Peroxisome proliferator activated receptor-γ agonist pioglitazone improves vascular and metabolic dysfunction in systemic lupus erythematosus

• Published in: Annals of the rheumatic diseases Vol. 81; no. 11; pp. 1576 - 1584
• Main Authors: Hasni, Sarfaraz, Temesgen-Oyelakin, Yenealem, Davis, Michael, Chu, Jun, Poncio, Elaine, Naqi, Mohammad, Gupta, Sarthak, Wang, Xinghao, Oliveira, Christopher, Claybaugh, Dillon, Dey, Amit, Lu, Shajia, Carlucci, Philip, Purmalek, Monica, Manna, Zerai G, Shi, Yinghui, Ochoa-Navas, Isabel, Chen, Jinguo, Mukherjee, Amrita, Han, Kyu Lee, Cheung, Foo, Koroleva, Galina, Belkaid, Yasmine, Tsang, John S, Apps, Richard, Thomas, Donald E, Heller, Theo, Gadina, Massimo, Playford, Martin P, Li, Xiaobai, Mehta, Nehal N, Kaplan, Mariana J
• Format: Journal Article
• Language: English
• Published: United States BMJ Publishing Group Ltd and European League Against Rheumatism 01.11.2022; Elsevier Limited; BMJ Publishing Group
• Subjects: Agonists; Ankle; Cardiovascular diseases; Disease; Gene expression; Inflammatory diseases; Insulin; Insulin resistance; Leukocytes (neutrophilic); lipids; Lupus; Metabolism; Morbidity; Neutrophils; Pioglitazone; Placebos; Systemic Lupus Erythematosus; Vascular diseases; lipids; systemic lupus erythematosus; cardiovascular diseases
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/ard-2022-222658

ObjectivesPremature cardiovascular events in systemic lupus erythematosus (SLE) contribute to morbidity and mortality, with no effective preventive strategies described to date. Immune dysregulation and metabolic disturbances appear to play prominent roles in the induction of vascular disease in SLE. The peroxisome proliferator activated receptor-gamma agonist pioglitazone (PGZ suppresses vascular damage and immune dysregulation in murine lupus and improves endothelial dysfunction in other inflammatory diseases. We hypothesised that PGZ could improve vascular dysfunction and cardiometabolic parameters in SLE.MethodsEighty SLE subjects with mild to severe disease activity were randomised to a sequence of PGZ followed by placebo for 3 months, or vice versa, in a double-blind, cross-over design with a 2-month wash-out period. Primary endpoints were parameters of endothelial function and arterial inflammation, measured by multimodal assessments. Additional outcome measures of disease activity, neutrophil dysregulation, metabolic disturbances and gene expression studies were performed.ResultsSeventy-two subjects completed the study. PGZ was associated with a significant reduction in Cardio-Ankle Vascular Index (a measure of arterial stiffness) compared with placebo. Various metabolic parameters improved with PGZ, including insulin resistance and lipoprotein profiles. Circulating neutrophil extracellular trap levels also significantly decreased with PGZ compared with placebo. Most adverse events experienced while on PGZ were mild and resolved with reduction in PGZ dose.ConclusionPGZ was well tolerated and induced significant improvement in vascular stiffness and cardiometabolic parameters in SLE. The results suggest that PGZ should be further explored as a modulator of cardiovascular disease risk in SLE.Trial registration number NCT02338999.