SLE controls, and this risk is more significant in females. In addition, SLE is an independent risk factor for post-acute MI mortality.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0050" class="elsevierStylePara elsevierViewall">Platelets bearing complement protein C4d (P-C4d) were initially determined to be specific for diagnosis of SLE and were later found to be associated with acute ischemic stroke in non-SLE patients. P-C4d may identify a subset of SLE patients with a worse clinical prognosis and is associated with all-cause mortality and stroke in these patients. P-C4d may be a prognostic biomarker as well as a pathogenic clue that links platelets, complement activation, and thrombosis.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0055" class="elsevierStylePara elsevierViewall">The R131 allele of the Fc gamma receptor IIa (FcγRIIa) is associated with SLE incidence and disease severity but also with coronary artery disease. This finding implies that risk stratification of SLE patients and other high-risk patients with troponin-negative angina could be significantly improved by FcγRIIa genotyping.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9.</span><p id="par0060" class="elsevierStylePara elsevierViewall">SLE nearly doubles mortality and event hazards in cardiovascular disease (MI, stroke, or congestive heart failure) compared to age- and sex-matched comparisons. This raises research questions regarding delayed SLE diagnosis versus accelerated cardiovascular disease prior to SLE, particularly in older-onset SLE.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10.</span><p id="par0065" class="elsevierStylePara elsevierViewall">Cardiovascular events including acute MI and stroke in SLE patients are caused by multifactorial mechanisms, including both traditional and disease-specific risk factors. An overall evaluation with individual risk stratification based on both these features is important to correctly manage these patients in order to reduce negative outcomes.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a></p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">Consequently, in order to elucidate the pathophysiology of the association of SLE and acute coronary syndromes and to discover potential therapeutic and preventive measures for acute coronary events, a search for inflammatory cells and measurement of inflammatory cell mediators released from these cells should always be performed.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary artery spasm as a cause for myocardial infarction in patients with systemic inflammatory disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 5 | 12 |
| 2024 Outubro | 38 | 35 | 73 |
| 2024 Setembro | 54 | 22 | 76 |
| 2024 Agosto | 47 | 35 | 82 |
| 2024 Julho | 35 | 29 | 64 |
| 2024 Junho | 41 | 25 | 66 |
| 2024 Maio | 41 | 30 | 71 |
| 2024 Abril | 48 | 25 | 73 |
| 2024 Maro | 41 | 22 | 63 |
| 2024 Fevereiro | 33 | 24 | 57 |
| 2024 Janeiro | 37 | 28 | 65 |
| 2023 Dezembro | 32 | 18 | 50 |
| 2023 Novembro | 34 | 20 | 54 |
| 2023 Outubro | 19 | 13 | 32 |
| 2023 Setembro | 29 | 23 | 52 |
| 2023 Agosto | 29 | 14 | 43 |
| 2023 Julho | 27 | 5 | 32 |
| 2023 Junho | 27 | 16 | 43 |
| 2023 Maio | 28 | 21 | 49 |
| 2023 Abril | 15 | 3 | 18 |
| 2023 Maro | 22 | 30 | 52 |
| 2023 Fevereiro | 28 | 19 | 47 |
| 2023 Janeiro | 13 | 16 | 29 |
| 2022 Dezembro | 20 | 23 | 43 |
| 2022 Novembro | 38 | 23 | 61 |
| 2022 Outubro | 31 | 22 | 53 |
| 2022 Setembro | 25 | 29 | 54 |
| 2022 Agosto | 34 | 25 | 59 |
| 2022 Julho | 33 | 31 | 64 |
| 2022 Junho | 29 | 17 | 46 |
| 2022 Maio | 25 | 35 | 60 |
| 2022 Abril | 31 | 20 | 51 |
| 2022 Maro | 33 | 30 | 63 |
| 2022 Fevereiro | 29 | 35 | 64 |
| 2022 Janeiro | 21 | 23 | 44 |
| 2021 Dezembro | 18 | 25 | 43 |
| 2021 Novembro | 32 | 35 | 67 |
| 2021 Outubro | 20 | 34 | 54 |
| 2021 Setembro | 32 | 29 | 61 |
| 2021 Agosto | 28 | 20 | 48 |
| 2021 Julho | 22 | 43 | 65 |
| 2021 Junho | 19 | 16 | 35 |
| 2021 Maio | 17 | 24 | 41 |
| 2021 Abril | 43 | 32 | 75 |
| 2021 Maro | 50 | 21 | 71 |
| 2021 Fevereiro | 55 | 15 | 70 |
| 2021 Janeiro | 29 | 6 | 35 |
| 2020 Dezembro | 32 | 8 | 40 |
| 2020 Novembro | 29 | 14 | 43 |
| 2020 Outubro | 21 | 6 | 27 |
| 2020 Setembro | 51 | 9 | 60 |
| 2020 Agosto | 12 | 9 | 21 |
| 2020 Julho | 42 | 7 | 49 |
| 2020 Junho | 34 | 10 | 44 |
| 2020 Maio | 35 | 3 | 38 |
| 2020 Abril | 27 | 14 | 41 |
| 2020 Maro | 27 | 12 | 39 |
| 2020 Fevereiro | 64 | 30 | 94 |
| 2020 Janeiro | 30 | 5 | 35 |
| 2019 Dezembro | 26 | 4 | 30 |
| 2019 Novembro | 32 | 16 | 48 |
| 2019 Outubro | 33 | 8 | 41 |
| 2019 Setembro | 17 | 5 | 22 |
| 2019 Agosto | 29 | 12 | 41 |
| 2019 Julho | 34 | 11 | 45 |
| 2019 Junho | 22 | 9 | 31 |
| 2019 Maio | 34 | 11 | 45 |
| 2019 Abril | 13 | 9 | 22 |
| 2019 Maro | 13 | 8 | 21 |
| 2019 Fevereiro | 36 | 10 | 46 |
| 2019 Janeiro | 18 | 9 | 27 |
| 2018 Dezembro | 34 | 10 | 44 |
| 2018 Novembro | 78 | 13 | 91 |
| 2018 Outubro | 185 | 10 | 195 |
| 2018 Setembro | 82 | 13 | 95 |
| 2018 Agosto | 110 | 11 | 121 |
| 2018 Julho | 35 | 7 | 42 |
| 2018 Junho | 64 | 5 | 69 |
| 2018 Maio | 79 | 9 | 88 |
| 2018 Abril | 149 | 5 | 154 |
| 2018 Maro | 163 | 7 | 170 |
| 2018 Fevereiro | 114 | 5 | 119 |
| 2018 Janeiro | 204 | 8 | 212 |
| 2017 Dezembro | 195 | 17 | 212 |
| 2017 Novembro | 61 | 11 | 72 |
| 2017 Outubro | 34 | 12 | 46 |
| 2017 Setembro | 46 | 2 | 48 |
| 2017 Agosto | 32 | 9 | 41 |
| 2017 Julho | 31 | 6 | 37 |
| 2017 Junho | 32 | 14 | 46 |
| 2017 Maio | 41 | 11 | 52 |
| 2017 Abril | 25 | 6 | 31 |
| 2017 Maro | 30 | 3 | 33 |
| 2017 Fevereiro | 22 | 8 | 30 |
| 2017 Janeiro | 26 | 7 | 33 |
| 2016 Dezembro | 29 | 9 | 38 |
| 2016 Novembro | 20 | 15 | 35 |
| 2016 Outubro | 17 | 13 | 30 |
| 2016 Setembro | 16 | 8 | 24 |
| 2016 Agosto | 16 | 4 | 20 |
| 2016 Julho | 9 | 6 | 15 |
| 2016 Junho | 11 | 7 | 18 |
| 2016 Maio | 4 | 9 | 13 |
| 2016 Abril | 34 | 3 | 37 |
| 2016 Maro | 62 | 12 | 74 |
| 2016 Fevereiro | 59 | 14 | 73 |
| 2016 Janeiro | 55 | 7 | 62 |
| 2015 Dezembro | 61 | 7 | 68 |
| 2015 Novembro | 56 | 12 | 68 |
| 2015 Outubro | 60 | 12 | 72 |
| 2015 Setembro | 58 | 11 | 69 |
| 2015 Agosto | 52 | 17 | 69 |
| 2015 Julho | 65 | 20 | 85 |
| 2015 Junho | 53 | 23 | 76 |
| 2015 Maio | 111 | 51 | 162 |
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