vitamin-b-12 and Lupus-Erythematosus--Systemic

Patients with systemic lupus erythematosus (SLE) have elevated cardiovascular risk. Hyperhomocysteinemia may be one of the contributing factors to this phenomenon. This study therefore aimed to compare the serum homocysteine levels and the levels of folate and vitamin B12, cofactors for homocysteine metabolism, between individuals with and without SLE.. A literature search was performed in PubMed, Embase, and the Cochrane library (from inception to March 31, 2019). Studies comparing serum homocysteine, folate or vitamin B. A total of 50 studies involving 4396 patients with SLE were included. Patients with SLE had a significantly higher serum level of homocysteine (standardized mean difference [SMD], 1.134; 95% CI, 0.795-1.474) and lower level of vitamin B. Serum homocysteine levels were higher and vitamin B

Topics: Adult; Folic Acid; Homocysteine; Humans; Lupus Erythematosus, Systemic; Vitamin B 12; Vitamins

Topics: Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Megaloblastic; Arthritis, Juvenile; Arthritis, Rheumatoid; Blood Volume; Collagen Diseases; Dermatomyositis; Felty Syndrome; Folic Acid; Hemolysis; Humans; Hyperplasia; Iron; Lupus Erythematosus, Systemic; Myositis; Polyarteritis Nodosa; Polymyalgia Rheumatica; Scleroderma, Systemic; Vitamin B 12

To evaluate the effect of a culturally sensitive cholesterol lowering dietary program on energy, protein, fiber, vitamin and mineral intake, diet quality, and hemoglobin levels in patients with systemic lupus erythematosus (SLE).. Seventeen patients with SLE were randomized to a Step II diet intervention group or a control group for 12 weeks. The diet intervention was made up of weekly group sessions during the first 6 weeks followed by telephone counseling every 2 weeks for the last 6 weeks. Food intake was assessed by 3-day food record at baseline, 6, and 12 weeks. Diet quality was assessed by expressing the nutrients as a percentage of the Dietary Reference Intakes of the US National Academy of Sciences, or as a percentage of the nutrient guidelines by the National Cholesterol Education Program, Adult Treatment Panel III. Between- and within-group changes in nutrient intakes were assessed by repeated measures ANOVA.. The changes in nutrient intakes were not significantly different between the groups for any of the nonfat nutrients except vitamin B12 (p = 0.05), which decreased in the diet group and increased in the control group. Within-group analysis showed a significant reduction (p = 0.0003 to 0.02) in the diet group in energy and sodium intake at 6 and 12 weeks and B12 intake at 12 weeks compared to the respective baseline values (28-32%, 37-41%, and 43%, respectively). Sodium intake decreased to 66-71% of the total sodium allowance (< 2400 mg per day) in the diet group. The intervention was successful in maintaining adequate intakes or even increasing intakes of most nutrients except B12, dietary fiber, folate, calcium, and iron, which were slightly higher or below 67% of the Dietary Reference Intakes or other dietary guidelines. Anemia, as assessed by hemoglobin levels, was present throughout the study and did not correlate with iron intake.. This culturally sensitive cholesterol reducing diet program was successful in decreasing sodium intake and maintaining adequate intakes of most nutrients except B12, dietary fiber, iron, calcium, and folate. Future intervention studies in patients with SLE need to pay special attention to these nutrients and the presence of anemia.

Topics: Adult; Calcium, Dietary; Cholesterol; Culture; Diet, Fat-Restricted; Female; Folic Acid; Humans; Iron, Dietary; Lupus Erythematosus, Systemic; Middle Aged; Minority Groups; Nutrition Assessment; Sodium, Dietary; Vitamin B 12

Patients with active lupus have altered T cells characterized by low DNA methyltransferase levels. We hypothesized that low DNA methyltransferase levels synergize with low methionine levels to cause greater overexpression of genes normally suppressed by DNA methylation. CD4+ T cells from lupus patients and controls were stimulated with PHA then cultured in custom media with normal or low methionine levels. Oxidative stress was induced by treating the normal CD4+ T cells with peroxynitrite prior to culture. Methylation sensitive gene expression was measured by flow cytometry. Results showed low methionine levels caused greater overexpression of methylation sensitive genes in peroxynitrite treated T cells relative to untreated T cells, and in T cells from lupus patients relative to T cells from healthy controls. In conclusion, low dietary transmethylation micronutrient levels and low DNA methyltransferase levels caused either by oxidative stress or lupus, have additive effects on methylation sensitive T cell gene expression.

Topics: Adult; Aged; Case-Control Studies; CD4-Positive T-Lymphocytes; Choline; Diet; DNA Methylation; DNA Modification Methylases; Epigenesis, Genetic; Female; Flow Cytometry; Folic Acid; Gene Expression Regulation; Homocysteine; Humans; Lupus Erythematosus, Systemic; Male; Methionine; Micronutrients; Middle Aged; Oxidative Stress; Peroxynitrous Acid; Riboflavin; T-Lymphocytes; Vitamin B 12; Vitamin B 6; Young Adult; Zinc

Mechanisms responsible for anemia in systemic lupus erythematosus (SLE) can be immune or non-immune. A 27-year-old previously healthy woman was admitted with echymotic patches over the lower limbs for six months, multiple joint pain and fatigue for 2 months. She had severe pallor and multiple echymotic patches over the lower limbs. She was diagnosed with SLE with pernicious anemia and iron deficiency anemia. The rare association of SLE with pernicious anemia was reported previously in few patients. Treatment of SLE along with B12 supplementation is necessary for such patients. Since etiology for anemia in SLE can be of various kinds, a detailed workup for identifying the underlying mechanism is necessary.

Topics: Adult; Anemia, Iron-Deficiency; Anemia, Pernicious; Erythrocytes, Abnormal; Female; Humans; Lupus Erythematosus, Systemic; Vitamin B 12

Lupus flares occur when genetically predisposed individuals encounter appropriate environmental agents. Current evidence indicates that the environment contributes by inhibiting T cell DNA methylation, causing overexpression of normally silenced genes. DNA methylation depends on both dietary transmethylation micronutrients and ERK-regulated DNA methyltransferase 1 (DNMT-1) levels. We used transgenic mice to study the effect of interactions between diet, DNMT-1 levels, and genetic predisposition on the development and severity of lupus.. A doxycycline-inducible ERK defect was bred into lupus-resistant (C57BL/6) and lupus-susceptible (C57BL/6 × SJL) mouse strains. Doxycycline-treated mice were fed a standard commercial diet for 18 weeks and then switched to a transmethylation micronutrient-supplemented (MS) or -restricted (MR) diet. Disease severity was assessed by examining anti-double-stranded DNA (anti-dsDNA) antibody levels, the presence of proteinuria and hematuria, and by histopathologic analysis of kidney tissues. Pyrosequencing was used to determine micronutrient effects on DNA methylation.. Doxycycline induced modest levels of anti-dsDNA antibodies in C57BL/6 mice and higher levels in C57BL/6 × SJL mice. Doxycycline-treated C57BL/6 × SJL mice developed hematuria and glomerulonephritis on the MR and standard diets but not the MS diet. In contrast, C57BL/6 mice developed kidney disease only on the MR diet. Decreasing ERK signaling and methyl donors also caused demethylation and overexpression of the CD40lg gene in female mice, consistent with demethylation of the second X chromosome. Both the dietary methyl donor content and the duration of treatment influenced methylation and expression of the CD40lg gene.. Dietary micronutrients that affect DNA methylation can exacerbate or ameliorate disease in this transgenic murine lupus model, and contribute to lupus susceptibility and severity through genetic-epigenetic interactions.

Topics: Animals; Antibodies, Antinuclear; Betaine; CD40 Ligand; Choline; Coenzymes; Diet; Disease Models, Animal; DNA (Cytosine-5-)-Methyltransferase 1; DNA (Cytosine-5-)-Methyltransferases; DNA Methylation; Epigenesis, Genetic; Folic Acid; Gene Silencing; Genetic Predisposition to Disease; Lupus Erythematosus, Systemic; Methionine; Mice; Mice, Inbred C57BL; Mice, Transgenic; Micronutrients; Riboflavin; Vitamin B 12; Vitamin B 6; Zinc

To evaluate the presence of dyslipidemia and plasma concentrations of homocysteine (Hcy) and cysteine (Cys) in adolescents with juvenile systemic lupus erythematosus (SLE) and relate these findings to disease activity (Systemic Lupus Erythematosus Disease Activity Index, SLEDAI) and cardiovascular risk factors.. A cross-sectional controlled study including 26 female adolescents with SLE and 26 healthy controls was conducted. We evaluated SLEDAI, medications, anthropometric data, dietary intake, lipid profile, proteinuria, Hcy, Cys, folic acid, vitamin B12, and high-sensitivity C-reactive protein levels.. Dyslipidemia was observed in 46.2% of the patients and in 19.2% of the controls. The SLE group had a higher Cys concentration and a lower high-density lipoprotein cholesterol concentration compared with the controls. In the multivariate analysis only Hcy was significantly and independently associated with the presence of dyslipidemia in the juvenile SLE group; an increase of 1 μmol/l in the Hcy concentration doubled the chance of dyslipidemia (OR: 2.1; 95% CI: 1.1-4.9; p = 0.030). The Cys concentration was correlated with Hcy, total cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations.. We observed the presence of cardiovascular risk factors in adolescents with juvenile SLE. The early identification of biochemical alterations allows the development of intervention strategies that may lower the risk of cardiovascular disease.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Body Mass Index; C-Reactive Protein; Cardiovascular Diseases; Case-Control Studies; Child; Cholesterol, HDL; Cholesterol, LDL; Cross-Sectional Studies; Cysteine; Dyslipidemias; Energy Intake; Female; Folic Acid; Homocysteine; Humans; Lupus Erythematosus, Systemic; Multivariate Analysis; Nutritional Status; Puberty; Risk Factors; Triglycerides; Vitamin B 12; Waist Circumference; Young Adult

Topics: Anemia, Pernicious; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Middle Aged; Risk Factors; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Hyperhomocysteinemia is known to predispose to atherosclerosis and occurs more commonly in patients with systemic lupus erythematosus (SLE) than in the general population. It has been shown that elevated plasma total homocysteine (tHcy) results in protein N-homocysteinylation and production o autoantibodies against N-homocysteinylated (N-Hcy) proteins.. The aim of the study was to investigate whether anti-N-Hcy-albumin antibodies occur in patients with SLE and identify factors that determine these antibodies in such population. Patients and methods. In 50 subjects with SLE and 50 age- and sex-matched healthy controls, we determined serum IgG antibodies to N-Hcy-albumin using an in-house enzyme linked immunosorbent assay.. Patients had higher plasma tHcy and C-reactive protein (CRP) than controls, while serum folate and witamin B12 were lower in patients. Levels of anti-N-Hcy-albumin were higher in patients with SLE than in controls (medians: 0.31; vs. 0.19; p < 0.0001). In SLE patients, levels of anti- N-Hcy-albumin antibodies correlated with tHcy (r = 0.83; p <0.0001), CRP (r = 0.33; p = 0.02) and the duration of the disease (r = 0.3; p = 0.04). Seropositivity to anti-N-Hcy-albumin antibodies was more frequent in SLE patients than in controls (50% vs. 10%; p < 0.001). In SLE patients tHcy and CRP concentrations, along with the duration of the disease were independent predictors of anti-N-Hcy-albumin antibodies level. There were no associations between a type or levels of antinuclear antibodies patent's, or age with anti-N-Hcy-albumin antibodies.. Compared with healthy controls, in SLE patients levels of anti-N-Hcy-albumin antibodies are significantly higher and are largely determined by tHcy, CRP and the disease duration. This novel autoimmune response might contribute to increased risk of vascular events in SLE patients.

Topics: Adolescent; Adult; Autoantibodies; C-Reactive Protein; Case-Control Studies; Female; Folic Acid; Homocysteine; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Serum Albumin; Vitamin B 12

Although anemia is frequent in inflammatory rheumatic diseases, data regarding vitamin B12 status is scarce. The purpose of this study was to analyze the incidence and nature of B12 and folic acid (FA) deficiencies in a cohort of rheumatic patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE).. Levels of B12, FA, and parameters of anemia were recovered or examined in 276 outpatients. In those with recent findings of low serum B12 levels, further studies of serum homocysteine (Hcy) and urine methylmalonic acid (MMA) levels were performed.. The incidence of anemia was high: 49%, 46%, and 35%, in RA, SLE, and PsA, respectively. Low levels of serum B12 were also frequent (24%), with almost similar occurrence in the three disease groups. Deficiency in FA was rare (<5%). Mean levels of both vitamins did not differ significantly among the three groups. No correlation between serum B12 levels and anemia was found. In the 15 patients with recently detected low B12 levels, Hcy and MMA were evaluated before and following B12 therapy. In ten of them, baseline Hcy levels were high, while MMA was increased in one patient only. Response to B12 administration, i.e., a decrease in Hcy and/or MMA levels, was noticed in four patients only, suggesting that only 26% of the low-serum-B12 patients had true B12 deficiency.. The incidences of anemia and decreased serum B12 levels were high in these three groups of rheumatic patients. However, true tissue deficiency seems to be much rarer.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Arthritis, Psoriatic; Arthritis, Rheumatoid; Cohort Studies; Female; Folic Acid Deficiency; Homocysteine; Humans; Incidence; Israel; Lupus Erythematosus, Systemic; Male; Methylmalonic Acid; Middle Aged; Retrospective Studies; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Cardiovascular disease is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Antiphospholipid syndrome (APS) is one of the most important causes of thrombosis in SLE. In addition, an association between hyperhomocysteinemia and increased cardiovascular risk has also been reported. Our aim is to analyse the association of thrombosis with plasma total homocysteine (ptHcy), antiphospholipid antibodies (aPL) and other vascular risk factors in SLE patients. Fasting plasma levels of ptHcy, vitamin B12, folate, total cholesterol and creatinine were measured in 117 SLE patients. Clinical and immunological data were obtained from our prospective computerized database. aPL-positivity was defined according to Sapporo criteria. There was no association between aPL and ptHcy. ptHcy was higher in patients with arterial (median 13.02 versus 10.16 micromol/L, P = 0.010) but not venous thrombosis. In the subgroup analysis, this association was only seen in aPL-negative patients. In logistic regression, aPL (OR 6.60, 95% CI 1.86-23.34) and ptHcy (OR 1.10, 95% CI 1.01-1.19) were independently associated with arterial thrombosis. However, when hypertension, smoking and plasma total cholesterol were added to the model, only aPL (OR 7.38, 95% CI 2.02-26.91) and hypertension (OR 7.70, 95% CI 2.33-25.39), but not ptHcy, remained independently related to arterial events. aPL was the only variable independently related to venous thrombosis (OR 7.68, 95% CI 1.60-36.86). ptHcy concentrations are higher in SLE patients with arterial thrombosis. No interaction between homocysteine and aPL was found. Raised ptHcy may be a marker of increased vascular risk in aPL-negative SLE patients. The role of homocysteine as a marker of vascular risk may depend on the presence of traditional risk factors, although a modest intrinsic effect cannot be entirely excluded.

Topics: Adult; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Cholesterol; Creatinine; Female; Folic Acid; Homocysteine; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Risk Factors; Thrombosis; Vitamin B 12

As the co-existence of pernicious anaemia (PA) and systemic lupus erythematosus (SLE) has been repeatedly reported, we have investigated the presence of anti-intrinsic factor antibodies (IFAb), the immunological hallmark of PA, in patients diagnosed with SLE. Serum cobalamin levels and IFAb were determined in 30 women diagnosed with SLE as well as in 45 controls. Cobalamin levels were low in 7/30 patients. IFAb were detected in 3/30 sera from patients but in none of the control sera. The presence of IFAb was associated with a low cobalamin concentration, anaemia and macrocytosis in only one patient. There was no evident relationship between the presence of IFAb and serological markers of SLE. We conclude that IFAb may appear in SLE patients, although the cobalamin deficiency described in SLE seems to be due to the presence of IFAb in only a minority of cases.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies; Female; Fluorescent Antibody Technique; Hemoglobins; Humans; Immunodiffusion; Intrinsic Factor; Lupus Erythematosus, Systemic; Middle Aged; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Drug Therapy, Combination; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Steroids; Vitamin B 12

The purpose of this study was to assay serum cobalamin levels in patients with systemic lupus erythematosus (SLE) as there are few case reports on the association of pernicious anemia and SLE.. Serum cobalamin levels were assayed in 43 female SLE patients by a radio-dilution assay using purified intrinsic factor.. Cobalamin levels were found to be significantly lower in the SLE group compared with a normal control group, eight of whom (18.6%) had serum cobalamin levels equal to or lower than 180 pg/mL (mean: 129.25 +/- 40.05 pg/mL). None of the SLE patients had been found to have pernicious anemia. The transcobalamin II level and unsaturated vitamin B12 binding capacity, but not the cobalamin level, were positively correlated with SLE activity.. Our results may indicate a subtle cobalamin deficiency in SLE patients without pernicious anemia.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Folic Acid; Humans; Infant; Lupus Erythematosus, Systemic; Middle Aged; Transcobalamins; Vitamin B 12

Topics: Anemia, Hemolytic, Autoimmune; Anemia, Pernicious; Humans; Injections, Intramuscular; Lupus Erythematosus, Systemic; Male; Middle Aged; Prednisone; Vitamin B 12

Topics: Adult; Anemia, Pernicious; Female; Folic Acid; Humans; Lupus Erythematosus, Systemic; Pregnancy; Vitamin B 12

Topics: Adult; Anemia, Sideroblastic; Bone Marrow Cells; Bone Marrow Examination; Erythropoiesis; Erythropoietin; Exchange Transfusion, Whole Blood; Folic Acid; Humans; Iron; Isoniazid; Lupus Erythematosus, Systemic; Male; Megakaryocytes; Prednisone; Proteinuria; Pyridoxine; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Blood Proteins; Female; Hematologic Diseases; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Leukocyte Count; Liver Cirrhosis; Lupus Erythematosus, Systemic; Lymphoma; Male; Multiple Myeloma; Neoplasms; Polycythemia; Primary Myelofibrosis; Protein Binding; Uremia; Vitamin B 12

Topics: Adolescent; Adult; Biopsy; Cecum; Celiac Disease; Colon; Female; Hemoglobinometry; Humans; Intestinal Mucosa; Lupus Erythematosus, Systemic; Malabsorption Syndromes; Male; Mesenteric Vascular Occlusion; Middle Aged; Prednisone; Radiography; Vitamin B 12; Xylose

Topics: Ascorbic Acid; Collagen Diseases; Corrinoids; Cystitis; Cystitis, Interstitial; Drug Therapy; Humans; Lupus Erythematosus, Systemic; Pyridoxine; Scleroderma, Systemic; Ulcer; Vitamin B 12

Topics: Corrinoids; Hematinics; Humans; Lupus Erythematosus, Systemic; Vitamin B 12

Topics: DNA; Humans; Lupus Erythematosus, Systemic; Vitamin B 12

Topics: Depression; Humans; Lupus Erythematosus, Systemic; Vibration; Vitamin B 12

Topics: Humans; Lupus Erythematosus, Systemic; Vitamin B 12

Topics: Humans; Lupus Erythematosus, Systemic; Vitamin B 12

Topics: Humans; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Vitamin B 12

Topics: Corrinoids; Hematinics; Lupus Erythematosus, Systemic; Quinacrine; Vitamin B 12

Topics: Humans; Lupus Erythematosus, Systemic; Vitamin B 12