الفهرس 
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Abstract
Lupus erythematosus (LE) is a devastating autoimmune disease that targets multiple organ systems. LE is characterized by autoantibody production, immune complex (IC) formation, chronic inflammation and end organ damage, Discoid lupus erythematosus (DLE) may present years before the development of systemic disease, Progression to systemic disease may occur in as many as 18%by 3 years. Apoptosis of keratinocytes is a key process in the pathogenesis of DLE as has been demonstrated by the detection of apoptotic keratinocytes in the basal layer of CCLE lesions. The IFN cytokine family plays a key part in the pathogenesis of lupus; however, much of the data have focused on IFN- α and IFN-ɤ IFN-α.
Stem cells are unspecialized cells that have two defining properties: the ability to differentiate into other cells and the ability to self-regenerate. Bone marrow derived cells can bedivided into hematopoietic stem cells and mesenchymal stem cells. The aim of the present study to investigate the role of hematopoietic and non-hematopoietic stem cells in lupus erythematosus through exploring the immunohistochemical expression of CD 34 and CD117 and correlating their expression with the established clinic-pathologic parameters. This prospective study was performed on 25 patients (5 males and 20 females) with DLE, attending Dermatology Clinic of Menoufia University Hospital with age range from 14-59 years. The diagnosis of LE was established according to clinical histo-pathological findings of examined cases. Patients did not receive any topical therapy prior to the study.
Skin biopsies were taken from normal skin of 15 age and sex matched patients seeking for plastic surgery, representing as a control group, Faculty of Medicine, Menoufia University. The biopsies were processed at the Pathology Department, Faculty of Medicine, Menoufia University. Also immunohistochemical staining was done, the degree of immunoreactivity for CD34 was evaluated, the level of epidermal staining; three groups were distinguished; basal only, suprabasal and full thickness epidermis. The degree of immunoreactivity for C-KIT was evaluated according to intracellular localization: stromal, periadenexial. The intensity of expression of CD34 and C-KIT in both epidermal and dermal inflammatory cells were graded as mild, moderate and severe. There was no significant difference between DLE cases and control regarding to age and gender.
Regarding control group; CD 34 was not expressed in the epidermis and hair follicles of all examined sections (15 cases). It was expressed in the dermis in all sections with strong intensity. Stromal and periadenexal localization was detected in all sections. CD 34 H score has mean ±SD of 190.67±23.14. Regarding DLE cases; CD 34 was not expressed in the epidermis and hair follicles of all examined cases. CD 34 was expressed in the dermis in 96% of cases,12.5% of cases were with mild intensity,79% were with moderate and 8% were with strong intensity. Stromal and periadenexial localization was detected in all cases. CD 34 H score has mean ±SD value of 106.66 ± 27.77.
There was a significant difference of dermal intensity of CD 34 expression in DLE cases and control as regards to intensity that was strong only in 8.3% DLE cases and in all control. There was also a significant difference of dermal CD 34 H score between DLE cases and control group. There was no significant relationship between CD34 dermal H score and any of studied clinical data or laboratory variables. However, lower H score value was significantly associated with follicular plugging with P value < 0.03.
C-Kit was expressed in the epidermis of all control group; 20% of them had moderate intensity and 80% were strong. C-kit expression decorated the full thickness of epidermis in all control group . C-Kit was expressed in hair follicle of 5 of this group only, all of them displayed expression in the inner and outer root sheath. C-Kit was expressed in the dermis of all control group, 20% had moderate intensity and 80% were strong. C-Kit was expressed in stroma in all control group with mean ±SD value 182.7±26.6
Regarding DLE cases; C-Kit was expressed in the epidermis of 80% of cases; 55% of them had mild intensity, 30% were moderate and15% were strong. C-kit expression decorated the full thickness of epidermis in 85% of cases and in 15% expressed in suprabasal location. C-Kit was expressed in hair follicle of 24% CLED cases only, 66.7% of them displayed expression in the inner root sheath. C- Kit was expressed in the dermis of 84% of DLE cases, 52.4% of cases had mild intensity and 47.6 had moderate intensity. C-Kit was expressed in stroma in all cases with mean ±SD value 90.0 ± 32.7.
There was a significant difference between DLE case and control group as regards to intensity of epidermal expression of C-kit whereas15% of DLE cases and 80% of control had strong staining (P-value < 0.001). There was a also a significant difference between DLE case and control group as regards to H score of epidermal expression of C-kit whereas a mean value was 89.5 ± 44.4 in DLE case and 203.3 ± 20.9 in control (P-value < 0.001). There was another significant difference between DLE case and control group as regards to intensity of dermal expression of C-kit whereas none of DLE cases and 80% of control had strong staining (P-value < 0.001).There was a also a significant difference between DLE case and control group as regards to H score of dermal expression of C-kit whereas a mean value was 90.0 ± 32.7 in DLE case and 182.7 ± 26.6 in control (P-value < 0.001).
There was no significant relationship between C-kit epidermal intensity and clinical or lab investigations
There was no significant relationship between C-Kit epidermal intensity and epidermal or dermal changes in DLE cases. There was no significant relationship between C-Kit epidermal H score with the clinical data or lab investigations.
There was no significant relationship between C-Kit epidermal H score and epidermal or dermal changes of DLE cases There was no significant relationship between C-Kit dermal intensity and clinical parameters or lab investigations. There was no significant relationship between dermal C-kit intensity and epidermal or dermal changes of DLE cases. There was no significant relationship between dermal C-Kit H score with the clinical data or lab investigations.
There was no significant relationship between C-Kit dermal H score and epidermal or dermal changes of DLE cases There was a significant positive correlation between dermal CD34 H Score and both epidermal and dermal C-kit H- Score.