Endothelial dysfunction in pathogenesis of immunoinflammatory diseases and comorbidites

Currently, rheumatic diseases are classified as a group of immune-inflammatory disorders, in which endothelial dysfunction plays a significant role in their pathogenesis. The aim of the study was to present the heterogeneous pathogenesis of immune inflammation, to trace the links of pathogenesis, and to highlight the role of endothelial dysfunction in immune-inflammatory rheumatic diseases.

Material and methods. A total of 144 patients were examined: 80 with rheumatoid arthritis (RA) and 64 with systemic lupus erythematosus (SLE). The study involved the determination of rheumatoid factor (RF) IgG, C-reactive protein (CRP), soluble vascular cell adhesion molecule (sVCAM-1), von Willebrand factor antigen (vWF Ag), endothelin-1 (ET-1), and the number of desquamated endothelial cells (DEC) counted using a Goryaev chamber.

Results. Signs of endothelial dysfunction were identified in patients with RA and SLE, as evidenced by significant differences in endothelial activation markers compared to the control group. The level of ET-1 was lower in patients with RA at 2.54 [0.09; 3.51] fmol/ ml, compared to 5.96 [0.20; 9.54] fmol/ml in patients with SLE, and 0.46 [0.34; 0.56] fmol/ml in the control group, p < 0.05. The level of sVCAM-1 in RA was 1929 [1297.6; 2739.6] ng/ml, in the SLE group it was 1497.3 [919.6; 2348.6] ng/ml, and in the control group it was 750 [250; 890] ng/ml, p < 0.01. The number of DEC was significantly higher. An increase in IL-8 levels was noted in the RA group at 414.2 [285; 541] pg/ml, in the SLE group at 335.2 [280; 398.6] pg/ml, and in the control group at 208 [206; 211] pg/ml, p < 0.01. There was an increase in CRP levels in RA up to 19.67 [4.2; 27] mg/l, and in SLE up to 16.5 [10; 22], which significantly exceeded the control group value of 2.6 [2.2; 3.3], p < 0.01. In patients with RA and SLE, markers of endothelial activation positively correlated with the level of RF IgG and indicators of immune inflammation: with increasing values of CRP and ESR, rising concentrations of sVCAM-1, vWF Ag, and the number of DEC, p < 0.01.

Conclusion. Endothelial dysfunction plays a significant role in the pathogenesis of rheumatic diseases, and its correction may lead to the development of new therapeutic targets and help prevent complications in this patient category.

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