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The Egyptian Journal of Bronchology
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Serum interleukin 23 and its associations with interstitial lung disease and clinical manifestations of scleroderma

Egyptian Journal of Bronchology volume 12, pages 69–75 (2018)Cite this article

Abstract

Introduction

Systemic sclerosis (SSc) is a complex disease linked to immune system activation, vascular damage, associated with increased synthesis, and deposition of extracellular matrix, which contain excessive amounts of structurally normal collagen. Interleukin 23 (IL-23) might play a role in disease development and severity. This study aimed to assess the relationship between serum level of IL-23 and interstitial lung disease in SSc.

Patients and methods

Thirty patients with SSc together with 30 age-matched and sex-matched healthy volunteers were recruited in this study. Serum IL-23 levels were measured by enzyme-linked immunosorbent assay. Functionally, lung involvement was assessed by pulmonary function tests and radiologically by chest radiography and high-resolution computed tomography of the lungs.

Results

Mean serum IL-23 level was significantly highly elevated in SSc patients compared with healthy controls (P<0.005). Patients with elevated IL-23 levels exhibited shorter disease duration (P<0.05). Moreover, mean serum IL-23 level was elevated in diffuse SSc cases compared with limited SSc cases and in cases with pulmonary fibrosis (P<0.05), although they were not associated with other clinical features. Elevated mean serum IL-23 level was significantly higher in mild restrictive cases compared with moderate and severe restrictive cases. As regards highresolution computed tomography, mean serum IL-23 level was statistically highly significantly elevated in cases with ground-glass appearance (P<0.001) compared with others.

Conclusion

Alterations in serum concentrations of IL-23 support the hypothesis that IL-23 is associated with induction of SSc generally and SSc associated with interstitial lung disease specifically. Presumably, blockage of IL-23 could be used as a potential therapeutic target in early SSc.

References

  1. Awasthi A, Kuchroo VK. Th17 cells: from precursors to players in inflammation and infection. Int Immunol 2009; 21:489–498.

    Article  CAS  Google Scholar 

  2. Jain S, Anupama S, Chris TD. Interstitial lung disease in systemic sclerosis: pathophysiology, current and new advances in therapy. Inflamm Allergy Drug Targets 2012; 11:266–277.

    Article  CAS  Google Scholar 

  3. Sara RS, Flavia VC. Interstitial lung disease in scleroderma. Rheum Dis Clin North Am 2015; 41:237–248.

    Article  Google Scholar 

  4. Smith J, Colbert R. The interleukin-23/interleukin-17 axis in spondyloarthritis pathogenesis. Arthritis Rheumatol 2014; 66:231–241.

    Article  CAS  Google Scholar 

  5. Zhao XF, Pan HF, Yuan H, Zhang WH, Li XP, Wang GC, et al. Increased serum interleukin 17 in patients with systemic lupus erythematosus. Mol Biol Rep 2010; 37:81–85.

    Article  Google Scholar 

  6. Kastelein RA, Hunter CA, Cua DJ. Discovery and biology of IL-23 and IL-27: related but functionally distinct regulators of inflammation. Annu Rev Immunol 2007; 25:221–242.

    Article  CAS  Google Scholar 

  7. Dalila AS, Mohd Said MS, Shaharir SS, Asrul AW, Low SF, Shamsul AS, et al. Interleukin-23 and its correlation with disease activity, joint damage, and functional disability in rheumatoid arthritis. Kaohsiung J Med Sci 2014; 30:337–342.

    Article  Google Scholar 

  8. Masi AT, Rodnan GP, Medsger TA. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 1980; 23:581–590.

    Article  Google Scholar 

  9. Clements P, Lachenbruch P, Seibold J, White B, Weiner S, Martin R, et al. Inter- and intraobserver variability of total skin thickness score (modified Rodan TSS) in systemic sclerosis. J Rheumatol 1995; 22:1281–1285.

    CAS  PubMed  Google Scholar 

  10. Magyari L, Varszegi D, Kovesdi E, Sarlos P, Farago B, Javorhazy A, et al. Interleukins and interleukin receptors in rheumatoid arthritis: research, diagnosis and clinical implications. World J Orthop; 2014; 5:516–536.

  11. Goh NS, Desai SR, Veeraraghavan S, Hansell DM, Copley SJ, Maher TM, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med 2008; 177:1248–1254.

    Article  Google Scholar 

  12. Greenberg RS, Daniels RS, Flanders D, Eley JW, Boring JR, editors. Diagnostic testings. In: Medical epidemiology. 3rd ed. New York: McGraw-Hill; 1996. pp. 77–89.

  13. Murata M, Fujimoto M, Matsushita T, Hamaguchi Y, Hasegawa M, Takehara K, et al. Clinical association of serum interleukin-17 levels in systemic sclerosis: is systemic sclerosis a Th17 disease? J Dermatol Sci 2008; 50:240–242.

  14. Mathian A, Parizot C, Dorgham K, Trad S, Arnaud L, Larsen M, et al. Activated and resting regulatory T cell exhaustion concurs with high levels of interleukin-22 expression in systemic sclerosis lesions. Ann Rheum Dis 2012; 71:1227–1234.

    Article  CAS  Google Scholar 

  15. Olewicz GA, Danczak PA, Kuznar KB, Pawel H. Interleukin-17 and interleukin-23: importance in the pathogenesis of lung impairment in patients with systemic sclerosis. Int J Rheum Dis 2014; 17:664–670.

    Article  Google Scholar 

  16. Agarwal SK, Gourh P, Shete S, Paz G, Divecha D, Reveille JD, et al. Association of interleukin 23 receptor polymorphisms with anti-topoisomerase-I positivity and pulmonary hypertension in systemic sclerosis. J Rheumatol 2009; 36:2715–2723.

    Article  CAS  Google Scholar 

  17. Komura K, Fujimoto M, Hasegawa M, Ogawa F, Hara T, Muroi E, et al. Increased serum interleukin 23 in patients with systemic sclerosis. J Rheumatol 2008; 35:120–125.

    Article  CAS  Google Scholar 

  18. Aggarwal S, Ghilardi N, Xie MH, de Sauvage FJ, Gurney AL. Interleukin-23 promotes a distinct CD4 T cell activation state characterized by the production of interleukin-17. J Biol Chem 2003; 278:1910–1914.

    Article  CAS  Google Scholar 

  19. Croxford AL, Mair F, Becher B. IL-23: one cytokine in control of autoimmunity. Eur J Immunol 2009; 42:2263–2273.

    Article  Google Scholar 

  20. Truchetet ME, Allanore Y, Montanari E, Chizzolini C, Brembilla NC. Prostaglandin I(2) analogues enhance already exuberant Th17 cell responses in systemic sclerosis. Ann Rheum Dis 2012; 71:2044–2050.

    Article  CAS  Google Scholar 

  21. Radstake TJ, Lenny van Bon, Jasper B, Anila H, Roger H, Dirk MW, et al. The pronounced Th17 profile in systemic sclerosis (SSc) together with intracellular expression of TGFb and IFNc distinguishes SSc phenotypes. PLoS One 2009; 4:e5903.

  22. Demir C, Sahin A, Kucuksahin O, Turgay M, Turkcapar N, Erten S, Kınıklı G. Sclerosis comparison of serum IL-23 and IL-17 levels in patients with systemic sclerosis and healthy subjects, sclerosis. J Clin Analytic Med 2015; 6:83–87. This study was presented as a poster presentation on 5th Turkish-Greek Rheumatology Days, October 14–16, 2011.

    Google Scholar 

  23. Gourh P, Arnett F, Assassi S, Filemon KT, Mei H, Laura D, et al. Plasma cytokine profiles in systemic sclerosis: associations with autoantibody subsets and clinical manifestations. Arthritis Res Ther 2009; 11:R1.

  24. Meloni F, Solari N, Cavagna L, Morosini M, Montecucco CM, Fietta AM. Frequency of Th1, Th2 and Th17 producing T lymphocytes in bronchoalveolar lavage of patients with systemic sclerosis. Clin Exp Rheumatol 2009; 27:765–772.

    CAS  PubMed  Google Scholar 

  25. Kurasawa K, Hirose K, Sano H, Endo H, Shinkai H, Nawata Y, et al. Increased interleukin-17 production in patients with systemic sclerosis. Arthritis Rheum 2000; 43:2455–2463.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Benha, Egypt

    Gamal A. Hammad, Refaat M. Eltanawy, Rasha M. Fawzy & Mona A. Eltohamy

  2. Chest Diseases Department, Faculty of Medicine, Benha University, Benha, Egypt

    Tahany M. A. Gouda

Authors
  1. Gamal A. Hammad
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  2. Refaat M. Eltanawy
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  3. Rasha M. Fawzy
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  4. Tahany M. A. Gouda
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  5. Mona A. Eltohamy
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Correspondence to Tahany M. A. Gouda.

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Hammad, G.A., Eltanawy, R.M., Fawzy, R.M. et al. Serum interleukin 23 and its associations with interstitial lung disease and clinical manifestations of scleroderma. Egypt J Bronchol 12, 69–75 (2018). https://doi.org/10.4103/ejb.ejb_22_17

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  • DOI: https://doi.org/10.4103/ejb.ejb_22_17

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