Intestinal microflora linked to lupus nephritis flares

Written By : Dr. Kamal Kant Kohli Published On 2023-06-29T20:00:19+05:30 | Updated On 29 Jun 2023 8:57 PM IST

USA: A recent study published in Annals of the Rheumatic Diseases revealed an association between "blooms" of Ruminococcus gnavus, a microbial species, and lupus nephritis flares' onset. Flares of lupus nephritis is a systemic lupus erythematosus (SLE) complication that affects the kidneys.

In the study, researchers from New York University analyzed serial faecal samples from women with SLE. They revealed significant variability in the microbial composition over time, with more pronounced fluctuations than observed in healthy individuals.

In the study published in the Annals of the Rheumatic Diseases, researchers Gregg Silverman, MD, of New York University in New York City, and colleagues found that four patients with lupus nephritis experienced substantial increases in the abundance of R. gnavus, averaging a ninefold rise during periods of active disease compared to less active periods. Furthermore, specific strains of R. gnavus were identified as more disease-inducing than others.

These strains expressed lipoglycans acting as non-protein antigens, triggering an immune response. Lab studies demonstrated immunoreactivity with these lipoglycans in the serum of lupus nephritis patients, indicating their role in provoking an immune response

The researchers postulated that immune responses to these novel R. gnavus lipoglycans may contribute to the immune-complex mediated pathways associated with lupus disease flares. Patients with higher levels of R. gnavus in their microbiomes also exhibited elevated titers of immunoglobulin G antibodies that recognized the lipoglycans, supporting this hypothesis.

However, the study also highlighted that not all lupus nephritis flares were associated with R. gnavus blooms, suggesting the involvement of other yet undiscovered disease drivers. The researchers acknowledged the limitations of their study, including the small number of patients and variations in sample collection intervals not necessarily tied to disease activity. Additionally, factors such as diet, prior antibiotic exposure, and over-the-counter medication use, which were not tracked, could have influenced the results.

The findings add to the growing body of evidence linking the gut microbiome to various physiological functions beyond digestion, including its potential role in autoimmune diseases. Dysbiosis, an imbalance in the gut microbiota, has been proposed as a contributing factor in conditions such as rheumatoid arthritis. In lupus nephritis, dysbiosis may trigger an innate immune response to R. gnavus lipoglycans, leading to flares of the disease.

These findings open up possibilities for novel treatment approaches for lupus nephritis. Targeting R. gnavus or its lipoglycans with specific therapies could potentially abrogate flares, offering an alternative to immunosuppressants in these cases. However, further research is needed to validate these findings and explore the effectiveness and safety of such treatments.

As the medical community continues to delve into the complex interactions between the gut microbiome and autoimmune diseases, this study provides valuable insights into the potential microbial triggers of lupus nephritis. Identifying and understanding these mechanisms could pave the way for more targeted and personalized interventions, improving managing this challenging condition and potentially reducing the burden of lupus-related kidney complications.

It is important to note that consulting with healthcare professionals and adhering to individualized treatment plans remain crucial for patients with lupus nephritis. This study contributes to the growing understanding of the gut-kidney connection in autoimmune diseases, offering hope for future advancements in therapeutic strategies and improved outcomes for those living with lupus nephritis.

Reference: Annals of the Rheumatic Diseases Azzouz D, et al "Longitudinal gut microbiome analyses and blooms of pathogenic strains during lupus disease flares" Ann Rheum Dis 2023; DOI: 10.1136/ard-2023-223929

Annals of the Rheumatic Diseaseslupus nephritisRuminococcus gnavusGut MicrobiotaLupus Nephritis

Source : Annals of the Rheumatic Diseases

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751