Abstract
The aim of this study was to investigate the association of anti-early apoptotic cell autoantibodies, anti-SSA, and anti-SSB with clinical features of lupus nephritis (LN). Multiparameter flow cytometry was used to determine early apoptotic cells and for measuring the simultaneous binding of annexin V, 7-AAD, and IgG from LN patients (n = 39). The association between clinical features of LN and autoantibodies against early apoptotic cells, and between the autoantibodies and anti-SSA and anti-SSB, were further investigated. Thirteen LN patients (33.3 %) were positive for autoantibodies against early apoptotic cells. The prevalence of anti-SSA and anti-SSB were similar in patients with anti-early apoptotic cell autoantibodies and those without (anti-SSA: 9/13 versus 15/26; anti-SSB: 3/13 versus 4/26). Anti-early apoptotic cell antibody-positive patients had lower C3 levels (0.34 ± 0.22) than the antibody-negative patients (0.47 ± 0.17, p = 0.059); and significantly higher anti-dsDNA levels (502.99 ± 275.48 versus 214.13 ± 229.29, p = 0.001). In univariate logistic regression analysis, the presence of anti-early apoptotic cell antibody could predict poor short-term prognosis (HR 7.500, 95 % CI: 1.210 - 46.504, p = 0.030), while patients who were double positive for anti-SSA and anti-early apoptotic cell antibody had significantly increased risk of poor short-term outcome (HR 17.500, 95 % CI: 2.500 - 122.500, p = 0.004). The combination of anti-early apoptotic cell autoantibodies and anti-SSA might be of predictive value in LN.
Highlights
Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease characterized by the production of multiple pathogenic autoantibodies associated with multiple organ damage
The results reveal that sex, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), serum creatinine, anti-SSB antibody at baseline are risk factors
Results from assays of autoantibodies against early apoptotic cells in anti-SSA positive SLE patients have suggested that SSA is the major autoantigen exposed on the surface of early apoptotic cells [21]
Summary
Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease characterized by the production of multiple pathogenic autoantibodies associated with multiple organ damage. Decades of investigations have revealed that a variety of potentially pathogenic autoantibodies are implicated in SLE. These are anti-double-stranded DNA (anti-dsDNA) antibodies [2,3,4], anti-C1q antibodies [5,6,7,8], anti-ribosomal P proteins antibodies [9], antiSm antibodies [10], and anti-C-reactive protein (CRP) antibodies [11,12,13]. High titers of anti-SSA antibodies have been found in eluates from kidneys of patients with progressive renal disease [14], and several clinical studies have demonstrated that the presence of anti-SSA or anti-SSB antibodies is correlated with poor outcome in LN [15, 16]
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