Autoantibodies Affect Brain Density Reduction in Nonneuropsychiatric Systemic Lupus Erythematosus Patients

Abstract

This study explores the relationship between autoantibodies and brain density reduction in SLE patients without major neuropsychiatric manifestation (NPSLE). Ninety-five NPSLE patients without obvious cerebral deficits, as determined by conventional MRI, as well as 89 control subjects, underwent high-resolution structural MRI. Whole-brain density of grey matter (GMD) and white matter (WMD) were calculated for each individual, and correlations between the brain density, symptom severity, immunosuppressive agent (ISA), and autoantibody levels were assessed. The GMD and WMD of the SLE group decreased compared to controls. GMD was negatively associated with SLE activity. The WMD of patients who received ISA treatment were higher than that in the patients who did not. The WMD of patients with anticardiolipin (ACL) or anti-SSB/La antibodies was lower than in patients without these antibodies, while the GMD was lower in patients with anti-SM or anti-U1RNP antibodies. Thus, obvious brain atrophy can occur very early even before the development of significant symptoms and specific autoantibodies might contribute to the reduction of GMD or WMD in NPSLE patients. However, ISAs showed protective effects in minimizing GMD and WMD reduction. The presence of these specific autoantibodies might help identify early brain damage in NPSLE patients.

Hippocampal Atrophy in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations

“…It implied that early hippocampal atrophy might be associated with SLE disease activity and other organ damages. The associations between early brain atrophy and SLE disease activity were reported by our team earlier (7,8). Appenzeller et al reported that SLE patients with white matter lesions had hippocampal atrophy more frequently than patients without it.…”

“…Furthermore, in another study, we also found that specific autoantibodies, such as anti-cardiolipin (aCL) antibodies, might contribute to the reduction of grey matter density (GMD) and white matter density (WMD) in non-NPSLE patients. ISA treatment also showed effects in preventing the reduction of GMD and WMD (8). It has been reported that abnormal hippocampal structural changes could be found in non-NPSLE patients with normal conventional brain MRI (9,10).…”

“…The underlying mechanisms of hippocampal involvement in SLE patients remain unclear. Various autoantibodies including aCL antibodies and anti-NR2 subtype of the Nmethyl-D-aspartate receptor (NMDAR) antibodies were considered to play important roles in the pathogenesis of neuropsychiatric SLE (NPSLE) (8,11,12). However, few studies were focused on the relationship between autoantibodies and hippocampal atrophy.…”

Anti-SmD1 antibodies are associated with renal disorder, seizures, and pulmonary arterial hypertension in Chinese patients with active SLE

“…Previous studies have demonstrated that the anti-Sm autoimmune response is a polyclonal humoral immune response against protein components of snRNP particles, and it is found in about 30% of SLE patients 16 . Anti-Sm antibodies have demonstrated greater effects on the grey matter density (GMD) 17 , and the association between anti-Sm antibodies and the GMD reduction suggests a possible diagnostic and prognostic value of anti-Sm antibodies in determining CNS involvement in SLE. Moreover, a correlation between the presence of anti-Sm antibodies in serum and central NPSLE has been observed 18 .…”

Neuropsychiatric Systemic Lupus Erythematosus Involvement: Towards a Tailored Approach to Our Patients?

“…A growing number of self-reactive antibodies (in serum and CSF) have been associated with NPSLE, possibly with pathogenic roles. 25 , 33 …”