Feb. 10, 2011

New Combination of Antibodies May Better Predict Childhood Neuropsychiatric Lupus

The role of measurement of serum autoantibodies in prediction of pediatric neuropsychiatric systemic lupus erythematosus
Authors: Mostafa GA, Ibrahim DH, Shehab AA, and Mohammed AK. (2010). Journal of Neuroimmunology 227: 195-201.

What is the topic?
Neuropsychiatric lupus (NPSLE) is difficult to diagnose and can be present when disease activity in other organs cannot be identified. 

Gangliosides are fats on the outer covering of cells and are found throughout the brain. Some people can make antibodies (immune proteins) that target one of these fats, called ganglioside M1. 

What did the researchers hope to learn?
The researchers hoped to learn whether antibodies to ganglioside M1 could predict childhood NPSLE any better than standard laboratory measures currently in use.  

Who was studied?
The researchers studied 30 children with lupus (24 girls and 6 boys) between the ages of 8 and 16. For purposes of comparison, 30 healthy children with no immune or neuropsychiatric disorders were also included. Children who clearly had NPSLE at the start of the study were not included since the idea was to see if the test for antibodies would predict the onset of NPSLE. 

How was the study conducted?
All of the children with lupus were given the steroid treatment prednisolone (0.5 mg/kg/day), either alone or along with other immune-suppressing drugs such as intravenous cyclophosphamide. The children were tested for symptoms of NPSLE and overall lupus disease activity. Blood was drawn from each study participant to assess anti-ganglioside and anti-ribosomal P antibodies. Patients were then examined and tested for brain function (neuropsychological tests) every month for one year.

What did the researchers find?
12 of the 30 children with lupus developed some clinical evidence of NPSLE during follow-up. Children with NPSLE had significantly higher anti-ganglioside and anti-ribosomal P antibodies than did healthy children or children with lupus that did not develop NPSLE. At the time of initial evaluation (and before NPSLE developed), 83% and 50% of children who later developed NPSLE had anti-ganglioside M1 and anti-ribosomal P antibodies, respectively. Both antibodies were found together in 33% of those patients. All patients who developed NPSLE during the study follow-up had at least one of the antibodies. None of the 18 patients who did not develop NPSLE had either one of these antibodies.

Children with higher levels of anti-ganglioside M1 antibodies seemed to have weaker results on brain (neuropsychological) tests. A similar trend was observed for children with higher levels of anti-ribosomal P antibodies, but this finding was not statistically confirmed. 

In children with lupus, overall disease activity level was not statistically related to levels of either anti-ganglioside or anti-ribosomal P antibodies. Levels of anti-nuclear antibodies or antibodies to double-stranded DNA were not statistically related to clinical evidence for NPSLE.   

What were the limitations of the study?
This small, preliminary study suggests that children with lupus may have anti-ganglioside M1 and anti-ribosomal P antibodies before developing NPSLE. This does not prove cause and effect and should be confirmed in a large group of children with lupus.   

What do the results mean for you?
This study found that anti-ganglioside M1 antibodies might help to predict NPSLE in children with lupus, especially when paired with anti-ribosomal P antibodies. 


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