Influence of air pollution, measured individually, on disease activity in childhood-onset systemic lupus erythematosus patients through the evaluation of inflammatory biomarkers in exhaled condensed air

Abstract

Juvenile Systemic Lupus Erythematous (JSLE) is a chronic inflammatory autoimmune and multifactorial disease with elevation of inflammatory cytokines, such as: IL-6, IL-10, IL-17, lymphocyte B stimulator factor (Blys), Type 1 interferon (IFN alfa/beta) and tissue necrosis factor (TNF alfa). Inhalaled thin particles have been correlated with the elevation of inflammatory cytokines in experimental and epidemiological studies. However, there are few publications evaluating the effects of exposure to pollution and JSLE. Since the interface of environmental effects on systemic inflammatory diseases has grown enormously in recent decades, and there is still no study that has evaluated the correlation between exposure to air pollution in a metropolis and serum inflammatory interleukins in JSLE patients, the interest in developing this prospective study has appeared.Objectives: To evaluate the effect of real exposure to air pollutants, during individual monitoring for 21 days, in JSLE by evaluating disease activity, the inflammatory cytokines in exhaled breath condensate (EBC) (IL-6, IL-10, IL-17, IL-1 beta, TNFalfa, IFN alfa) in children and adolescents with JSLE residents of metropolitan area of Sao Paulo.Methods:A longitudinal repeated-measures panel study (total 108 measures in 10 consecutive months, 9 patients with JSLE) with 10-18 years old, followed at Pediatric Rheumatology Unit, Department of Pediatrics, FMUSP. After the signing the free informed consent, patients will be distributed according to the severity of the disease in three groups: mild JSLE (predominant cutaneous-mucosae involvement and/or muscle-skeletal involvement), moderate JSLE (predominant recurrent serotides and/or mesangial nephritis) and severe JLSE (proliferative/membranous nephritis and/or neuropsychiatric involvement and/or persistent thrombocytopenia/hemolytic anemia). They will be evaluated clinically and by laboratory tests for evaluation of the disease activity and the exhaled breath condensate will be collected. Then, the patients will receive a backpack with individual monitor (active and passive for particulate matter and gases respectively) of pollutants, temperature and humidity. They will be monitored individually for three consecutive weeks and in the third and fourth weeks laboratorial exams and clinical evaluation will be performed. Each group of three patients will participate in four cycles over 10 months. Each cycle will have 3 measures (clinical, laboratory and EBC) for each patient. So each group will have 36 measures and at the end of the study there will be 108 measures.Stastitical analysis: All variables studied and obtained from each participant will be subjected to statistical analysis review of linear regression, separately for each of the three pollutants studied, controlling the temperature and relative humidity of the air. The regression analysis will be performed with data from the daily average concentration of pollutants measured individually and the daily average mean temperature and relative humidity measured individually in lag ( lag 1 equals the daily average of the data from the previous day) and structure of moving average (moving average of 2 days equal to average of the day and the previous day) the method used to evaluate the association and effect of pollutants in the categorical variables will be the general estimative equations and for the non-categorical variables with normal distribution will be used the method of linear mixed effect (LME). (AU)