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Avidity of antibodies in SLE: relation to severity of renal involvement.

The avidity of antibodies to DNA in the sera of 8 patients with SLE was determined by saturation analysis and Scatchard plots. Five of the patients had severe lupus nephritis; the other 3 had relatively mild or no kidney disease. The Scatchard plots revealed components with high relative avidity in the patients with severe nephritis (K values 4.4-10.4 X 10(5) M-1 for nDNA), compared with the patients who had mild or no kidney disease (K values 0.3-1.8 X 10(5) M-1 for nDNA). Avidity measurements may be helpful in the evaluation and treatment of patients with SLE.

Affinity Labels↗

Central nervous system involvement in SLE. Diagnostic profile and clinical features.

The clinical course and diagnostic profile of 13 patients with central nervous system involvement and systemic lupus erythematosus (CNS-SLE) are presented. The diagnostic yield for each procedure was measured as the precent abnormal: CSF total protein was 38%; increased CSF IgG 69%; decreased CSF hemolytic C4 10%; increased CSF anti-DNA 64%; electroencephalogram 80%; flow brain scan 50%; and static brain scan 0%. No single procedure was consistently abnormal, but the battery of tests provided a useful and specific CNS-SLE diagnostic profile.

Adrenal Cortex Hormones↗

T-lymphocyte subpopulation in untreated SLE. Variations with disease activity.

An active subpopulation of T lymphocytes characterized by their ability to form early rosettes with sheep erythrocytes (active E-RBL) was studied in the blood of 50 patients with untreated systemic lupus erythematosus (SLE) and in 50 normal controls. The findings were related to the absolute number of circulating lymphocytes and total E-receptor-bearing lymphocytes (total E-RBL). Lupus patients with active disease had markedly decreased absolute lymphocyte counts, but the decrease of both the total and the active E-RBL surpassed what would be expected from the lymphopenia. Patients with inactive disease had moderately decreased absolute lymphocyte counts with a marked and disproportionate decrease in total E-RBL and a moderate decrease in active E-RBL, which seemed to reflect only the absolute lymphopenia. Patients with active disease had significantly lower active E-RBL than those with inactive disease. The changes of these and other lymphocyte subpopulations in relation to disease activity in SLE may reflect the influence of factors leading to T-cell depletion and immaturity. Circulating thymic products may be one of those factors.

Adolescent↗

Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE.

OBJECTIVE: To standardize outcome measures in systemic lupus erythematosus (SLE). Three indices were identified which could adequately describe outcome (disease activity, damage from disease, and health status); we describe here the development of the Disease Activity Index. METHODS: Twenty-four variables were identified as important factors in a disease activity index. These were used to generate 574 patient profiles, which were rated on a disease activity scale of 0-10 by 14 rheumatologists. A second rating of 10 of the profiles yielded scores that were not significantly different from the first, indicating that experienced clinicians can reliably make global estimates of disease activity. Multiple regression models were used to estimate the relative importance of the 24 clinical variables in the physicians' global rating of disease activity. These were estimated on a "training set" of 75% of physicians' ratings, and then validated on a "testing set," consisting of the remaining 25% of physicians' ratings. RESULTS: The explanatory power of the models in the training set was high (R2 = 0.93). The models' regression coefficients for the organ systems were simplified for easier use in clinical practice. This generated a "weighted" index of 9 organ systems for disease activity in SLE, the SLEDAI, as follows: 8 for central nervous system and vascular, 4 for renal and musculoskeletal, 2 for serosal, dermal, immunologic, and 1 for constitutional and hematologic. The maximum theoretical score is 105, but in practice, few patients have scores greater than 45. The SLEDAI predicted well the physicians' ratings in the testing set (Pearson's correlation coefficients = 0.64-0.79). CONCLUSION: The SLEDAI is a validated model of experienced clinicians' global assessments of disease activity in lupus. It represents the consensus of a group of experts in the field of lupus research.

Central Nervous System↗

Regional cerebral glucose metabolism in SLE chorea: further evidence that striatal hypometabolism is not a correlate of chorea.

The pathophysiology of chorea in systemic lupus erythematosus (SLE) is uncertain. Pathologic examination has not identified a specific location for the causative lesion(s) and immunologic mechanisms have been suggested in its etiology. In other choreic disorders, such as Huntington's disease and benign hereditary chorea, glucose hypometabolism in the striatum has been demonstrated by positron computed tomography (PCT) using [18F]deoxyglucose. With this technique we have studied four patients with chorea secondary to SLE. In these patients the regional distribution of cerebral glucose metabolism was normal. In particular, striatal glucose metabolism was within the normal range, even though the ratio of striatal to cortical glucose metabolism was increased. Our results show that striatal hypometabolism, as seen in other disorders manifesting chorea, is not the PCT correlate of the dyskinesia.

Adult↗

Alterations in hypothalamic-pituitary-adrenal function correlated with the onset of murine SLE in MRL +/+ and lpr/lpr mice.

Systemic lupus erythematosus (SLE) is a spontaneously occurring, chronic autoimmune disease that can manifest neuropsychiatric abnormalities. The pathways mediating these central changes are not known; however, neuroendocrine alterations associated with inflammation may play a role. Predisposition to and progression of autoimmune disease has been associated with altered hypothalamic-pituitary-adrenal (HPA) function and inflammation has been reported to alter hypothalamic regulation of HPA responses. We investigated whether disease progression in a murine model of systemic lupus erythematosus (MRL +/+. MRL lpr/lpr) resulted in altered expression of HPA regulatory peptides at the level of the hypothalamus and how these alterations related to circulating levels of corticosterone, corticosterone binding globulin, and autoantibody titers. We report that as MRL +/+ and MRL lpr/lpr mice age and circulating levels of autoantibodies increase, there is a decrease in hypothalamic CRH mRNA expression and finally an increase in AVP mRNA expression. We also report that associated with increased autoantibody levels, disease progression, and altered hypothalamic peptide expression there is an increase in circulating levels of corticosterone and a trend for levels of corticosterone binding globulin to decrease. Our data complement previous observations of altered peptidergic regulation of the HPA axis and increased HPA activity during chronic inflammation in exogenously induced rodent models of chronic inflammation and indicate that similar processes may occur in spontaneous murine models of SLE.

Aging↗

Estrogen decreases in vitro apoptosis of peripheral blood mononuclear cells from women with normal menstrual cycles and decreases TNF-alpha production in SLE but not in normal cultures.

Estrogen has been suspected of causing changes in the lupus disease process by an as yet undetermined mechanism. In vitro apoptosis of peripheral blood mononuclear cells (PBMCs) in short-term unstimulated cultures of systemic lupus erythematosus (SLE) cells is accelerated compared to that in cells from normal individuals. To determine whether estrogen might be involved in regulating the rate of apoptosis in lupus, PBMCs or T cells from women with or without normal menstrual cycles were cultured for 16-20 hr with or without 30 ng/ml estradiol. The rate of apoptosis of the cells was measured, and supernatants of these cultures were tested for various cytokines known to affect apoptosis directly or indirectly. Compared to untreated cultures, estrogen significantly reduced in vitro apoptosis of both patient (P < 0.05, n = 12) and normal (P < 0.001, n = 14) PBMCs if the donors had normal menstrual cycles. Estrogen did not decrease apoptosis of noncycling patient (n = 8) nor of normal (n = 11) cells. Apoptosis of T cells cultured alone was not affected by estrogen. Supernatants from patients' estrogen-treated PBMCs had significantly less TNF-alpha than untreated cultures (P < 0.05, n = 12). TNF-alpha levels from normals' cell cultures were unchanged. Changes in hormone status (hysterectomy or menopause) alter estrogen-sensitive apoptosis, which may be mediated through monocytes. Estrogen-induced decreases in apoptosis combined with decreased TNF-alpha production in the presence of estrogen may allow survival of auto-immune cells in SLE patients.

Apoptosis↗

Screening of SLE sera using purified recombinant Sm-D1 protein from a baculovirus expression system.

The Sm-D1 polypeptide is a major target of autoantibodies diagnostic for systemic lupus erythematosus (SLE). The cDNA encoding the human antigen was expressed as a full-length, nonfusion protein using a eukaryotic baculovirus expression system. This recombinant version of Sm-D1 (rSm-D1) was purified to apparent homogeneity by a combination of differential extraction steps and FPLC chromatography. A direct antibody-binding ELISA was developed using the purified antigen. There was 96% correlation between the rSm-D1 and bona fide Sm-D1 from either HeLa cells or rabbit thymus when tested against Sm-positive patient sera by ELISA. The baculovirus-expressed Sm-D1 is reactive not only with patient anti-Sm sera, but also with anti-Sm monoclonal antibodies. Our results suggest that this rSm-D1 mimics the bona fide sources, providing a valuable addition to the roster of antigens available for SLE screening, epitope mapping and overall structure study.

Antibodies, Monoclonal↗

p32, a platelet autoantigen recognized by an SLE-derived autoantibody that inhibits platelet aggregation.

We have previously described an SLE-derived human hybridoma autoantibody, 9604, which binds to activated but not to resting platelets, inhibits platelet aggregation, and immunoprecipitates a surface-labelled poly-peptide of 32,000 molecular weight (MW) (p32). In the present study, using a murine monoclonal anti-p32 antibody (8E8), we show that p32 is responsible for the binding of 9604 to activated platelets. First, 8E8 bound to the surface of activated but not resting platelets, as detected by flow cytometry, showing saturation with 1900 antibody molecules bound/platelet and a Kd of 72 nM. Second, complete inhibition of the binding of 9604 to ADP-activated platelets by 8E8 and inhibition of the reactivity of 8E8 with p32 by 9604 demonstrated that 8E8 and 9604 recognize the same 32,000 MW platelet polypeptide. Isolation of platelet proteins, using an 8E8-affinity column, showed high MW bands corresponding to multimers of p32 under non-reducing conditions, and isolated p32 tended to self-associate even under reducing conditions. High performance liquid chromatography (HPLC) demonstrated that the native p32-containing protein has an approximate MW of 450,000. A comparison of the functional properties of murine monoclonal 8E8 and human monoclonal 9604 revealed that both antibodies are cytotoxic to platelets in 51Cr-release assays. In contrast, 8E8, unlike 9604, did not affect platelet aggregation, suggesting that different epitopes may be recognized by the two antibodies. These findings demonstrate that p32 is a subunit of an activation marker that is expressed on the surface of activated platelets and recognized by an SLE-derived anti-platelet autoantibody. Our data also indicate that murine monoclonal antibodies produced against platelet autoantigens may not mimic the functional activities of spontaneously occurring autoantibodies, probably due to the recognition of different epitopes.

Animals↗

The urine of SLE patients contains antibodies that bind to the laminin component of the extracellular matrix.

Direct immunofluorescence of tissues derived from patients affected with SLE demonstrates antibodies bound to the extracellular matrix (ECM). In the present work we have tested whether such antibodies are found in the serum and urine of lupus patients and mice. We found that the urine of patients with active SLE and of MRL/lpr/lpr mice contains antibodies that bind ECM and that a major target for these antibodies is the 200 kDa light chain of laminin which is one of the matrix components. The level of the anti-ECM, anti-laminin antibodies correlates with disease activity.

Albuminuria↗

Sex hormones and SLE: influencing the fate of autoreactive B cells.

The prevalence of systemic lupus erythematosus (SLE) is far higher in females than in males and numerous investigations to understand this gender bias have been conducted. While it is plausible that some sex-linked genes may contribute to the genetic predisposition for the disease, other likely culprits are the sex hormones estrogen and prolactin. In this chapter we review studies that have addressed the influence of sex hormones in SLE activity and discuss the recent data established in a BALB/c mouse transgenic for the heavy chain of an anti-DNA antibody. These mice are prone to develop lupus following exposure to exogenous sex hormones. We describe how estrogen and prolactin influence B cell maturation and selection, permitting B cells to mature to immunocompetence. Finally, we discuss the relevance and implications of these data for human disease.

Animals↗

HLA-antigens in systemic lupus erythematosus (SLE).

Histocompatibility antigens were determined in 27 patients with SLE and 283 normal blood donors. HLA-B8 was significantly increased in patients with SLE (59.3%) as compared to the controls (20.5%, Pc less than 0.005). The relative risk for HLA-B8 was 5.64. No correlation could be demonstrated to specific organ involvement, immunopathological data, age of onset or prognosis.

Adolescent↗

Monoclonal human anti-DNA antibodies from EB virus-transformed lymphocytes of systemic lupus erythematosus (SLE) patients.

Sixteen monoclonal human anti-DNA antibodies were obtained from Epstein-Barr virus-transformed lymphoblastoid cells of patients with systemic lupus erythematosus (SLE) and were studied in terms of antigenic specificity. All of the antibodies showed polyspecificity to polynucleotides. Among them, some antibodies had a specificity to single-stranded (ss) DNA. Especially, O-8 antibodies showed a preference for polynucleotides with pyrimidine bases. The binding specificity of the antibody was also studied using different sizes of dT oligomers in order to assess the size of the epitope. It was revealed that oligonucleotides with a size of more than 25-30 nucleotides are required for inhibition of the antibody to ss-DNA. Other studies also demonstrated that anti-ss-DNA (O-8) antibody and anti-double-stranded (ds) DNA (NE-28) antibody bound to different combining sites in the same polynucleotides, poly(dT). These results suggest that some anti-ss-DNA antibodies are directed to the conformational structure related to the base sequence and that nucleic acids, therefore, might be responsible for the possible immunogenic stimulus causing the anti-DNA immune response. We also indicate that this type of antibody would be popular among serum anti-DNA antibodies in SLE.

Antibodies, Monoclonal↗

Immunoregulation of SLE-like disease by the IL-1 receptor: disease modifying activity on BDF1 hybrid mice and MRL autoimmune mice.

Due to the immunopharmacological profile of the recombinant IL-1 receptor (IL-1-R) and its potential to modulate biological activity in various inflammatory autoimmune disease models, we further elucidated its disease modifying activity on the development of a systemic lupus erythematosus (SLE)-like disease in BDF1 hybrid mice and in MRL/lpr autoimmune mice. Treatment of BDF1 mice with the IL-1-R during the induction phase resulted in a strong inhibition of the development of a glomerulonephritis, prolonged the survival time and improved the survival rate. Even a therapeutic effect was demonstrated when this receptor was given after the appearance of clinical symptoms. Treating MRL/lpr mice, which develop spontaneously a SLE-like disease, with the IL-1-R resulted in an inhibition of the developing glomerulonephritis and splenomegaly, in a reduction of swollen lymph nodes and in a decrease of autoantibody formation. Even in the established autoimmune disease of MRL/1 pr mice the IL-1-R reduced proteinuria, the levels of autoantibodies and also improved the survival rate.

Animals↗

Is MCTD a distinct entity? Comparison of clinical and laboratory findings in MCTD, SLE, PSS, and RA patients.

Eighteen patients diagnosed as suffering from MCTD were reexamined during follow-up (mean duration 4.6 years). The clinical features of these patients were compared with those of 19 patients with systemic lupus erythematosus (SLE), 11 with progressive systemic sclerosis (PSS) and 22 with rheumatoid arthritis (RA). Considerable overlapping of abnormal features was found between MCTD and the other syndromes. At the end of the follow-up period, 70 per cent of the cases initially diagnosed as MCTD evolved to a more classical connective tissue disease, i.e., either PSS or SLE. Generally, however, the clinical evolution of the individual MCTD patient was not predictable. Abnormal aortic valve calcifications were found in the MCTD group. Four of the 18 MCTD patients were anti-RNP negative at reexamination. There was a tendency for HLA antigens B7 and B8 to be increased in the MCTD group, but this difference was not statistically significant. Three MCTD patients died before they could be reexamined (two of them from pulmonary hypertension with proliferative endarteritis of the lung vessels and one from septicaemia and multiple cerebral infarctions.

Adult↗

Antibodies to extractable cellular antigens in Spanish systemic lupus erythematosus (SLE) patients.

We studied the frequency of antibodies to extractable cellular antigens in 90 Spanish SLE patients. Antibodies to Sm, nRNP, Ro and La were found, respectively, in 6 (6.6%), 18 (20%), 30 (33.3%) and 6 (6.6%) patients. In spite of HLA differences, these results are similar to those found by other authors in Caucasian SLE patients. Our only relevant association was the finding of severe renal disease and high frequency of anti-DNA and hypocomplementemia in patients with antibodies to Ro. Based on these and earlier findings, we discuss the possibility that the immune response to Ro in Spanish patients might be located in a unique extended HLA-complement haplotype.

Adult↗

Pulmonary amyloidosis and unusual lung involvement in SLE.

The association of systemic lupus erythematosus (SLE) with amyloidosis is exceptional. We present a 37-year-old patient who was diagnosed five months earlier for SLE. She developed an acute episode of chest pain, cough and dyspnoea. Hypoxemia and obstructive changes in respiratory tests were present. The chest X-ray was repeatedly normal. Open lung biopsy revealed lupus pneumonitis with positive stain for immunoglobulins and complement, bronchiolitis obliterans, and pulmonary amyloidosis.

Adult↗

A case of association between type I hyperlipoproteinemia and systemic lupus erythematosus (SLE). Effects of steroid treatment.

The case of a girl aged 19 yr with hypertriglyceridemia and systemic lupus erythematosus (SLE) is described. The girl had been admitted to a Lipid Outpatient Clinic in 1981 and diagnosed as having a Type I hyperlipidemia pattern. In November 1984 the patient acutely developed a SLE syndrome. Steroid treatment led to a dramatic fall of serum triglycerides from a starting value of 2100 mg/dl to 95 mg/dl. The role of steroids in completely correcting genetically deficient Lipoprotein Lipase Activity (LLA) is discussed.

Adult↗