title: Toll-like receptor 9 in systemic lupus erythematosus, impact on glucocorticoid treatment.
abstract: OBJECTIVE
  To assess TLR9 expression in systemic lupus erythematosus (SLE) patients, its correlation with disease activity, and impact of TLR9 expression on the response to oral glucocorticoids.
  
  
  METHODS
  Twenty-five active SLE, 15 inactive, and 15 control subjects were included. Anti-DNA, ANA, C3, C4, and TLR9 mRNA expressions were assessed. Active SLE patients only received oral steroid for 6 weeks. Post therapy, they were classified into steroid sensitive and steroid resistant. Data were reassessed after treatment.
  
  
  RESULTS
  SLEDAI, anti-DNA, ANA, and TLR9 expressions were significantly higher in active SLE patients. Based on retrograde analysis, TLR9 expression was significantly higher in steroid-resistant versus steroid-sensitive group before treatment, with no significant difference between them after treatment. There was a significant positive correlation between TLR9 expression and SLEDAI score and anti-DNA and negative correlation with C3 and C4 in all patients.
  
  
  CONCLUSIONS
  TLR9 may play a role in the pathogenesis of SLE and correlates with the disease activity. Corticosteroids have no effect on TLR9 expression, explaining lack of corticosteroid response in some SLE patients. TLR 9 expression can be used in predicting glucocorticoid response in active SLE patients. New treatment modalities targeting TLR9 expression may be of value in steroid-resistant patients.
authors.affiliation: Tanta University, Faculty of Medicine, Dermatology & Venereology , Tanta , Egypt.
authors.forename: Nahla R
authors.initials: NR
authors.lastname: Ghaly
authors.forename: Nesreen A
authors.initials: NA
authors.lastname: Kotb
authors.forename: Hala M
authors.initials: HM
authors.lastname: Nagy
authors.forename: El Sayed M
authors.initials: el SM
authors.lastname: Rageh
mesh_terms: D000974:Antibodies, Antinuclear / Q000235:genetics / Q000378:metabolism; D016022:Case-Control Studies; D003176:Complement C3 / Q000378:metabolism; D003181:Complement C4 / Q000378:metabolism; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism*; D008297:Male; D012333:RNA, Messenger / Q000378:metabolism; D051217:Toll-Like Receptor 9 / Q000235:genetics / Q000378:metabolism*
chemical_list: D000974:Antibodies, Antinuclear; D003176:Complement C3; D003181:Complement C4; D005938:Glucocorticoids; D012333:RNA, Messenger; C495371:TLR9 protein, human; D051217:Toll-Like Receptor 9