title: Multidrug resistance-1 (MDR-1) in rheumatic autoimmune disorders. Part I: Increased P-glycoprotein activity in lymphocytes from rheumatoid arthritis patients might influence disease outcome.
abstract: BACKGROUND
  Multidrug resistance (MDR) is characterized by overexpression of P-glycoprotein, a pump molecule that decreases intracellular drug concentrations by increasing drug efflux from cells.
  
  
  OBJECTIVE
  To look for correlations between clinical status and P-glycoprotein activity and/or TNF-alpha mRNA levels in patients with rheumatoid arthritis.
  
  
  METHODS
  Sixteen patients were studied. Based on response to therapy, eight were refractory and eight nonrefractory to treatment. Findings were compared to those in 24 healthy controls. Flow cytometry was used to evaluate P-glycoprotein activity in peripheral blood mononuclear cells isolated by gradient centrifugation and incubated with the P-glycoprotein substrate daunorubicin. TNF-alpha mRNA levels were determined using quantitative PCR.
  
  
  RESULTS
  Patients with rheumatoid arthritis showed an increased number of lymphocytes with high P-glycoprotein activity (p = 0.0001) as compared to the normal controls. P-glycoprotein activity was higher in the refractory than in the non-refractory patient subgroup (p = 0.006). Also, TNF-alpha mRNA levels were markedly higher in the refractory subgroup than in the nonrefractory subgroup, and were undetectable in the normal controls.
  
  
  CONCLUSIONS
  Enhanced P-glycoprotein activity may be closely related to an unfavorable clinical course and a poor response to treatment. Increased TNF-alpha expression and chronic exposure to various drugs, including glucocorticoids, may contribute to increase P-glycoprotein activity. Both high P-glycoprotein activity and excessive amounts of TNF-alpha seem associated with poor outcome in rheumatoid arthritis.
authors.affiliation: Department of Immunology and Rheumathology, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: L
authors.initials: L
authors.lastname: Llorente
authors.forename: Y
authors.initials: Y
authors.lastname: Richaud-Patin
authors.forename: A
authors.initials: A
authors.lastname: Díaz-Borjón
authors.forename: C
authors.initials: C
authors.lastname: Alvarado de la Barrera
authors.forename: J
authors.initials: J
authors.lastname: Jakez-Ocampo
authors.forename: H
authors.initials: H
authors.lastname: de la Fuente
authors.forename: R
authors.initials: R
authors.lastname: Gonzalez-Amaro
authors.forename: E
authors.initials: E
authors.lastname: Diaz-Jouanen
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000235:genetics* / Q000378:metabolism; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000235:genetics* / Q000378:metabolism / Q000503:physiopathology; D002452:Cell Count; D002478:Cells, Cultured; D017931:DNA Primers / Q000737:chemistry; D003630:Daunorubicin / Q000494:pharmacology; D018432:Drug Resistance, Multiple; D005260:Female; D005434:Flow Cytometry; D019450:Genes, MDR; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000166:cytology / Q000187:drug effects / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012333:RNA, Messenger / Q000378:metabolism*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics* / Q000378:metabolism
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D017931:DNA Primers; D012333:RNA, Messenger; D014409:Tumor Necrosis Factor-alpha; D003630:Daunorubicin