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Neuropsychiatric systemic lupus erythematosus persists despite attenuation of systemic disease in MRL/lpr mice. J Neuroinflammation 2015; 12:205. [PMID: 26546449 PMCID: PMC4636802 DOI: 10.1186/s12974-015-0423-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 10/27/2015] [Indexed: 01/23/2023] Open
Abstract
Background Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease marked by both B and T cell hyperactivity which commonly affects the joints, skin, kidneys, and brain. Neuropsychiatric disease affects about 40 % of SLE patients, most frequently manifesting as depression, memory deficits, and general cognitive decline. One important and yet unresolved question is whether neuropsychiatric SLE (NPSLE) is a complication of systemic autoimmunity or whether it is primarily driven by brain-intrinsic factors. Methods To dissect the relative contributions of the central nervous system from those of the hematopoietic compartment, we generated bone marrow chimeras between healthy control (MRL/+) and lupus-prone MRL/Tnfrsf6lpr/lpr mice (MRL/+ → MRL/lpr), as well as control chimeras. After bone marrow reconstitution, mice underwent extensive behavioral testing, analysis of brain tissue, and histological assessment. Results Despite transfer of healthy MRL/+ bone marrow and marked attenuation of systemic disease, we found that MRL/+ → MRL/lpr mice had a behavioral phenotype consisting of depressive-like behavior and visuospatial memory deficits, comparable to MRL/lpr → MRL/lpr control transplanted mice and the behavioral profile previously established in MRL/lpr mice. Moreover, MRL/+ → MRL/lpr chimeric mice displayed increased brain RANTES expression, neurodegeneration, and cellular infiltration in the choroid plexus, as well as blood brain barrier disruption, all in the absence of significant systemic autoimmunity. Conclusions Chimeric MRL/+ → MRL/lpr mice displayed no attenuation of the behavioral phenotype found in MRL/lpr mice, despite normalized serum autoantibodies and conserved renal function. Therefore, neuropsychiatric disease in the MRL/lpr lupus-prone strain of mice can occur absent any major contributions from systemic autoimmunity.
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Kivity S, Shoenfeld Y. Association Between Autoantibodies and Neuropsychiatric Manifestations of Autoimmune Disease: Comment on the Article by Lauvsnes et al. Arthritis Rheumatol 2015; 67:1683. [DOI: 10.1002/art.39077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shaye Kivity
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Tel-Hashomer Israel
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Tel-Hashomer Israel
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53
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Kivity S, Agmon-Levin N, Zandman-Goddard G, Chapman J, Shoenfeld Y. Neuropsychiatric lupus: a mosaic of clinical presentations. BMC Med 2015; 13:43. [PMID: 25858312 PMCID: PMC4349748 DOI: 10.1186/s12916-015-0269-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/06/2015] [Indexed: 12/29/2022] Open
Abstract
Neuropsychiatric symptoms affect nearly half of the patients with systemic lupus erythematosus; however, the effect on disease severity, quality of life, and prognosis is tremendous. Symptoms of neuropsychiatric systemic lupus erythematosus may range from mild diffuse ones, to acute life threatening events. Although the underlying mechanisms are still largely unraveled, several pathogenic pathways are identified, such as antibody-mediated neurotoxicity, vasculopathy due to anti-phospholipid antibodies and other mechanisms, and cytokine-induced neurotoxicity. In the current review, we describe the old and the new regarding epidemiology, pathophysiology, diagnosis, and management of neuropsychiatric systemic lupus erythematosus. The possible link between neuropsychiatric symptoms and specific mechanisms may help to facilitate our understanding of the disease in the future, thus allowing for better treatment strategies.
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Yaniv G, Twig G, Shor DBA, Furer A, Sherer Y, Mozes O, Komisar O, Slonimsky E, Klang E, Lotan E, Welt M, Marai I, Shina A, Amital H, Shoenfeld Y. A volcanic explosion of autoantibodies in systemic lupus erythematosus: A diversity of 180 different antibodies found in SLE patients. Autoimmun Rev 2015; 14:75-9. [DOI: 10.1016/j.autrev.2014.10.003] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/23/2014] [Indexed: 12/29/2022]
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Abstract
Systemic lupus erythematosus is a remarkable and challenging disorder. Its diversity of clinical features is matched by the complexity of the factors (genetic, hormonal, and environmental) that cause it, and the array of autoantibodies with which it is associated. In this Seminar we reflect on changes in its classification criteria; consider aspects of its more serious clinical expression; and provide a brief review of its aetiopathogenesis, major complications, coping strategies, and conventional treatment. Increased understanding of the cells and molecules involved in the development of the diseases has encouraged the identification of new, better targeted biological approaches to its treatment. The precise role of these newer therapies remains to be established.
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Affiliation(s)
| | - Grainne Murphy
- Centre for Rheumatology, Department of Medicine, University College London Hospital, London, UK
| | - David Isenberg
- Centre for Rheumatology, Department of Medicine, University College London Hospital, London, UK.
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Agmon-Levin N, Arango MT, Kivity S, Katzav A, Gilburd B, Blank M, Tomer N, Volkov A, Barshack I, Chapman J, Shoenfeld Y. Immunization with hepatitis B vaccine accelerates SLE-like disease in a murine model. J Autoimmun 2014; 54:21-32. [DOI: 10.1016/j.jaut.2014.06.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 06/29/2014] [Indexed: 12/12/2022]
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Saad K, Badry R. Commentary. J Neurosci Rural Pract 2014; 5:S77. [PMID: 25540551 PMCID: PMC4271394 DOI: pmid/25540551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Khaled Saad
- Department of Pediatrics, Assiut University, Assiut, Egypt
- Address for correspondence: Dr. Khaled Saad, Department of Pediatrics, Faculty of Medicine, University of Assiut, Assiut 71516, Egypt. E-mail:
| | - Reda Badry
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt
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58
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Cognitive and affective dysfunctions in autoimmune thyroiditis. Brain Behav Immun 2014; 41:261-6. [PMID: 24685840 DOI: 10.1016/j.bbi.2014.03.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/07/2014] [Accepted: 03/14/2014] [Indexed: 11/21/2022] Open
Abstract
Hashimoto's thyroiditis (HT) is the most frequent cause of hypothyroidism in areas with sufficient iodine intake. While the impact of thyroid function on mood and cognition is well known, only in the recent years, an increasing number of studies report on the association of HT with cognitive and affective disturbances also in the euthyroid state. Recent imaging studies have shown that these impairments are accompanied by altered brain perfusion, in particular, in the frontal lobe and a reduced gray matter density in the left inferior gyrus frontalis. Brain function abnormalities in euthyroid patients with HT may be subtle and only detected by specific testing or even severe as it is the case in the rare neuropsychiatric disorder Hashimoto's encephalopathy (HE). The good response to glucocorticoids in patients with HE indicates an autoimmune origin. In line with this, the cognitive deficits and the high psycho-social burden in euthyroid HT patients without apparent signs of encephalopathy appear to be associated with anti-thyroid peroxidase auto-antibody (TPO Abs) levels. Though in vitro studies showing binding of TPO Abs to human cerebellar astrocytes point to a potential direct role of TPO Abs in the pathogenesis of brain abnormalities in HT patients, TPO Abs may function only as a marker of an autoimmune disorder of the central nervous system. In line with this, anti-central nervous system auto-antibodies (CNS Abs) which are markedly increased in patients with HT disturb myelinogenesis in vitro and, therefore, may impair myelin sheath integrity. In addition, in HT patients, production of monocyte- and T-lymphocyte-derived cytokines is also markedly increased which may negatively affect multiple neurotransmitters and, consequently, diverse brain neurocircuits.
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Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus: pathogenesis and biomarkers. Nat Rev Neurol 2014; 10:579-96. [DOI: 10.1038/nrneurol.2014.148] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus and cognitive dysfunction: the MRL-lpr mouse strain as a model. Autoimmun Rev 2014; 13:963-73. [PMID: 25183233 DOI: 10.1016/j.autrev.2014.08.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/10/2014] [Indexed: 12/19/2022]
Abstract
Mouse models of autoimmunity, such as (NZB×NZW)F1, MRL/MpJ-Fas(lpr) (MRL-lpr) and BXSB mice, spontaneously develop systemic lupus erythematosus (SLE)-like syndromes with heterogeneity and complexity that characterize human SLE. Despite their inherent limitations, such models have highly contributed to our current understanding of the pathogenesis of SLE as they provide powerful tools to approach the human disease at the genetic, cellular, molecular and environmental levels. They also allow novel treatment strategies to be evaluated in a complex integrated system, a favorable context knowing that very few murine models that adequately mimic human autoimmune diseases exist. As we move forward with more efficient medications to treat lupus patients, certain forms of the disease that requires to be better understood at the mechanistic level emerge. This is the case of neuropsychiatric (NP) events that affect 50-60% at SLE onset or within the first year after SLE diagnosis. Intense research performed at deciphering NP features in lupus mouse models has been undertaken. It is central to develop the first lead molecules aimed at specifically treating NPSLE. Here we discuss how mouse models, and most particularly MRL-lpr female mice, can be used for studying the pathogenesis of NPSLE in an animal setting, what are the NP symptoms that develop, and how they compare with human SLE, and, with a critical view, what are the neurobehavioral tests that are pertinent for evaluating the degree of altered functions and the progresses resulting from potentially active therapeutics.
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Affiliation(s)
- Hélène Jeltsch-David
- CNRS, Immunopathologie et chimie thérapeutique/Laboratory of excellence Medalis, Institut de Biologie Moléculaire et Cellulaire, 67000 Strasbourg, France.
| | - Sylviane Muller
- CNRS, Immunopathologie et chimie thérapeutique/Laboratory of excellence Medalis, Institut de Biologie Moléculaire et Cellulaire, 67000 Strasbourg, France.
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Zardi EM, Taccone A, Marigliano B, Margiotta DP, Afeltra A. Neuropsychiatric systemic lupus erythematosus: Tools for the diagnosis. Autoimmun Rev 2014; 13:831-9. [DOI: 10.1016/j.autrev.2014.04.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/30/2014] [Indexed: 01/18/2023]
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Antibody-specific behavioral effects: Intracerebroventricular injection of antiphospholipid antibodies induces hyperactive behavior while anti-ribosomal-P antibodies induces depression and smell deficits in mice. J Neuroimmunol 2014; 272:10-5. [DOI: 10.1016/j.jneuroim.2014.04.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/20/2022]
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63
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Sciascia S, Bertolaccini ML, Roccatello D, Khamashta MA, Sanna G. Autoantibodies involved in neuropsychiatric manifestations associated with systemic lupus erythematosus: a systematic review. J Neurol 2014; 261:1706-14. [DOI: 10.1007/s00415-014-7406-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/05/2014] [Accepted: 06/06/2014] [Indexed: 11/28/2022]
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64
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Tamashiro LF, Oliveira RDR, Oliveira R, Frota ERC, Donadi EA, Del-Ben CM, Teixeira AL, Louzada-Junior P. Participation of the neutrophin brain-derived neurotrophic factor in neuropsychiatric systemic lupus erythematosus. Rheumatology (Oxford) 2014; 53:2182-90. [PMID: 24942492 DOI: 10.1093/rheumatology/keu251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Brain-derived neurotrophic factor (BDNF) is associated with the pathogenesis of several neuropsychiatric (NP) diseases, but there are few studies involving SLE. The aim of this study was to investigate whether plasma BDNF levels are associated with disease activity in SLE patients with severe NPSLE and non-NPSLE manifestations. METHODS We assessed 131 SLE patients and 24 randomly selected healthy individuals. SLE patients were evaluated in a cross-sectional study allocated according to the presence or not of NP manifestations and disease activity: (i) active NPSLE (n = 40), (ii) inactive NPSLE (n = 26), (iii) active SLE (n = 29) and (iv) inactive SLE (n = 36). In addition, NPSLE patients (n = 40) were evaluated before and after treatment. Disease activity was assessed according to the SLEDAI score. The plasma BDNF was measured by ELISA. RESULTS BDNF levels were increased in inactive NPSLE when compared with active SLE and controls (P < 0.0001). We observed similar findings in inactive SLE when compared with active SLE (P < 0.0001). In addition, we found an inverse correlation between plasma BDNF levels and the SLEDAI (r = -0.54, P < 0.0001) and a positive correlation with complement levels. We also observed an increase in BDNF levels in parallel with the improvement in NP symptoms. CONCLUSION Plasma BDNF level is increased in SLE patients and this increase is independent of the occurrence of NP manifestations. In addition, plasma BDNF levels increased with control of SLE activity, which points to the potential use of BDNF as a biomarker of response to treatment.
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Affiliation(s)
- Leticia Faleiros Tamashiro
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Renê D R Oliveira
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Oliveira
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Elizabeth Regina Comini Frota
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Eduardo Antonio Donadi
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio Lucio Teixeira
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Paulo Louzada-Junior
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Division of Clinical Immunology, School of Medicine of Ribeirão Preto, Center for Research in Inflammatory Diseases, University of São Paulo, São Paulo, Neurology Unit, University Hospital, Federal University of Minas Gerais, Minas Gerais and Division of Psychiatry, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
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Gaber W, Ezzat Y, El Fayoumy NM, Helmy H, Mohey AM. Detection of asymptomatic cranial neuropathies in patients with systemic lupus erythematosus and their relation to antiribosomal P antibody levels and disease activity. Clin Rheumatol 2014; 33:1459-66. [DOI: 10.1007/s10067-014-2679-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/27/2014] [Accepted: 04/27/2014] [Indexed: 11/29/2022]
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Stock AD, Wen J, Putterman C. Neuropsychiatric Lupus, the Blood Brain Barrier, and the TWEAK/Fn14 Pathway. Front Immunol 2013; 4:484. [PMID: 24400009 PMCID: PMC3872310 DOI: 10.3389/fimmu.2013.00484] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/10/2013] [Indexed: 11/13/2022] Open
Abstract
Patients with systemic lupus erythematosus (SLE) can experience acute neurological events such as seizures, cerebrovascular accidents, and delirium, psychiatric conditions including depression, anxiety, and psychosis, as well as memory loss and general cognitive decline. Neuropsychiatric SLE (NPSLE) occurs in between 30 and 40% of SLE patients, can constitute the initial patient presentation, and may occur outside the greater context of an SLE flare. Current efforts to elucidate the mechanistic underpinnings of NPSLE are focused on several different and potentially complementary pathways, including thrombosis, brain autoreactive antibodies, and complement deposition. Furthermore, significant effort is dedicated to understanding the contribution of neuroinflammation induced by TNF, IL-1, IL-6, and IFN-γ. More recent studies have pointed to a possible role for the TNF family ligand TWEAK in the pathogenesis of neuropsychiatric disease in human lupus patients, and in a murine model of this disease. The blood brain barrier (BBB) consists of tight junctions between endothelial cells (ECs) and astrocytic projections which regulate paracellular and transcellular flow into the central nervous system (CNS), respectively. Given the privileged environment of the CNS, an important question is whether and how the integrity of the BBB is compromised in NPSLE, and its potential pathogenic role. Evidence of BBB violation in NPSLE includes changes in the albumin quotient (Qalb) between plasma and cerebrospinal fluid, activation of brain ECs, and magnetic resonance imaging. This review summarizes the evidence implicating BBB damage as an important component in NPSLE development, occurring via damage to barrier integrity by environmental triggers such as infection and stress; cerebrovascular ischemia as result of a generally prothrombotic state; and immune mediated EC activation, mediated by antibodies and/or inflammatory cytokines. Additionally, new evidence supporting the role of TWEAK/Fn14 signaling in compromising the integrity of the BBB in lupus will be presented.
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Affiliation(s)
- Ariel D Stock
- Department of Microbiology and Immunology, Albert Einstein College of Medicine , Bronx, NY , USA
| | - Jing Wen
- Department of Microbiology and Immunology, Albert Einstein College of Medicine , Bronx, NY , USA
| | - Chaim Putterman
- Department of Microbiology and Immunology, Albert Einstein College of Medicine , Bronx, NY , USA ; Division of Rheumatology, Albert Einstein College of Medicine , Bronx, NY , USA
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An unusual presentation of lupus in a pediatric patient. Case Rep Pediatr 2013; 2013:180208. [PMID: 24066251 PMCID: PMC3771485 DOI: 10.1155/2013/180208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/17/2013] [Indexed: 11/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease causing inflammatory tissue damage. Multiple organ damage can ensue with renal and neurological involvement carrying the worse prognosis. In this case report we present a 10-year-old African American girl who presented with abnormal choreiform movements, headache, weight loss, and fatigue. Detailed clinical examination with laboratory and imaging studies clinched the diagnosis of SLE. Echocardiogram revealed the presence of Libman-sacks endocarditis. Patient showed rapid resolution of symptoms with steroid therapy. A brief discussion on childhood onset lupus along with the varied clinical presentation is discussed.
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Increased anti-phospholipid antibodies in autism spectrum disorders. Mediators Inflamm 2013; 2013:935608. [PMID: 24174712 PMCID: PMC3794552 DOI: 10.1155/2013/935608] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/14/2013] [Indexed: 12/14/2022] Open
Abstract
Autism spectrum disorders (ASD) are characterized by impairments in communication, social interactions, and repetitive behaviors. While the etiology of ASD is complex and likely involves the interplay of genetic and environmental factors, growing evidence suggests that immune dysfunction and the presence of autoimmune responses including autoantibodies may play a role in ASD. Anti-phospholipid antibodies are believed to occur from both genetic and environmental factors and have been linked to a number of neuropsychiatric symptoms such as cognitive impairments, anxiety, and repetitive behaviors. In the current study, we investigated whether there were elevated levels of anti-phospholipid antibodies in a cross-sectional analysis of plasma of young children with ASD compared to age-matched typically developing (TD) controls and children with developmental delays (DD) other than ASD. We found that levels of anti-cardiolipin, β2-glycoprotein 1, and anti-phosphoserine antibodies were elevated in children with ASD compared with age-matched TD and DD controls. Further, the increase in antibody levels was associated with more impaired behaviors reported by parents. This study provides the first evidence for elevated production of anti-phospholipid antibodies in young children with ASD and provides a unique avenue for future research into determining possible pathogenic mechanisms that may underlie some cases of ASD.
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Li Q, Lu Q, Lu H, Tian S, Lu Q. Systemic autoimmunity in TAM triple knockout mice causes inflammatory brain damage and cell death. PLoS One 2013; 8:e64812. [PMID: 23840307 PMCID: PMC3688737 DOI: 10.1371/journal.pone.0064812] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 04/18/2013] [Indexed: 12/14/2022] Open
Abstract
The Tyro3, Axl and Mertk (TAM) triply knockout (TKO) mice exhibit systemic autoimmune diseases, with characteristics of increased proinflammatory cytokine production, autoantibody deposition and autoreactive lymphocyte infiltration into a variety of tissues. Here we show that TKO mice produce high level of serum TNF-α and specific autoantibodies deposited onto brain blood vessels. The brain-blood barrier (BBB) in mutant brains exhibited increased permeability for Evans blue and fluorescent-dextran, suggesting a breakdown of the BBB in the mutant brains. Impaired BBB integrity facilitated autoreactive T cells infiltrating into all regions of the mutant brains. Brain autoimmune disorder caused accumulation of the ubiquitin-reactive aggregates in the mutant hippocampus, and early formation of autofluorescent lipofuscins in the neurons throughout the entire brains. Chronic neuroinflammation caused damage of the hippocampal mossy fibers and neuronal apoptotic death. This study shows that chronic systemic inflammation and autoimmune disorders in the TKO mice cause neuronal damage and death.
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MESH Headings
- Animals
- Apoptosis
- Autoantibodies/blood
- Autoimmune Diseases/genetics
- Autoimmune Diseases/immunology
- Autoimmune Diseases/pathology
- Blood-Brain Barrier/metabolism
- Brain Damage, Chronic/genetics
- Brain Damage, Chronic/immunology
- Brain Damage, Chronic/pathology
- CA3 Region, Hippocampal/blood supply
- CA3 Region, Hippocampal/immunology
- CA3 Region, Hippocampal/pathology
- Capillary Permeability/immunology
- Cells, Cultured
- Cytokines/metabolism
- Dentate Gyrus/blood supply
- Dentate Gyrus/immunology
- Dentate Gyrus/pathology
- Endothelial Cells/immunology
- Endothelial Cells/metabolism
- Female
- Gene Knockdown Techniques
- Inclusion Bodies/metabolism
- Inflammation Mediators/metabolism
- Lipopolysaccharides/pharmacology
- Mice
- Mice, 129 Strain
- Mice, Inbred C57BL
- Mice, Knockout
- Microvessels/immunology
- Microvessels/metabolism
- Neurons/physiology
- Proto-Oncogene Proteins/genetics
- Receptor Protein-Tyrosine Kinases/genetics
- T-Lymphocytes/immunology
- Tumor Necrosis Factor-alpha/blood
- Ubiquitinated Proteins/metabolism
- c-Mer Tyrosine Kinase
- Axl Receptor Tyrosine Kinase
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Affiliation(s)
- Qiutang Li
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, United States of America
- The James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, United States of America
| | - Qingjun Lu
- School of Basic Medicine and Beijing Tong-Ren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Huayi Lu
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Shifu Tian
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Qingxian Lu
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, United States of America
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, United States of America
- The James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, United States of America
- * E-mail:
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Kohut SA, Williams TS, Jayanthikumar J, Landolt-Marticorena C, Lefebvre A, Silverman E, Levy DM. Depressive symptoms are prevalent in childhood-onset systemic lupus erythematosus (cSLE). Lupus 2013; 22:712-20. [DOI: 10.1177/0961203313488840] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Depressive symptoms are common in adolescence and young adulthood; however, their prevalence in childhood-onset systemic lupus erythematosus (cSLE) is unknown. Objective The objective of this study was to examine the prevalence of depressive symptoms and their association with disease characteristics in children, adolescents, and young adults with cSLE. Methods A cross-sectional sample of patients with cSLE between 10 to 24 years old completed standardized depression inventories. Demographics and disease characteristics were collected. Results Total depression inventory scores reported were below standard cut-off values for depression. However, 26% (10/38) of children and adolescents, and 44% (seven of 16) of young adults had scores at or above established cut-offs for elevated depression symptoms. Physical symptoms of depression were endorsed most frequently. There were no differences in depressive symptoms by disease characteristics including disease duration, health-related quality of life inventory scores, antiphospholipid antibody status, and a history of renal involvement or neuropsychiatric SLE (NPSLE). However, two patients had a history of depression as an NPSLE manifestation of their SLE. In the children and adolescents, prednisone dose was associated with negative self-esteem ( r = 0.37, p = 0.04) and somatic depressive symptoms ( r = 0.39, p = 0.02), but we did not observe a significant association in the young adults. Conclusion Depressive symptoms in cSLE are frequent, although similar to the high prevalence rates in the general population. Physical symptoms are most frequently endorsed. Further study will determine if serial evaluations are recommended for early detection in this at-risk population.
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Affiliation(s)
- S Ahola Kohut
- York University, Toronto, Canada
- Hospital for Sick Children, Toronto, Canada
| | | | | | | | - A Lefebvre
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - E Silverman
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
- The SickKids Research Institute, Toronto, Canada
| | - DM Levy
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
- The SickKids Research Institute, Toronto, Canada
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71
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Bhangle SD, Kramer N, Rosenstein ED. Corticosteroid-induced neuropsychiatric disorders: review and contrast with neuropsychiatric lupus. Rheumatol Int 2013; 33:1923-32. [DOI: 10.1007/s00296-013-2750-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 04/03/2013] [Indexed: 11/28/2022]
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Wen J, Xia Y, Stock A, Michaelson JS, Burkly LC, Gulinello M, Putterman C. Neuropsychiatric disease in murine lupus is dependent on the TWEAK/Fn14 pathway. J Autoimmun 2013; 43:44-54. [PMID: 23578591 DOI: 10.1016/j.jaut.2013.03.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/05/2013] [Accepted: 03/05/2013] [Indexed: 01/11/2023]
Abstract
Given the early onset of neuropsychiatric disease and the potential response to immunosuppressive therapy, neuropsychiatric disease is considered a primary disease manifestation in systemic lupus erythematosus (SLE). However, the pathogenesis is not fully understood and optimal treatment has yet to be determined. TWEAK is a TNF family ligand that mediates pleotropic effects through its receptor Fn14, including the stimulation of inflammatory cytokine production by astrocytes, endothelial cells, and other non-hematopeotic cell types, and induction of neuronal death. Furthermore, TWEAK-inducible mediators are implicated in neuropsychiatric lupus. Thus, we hypothesized that the TWEAK/Fn14 pathway may be involved in the pathogenesis of neuropsychiatric SLE. We generated MRL-lpr/lpr (MRL/lpr) mice deficient for Fn14, the sole known signaling receptor for TWEAK. Neuropsychiatric disease was compared in age- and gender-matched MRL/lpr Fn14 wild type (WT) and knockout (KO) mice, using a comprehensive battery of neurobehavioral tests. We found that MRL/lpr Fn14WT mice displayed profound depression-like behavior as seen by increased immobility in a forced swim test and loss of preference for sweetened fluids, which were significantly ameliorated in Fn14KO mice. Similarly, MRL/lpr Fn14WT mice had impaired cognition, and this was significantly improved in Fn14KO mice. To determine the mechanism by which Fn14 deficiency ameliorates neuropsychiatric disease, we assessed the serum levels of autoantibodies and local expression of cytokines in the cortex and hippocampus of lupus mice. No significant differences were found in the serum levels of antibodies to nuclear antigens, or autoantibodies specifically associated with neuropsychiatric disease, between MRL/lpr Fn14WT and KO mice. However, MRL/lpr Fn14KO mice had significantly decreased brain expression of RANTES, C3, and other proinflammatory mediators. Furthermore, MRL/lpr Fn14KO mice displayed improved blood brain barrier integrity. In conclusion, several central manifestations of neuropsychiatric lupus, including depression-like behavior and altered cognition, are normalized in MRL/lpr mice lacking Fn14. Our results are the first to indicate a role for the TWEAK/Fn14 pathway in the pathogenesis of neuropsychiatric lupus, and suggest this ligand-receptor pair as a potential therapeutic target for a common and dangerous disease manifestation.
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Affiliation(s)
- Jing Wen
- The Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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73
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16/6-idiotype expressing antibodies induce brain inflammation and cognitive impairment in mice: the mosaic of central nervous system involvement in lupus. BMC Med 2013; 11:90. [PMID: 23556432 PMCID: PMC3616817 DOI: 10.1186/1741-7015-11-90] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 12/13/2012] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The 16/6-idiotype (16/6-Id) of the human anti-DNA antibody was found to induce experimental lupus in naïve mice, manifested by production of autoantibodies, leukopenia and elevated inflammatory markers, as well as kidney and brain involvement. We assessed behavior and brain pathology of naive mice injected intra-cerebra-ventricularly (ICV) with the 16/6-Id antibody. METHODS C3H female mice were injected ICV to the right hemisphere with the human 16/6-Id antibody or commercial human IgG antibodies (control). The mice were tested for depression by the forced swimming test (FST), locomotor and explorative activity by the staircase test, and cognitive functions were examined by the novel object recognition and Y-maze tests. Brain slices were stained for inflammatory processes. RESULTS 16/6-Id injected mice were cognitively impaired as shown by significant differences in the preference for a new object in the novel object recognition test compared to controls (P = 0.012). Similarly, the preference for spatial novelty in the Y-maze test was significantly higher in the control group compared to the 16/6-Id-injected mice (42% vs. 9%, respectively, P = 0.065). Depression-like behavior and locomotor activity were not significantly different between the16/6-Id-injected and the control mice. Immunohistochemistry analysis revealed an increase in astrocytes and microglial activation in the hippocampus and amygdala, in the 16/6-Id injected group compared to the control. CONCLUSIONS Passive transfer of 16/6-Id antibodies directly into mice brain resulted in cognitive impairments and histological evidence for brain inflammation. These findings shed additional light on the diverse mosaic pathophysiology of neuropsychiatric lupus.See related Commentary article: http://www.biomedcentral.com/1741-7015/11/91.
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74
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Palagini L, Mosca M, Tani C, Gemignani A, Mauri M, Bombardieri S. Depression and systemic lupus erythematosus: a systematic review. Lupus 2013; 22:409-16. [DOI: 10.1177/0961203313477227] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) is a chronic, relapsing–remitting autoimmune disorder that involves multiple organ systems including the central nervous system. Among the items included in the nomenclature for neuropsychiatric SLE, mood disorders have been identified. The aim of this paper is to review the clinical and psychobiological relationship between depression and SLE. Method We performed a systematic search of MEDLINE, EMBASE, PsychINFO, using MeSH headings and keywords for ‘depression’ and ‘SLE’. Results Seventeen studies reported depressive disorders, with prevalence rates in the range 17–75%. Three studies reported the most frequent symptoms, which may be represented by fatigue, weakness, somatic disorders and sleep disorders. Suicide ideation was much higher than in the general population. Nine studies analysed the relationship to SLE disease activity. The results of the available literature are contradictory. Psychobiological hypotheses have been considered in 13 studies. Among the psychobiological hypotheses which might underline the plausibility of their relationship, ‘psychosocial factors’ were the most frequently reported. Conclusions Differences in assessment techniques appear to be the main explanation for the variability in findings and important methodological limitations are present in the available literature to definitively point to the prevalence of depression, type of depression and most prevalent symptoms. To date, the relationship between depression and SLE disease activity also appears controversial. Methodological limitations are present in the available literature and it would be necessary to develop evidence-based guidelines to improve the diagnosis of depression in SLE. Identification of SLE-specific biomarkers of depression also has high priority.
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Affiliation(s)
- L Palagini
- Psychiatry Unit, Department of Neuroscience, University of Pisa, Italy
| | - M Mosca
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Italy
| | - C Tani
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Italy
| | - A Gemignani
- Department of Physiological Sciences, University of Pisa, Italy Extreme Centre, Italy
| | - M Mauri
- Psychiatry Unit, Department of Neuroscience, University of Pisa, Italy
| | - S Bombardieri
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Italy
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75
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Ramage AE, Fox PT, Brey RL, Narayana S, Cykowski MD, Naqibuddin M, Sampedro M, Holliday SL, Franklin C, Wallace DJ, Weisman MH, Petri M. Neuroimaging evidence of white matter inflammation in newly diagnosed systemic lupus erythematosus. ACTA ACUST UNITED AC 2013; 63:3048-57. [PMID: 21618460 DOI: 10.1002/art.30458] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Central nervous system (CNS) involvement occurs frequently in systemic lupus erythematosus (SLE) and frequently results in morbidity. The primary pathophysiology of CNS involvement in SLE is thought to be inflammation secondary to autoantibody-mediated vasculitis. Neuroimaging studies have shown hypometabolism (representing impending cell failure) and atrophy (representing late-stage pathology), but not inflammation. The purpose of this study was to detect the presence and regional distribution of inflammation (hypermetabolism) and tissue failure, apoptosis, or atrophy (hypometabolism). METHODS Eighty-five patients with newly diagnosed SLE, who had no focal neurologic symptoms, were studied. Disease activity was quantified using the Safety of Estrogens in Lupus Erythematosus: National Assessment version of the SLE Disease Activity Index (SELENA-SLEDAI), a validated index of SLE-related disease activity. 18Fluorodeoxyglucose (FDG) positron emission tomography (PET) images of glucose uptake were analyzed by visual inspection and as group statistical parametric images, using the SELENA-SLEDAI score as the analysis regressor. RESULTS SELENA-SLEDAI-correlated increases in glucose uptake were found throughout the white matter, most markedly in heavily myelinated tracts. SELENA-SLEDAI-correlated decreases were found in the frontal and parietal cortex, in a pattern similar to that seen during visual inspection and presented in previous reports of hypometabolism. CONCLUSION The SELENA-SLEDAI-correlated increases in glucose consumption are potential evidence of inflammation, consistent with prior reports of hypermetabolism in inflammatory disorders. To our knowledge, this is the first imaging-based evidence of SLE-induced CNS inflammation in an SLE inception cohort. The dissociation among 18FDG uptake characteristics, spatial distribution, and disease activity correlation is in accordance with the notion that glucose hypermetabolism and hypometabolism reflect fundamentally different aspects of the pathophysiology of SLE with CNS involvement.
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Affiliation(s)
- Amy E Ramage
- University of Texas Health Science Center at San Antonio and Department of Veterans Affairs Heart of Texas Health Care Network, San Antonio, TX 78229, USA.
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76
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Immunoglobulin-Mediated Neuro-Cognitive Impairment: New Data and a Comprehensive Review. Clin Rev Allergy Immunol 2013; 45:248-55. [DOI: 10.1007/s12016-013-8357-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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77
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Li CH, Chou MC, Liu CK, Lai CL. Antiphospholipid syndrome presenting as progressive neuropsychiatric disorders: two case reports. Neuropsychiatr Dis Treat 2013; 9:739-42. [PMID: 23723705 PMCID: PMC3666907 DOI: 10.2147/ndt.s44140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The antiphospholipid syndrome (APS) is a rare form of autoimmune coagulopathy. In this syndrome, the most common neurologic abnormality is transient ischemic attack. This can be easily overlooked if a patient presents with progressive neuropsychiatric disorders, such as depression or dementia. We report two cases of young women, aged 35 and 22 years, presenting with progressive depression and mental decline over a certain period. The neuropsychological diagnoses of the two patients were, respectively, dementia with disinhibition and borderline dementia with depression. Brain magnetic resonance imaging showed multiple old infarcts with encephalomalacia in the former case, and only one cortical hemorrhagic infarction, over the right temporoparietal lobe, observed in the latter case. The outcomes of the two cases were also very different. Progressive neuropsychiatric disorders are increasingly observed in the young; therefore, APS and other autoimmune diseases should be considered during the differential diagnosis. Brain imaging examinations may prevent a delay in the detection of a structural lesion and facilitate the early intervention with good prognosis. Careful investigations by experts from different disciplines are always encouraged in complicated cases.
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Affiliation(s)
- Chien-Hsun Li
- Department of Neurology, Fooyin University Hospital, Pingtung, Taiwan ; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Department of and Master's Program in Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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78
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Gatto M, Zen M, Ghirardello A, Bettio S, Bassi N, Iaccarino L, Punzi L, Doria A. Emerging and critical issues in the pathogenesis of lupus. Autoimmun Rev 2012; 12:523-36. [PMID: 23000207 DOI: 10.1016/j.autrev.2012.09.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 09/10/2012] [Indexed: 01/10/2023]
Abstract
Systemic lupus erythematosus (SLE) is a multisystemic, autoimmune disease, encompassing either mild or severe manifestations. SLE was originally labeled as being an immune complex-mediated disease, but further knowledge suggested its pathogenesis is motlier than that, involving complex interactions between predisposed individuals and their environment. People affected with SLE have their immune system skewed toward aberrant self-recognition usually after encountering a triggering agent. Defeats in early and late immune checkpoints contribute to tolerance breakdown and further generation and expansion of autoreactive cell-clones. B and T cells play a master role in SLE, however clues are emerging about other cell types and new light is being shed on SLE autoantibodies, since some of them display really harmful potential (pathogenic antibodies), while others are just connected with disease development (pathological antibodies) and may even be protective. Autoantibody generation is elicited by abnormal apoptosis and inefficient clearance of cellular debris causing intracellular autoantigens (e.g. nucleosomes) to persist in the extracellular environment, being further recognized by autoreactive cells. Here we explore the complexity of SLE pathogenesis through five core issues, i.e. genetic predisposition, B and T cell abnormalities, abnormal autoantigen availability, autoantibody generation and organ damage, relying on current knowledge and recent insights into SLE development.
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Affiliation(s)
- Mariele Gatto
- Division of Rheumatology, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
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79
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Lefèvre G, Zéphir H, Michelin E, Semah F, Warembourg F, Pruvo JP, Hachulla E, Lenfant P, Dubucquoi S, Vermersch P, Hatron PY, Prin L, Launay D. Neurolupus (2e partie). Description des outils diagnostiques et thérapeutiques devant une manifestation psychiatrique ou neurologique centrale au cours du lupus érythémateux systémique. Rev Med Interne 2012; 33:503-13. [DOI: 10.1016/j.revmed.2012.03.354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 01/02/2012] [Accepted: 03/31/2012] [Indexed: 12/23/2022]
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80
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Benkler M, Agmon-Levin N, Hassin-Baer S, Cohen OS, Ortega-Hernandez OD, Levy A, Moscavitch SD, Szyper-Kravitz M, Damianovich M, Blank M, Chapman J, Shoenfeld Y. Immunology, autoimmunity, and autoantibodies in Parkinson's disease. Clin Rev Allergy Immunol 2012; 42:164-71. [PMID: 21234712 DOI: 10.1007/s12016-010-8242-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent revelations of immune alterations in Parkinson's disease have led to the convergence that an autoimmune mechanism may play a role in the etiopathogenesis of this neurodegenerative disease. In the current study, 77 Parkinson's disease patients and 77 matched healthy controls were analyzed for the presence of seven autoantibodies previously found to be associated with central nervous system manifestations namely: antineuronal-cells, anti-brain lysate, anti-dsDNA, anti-phosphatidylserine, anti-cardiolipin, anti-serotonin, and anti-melanocytes antibodies. Patients underwent systematic assessments of demographics, clinical, and biochemical manifestations. Three autoantibodies were found to be more prevalent among Parkinson's disease patients (antineuronal cells10.3% vs. 1.3%, p = 0.017; anti-brain lysate 9.1% vs. 1.3%, p = 0.032; anti-dsDNA 10.3% vs. 2.6%, p = 0.049). Clinical manifestations of Parkinson's disease, particularly dyskinesia and depression, were found to be associated with the presence of these autoantibodies.
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Affiliation(s)
- Michal Benkler
- Faculty of Health Sciences, Medical School, Ben-Gurion University of the Negev, Beer-Sheba, Israel
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81
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Mantovani C, Louzada-Junior P, Nunes EA, de Figueiredo FP, Oliveira GR, Del-Ben CM. Antinuclear antibodies testing as a routine screening for systemic lupus erythematosus in patients presenting first-episode psychosis. Early Interv Psychiatry 2012; 6:322-5. [PMID: 22260390 DOI: 10.1111/j.1751-7893.2011.00339.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS This report discusses the use of antinuclear antibody (ANA) detection as a screening test for neuropsychiatry systemic lupus erythematosus (NPSLE) in patients presenting a first-episode psychosis. METHODS We reviewed the medical records of 85 patients admitted to an emergency service due to first-episode psychosis, during a 1-year period, for whom ANA detection was performed through an IFI HEp2 cell assay. ANA-positive patients were subsequently evaluated for autoantibodies and neuroimaging exams. RESULTS Three patients presented as ANA positive in the initial screening and further investigation confirmed NPSLE in two patients. The patients were treated with antipsychotics and cyclophosphamide pulses with satisfactory outcomes. CONCLUSION Even though ANA detection is not specific, it is a low-cost procedure and could be an important screening test for NPSLE in the early-onset psychosis.
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Affiliation(s)
- Célia Mantovani
- Department of Neurosciences and Behaviour, Division of Psychiatry, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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82
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Aldar H, Lapa AT, Bellini B, Sinicato NA, Postal M, Fernandes PT, Costallat LTL, Marini R, Appenzeller S. Prevalence and clinical significance of anti-ribosomal P antibody in childhood-onset systemic lupus erythematosus. Lupus 2012; 21:1225-31. [DOI: 10.1177/0961203312451201] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the prevalence of the anti-ribosomal P (anti-P) antibodies in childhood-onset systemic lupus erythematosus patients (cSLE), healthy controls and first degree relatives. To elucidate the association between anti-P and disease activity, laboratory and treatment features in cSLE patients. Methods: We included consecutive SLE patients with disease onset before 16 years. Controls were age- and sex-matched. SLE patients were assessed for clinical and laboratory SLE manifestations, disease activity (SLE Disease Activity Index (SLEDAI)), damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)) and current drug exposures. Mood disorders were determined through Becks Depression and Becks Anxiety Inventory. Anti-P measured by enzyme-linked immunosorbent assay. Results: We included 50 consecutive cSLE patients (mean age of 16.82 ± 3.46 years), 35 first degree relatives (mean age of 38.73 ± 3.89 years) and 20 health control (mean age of 18.3 ± 4.97 years). Anti-P was observed in 13 (26%) cSLE patients and in no first-degree relative ( p < 0.01) or control ( p < 0.01). Anti-P was more frequently observed in patients with anxiety ( p < 0.002). No other clinical, laboratory or treatment features, including SLEDAI and SDI scores were associated with the presence of anti-P in cSLE patients. Conclusion: Anti-P is frequently observed in cSLE patients and was associated with the presence of anxiety in this cohort of cSLE.
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Affiliation(s)
- H Aldar
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science, State University of Campinas, Brazil
| | - AT Lapa
- Faculty of Medical Science, State University of Campinas, Brazil
| | - B Bellini
- Faculty of Medical Science, State University of Campinas, Brazil
| | - NA Sinicato
- Faculty of Medical Science, State University of Campinas, Brazil
| | - M Postal
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science, State University of Campinas, Brazil
| | - PT Fernandes
- Physical Education and Medical Sciences of the State University of Campinas, Brazil
| | - LTL Costallat
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science, State University of Campinas, Brazil
| | - R Marini
- Department of Pediatrics, Pediatric Rheumatology Unit, Faculty of Medical Science, State University of Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science, State University of Campinas, Brazil
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Rekvig OP, Putterman C, Casu C, Gao HX, Ghirardello A, Mortensen ES, Tincani A, Doria A. Autoantibodies in lupus: Culprits or passive bystanders? Autoimmun Rev 2012; 11:596-603. [DOI: 10.1016/j.autrev.2011.10.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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84
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Baizabal-Carvallo JF, Jankovic J. Movement disorders in autoimmune diseases. Mov Disord 2012; 27:935-46. [PMID: 22555904 DOI: 10.1002/mds.25011] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 03/09/2012] [Accepted: 03/26/2012] [Indexed: 12/13/2022] Open
Abstract
Movement disorders have been known to be associated with a variety of autoimmune diseases, including Sydenham's chorea, pediatric autoimmune neuropsychiatric disorders associated with streptococcus, systemic lupus erythematosus, antiphospholipid syndrome, gluten sensitivity, paraneoplastic and autoimmune encephalopathies. Tremors, dystonia, chorea, ballism, myoclonus, parkinsonism, and ataxia may be the initial and even the only presentation of these autoimmune diseases. Although antibodies directed against various cellular components of the central nervous system have been implicated, the pathogenic mechanisms of these autoimmune movement disorders have not yet been fully elucidated. Clinical recognition of these autoimmune movement disorders is critically important as many improve with immunotherapy or dietary modifications, particularly when diagnosed early. We discuss here the clinical features, pathogenic mechanisms, and treatments of movement disorders associated with autoimmune diseases, based on our own experience and on a systematic review of the literature.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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85
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Katsumata Y, Kawaguchi Y, Baba S, Hattori S, Tahara K, Ito K, Iwasaki T, Yamaguchi N, Hattori H, Nagata K, Okamoto Y, Yamanaka H, Hara M. Serum antibodies against the 70k polypeptides of the U1 ribonucleoprotein complex are associated with psychiatric syndromes in systemic lupus erythematosus: a retrospective study. Mod Rheumatol 2012; 23:71-80. [PMID: 22454191 DOI: 10.1007/s10165-012-0624-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We assessed the association between serum autoantibodies against the 70-kDa polypeptide of the U1-ribonucleoprotein (RNP) complex (U1-70k) and the central nervous system (CNS) syndromes in systemic lupus erythematosus (SLE) patients. METHODS We studied 106 hospitalized patients with active SLE, comparing those with (n = 32) and without (n = 74) CNS syndromes. CNS syndromes were further classified into neurologic (n = 21) and psychiatric (n = 15) disorders. Immunoglobulin G (IgG) anti-U1-70k antibodies were measured by enzyme-linked immunosorbent assay (ELISA) using recombinant antigens. IgG antibodies against whole U1-RNP were measured using commercial ELISA kits. RESULTS Although there was no significant difference in the levels of serum anti-U1-70k antibodies in SLE patients with or without CNS syndromes (p = 0.83), the levels were significantly elevated in SLE patients compared with patients without psychiatric syndromes (p = 0.030). In contrast, no significant difference was observed in the levels of serum anti-U1-RNP antibodies in SLE patients with or without psychiatric syndromes (p = 0.555). CONCLUSIONS These results indicate that serum anti-U1-70k antibodies are associated with psychiatric syndromes in SLE but that they are not associated with CNS syndromes as a whole or with neurologic syndromes. The anti-U1-70k antibodies might be involved in the pathological mechanisms of psychiatric syndromes in SLE.
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Affiliation(s)
- Yasuhiro Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
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Conti F, Alessandri C, Perricone C, Scrivo R, Rezai S, Ceccarelli F, Spinelli FR, Ortona E, Marianetti M, Mina C, Valesini G. Neurocognitive dysfunction in systemic lupus erythematosus: association with antiphospholipid antibodies, disease activity and chronic damage. PLoS One 2012; 7:e33824. [PMID: 22461897 PMCID: PMC3312889 DOI: 10.1371/journal.pone.0033824] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 02/17/2012] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is characterized by frequent neuropsychiatric involvement, which includes cognitive impairment (CI). We aimed at assessing CI in a cohort of Italian SLE patients by using a wide range of neurocognitive tests specifically designed to evaluate the fronto-subcortical dysfunction. Furthermore, we aimed at testing whether CI in SLE is associated with serum autoantibodies, disease activity and chronic damage. METHODS Fifty-eight consecutive patients were enrolled. Study protocol included data collection, evaluation of serum levels of ANA, anti-dsDNA, anti-cardiolipin, anti-β(2)-glycoprotein I, anti-P ribosomal, anti-endothelial cell, and anti-Nedd5 antibodies. SLEDAI-2000 and SLICC were used to assess disease activity and chronic damage. Patients were administered a test battery specifically designed to detect fronto-subcortical dysfunction across five domains: memory, attention, abstract reasoning, executive function and visuospatial function. For each patient, the raw scores from each test were compared with published norms, then transformed into Z scores (deviation from normal mean), and finally summed in the Global Cognitive Dysfunction score (GCDs). RESULTS Nineteen percent of patients had mild GCDs impairment (GCDs 2-3), 7% moderate (GCDs 4-5) and 5% severe (GCDs≥6). The visuospatial domain was the most compromised (MDZs = -0.89±1.23). Anti-cardiolipin IgM levels were associated with visuospatial domain impairment (r = 0.331, P = 0.005). SLEDAI correlated with GCDs, and attentional and executive domains; SLICC correlated with GCDs, and with visuospatial and attentional domains impairment. CONCLUSIONS Anti-phospholipids, disease activity, and chronic damage are associated with cognitive dysfunction in SLE. The use of a wide spectrum of tests allowed for a better selection of the relevant factors involved in SLE cognitive dysfunction, and standardized neuropsychological testing methods should be used for routine assessment of SLE patients.
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Affiliation(s)
- Fabrizio Conti
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Carlo Perricone
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Rossana Scrivo
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Soheila Rezai
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Elena Ortona
- Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Marianetti
- Department of Neurology and ORL, Sapienza Università di Roma, Rome, Italy
| | - Concetta Mina
- Department of Neurology and ORL, Sapienza Università di Roma, Rome, Italy
| | - Guido Valesini
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
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87
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Labrador-Horrillo M, Martinez-Valle F, Gallardo E, Rojas-Garcia R, Ordi-Ros J, Vilardell M. Anti-ganglioside antibodies in patients with systemic lupus erythematosus and neurological manifestations. Lupus 2012; 21:611-5. [PMID: 22323340 DOI: 10.1177/0961203312436856] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Anti-ganglioside antibodies (AGA) have been associated with several peripheral neuropathies, such as Miller-Fisher syndrome, Guillain-Barré syndrome and multifocal motor neuropathy. They have also been studied in patients with systemic lupus erythematosus (SLE), focusing on neuropsychiatric manifestations and peripheral neuropathy, but the results are contradictory. OBJECTIVE To study the presence of AGA in a large cohort of patients with SLE and neuropsychiatric manifestations. PATIENTS AND METHODS Serum from 65 consecutive patients with SLE and neuropsychiatric manifestations, collected from 1985 to 2009, was tested for the presence of AGA antibodies (GM1, GM2, GM3, asialo-GM1 GD1a, GD1b, GD3, GT1b, GQ1b) using a standard enzyme-linked immunosorbent assay ELISA test (INCAT 1999) and thin layer chromatography (TLC). RESULTS Positive results for asialo-GM1 (IgM) were found in 10 patients, 6 were positive for asialo-GM1 (IgM and IgG), and 4 were positive for other AGA such as GM1, GM2, GM3, GD1b, GT1b, GD3, (mainly IgM). CONCLUSIONS Clinical and statistical studies showed no correlation between AGA and neuropsychiatric manifestations of SLE. Although some patients showed reactivity to AGA, these antibodies are not a useful marker of neuropsychiatric manifestations in SLE patients.
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Affiliation(s)
- M Labrador-Horrillo
- Internal Medicine Department, Hospital Vall d'Hebron, UAB, Barcelona, Spain.
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88
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Sakić B. The MRL model: an invaluable tool in studies of autoimmunity-brain interactions. Methods Mol Biol 2012; 934:277-99. [PMID: 22933151 DOI: 10.1007/978-1-62703-071-7_14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The link between systemic autoimmunity, brain pathology, and aberrant behavior is still largely unexplored field of biomedical science. Accumulating evidence points to causal relationships between immune factors, neurodegeneration, and neuropsychiatric manifestations. By documenting autoimmunity-associated neuronal degeneration and cytotoxicity of the cerebrospinal fluid from disease-affected subjects, the murine MRL model had shown high validity in revealing principal pathogenic circuits. In addition, unlike any other autoimmune strain, MRL mice produce antibodies commonly found in patients suffering from lupus and other autoimmune disorders. This review highlights importance of the MRL model as an indispensible preparation in understanding the links between immune system and brain function.
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Affiliation(s)
- Boris Sakić
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
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89
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Zandman-Goddard G, Solomon M, Rosman Z, Peeva E, Shoenfeld Y. Environment and lupus-related diseases. Lupus 2011; 21:241-50. [DOI: 10.1177/0961203311426568] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Clinical manifestations of lupus are encountered in a variety of disease entities, including isolated cutaneous lupus, undifferentiated connective tissue disease, mixed connective tissue disease, drug-induced lupus, overlap syndrome, and systemic lupus erythematosus (SLE). While each entity has been recognized as a specific disease with its own diverse clinical and serological pattern, one could argue that many findings are common. Could it be that all of these entities actually represent a spectrum of one disease? Could it be that rather than the genetic predisposition and hence controlled factors that govern this spectrum of diseases, that environmental factors associated with SLE could also play a role in the different entities of this spectrum? The traditional environmental triggers in SLE include sunlight and ultraviolet (UV) light, infections, smoking, and medications including biologics such as tumor necrosis factor alpha (TNF-a) blockers. In this review, we update and further substantiate these traditional factors in the various lupus-related syndromes. We will also discuss the association with vaccine exposure, industrial estrogens, and other factors.
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Affiliation(s)
- G Zandman-Goddard
- Department of Medicine C, Wolfson Medical Center, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - M Solomon
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
- Department of Dermatology, Sheba Medical Center, Israel
| | - Z Rosman
- Department of Medicine C, Wolfson Medical Center, Israel
| | - E Peeva
- Department of Medicine, Albert Einstein College of Medicine, New York, USA
| | - Y Shoenfeld
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
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90
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Kapadia M, Sakic B. Autoimmune and inflammatory mechanisms of CNS damage. Prog Neurobiol 2011; 95:301-33. [DOI: 10.1016/j.pneurobio.2011.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 12/13/2022]
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Abstract
PURPOSE OF REVIEW The most relevant advances in immune-mediated movement disorders are described, with emphasis on the clinical--immunological associations, novel antigens, and treatment. RECENT FINDINGS Many movement disorders previously considered idiopathic or degenerative are now recognized as immune-mediated. Some disorders are paraneoplastic, such as anti-CRMP5-associated chorea, anti-Ma2 hypokinesis and rigidity, anti-Yo cerebellar ataxia and tremor, and anti-Hu ataxia and pesudoathetosis. Other disorders such as Sydenham's chorea, or chorea related to systemic lupus erythematosus and antiphospholipid syndrome occur in association with multiple antibodies, are not paraneoplastic, and are triggered by molecular mimicry or unknown mechanisms. Recent studies have revealed a new category of disorders that can be paraneoplastic or not, and associate with antibodies against cell-surface or synaptic proteins. They include anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, which may cause dyskinesias, chorea, ballismus or dystonia (NMDAR antibodies), the spectrum of Stiff-person syndrome/muscle rigidity (glutamic acid decarboxylase, amphiphysin, GABA(A)-receptor-associated protein, or glycine receptor antibodies), neuromyotonia (Caspr2 antibodies), and opsoclonus--myoclonus--ataxia (unknown antigens). SUMMARY Neurologists should be aware that many movement disorders are immune-mediated. Recognition of these disorders is important because it may lead to the diagnosis of an occult cancer, and a substantial number of patients, mainly those with antibodies to cell-surface or synaptic proteins, respond to immunotherapy.
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Affiliation(s)
- Jessica Panzer
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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92
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Dale RC, Yin K, Ding A, Merheb V, Varadkhar S, McKay D, Singh-Grewal D, Brilot F. Antibody binding to neuronal surface in movement disorders associated with lupus and antiphospholipid antibodies. Dev Med Child Neurol 2011; 53:522-8. [PMID: 21574989 DOI: 10.1111/j.1469-8749.2011.03922.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM Systemic lupus erythematosus is a multi-organ autoimmune disorder associated with autoantibodies of complex diversity. Antiphospholipid antibodies (aPL), which are commonly associated with lupus, create a pro-thrombotic tendency, but are also associated with non-thrombotic neurological features. Movement disorders are rare neuropsychiatric complications of lupus and antiphospholipid syndrome, and autoimmune and thromboembolic disease mechanisms have been proposed. METHOD We describe the clinical features, investigation findings, treatment, and outcome of six paediatric participants with movement disorders associated with lupus and/or aPL (six females, median age 13 y, range 8-15). To examine the autoantibody hypothesis, we used a neuronal cell line with dopaminergic characteristics and measured serum antibody binding to neuronal cell-surface antigens using flow cytometry. For comparison with the six participants, we used serum from healthy individuals (n=12, six females, median age 11 y, range 9-13) and children with other neurological diseases (n=13, seven females, median age 7 y, range 2-15). RESULTS Of the six participants, two had lupus only, two had lupus with aPL, and two had aPL only. The movement disorder was chorea in four and parkinsonism in two. All four participants with chorea had aPL and movement disorder relapses. The two participants with parkinsonism did not have aPL, but had a progressive course until rituximab or plasma exchange resulted in neuropsychiatric remission. All six participants demonstrated elevated serum antibody binding to neuronal cell-surface antigens compared with healthy individuals and those with other neurological diseases. INTERPRETATION This report supports the association of chorea with aPL, but suggests a different autoimmune mechanism operates in lupus parkinsonism. The presence of antibody binding to neuronal cell-surface antigens supports a possible direct action of autoantibodies on neurons in patients with movement disorders associated with lupus and aPL.
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Affiliation(s)
- Russell C Dale
- Neuroimmunology Group, Institute of Neuroscience and Muscle Research, The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia.
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93
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Telerman A, Lapter S, Sharabi A, Zinger H, Mozes E. Induction of hippocampal neurogenesis by a tolerogenic peptide that ameliorates lupus manifestations. J Neuroimmunol 2011; 232:151-7. [DOI: 10.1016/j.jneuroim.2010.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 10/28/2010] [Accepted: 11/01/2010] [Indexed: 11/27/2022]
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94
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Luyendijk J, Steens SCA, Ouwendijk WJN, Steup-Beekman GM, Bollen ELEM, van der Grond J, Huizinga TWJ, Emmer BJ, van Buchem MA. Neuropsychiatric systemic lupus erythematosus: Lessons learned from magnetic resonance imaging. ACTA ACUST UNITED AC 2011; 63:722-32. [DOI: 10.1002/art.30157] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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95
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Haddad F, Anouti S, Maalouly G, Koussa S. [Narcolepsy associated with systemic lupus erythematosus]. Rev Med Interne 2010; 32:e114-5. [PMID: 21145142 DOI: 10.1016/j.revmed.2010.10.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022]
Abstract
Many neurologic and psychiatric manifestations have been associated with systemic lupus erythematosus. Narcolepsy, currently hypothesized as related to an autoimmune process, has been rarely associated with systemic lupus erythematosus. We report a 36-year-old woman who presented with narcolepsy and who subsequently developed systemic lupus erythematosus. Excessive daytime sleepiness resolved after the administration of four intravenous bolus of cyclophosphamide and methylprednisolone followed by maintenance therapy with hydroxychloroquine, aspirine and prednisone. Narcolepsy should be included in the neuropsychiatric manifestations of systemic lupus erythematosus and it may have a parallel clinical course to the activity of the lupus.
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Affiliation(s)
- F Haddad
- Service de médecine interne, hôpital universitaire Hôtel-Dieu de France, Ashrafieh, Beyrouth, Liban.
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96
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Sato T, Fujii T, Yokoyama T, Fujita Y, Imura Y, Yukawa N, Kawabata D, Nojima T, Ohmura K, Usui T, Mimori T. Anti-U1 RNP antibodies in cerebrospinal fluid are associated with central neuropsychiatric manifestations in systemic lupus erythematosus and mixed connective tissue disease. ACTA ACUST UNITED AC 2010; 62:3730-40. [DOI: 10.1002/art.27700] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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97
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98
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Unterman A, Nolte JES, Boaz M, Abady M, Shoenfeld Y, Zandman-Goddard G. Neuropsychiatric syndromes in systemic lupus erythematosus: a meta-analysis. Semin Arthritis Rheum 2010; 41:1-11. [PMID: 20965549 DOI: 10.1016/j.semarthrit.2010.08.001] [Citation(s) in RCA: 206] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 07/10/2010] [Accepted: 08/06/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess the prevalence of the 19 neuropsychiatric (NP) syndromes in systemic lupus erythematosus (SLE) patients, as defined by the American College of Rheumatology (ACR) in 1999, and better understand the reasons for interstudy variability of prevalence estimates, by performing a meta-analysis of relevant publications. METHODS A literature search from April 1999 to May 2008 was performed to identify studies investigating NP syndromes in patients with definite SLE, applying the 1999 ACR case definitions and having a sample size of at least 30 patients. Excluded were studies that did not relate to all 19 NPSLE syndromes, presented duplicate data, or were irrelevant. RESULTS Seventeen of 112 identified studies matched the inclusion criteria, reporting on a total of 5057 SLE patients, including 1439 NPSLE patients, with 2709 NPSLE syndromes. In a subanalysis of the 10 higher quality prospective and elicited studies (2049 patients) using the random-effects model, the prevalence of NP syndromes in SLE patients was estimated to be 56.3% (95% CI 42.5%-74.7%), and the most frequent NP syndromes were headache 28.3% (18.2%-44.1%), mood disorders 20.7% (11.5%-37.4%), cognitive dysfunction 19.7% (10.7%-36%), seizures 9.9% (4.8%-20.5%), and cerebrovascular disease 8.0% (4.5%-14.3%), although significant between-study heterogeneity was present (P < 0.05). Autonomic disorder and Guillain-Barré syndrome carried a prevalence of less than 0.1%. No case of plexopathy was reported. CONCLUSIONS NP syndromes were estimated to exist in more than half of SLE patients. The most prevalent manifestations were headache, mood disorders, and cognitive dysfunction. A major limitation of the study was the significant heterogeneity of prevalence estimates between studies.
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Affiliation(s)
- Avraham Unterman
- Department of Medicine B and Center of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
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99
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Arnson Y, Shoenfeld Y, Alon E, Amital H. The Antiphospholipid Syndrome as a Neurological Disease. Semin Arthritis Rheum 2010; 40:97-108. [DOI: 10.1016/j.semarthrit.2009.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 04/08/2009] [Accepted: 05/03/2009] [Indexed: 02/06/2023]
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100
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Dogdu O, Yarlioglues M, Kaya MG, Ardic I, Oguzhan N, Akpek M, Sahin O, Akyol L, Kelesoglu S, Koc F, Ozdogru I, Oguzhan A. Deterioration of heart rate recovery index in patients with systemic lupus erythematosus. J Rheumatol 2010; 37:2511-5. [PMID: 20810503 DOI: 10.3899/jrheum.100163] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disorder resulting in multisystemic inflammatory damage. It is reported that cardiovascular diseases (CVD) are responsible for 20%-30% of deaths in patients with SLE. Heart rate recovery after exercise is a function of vagal reactivation, and its impairment is an independent prognostic indicator for cardiovascular and all-cause mortality. The aim of our study was to evaluate the heart rate recovery index in patients with SLE. METHODS The study population included 48 patients with SLE (35 women, mean age 46.3 ± 12.8 yrs, mean disease duration 6.0 ± 2.3 yrs) and 44 healthy controls (30 women, mean age 45.7 ± 12.9 yrs). Basal electrocardiography, echocardiography, and treadmill exercise testing were performed on all patients and controls. The heart rate recovery index was defined as the reduction in the heart rate from the rate at peak exercise to the rate at the first minute (HRR(1)), second minute (HRR(2)), third minute (HRR(3)), and fifth minute (HRR(5)) after stopping exercise stress testing. RESULTS There were significant differences in HRR(1) and HRR(2) indices between patients with SLE and the control group (24.1 ± 6.5 vs 33.3 ± 9.3; p < 0.001, and 44.6 ± 13.3 vs 53.7 ± 9.9; p < 0.001, respectively). Similarly, HRR(3) and HRR(5) indices of the recovery period were lower in patients with SLE, compared with indices in the control group (57.6 ± 13.0 vs 64.9 ± 11.7; p = 0.006, and 67.2 ± 12.3 vs 75.0 ± 15.4; p = 0.009, respectively). Effort capacity was markedly lower (9.0 ± 1.9 vs 11.1 ± 2.3 metabolic equivalents; p = 0.001, respectively) among the patients with SLE. CONCLUSION The heart rate recovery index is deteriorated in patients with SLE. When the prognostic significance of the heart rate recovery index is considered, these results may contribute to explain the increased occurrence of cardiac death. It points to the importance of the heart rate recovery index in the identification of high-risk patients.
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Affiliation(s)
- Orhan Dogdu
- Erciyes University School of Medicine, Department of Cardiology, Kayseri, Turkey.
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