Treatment Advances in Systemic Lupus Erythematosus: A Literature Review
Main Article Content
Abstract
Systemic lupus erythematosus (SLE) is a complex autoimmune disease with diverse clinical presentations, ranging from mild to severe, life-threatening organ involvement. Advances in understanding its multifaceted etiology—encompassing genetic, epigenetic, hormonal, and environmental factors—have shed light on key immunological pathways involved in disease pathogenesis. The roles of innate and adaptive immune responses, including dysregulated B and T cells, cytokines, and chemokines, have been elucidated, with interferon signaling emerging as a critical player. The introduction of novel therapeutic strategies, including monoclonal antibodies, Chimer Antigen Receptor T-cell therapy, and hematopoietic stem cell transplantation, reflects the evolving landscape of lupus management. Precision medicine and immunometabolism research offer promising avenues for tailoring treatment plans to individual patients, improving outcomes, and minimizing adverse effects. Despite significant progress, further studies are essential to refine therapeutic approaches, enhance disease remission rates, and explore potential curative solutions.
Keywords:
SLE, treatment, INF gamma, antibodies, autoimmune, epigenetic, innate immune response, adaptive immune response, cytokines, multi-organ, immunosuppressive, MCH, self-antigens, immunomodulation, chemokines, lymphocytes, CAR T cells, hematopoietic stem cell transplant
Article Details
How to Cite
ALJESHI, Aseel et al.
Treatment Advances in Systemic Lupus Erythematosus: A Literature Review.
Medical Research Archives, [S.l.], v. 13, n. 2, feb. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6270>. Date accessed: 17 mar. 2025.
doi: https://doi.org/10.18103/mra.v13i2.6270.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Ma A, H C, J M, et al. An Overview of Systemic Lupus Erythematosus (SLE) Pathogenesis, Classification, and Management. PubMed. Published online 2022. Accessed January 15, 2025. https://pubmed.ncbi.nlm.nih.gov/36407159/
2. Gómez-Bañuelos E, Fava A, Andrade F. An update on autoantibodies in systemic lupus erythematosus. Curr Opin Rheumatol. 2023;35(2):61-67. doi:10.1097/BOR.0000000000000922
3. Liu W, Zhang S, Wang J. IFN-γ, should not be ignored in SLE. Front Immunol. 2022;13:954706. doi:10.3389/fimmu.2022.954706
4. Sawada T, Fujimori D, Yamamoto Y. Systemic lupus erythematosus and immunodeficiency. Immunol Med. 2019;42(1):1-9. doi:10.1080/25785826.2019.1628466
5. Akhil A, Bansal R, Anupam K, Tandon A, Bhatnagar A. Systemic lupus erythematosus: latest insight into etiopathogenesis. Rheumatol Int. 2023;43(8):1381-1393. doi:10.1007/s00296-023-05346-x
6. Webber D, Cao J, Dominguez D, et al. Association of systemic lupus erythematosus (SLE) genetic susceptibility loci with lupus nephritis in childhood-onset and adult-onset SLE. Rheumatology. 2020;59(1):90-98. doi:10.1093/rheumatology/kez220
7. Ortíz-Fernández L, Martín J, Alarcón-Riquelme ME. A Summary on the Genetics of Systemic Lupus Erythematosus, Rheumatoid Arthritis, Systemic Sclerosis, and Sjögren’s Syndrome. Clin Rev Allergy Immunol. 2022;64(3):392-411. doi:10.1007/s12016-022-08951-z
8. Javinani A, Ashraf-Ganjouei A, Aslani S, Jamshidi A, Mahmoudi M. Exploring the etiopathogenesis of systemic lupus erythematosus: a genetic perspective. Immunogenetics. 2019;71(4):283-297. doi:10.1007/s00251-019-01103-2
9. C C, D Z, E E, et al. Environment and systemic lupus erythematosus. PubMed. Accessed January 15, 2025. https://pubmed.ncbi.nlm.nih.gov/38743446/
10. Kim JW, Kim HA, Suh CH, Jung JY. Frontiers | Sex hormones affect the pathogenesis and clinical characteristics of systemic lupus erythematosus. doi:10.3389/fmed.2022.906475
11. Y A, T M. Epigenetic Dysregulation in the Pathogenesis of Systemic Lupus Erythematosus. PubMed. Published online 2024. Accessed January 15, 2025. https://pubmed.ncbi.nlm.nih.gov/38256093/
12. Ce W, Tb N. The unexplained female predominance of systemic lupus erythematosus: clues from genetic and cytokine studies. PubMed. Accessed January 15, 2025. https://pubmed.ncbi.nlm.nih.gov/20063186/
13. The influence of reproductive hormones on systemic lupus erythematosus. Accessed January 15, 2025. https://www.explorationpub.com/Journals/ei/Article/100355
14. Mrw B, C D, T F, et al. Global epidemiology of systemic lupus erythematosus. PubMed. Accessed January 15, 2025. https://pubmed.ncbi.nlm.nih.gov/34345022/
15. C G, Mb AA, M G, et al. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. PubMed. Published online 2018. Accessed January 16, 2025. https://pubmed.ncbi.nlm.nih.gov/29029350/
16. M A, N L, Sr J. New Criteria for Lupus. PubMed. Published online 2020. Accessed January 16, 2025. https://pubmed.ncbi.nlm.nih.gov/32405775/
17. A F, M P. Systemic lupus erythematosus: Diagnosis and clinical management. PubMed. Accessed January 16, 2025. https://pubmed.ncbi.nlm.nih.gov/30448290/
18. A F, M K, J A, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. PubMed. Published online 2024. Accessed January 16, 2025. https://pubmed.ncbi.nlm.nih.gov/37827694/
19. Li H, Boulougoura A, Endo Y, Tsokos GC. Abnormalities of T cells in systemic lupus erythematosus: new insights in pathogenesis and therapeutic strategies. J Autoimmun. 2022;132:102870. doi:10.1016/j.jaut.2022.102870
20. Ghafouri-Fard S, Shahir M, Taheri M, Salimi A. A review on the role of chemokines in the pathogenesis of systemic lupus erythematosus. Cytokine. 2021;146:155640. doi:10.1016/j.cyto.2021.155640
21. Accapezzato D, Caccavale R, Paroli MP, et al. Advances in the Pathogenesis and Treatment of Systemic Lupus Erythematosus. Int J Mol Sci. 2023;24(7):6578. doi:10.3390/ijms24076578
22. Choi J, Kim ST, Craft J. The pathogenesis of systemic lupus erythematosus—an update. Curr Opin Immunol. 2012;24(6):651-657. doi:10.1016/j.coi.2012.10.004
23. Teichmann LL, Ols ML, Kashgarian M, Reizis B, Kaplan DH, Shlomchik MJ. Dendritic Cells in Lupus Are Not Required for Activation of T and B Cells but Promote Their Expansion, Resulting in Tissue Damage. Accessed January 16, 2025. https://www.cell.com/immunity/abstract/S1074-7613(10)00455-3
24. Takeshima Y, Iwasaki Y, Fujio K, Yamamoto K. Metabolism as a key regulator in the pathogenesis of systemic lupus erythematosus. Semin Arthritis Rheum. 2019;48(6):1142-1145. doi:10.1016/j.semarthrit.2019.04.006
25. Malkiel S, Barlev AN, Atisha-Fregoso Y, Suurmond J, Diamond B. Frontiers | Plasma Cell Differentiation Pathways in Systemic Lupus Erythematosus. doi:10.3389/fimmu.2018.00427
26. Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. scite.ai. Accessed January 4, 2025. https://scite.ai/reports/2019-update-of-the-eular-vJKjAkW
27. Vukelic M, Li Y, Kyttaris VC. Novel Treatments in Lupus. Front Immunol. 2018;9:2658. doi:10.3389/fimmu.2018.02658
28. M S, N D, C H, Ke R. Targeting the Protective Arm of the Renin-Angiotensin System to Reduce Systemic Lupus Erythematosus Related Pathologies in MRL -lpr Mice. PubMed. Published online 2020. Accessed January 4, 2025. https://pubmed.ncbi.nlm.nih.gov/32793221/
29. Law C, Wacleche VS, Cao Y, et al. Interferon subverts an AHR–JUN axis to promote CXCL13+ T cells in lupus. Nature. 2024;631(8022):857-866. doi:10.1038/s41586-024-07627-2
2. Gómez-Bañuelos E, Fava A, Andrade F. An update on autoantibodies in systemic lupus erythematosus. Curr Opin Rheumatol. 2023;35(2):61-67. doi:10.1097/BOR.0000000000000922
3. Liu W, Zhang S, Wang J. IFN-γ, should not be ignored in SLE. Front Immunol. 2022;13:954706. doi:10.3389/fimmu.2022.954706
4. Sawada T, Fujimori D, Yamamoto Y. Systemic lupus erythematosus and immunodeficiency. Immunol Med. 2019;42(1):1-9. doi:10.1080/25785826.2019.1628466
5. Akhil A, Bansal R, Anupam K, Tandon A, Bhatnagar A. Systemic lupus erythematosus: latest insight into etiopathogenesis. Rheumatol Int. 2023;43(8):1381-1393. doi:10.1007/s00296-023-05346-x
6. Webber D, Cao J, Dominguez D, et al. Association of systemic lupus erythematosus (SLE) genetic susceptibility loci with lupus nephritis in childhood-onset and adult-onset SLE. Rheumatology. 2020;59(1):90-98. doi:10.1093/rheumatology/kez220
7. Ortíz-Fernández L, Martín J, Alarcón-Riquelme ME. A Summary on the Genetics of Systemic Lupus Erythematosus, Rheumatoid Arthritis, Systemic Sclerosis, and Sjögren’s Syndrome. Clin Rev Allergy Immunol. 2022;64(3):392-411. doi:10.1007/s12016-022-08951-z
8. Javinani A, Ashraf-Ganjouei A, Aslani S, Jamshidi A, Mahmoudi M. Exploring the etiopathogenesis of systemic lupus erythematosus: a genetic perspective. Immunogenetics. 2019;71(4):283-297. doi:10.1007/s00251-019-01103-2
9. C C, D Z, E E, et al. Environment and systemic lupus erythematosus. PubMed. Accessed January 15, 2025. https://pubmed.ncbi.nlm.nih.gov/38743446/
10. Kim JW, Kim HA, Suh CH, Jung JY. Frontiers | Sex hormones affect the pathogenesis and clinical characteristics of systemic lupus erythematosus. doi:10.3389/fmed.2022.906475
11. Y A, T M. Epigenetic Dysregulation in the Pathogenesis of Systemic Lupus Erythematosus. PubMed. Published online 2024. Accessed January 15, 2025. https://pubmed.ncbi.nlm.nih.gov/38256093/
12. Ce W, Tb N. The unexplained female predominance of systemic lupus erythematosus: clues from genetic and cytokine studies. PubMed. Accessed January 15, 2025. https://pubmed.ncbi.nlm.nih.gov/20063186/
13. The influence of reproductive hormones on systemic lupus erythematosus. Accessed January 15, 2025. https://www.explorationpub.com/Journals/ei/Article/100355
14. Mrw B, C D, T F, et al. Global epidemiology of systemic lupus erythematosus. PubMed. Accessed January 15, 2025. https://pubmed.ncbi.nlm.nih.gov/34345022/
15. C G, Mb AA, M G, et al. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. PubMed. Published online 2018. Accessed January 16, 2025. https://pubmed.ncbi.nlm.nih.gov/29029350/
16. M A, N L, Sr J. New Criteria for Lupus. PubMed. Published online 2020. Accessed January 16, 2025. https://pubmed.ncbi.nlm.nih.gov/32405775/
17. A F, M P. Systemic lupus erythematosus: Diagnosis and clinical management. PubMed. Accessed January 16, 2025. https://pubmed.ncbi.nlm.nih.gov/30448290/
18. A F, M K, J A, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. PubMed. Published online 2024. Accessed January 16, 2025. https://pubmed.ncbi.nlm.nih.gov/37827694/
19. Li H, Boulougoura A, Endo Y, Tsokos GC. Abnormalities of T cells in systemic lupus erythematosus: new insights in pathogenesis and therapeutic strategies. J Autoimmun. 2022;132:102870. doi:10.1016/j.jaut.2022.102870
20. Ghafouri-Fard S, Shahir M, Taheri M, Salimi A. A review on the role of chemokines in the pathogenesis of systemic lupus erythematosus. Cytokine. 2021;146:155640. doi:10.1016/j.cyto.2021.155640
21. Accapezzato D, Caccavale R, Paroli MP, et al. Advances in the Pathogenesis and Treatment of Systemic Lupus Erythematosus. Int J Mol Sci. 2023;24(7):6578. doi:10.3390/ijms24076578
22. Choi J, Kim ST, Craft J. The pathogenesis of systemic lupus erythematosus—an update. Curr Opin Immunol. 2012;24(6):651-657. doi:10.1016/j.coi.2012.10.004
23. Teichmann LL, Ols ML, Kashgarian M, Reizis B, Kaplan DH, Shlomchik MJ. Dendritic Cells in Lupus Are Not Required for Activation of T and B Cells but Promote Their Expansion, Resulting in Tissue Damage. Accessed January 16, 2025. https://www.cell.com/immunity/abstract/S1074-7613(10)00455-3
24. Takeshima Y, Iwasaki Y, Fujio K, Yamamoto K. Metabolism as a key regulator in the pathogenesis of systemic lupus erythematosus. Semin Arthritis Rheum. 2019;48(6):1142-1145. doi:10.1016/j.semarthrit.2019.04.006
25. Malkiel S, Barlev AN, Atisha-Fregoso Y, Suurmond J, Diamond B. Frontiers | Plasma Cell Differentiation Pathways in Systemic Lupus Erythematosus. doi:10.3389/fimmu.2018.00427
26. Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. scite.ai. Accessed January 4, 2025. https://scite.ai/reports/2019-update-of-the-eular-vJKjAkW
27. Vukelic M, Li Y, Kyttaris VC. Novel Treatments in Lupus. Front Immunol. 2018;9:2658. doi:10.3389/fimmu.2018.02658
28. M S, N D, C H, Ke R. Targeting the Protective Arm of the Renin-Angiotensin System to Reduce Systemic Lupus Erythematosus Related Pathologies in MRL -lpr Mice. PubMed. Published online 2020. Accessed January 4, 2025. https://pubmed.ncbi.nlm.nih.gov/32793221/
29. Law C, Wacleche VS, Cao Y, et al. Interferon subverts an AHR–JUN axis to promote CXCL13+ T cells in lupus. Nature. 2024;631(8022):857-866. doi:10.1038/s41586-024-07627-2