Effect of anti-P ribosomal and anti-NR2 antibodies on depression and cognitive processes in SLE: an integrated clinical and functional MRI study

Abstract

ObjectivesTo explore the effects of anti-ribosomal P protein (anti-P) and anti-N-methyl-D-aspartic acid receptor subunit 2 (anti-NR2) autoantibodies on depression and cognitive dysfunction and their relationships with functional brain connectivity in SLE.MethodsThis cross-sectional study included adult patients who fulfilled the American College of Rheumatology/European Alliance of Associations for Rheumatology 2019 SLE criteria. Anti-P and anti-NR2 were quantified using ELISA. A 1-hour battery of neuropsychological testing interpreted by a neuropsychologist explored depressive symptoms (Center for Epidemiologic Studies Depression Scale, CES-D), cognitive domains and quality of life (SF-12). Resting-state functional connectivity (rs-fc) MRI analysis was performed within 1 month, and region-of-interest to region-of-interest (ROI-to-ROI) analyses with the graph theory were performed.ResultsThirty-three patients with SLE (9% male) were enrolled, mean age (SD) of 43.5 (14) years and median disease duration of 10.4 years (2.9–25.4). Anti-P was positive in 6 (18.2%) and anti-NR2 in 14 (42.4%) patients. Depressive symptoms were found in 14 (42.4%) patients using the CES-D (range 0–51). After correction for age, disease duration, disease activity and white matter lesion load, the CES-D score was independently associated with anti-P serum level (β=0.32; p=0.049) and prednisone daily dose (β=0.38; p=0.023). Nineteen patients (57.6%) showed at least a cognitive test alteration, but no significant association with autoantibodies was found. The rs-fc MRI analysis revealed an independent association between the anti-P serum levels and many altered brain ROI properties but no anti-NR2 and prednisone effects on the cerebral network.ConclusionsAnti-P was associated with brain network perturbation, which may be responsible for depressive symptoms in patients with SLE.

Predictive factors of psychiatric syndrome in patients with systemic lupus erythematosus

“…The presence of positive anti-ribP antibodies at baseline was associated with a greater proportion of neurological involvement (adjusted HR = 3.8, 95% CI 2.7-57) and cumulative neuropsychiatric damage during follow-up in our colleagues' recent study, which focused on NPSLE (25). In a recent cross-sectional study by Chessa et al, anti-ribP serum level was independently associated with depressive symptoms (26). In our present study, however, the aforementioned abs did not differ significantly between psychiatric diagnostic groups.…”

Quality of Life in Systemic Lupus Erythematosus and Other Chronic Diseases: Highlighting the Amplified Impact of Depressive Episodes

“…H-QoL appears to be linked with unfavorable outcomes in SLE [43] alongside depressive symptoms and stress [14]. Therefore, the prevention, early identification, and treatment of mood disorders are crucial for individuals with SLE and should consider their multifactorial pathogenesis involving both direct (e.g., antineuronal antibodies, pain) and indirect (e.g., glucocorticoids, relationship issues, comorbidities) factors [44,45]. This not only aids in recognizing the risk factors for compromised H-QoL but also in addressing these factors effectively.…”