The clinical manifestations and outcomes of systemic lupus erythematosus (SLE) are remarkably heterogeneous. In this thesis, issues relating to the diagnosis and prognosis of SLE were studied,... Show moreThe clinical manifestations and outcomes of systemic lupus erythematosus (SLE) are remarkably heterogeneous. In this thesis, issues relating to the diagnosis and prognosis of SLE were studied, focussing on the application of histopathologic evaluation in conjunction with clinical features in the setting of lupus nephritis (LN) and neuropsychiatric SLE (NP-SLE). In the first part, we demonstrated that classification criteria for SLE cannot be unequivocally applied to patients from nephrology clinics who present with full house glomerular deposits suggestive of LN/SLE. The patients with full house glomerular deposits without clinical SLE represented a distinct entity with a remarkably poor renal outcome. In the second part, clinical and histopathologic determinants of renal outcome were investigated to improve prognostication in LN. First, we identified a subgroup of patients with class III/IV LN with favourable renal outcome indicating that the current classification warrants refinement. Next, we identified prognosticators that may add to the current histopathologic classification of LN. The last part of this thesis was focused on the aetiopathogenesis of SLE, in which the complement system was identified as an important player and thereby therapeutic target in neuropsychiatric lupus and in which pregnancy-acquired microchimerism in relation to the occurrence of SLE was further investigated. Show less
This dissertation describes the development of glyco-bioinformatics tools that facilitate the high-throughput data processing of glycomics and glycoproteomics experiments, specifically for both... Show moreThis dissertation describes the development of glyco-bioinformatics tools that facilitate the high-throughput data processing of glycomics and glycoproteomics experiments, specifically for both MALDI-TOF-MS (Chapter 2) and LC-ESI-MS (Chapter 3). The developed methods also provide various quality control parameters that assist the researcher in curating both the measured spectra and quantified analytes, thereby providing high-quality data in a high-throughput manner.The tools that were developed within this thesis have been used to identify the influence of glycosylation on trypsin efficacy of Immunoglobulin G (Chapter 3) and two biological cohorts. Specifically, to investigate the serum N-glycosylation during and after pregnancy (Chapter 5) and to identify the differences in the N-glycosylation between maternal and fetal serum and IgG (Chapter 6). Show less
In this thesis several aspects of SLE were investigated. First, we studied interobserver agreement concerning class III/IV lupus nephritis lesions in a renal biopsy and found that agreement was... Show moreIn this thesis several aspects of SLE were investigated. First, we studied interobserver agreement concerning class III/IV lupus nephritis lesions in a renal biopsy and found that agreement was poor. This seemed, in part, due to inconsistent or ambiguous definitions as provided in the 2004 ISN/RPS classification. This led us to re-evaluate the current classification with an international group of highly experienced nephrologists. Second, we compared and summarized the lupus nephritis management guidelines that were published in 2012. Third, we studied microchimerism in peripheral blood of women with SLE and control subjects. We found that women with SLE have more microchimerism in their peripheral blood than control subjects. Then, we studied microchimerism in the peripheral blood of women with SLE and control subjects during and after pregnancy. We found that only just after delivery did the SLE patients have more chimeric cells in the granulocyte fraction than control subjects. These results suggest that after pregnancy chimeric cells become undetectable in peripheral blood, but possibly remain at other sites, only to re-emerge after un unknown trigger. Finally, we compared sporadic and familial lupus nephritis to find that, although there were clinical differences, no differences in histology or genetic background were apparent. Show less
