Jan. 31, 2010

Can Blood Tests Help Us Learn about CNS Lupus (Lupus and the Brain)?

Identification of autoantigens specific for systemic lupus erythematosus with central nervous system involvement.
Authors: Iizuka N, Okamoto K, Matsushita R, Kimura M, Nagai K, Arito M, Kurokawa MS, Masuko K, Suematsu N, Hirohata S, and Kato T. (2009).
Lupus, epub ahead of print December 21.

What is the topic?

Some people with lupus can develop mild or, more rarely, severe inflammation of the brain, also called Central Nervous System lupus (CNS lupus). Very rarely, people can develop serious problems from CNS lupus such as seizures or strokes.

Sometimes it is hard to know the difference between CNS lupus and problems that might be due to fatigue, depression, or migraine headaches. Therefore, it would be helpful to have blood tests that could tell the difference, so appropriate treatments could be given.

What did the researchers hope to learn?

The researchers wanted to find out if any proteins in the blood could be used to diagnose CNS lupus.

Who was studied?

60 lupus patients were studied. Half had CNS lupus and half did not.

How was the study conducted?

Blood samples were taken from each patient and the researchers looked to see whether the patients were making antibodies (immune proteins) that would have the potential to irritate brain cells.

Three patients also had a spinal tap to obtain spinal cord fluid, which surrounds the brain and circulates down the spine. Antibodies were studied in the cerebrospinal fluid samples, too, and compared to those found in the blood samples.

What did the researchers find?

The researchers found that antibodies against four specific proteins appeared more frequently in blood samples taken from people with CNS lupus than in other people with lupus. These four proteins are known to be involved in protecting cells from damage, breaking down proteins no longer needed, and regulating how new proteins are made in the body.

What were the limitations of the study?

Antibodies to the four proteins studied were also found in some of the people with lupus who never had CNS symptoms so just having these antibodies may not indicate the presence of CNS lupus or the possibility of developing this complication. Also, at least one of the antibodies was studied in only a small number of the blood samples. Only three people actually had the spinal tap, so no conclusions can be drawn from that part of the study. Nothing is known at this time about exactly how any of these proteins that the antibodies recognize might contribute to lupus or CNS lupus flares.

What do the results mean for you?

This study identified four possible proteins that seem to be a little more common in those lupus patients who develop CNS lupus. A better understanding of what their possible role is in lupus flares, or specifically in CNS lupus flares, might lead to new kinds of treatments in the future.

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