依鲁替尼长期给药对姥鲛烷诱导的系统性红斑狼疮模型小鼠的治疗作用和副作用

2017-12-08 11:29陈海清王久存上海润诺生物科技有限公司上海000复旦大学生命科学学院上海00438
中国药理学与毒理学杂志 2017年7期
关键词:泼尼松关节炎抗体

陈海清,胡 勇,戚 勇,王久存(.上海润诺生物科技有限公司,上海 000;.复旦大学生命科学学院,上海 00438)

依鲁替尼长期给药对姥鲛烷诱导的系统性红斑狼疮模型小鼠的治疗作用和副作用

陈海清1,2,胡 勇1,戚 勇1,王久存2(1.上海润诺生物科技有限公司,上海 200120;2.复旦大学生命科学学院,上海 200438)

目的评估依鲁替尼长期给药对姥鲛烷诱导的系统性红斑狼疮(SLE)模型小鼠的治疗作用及副作用。方法6周龄雌性BALB/c小鼠ip给予姥鲛烷0.5 mL制备SLE小鼠模型。4周后,根据抗双链DNA(DS-DNA)抗体滴度和体质量均匀分为模型组、依鲁替尼30 mg·kg-1治疗组和泼尼松10 mg·kg-1治疗组,每天ig给药1次,连续28周。每4周测定1次体质量,ELISA法测定血清中抗DS-DNA抗体、抗单链DNA(SS-DNA)抗体和抗组蛋白抗体水平,评估关节炎红肿等症状的评分及发病率;生物化学法检测血清肌酐、尿素氮和尿液尿蛋白水平评估肾功能。给药28周后处死小鼠,ELISA检测白细胞介素6(IL-6)、干扰素γ(IFN-γ)和肿瘤坏死因子α(TNF-α)水平;采集心、肝、脾、肺和肾,称重并计算脏器系数;生物化学法检测血清谷丙转氨酶、谷草转氨酶和碱性磷酸酶活性评估肝功能;HE染色观察后足和肾组织病理变化,并用免疫组化法检测肾组织免疫复合物IgG沉积。结果与正常对照组比较,模型组抗DS-DNA,SS-DNA和组蛋白抗体及IL-6,IFN-γ和TNF-α水平均明显升高(P<0.01),血清肌酐、尿素氮和尿蛋白升高,关节炎症状严重(P<0.01),后足组织炎症细胞浸润严重(P<0.01),肾和脾显著增大(P<0.01)。与模型组相比,依鲁替尼治疗28周可减缓SLE模型小鼠体质量下降,降低抗DS-DNA,SS-DNA和组蛋白抗体水平(P<0.01),减轻小鼠关节红肿等症状(P<0.01),并降低关节炎发病率,降低血清细胞因子IL-6,IFN-γ和TNF-α水平(P<0.01);后足关节病理观察显示,炎症细胞浸润、血管翳形成、软骨破坏和骨吸收减轻(P<0.01);肾组织病理观察显示,炎症细胞浸润和IgG免疫复合物沉积减少,血清肌酐、尿素氮和尿蛋白水平降低(P<0.01),血清GPT和ALP活性亦降低(P<0.01)。结论依鲁替尼给药28周对SLE模型小鼠有一定的治疗作用,未见明显副作用。

依鲁替尼;系统性红斑狼疮;自身抗体;模型,动物;关节炎;肾功能

系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种典型的多器官自身免疫性疾病,临床表现复杂多样[1]。目前普遍认为,SLE的病因主要与遗传、外源病原侵染、环境、性激素异常和免疫功能缺陷等多种因素有关[2]。SLE患者体内T和B淋巴细胞功能异常活化是介导SLE免疫调节紊乱的主要因素,其主要表现为T淋巴细胞功能异常,使B淋巴细胞高度活化,从而产生大量自身抗体,在体内形成免疫复合物,激活补体且最终导致多脏器损伤[3]。

近几年,以B淋巴细胞为靶标治疗SLE成为临床药物研究的新方向[4]。Bruton酪氨酸激酶(Bruton tyrosine kinase,BTK)是非受体蛋白酪氨酸激酶Tec家族成员之一,在B细胞受体(B-cell receptor,BCR)信号通路中发挥关键性作用。已有研究表明,抑制BTK信号通路对缓解以及治疗实验性关节炎有效,提示BTK可能是治疗自身免疫性疾病的一个理想靶点[5],这也是目前许多制药公司重视BTK新药开发的主要原因。

依鲁替尼(ibrutinib),分子式为C25H24N6O2,化学名为1-{(3R)-3-〔4-氨基-3-(4-苯氧基苯基)-1H-吡唑并[3,4-d]嘧啶-1-基〕-1-哌啶基}-2-丙烯-1-酮,由美国Pharmacyclics公司推出并持有合成专利[6],是一种能够口服的小分子BTK抑制剂,可与BTK活性位点上的半胱氨酸残基(Cys-481)选择性地共价结合,不可逆地抑制BTK活性,进而抑制BCR信号通路的激活,表现出较好的选择性[7]。临床前研究表明,在服药后4 h内依鲁替尼与BTK不可逆结合率高达95%以上,且该结合对周围血细胞无显著影响。依鲁替尼能抑制B细胞淋巴瘤的生长并诱导其凋亡,对包括BCR引发淋巴瘤的转基因小鼠模型在内的多种临床前肿瘤模型、胶原诱导的小鼠关节炎模型及肾病红斑狼疮模型均表现出治疗作用[8]。本研究观察依鲁替尼长期给药对SLE模型小鼠的治疗作用,观察其对自身抗体水平和关节炎症反应的影响及其副作用,为其临床应用提供参考。

1 材料与方法

1.1 药物、试剂和主要仪器

依鲁替尼,上海润诺生物科技有限公司,用1%甲基纤维素配制成3 g·L-1溶液;泼尼松,上海信谊药厂有限公司,用1%甲基纤维素溶解并配制1 g·L-1溶液。姥鲛烷、甲基纤维素、小牛胸腺单链DNA(singlestrand DNA,SS-DNA)、双链DNA(double-strand DNA,DS-DNA)、组蛋白、辣根过氧化物酶(HRP)标记羊抗兔IgG抗体(二抗)和小牛血清白蛋白(bovine serum albumin,BSA)均购自美国Sigma公司;兔抗小鼠IgG抗体(一抗),英国Abcam公司;HRP标记羊抗小鼠IgM和羊抗小鼠IgG抗体购自美国SouthernBiotech公司;血清尿素氮、血清肌酐、尿蛋白、谷丙转氨酶(glutamic-pyruvic transaminase,GPT)、谷草转氨酶〔glutamic-oxal(o)acetic transaminase,GOT〕和碱性磷酸酶(alkaline phosphatase,ALP)检测试剂盒均购自南京建成生物工程研究所;白细胞介素6(interleukin-6,IL-6)检测试剂盒购自美国eBioscience公司;干扰素γ(interferon-γ,IFN-γ)和肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)检测试剂盒购自美国R&D公司。多功能酶标仪,美国Molecular Devices公司;显微镜,日本Olympus公司。

1.2 实验动物

BALB/c小鼠,16~20 g,6周龄,雌性[9],由上海灵畅动物实验中心提供〔动物生产许可证号:SCXK(沪)2013-0018〕,饲养于上海润诺生物科技有限公司SPF级动物房。实验中所有动物操作经上海润诺生物科技有限公司实验动物福利与使用管理委员会批准。

1.3 SLE小鼠模型的制备

38只雌性BALB/c小鼠,每只ip给予姥鲛烷0.5 mL制备SLE模型[10]。另外10只ip等体积生理盐水作为正常对照组。4周后,小鼠眼眶采血,检测血清中抗DS-DNA抗体(IgG)的水平。剔除抗体水平A450nm<0.4的小鼠8只,根据体质量和抗DS-DNA抗体滴度将剩余30只小鼠均匀分为3组,即模型组(1%甲基纤维素)、泼尼松10 mg·kg-1治疗组(阳性对照组)[11]和依鲁替尼30 mg·kg-1治疗组,每天ig 给药1次,给药体积10 mL·kg-1,连续给药28周。

1.4 一般状况观察

实验期间观察小鼠的饮食、饮水、日常活动、毛色、排便及排尿情况。注射姥鲛烷当天为第0天,每4周测定体质量。观察关节炎症状,记录关节炎发病评分及发病率[12]。关节炎评分参考文献[13]。0分:无红斑和红肿;1分:近跗骨附近或踝关节或跖骨出现红斑或轻度红肿或有一个爪趾有红斑和红肿;2分:踝关节和跖骨轻微红斑和肿胀,≥2个爪趾有红肿和红斑;3分:踝、腕关节和跖骨中度红斑和肿胀;4分:踝、腕关节、跖骨和脚趾全部严重红肿。

1.5 ELlSA检测血清自身抗体和细胞因子水平

每4周眼眶采血,ELISA检测血清中抗DS-DNA抗体(IgG)、SS-DNA抗体和组蛋白抗体(IgM)水平。末次给药1 h后,二氧化碳安乐死处死小鼠,收集全血,以1000×g,4℃离心10 min取血清,-80℃储存备用。细胞因子TNF-α,IL-6和IFN-γ测定根据试剂盒说明书进行[14]。

ELISA检测血清抗DS-DNA,SS-DNA和组蛋白抗体水平[15]。将DS-DNA,SS-DNA或组蛋白抗原100 μL(10 mg·L-1,PBS溶解)包被于96孔板,4℃孵育过夜。清除包被液,用清洗液(0.05%吐温20)洗3次(每次300 μL)。每孔用300 μL封闭液(1%BSA,PBST)封闭,室温孵育2 h。清除封闭液,用清洗液洗3次。用稀释液(0.1%BSA,PBS)将待测血清稀释100倍,每孔加入100 μL,用稀释液做空白对照。室温孵育2 h。清洗3~5次。加入100 μL HRP标记的羊抗小鼠IgG或IgM抗体(1∶5000稀释,用0.1%BSA稀释),室温孵育2 h。清洗5次。每孔加100 μL 1×四甲基联苯胺溶液,室温避光孵育15 min。每孔加50 μL终止液(硫酸0.5 mol·L-1),450 nm 波长测定吸光度。

1.6 生物化学法检测肝肾功能

给药后每4周检测血清肌酐(肌氨酸氧化酶法)和尿素氮(脲酶法)水平;按压腹腔采集尿液,考马斯亮蓝法检测尿蛋白水平[16]。处死小鼠后,赖氏法检测血清GPT和GOT水平,微量酶标法检测ALP水平[17]。按照各试剂盒说明书进行。

1.7 HE染色法观察肾组织和关节组织病理变化

处死小鼠后进行肝、心、肾、脾和肺等器官称重。脏器系数=脏器质量(g)/体质量(g)×100。肾和后足用10%中性甲醛固定(后足用10%甲酸脱钙10 d),进行组织脱水、包埋、切片和HE染色,封片,拍照。观察肾组织损伤及炎症细胞浸润[18]。后足关节病理变化按照炎症细胞浸润、血管翳形成、软骨损伤和骨再吸收4项病理变化程度进行组织学观察评分[19],每项0~4分,总分16分。

1.8 免疫组化法检测肾组织lgG沉积[20]

肾组织切片经过二甲苯、100%乙醇和95%乙醇等处理后,用柠檬酸抗原修复液(pH 6.0,99℃,20 min)进行抗原修复。1%过氧化氢处理内源性过氧化物酶10 min,加兔抗小鼠IgG单克隆抗体4℃过夜。PBS清洗2次,每次3 min,羊血清封闭15 min。PBS清洗切片2次,每次3 min,加HRP标记羊抗兔IgG抗体,室温放置30 min。DBA试剂显色,苏木素复染,封片,拍照观察。根据棕色面积和深度判断免疫复合物IgG的沉积。

1.9 统计学分析

2 结果

2.1 依鲁替尼长期给药对SLE模型小鼠体质量的影响

实验期间,正常对照组小鼠生长状况良好,活动敏捷,毛顺色亮,体质量稳定增长,各项生理指标正常。姥鲛烷诱导的SLE模型小鼠出现足趾肿胀和四肢不灵活等典型的红斑狼疮关节炎症状。

图1结果显示,治疗20周后,与正常对照组比较,模型组小鼠体质量明显下降(P<0.01)。治疗28周后,与模型组比较,依鲁替尼和泼尼松组小鼠体质量下降幅度减小,但无统计学差异。

Fig.1 Effect of long-term treatment with ibrutinib on body mass of mice with systemic lupus erythematosus(SLE)induced by pristane.The SLE mouse model was induced by pristane(ip).Four weeks later,model mice were ig given 1.0%methyl cellulose(vehicle)10 mL·kg-1,prednisone 10 mg·kg-1or ibrutinib 30 mg·kg-1,respectively,once daily for 28 weeks.±s,n=10.**P<0.01,compared with normal control group.

2.2 依鲁替尼长期给药对SLE模型小鼠自身抗体水平的影响

图2结果显示,与正常对照组比较,随着时间延长,SLE模型组抗DS-DNA抗体(IgG)、抗SS-DNA抗体和抗组蛋白抗体(IgM)水平不断增加(P<0.01)。与模型组比较,依鲁替尼能显著降低SLE小鼠上述3种自身抗体的水平(P<0.01),其变化趋势与泼尼松组基本一致,提示依鲁替尼可抑制SLE模型小鼠自身抗体的产生。

Fig.2 Effect of long-term treatment with ibrutinib on auto-antibody production of mice with SLE induced by pristane detected by ELlSA.See Fig.1 for the mouse treatment.A:anti-double-strand DNA(DS-DNA)antibody(IgG);B:anti-single-strand DNA(SS-DNA)antibody(IgM);C:anti-histone antibody(IgM).±s,n=10.*P<0.05,**P<0.01,compared with normal control group;##P<0.01,compared with SLE model group.

2.3 依鲁替尼长期给药对SLE模型小鼠关节炎症的影响

图3A结果显示,与正常对照组比较,模型组小鼠在给药8周后开始出现关节红肿和行动迟缓症状;16周时关节炎评分增高(P<0.01)。与模型组比较,依鲁替尼和泼尼松能显著缓解小鼠的关节炎症状,关节红肿缓解或消退,行动较自由,关节炎评分维持在较低水平(P<0.01)。实验结束时,模型组小鼠关节炎发病数为10/10,依鲁替尼组为6/10,泼尼松组为4/10(图3B)。

后足关节HE染色结果(图3C和3D)表明,与正常对照组比较,模型组小鼠关节炎症细胞浸润严重,血管翳大量形成,软骨组织病变和骨吸收均较严重(P<0.01)。与模型组比较,依鲁替尼和泼尼松均能显著改善关节炎症细胞浸润、血管翳形成、软骨破坏和骨吸收(P<0.01)。与泼尼松比较,依鲁替尼作用较弱。

2.4 依鲁替尼长期给药对SLE模型小鼠血清细胞因子水平的影响

表1结果显示,依鲁替尼治疗28周时,与正常对照组比较,SLE模型组小鼠血清TNF-α,IL-6和IFN-γ水平显著升高(P<0.01);与模型组比较,依鲁替尼和泼尼松治疗组TNF-α,IL-6和IFN-γ水平显著下降(P<0.01,P<0.05)。

Tab.1 Effect of long-term treatment with ibrutinib on serum tumor necrosis factor- α(TNF- α),interleukin-6(lL-6) and interferon- γ(lFN- γ) levels of mice with SLE induced by pristane detected by ELlSA

2.5 依鲁替尼长期给药对SLE模型小鼠肾功能和肾组织病理变化的影响

图4A,B和C显示,与正常对照组比较,SLE模型组小鼠血清肌酐、尿素氮和尿液尿蛋白水平持续增加(P<0.01)。与模型组比较,依鲁替尼和泼尼松组血清肌酐、尿素氮和尿液尿蛋白水平明显降低(P<0.01),两组变化曲线基本一致。肾组织HE染色结果见图4D,与正常对照组比较,模型组炎症细胞浸润严重。依鲁替尼治疗能有效改善炎症细胞浸润。

Fig.3 Effect of long-term treatment with ibrutinib on hind foot joint inflammation of mice with SLE induced by pristane.See Fig.1 for the mouse treatment.A:arthritis score;B:number of mice with arthritis;C and D:joint tissue with HE staining.Hind foot histopathology score was evaluated by score system:inflammation,pannus,cartilage destruction and bone resorption[19].Red arrow:inflammation;blue arrow:cartilage destruction;green arrow:bone resorption;black arrow:pannus.±s,n=10.**P<0.01,compared with normal control group;##P<0.01,compared with SLE model group.

Fig.4 Effect of long-term treatment with ibrutinib on renal function of mice with SLE induced by pristane.See Fig.1 for the mouse treatment.A:serum creatinine;B:urine protein;C:serum urea nitrogen.±s,n=10.**P<0.01,compared with normal control group;#P<0.05,##P<0.01,compared with SLE model group.D:kidney tissue with HE staining.Red arrows show inflammation.

图5结果显示,SLE模型组肾组织免疫复合物沉积较正常对照组增多,而依鲁替尼和泼尼松治疗能显著减少肾组织中免疫复合物IgG的沉积。

Fig.5 Effect of long-term treatment with ibrutinib on immune complex lgG in kidney tissue of mice with SLE induced by pristane detected by immunohistochemical staining.See Fig.1 for the mouse treatment.Red arrows show immune complex IgG.

2.6 依鲁替尼长期给药对SLE模型小鼠脏器系数的影响

图6结果显示,治疗28周后,与正常对照组比较,模型组脾、肾和肺系数增加(P<0.01)。与模型组比较,依鲁替尼和泼尼松使肾和脾系数下降(P<0.01),心和肝系数无明显差别。

Fig.6 Effect of long-term treatment with ibrutinib on organ coefficient of mice with SLE induced by pristane.See Fig.1 for the mouse treatment.Organ coefficient was detected at the end of 28-week treatment.Organ coefficient=organ mass(g)/body mass(g)×100.±s,n=10.**P<0.01,compared with normal control group;#P<0.05,##P<0.01,compared with SLE model group.

2.7 依鲁替尼长期给药对SLE模型小鼠肝功能的影响

表2结果显示,给药28周后,与正常对照组比较,模型组血清GPT和ALP活性增加(P<0.01)。与模型组比较,依鲁替尼可降低GPT和ALP活性(P<0.01,P<0.05),对GOT活性无影响。

Tab.2 Effect of long-term treatment with ibrutinib on liver function of mice with SLE induced by pristane

3 讨论

依鲁替尼(PCI-32765)是BCR信号通路中研究BTK共价激酶抑制剂中最成功的一种,可与靶蛋白BTK活性位点半胱氨酸残基(Cys-481)选择性结合形成共价修饰,抑制BTK自我磷酸化激活,更重要的是,两者的结合具有高效、高选择性和不可逆的特点。研究报道,依鲁替尼对BTK的半抑制浓度(IC50)为0.5 nmol·L-1,其抑制作用可持续>24 h。此外,依鲁替尼还可抑制基质细胞衍生因子C-X-C基序趋化因子12(C-X-C motif chemokine 12,CXCL12),CXCL13和CCL19的应答。但依鲁替尼抑制BCR信号的同时存在破坏基质细胞的可能性,长期使用可能会干扰B细胞正常功能,导致低丙种球蛋白血症及其他并发症[21]。

文献报道,依鲁替尼给药周期多在8~16周,给药剂量范围为3~30 mg·kg-1[22]。本研究给药周期为28周,选择剂量为30 mg·kg-1,通过对体质量、自身抗体水平、关节炎及肾功能等每4周1次的动态观察,了解其长期给药对SLE模型小鼠的治疗作用和副作用;通过动态观察SLE模型小鼠自身免疫抗体水平和肾功能变化,结合肾组织病理变化,了解自身免疫抗体水平和肾功能损伤是否存在相关性,探讨依鲁替尼保护SLE模型小鼠肾功能作用的可能机制[23]。

本研究结果表明,依鲁替尼给药28周能进行性抑制姥鲛烷诱导的SLE模型小鼠自身抗体产生,减轻肾损伤;能缓解关节炎症状,降低关节炎的发病率;能显著降低血清炎症因子水平;提示可有效缓解SLE全身炎症反应。后足关节病理检测提示,依鲁替尼可通过抑制关节炎症细胞浸润、降低血管翳形成、减少软骨破坏和骨吸收对SLE关节炎起到治疗作用。肾组织病理变化和免疫复合物IgG沉积分析结果表明,依鲁替尼可通过缓解肾组织炎症反应,降低肾组织抗原抗体免疫复合物沉淀和积聚,从而保护肾小球及肾小管损伤,改善SLE小鼠肾功能。

本研究结果提示,依鲁替尼对SLE模型小鼠有明显的治疗作用,且未见明显的耐药性和副作用。与泼尼松比较,虽然改善炎症反应的作用较弱,但对SLE模型小鼠体质量和肾功能的保护、降低自身抗体水平等作用与泼尼松基本相近。

综上所述,依鲁替尼给药28周对SLE模型小鼠有明显的治疗作用,无明显副作用。依鲁替尼长期给药的优势使其具有开发为SLE新型治疗药物的潜在价值。

[1] Aslan M,Bicak U,Dogan DG,Dogan M,Yakinci C.Diffuse edema and bilateral massive pleural effusion as the presentation of systemic lupus erythematosus[J].Lupus,2011,20(3):308-310.

[2] Tucker DL,Rule SA.A critical appraisal of ibrutinib in the treatment of mantle cell lymphoma and chronic lymphocytic leukemia[J].Ther Clin Risk Manag,2015,11:979-990.

[3] Wiestner A.The role of B-cell receptor inhibitors in the treatment of patients with chronic lymphocytic leukemia[J].Haematologica,2015,100(12):1495-1507.

[4]Ka SM,Lin JC,Lin TJ,Liu FC,Chao LK,Ho CL,et al.Citral alleviates an accelerated and severe lupus nephritis model by inhibiting the activation signal of NLRP3 inflammasome and enhancing Nrf2 activation[J].Arthritis Res Ther,2015,17:331.

[5] Honigberg LA,Smith AM,Sirisawad M,Verner E,Loury D,Chang B,et al.The Bruton tyrosine kinase inhibitor PCI-32765 blocks B-cell activation and is efficacious in models of autoimmune disease and B-cell malignancy[J].Proc Natl Acad Sci USA,2010,107(29):13075-13080.

[6] Boissard F,Fournié JJ,Quillet-Mary A,Ysebaert L,Poupot M.Nurse-like cells mediate ibrutinib resistance in chronic lymphocytic leukemia patients[J].Blood Cancer J,2015,5:e355.

[7] Wang ML,Rule S,Martin P,Goy A,Auer R,Kahl BS,et al.Targeting BTK with ibrutinib in relapsed or refractory mantle-cell lymphoma[J].N Engl J Med,2013,369(6):507-516.

[8] Lipsky AH,Farooqui MZ,Tian X,Martyr S,Cullinane AM,Nghiem K,et al.Incidence and risk factors of bleeding-related adverse events in patients with chronic lymphocytic leukemia treated with ibrutinib[J].Haematologica,2015,100(12):1571-1578.

[9] Wu ZZ,Wu JY,Wang F,Li J,Jiang JQ,Zhang P.Experimental study of pristane-induced BALB/c mice systemic lupus erythematosus model[J].J Bengbu Med Coll(蚌埠医学院学报),2013,38(5):519-523.

[10] Scofield RH,James JA.Immunization as a model for systemic lupus erythematosus[J].Semin Arthritis Rheum,1999,29(3):140-147.

[11] Zhou LL,Wei W,Si JF,Yuan DP.Regulatory effect of melatonin on cytokine disturbances in the pristane-induced lupus mice[J].Mediators Inflamm,2010,2010:951210.

[12] Chang BY,Huang MM,Francesco M,Chen J,Sokolove J,Magadala P,et al.The Bruton tyrosine kinase inhibitor PCI-32765 ameliorates autoimmune arthritis by inhibition of multiple effector cells[J].Arthritis Res Ther,2011,13(4):R115.

[13] Nikitopoulou I, Kaffe E, Sevastou I, Sirioti I,Samiotaki M,Madan D,et al.A metabolically-stabilized phosphonate analog of lysophosphatidic acid attenuates collagen-induced arthritis[J].PLoS One,2013,8(7):e70941.

[14] Wang YX,Wang L,Wang HG,Wang YX.Effect of Qudu capsule on IL-6,IFN-γ and TNF-α in serum of lupoid model mice[J].J Mudanjiang Med Coll(牡丹江医学院学报),2004,25(6):5-7.

[15] Guo JJ,Liu JH.Clinical significance of combined detection of serum anti-nucleosome and anti-dsDNA antibodies in patients with lupus nephritis[J].Pract Prev Med(实用预防医学),2008,15(6):1931-1932.

[16]Ai MX,Leng XM,Ma L,Wu DM,Zeng XF.Difference of clinical manifestation and pathology of lupus nephritis between male and female patients with systemic lupus erythemetosus[J].Chin J Rheumatol(中华风湿病学杂志),2007,11(3):164-166.

[17]Dong SQ.To discuss the relationship of serum creatinine urea nitrogen values and their ratio and renal injury[J].Guide China Med(中国医药指南),2011,9(36):136-137.

[18] Rankin AL,Seth N,Keegan S,Andreyeva T,Cook TA,Edmonds J,Mathialagan N,et al.Selective inhibition of BTK prevents murine lupus and antibody-mediated glomerulonephritis[J].J Immunol,2013,191(9):4540-4550.

[19]NikitopoulouI, OikonomouN, KarouzakisE,Sevastou I,Nikolaidou-Katsaridou N,Zhao Z,et al.Autotaxin expression from synovial fibroblasts is essential for the pathogenesis of modeled arthritis[J].J Exp Med,2012,209(5):925-933.

[20] Tardif V,Manenkova Y,Berger M,Hoebe K,Zuo JP,Yuan C,et al.Critical role of transmethylation in TLR signaling and systemic lupus erythematosus[J].Clin Immunol,2013,147(2):133-143.

[21]Natarajan G,Terrazas C,Oghumu S,Varikuti S,Dubovsky JA,Byrd JC,et al.Ibrutinib enhances IL-17 response by modulating the function of bone marrow derived dendritic cells[J].Oncoimmunology,2015,5(1):e1057385.

[22] Honigberg LA,Smith AM,Sirisawad M,Verner E,Loury D,Chang B,et al.The Bruton tyrosine kinase inhibitor PCI-32765 blocks B-cell activation and is efficacious in models of autoimmune disease and B-cell malignancy[J].Proc Natl Acad Sci USA.,2010,107(29):13075-13080.

[23] Wallace N,Wong E,Cooper D,Chao H.A case of new-onset cardiomyopathy and ventricular tachycardia in a patient receiving ibrutinib for relapsed mantle cell lymphoma[J].Clin Case Rep,2016,4(12):1120-1121.

2017-02-03 接受日期:2017-07-10)

(本文编辑:齐春会)

Therapeutic action and side effects of long-term treatment with ibrutinib on systemic lupus erythematosus model mice induced by pristane

CHEN Hai-qing1,2,HU Yong1,QI Yong1,WANG Jiu-cun2
(1.Shanghai Bioduro Biotechnology Co.,Ltd.,Shanghai 200120,China;2.School of Life Sciences,Fudan University,Shanghai 200438,China)

OBJECTlVETo investigate the therapeutic effect and side effect of ibrutinib long-term treatment in systemic lupus erythematosus(SLE)model mice induced by pristane.METHODSFemale 6-week old BALB/c mice were ip given pristane 0.5 mL once for SLE induction.Four weeks later,the SLE model mice were divided into three groups based on the body mass and serum level of anti-doublestrand DNA(DS-DNA)antibody and treated with 1%methylcellulose(model control group,ig),ibrutinib(30 mg·kg-1,ig)or prednisone(10 mg·kg-1,ig),respectively,once daily for 28 weeks.Every 4 weeks,body mass of each mouse was measured.Autoantibodies against DS-DNA,single-strand DNA(SS-DAN),and histone were tested by ELISA.The incidence of lupus arthritis and clinical score of inflammation and edema were recorded and graded.Biochemical analysis of urea protein,serum urea nitrogen and creatinine was used to evaluate kidney function.Mice were euthanized post 28 weeks of dosing.Interleukin-6(IL-6),interferon-γ (IFN-γ)and tumor necrosis factor-α (TNF-α)were tested by ELISA.The heart,liver,spleen,lung,and kidney were collected and weighed for organ relative mass calculation.Biochemical analysis of serum glutamic-pyruvic transaminase(GPT),glutamic-oxal(o)acetic transaminase(GOT)and alkaline phosphatase(ALP)was used to evaluate liver function.Hind feet were collected for HE staining and pathological scoring to observe renal injury and inflammation.Immunohistochemical staining was used to study IgG immune complexes deposition in kidneys of lupus.RESULTSCompared with normal control group,autoantibodies(anti-DS-DNA,anti-SS-DNA and anti-histone antibodies),renal function indexes(serum creatinine,urea nitrogen and urine protein),and cytokines(IL-6,IFN-γ and TNF-α)levels in model group were significantly increased(P<0.01).The model group mice had obvious clinical symptoms of arthritis(P<0.01),serious inflammation cell invasion(P<0.01),and the mass of kidneys and spleen increased significantly(P<0.01).Compared with model group,after 28 weeks of treatment,ibrutinib decreased the level of anti-DS-DNA,anti-SS-DNA and anti-histone antibodies(P<0.01),decreased the lupus arthritis score(P<0.01)and the morbidity of arthritis,reduced the level of cytokines IL-6,IFN-γ and TNF-α (P<0.01),reduced the level of serum creatinine,serum urea nitrogen and urine protein(P<0.01),improved pathological symptoms of hind feet such as inflammation,cartilage destruction,bone resorption and pannus(P<0.01),alleviated renal tissue inflammatory cell invasion and the immune-complex precipitation,and reduced the mass of organs(spleen and kidneys,P<0.01)and the level of liver function(GPT and ALP,P<0.01).CONCLUSlONLong-term treatment with ibrutinib has therapeutic effect on the model mice of SLE,and has no obvious side effect.

ibrutinib;systemic lupus erythematosus;autoantibody;model,animal;arthritis;kidney function

The project supported by National International Cooperation in Science and Technology Special Fund(2013DFA30870)

WANG Jiu-cun,E-mail:jcwang@fudan.edu.cn

R967

A

1000-3002-(2017)07-0722-08

DOl:10.3867/j.issn.1000-3002.2017.07.004

国家国际科技合作专项基金(2013DFA30870)

陈海清,硕士,主要从事炎症及代谢药理学研究。

王久存,E-mail:jcwang@fudan.edu.cn

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