Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disease that is mainly diagnosed based on its clinical symptoms. Biomarkers that could facilitate the diagnosis of ME/CFS are not yet available; therefore, reliable and clinically useful disease indicators are of high importance. The aim of this work was to analyze the association between ME/CFS clinical course severity, presence of HHV-6A/B infection markers, and plasma levels of autoantibodies against adrenergic and muscarinic acetylcholine receptors. A total of 134 patients with ME/CFS and 33 healthy controls were analyzed for the presence of HHV-6A/B using PCRs, and antibodies against beta2-adrenergic receptors (β2AdR) and muscarinic acetylcholine receptors (M3 AChR and M4 AChR) using ELISAs. HHV-6A/B U3 genomic sequence in whole-blood DNA was detected in 19/31 patients with severe ME/CFS, in 18/73 moderate ME/CFS cases, and in 7/30 mild ME/CFS cases. Severity-related differences were found among those with a virus load of more than 1,000 copies/106 PBMCs. Although no disease severity-related differences in anti-β2AdR levels were observed in ME/CFS patients, the median concentration of these antibodies in plasma samples of ME/CFS patients was 1.4 ng/ml, while in healthy controls, it was 0.81 ng/ml, with a statistically significant increased level in those with ME/CFS (p = 0.0103). A significant difference of antibodies against M4 AChR median concentration was found between ME/CFS patients (8.15 ng/ml) and healthy controls (6.45 ng/ml) (p = 0.0250). The levels of anti-M4 plotted against disease severity did not show any difference; however, increased viral load correlates with the increase in anti-M4 level. ME/CFS patients with high HHV-6 load have a more severe course of the disease, thus confirming that the severity of the disease depends on the viral load—the course of the disease is more severe with a higher viral load. An increase in anti-M4 AchR and anti-β2AdR levels is detected in all ME/CFS patient groups in comparison to the control group not depending on ME/CFS clinical course severity. However, the increase in HHV-6 load correlates with the increase in anti-M4 level, and the increase in anti-M4 level, in turn, is associated with the increase in anti-β2AdR level. Elevated levels of antibodies against β2AdR and M4 receptors in ME/CFS patients support their usage as clinical biomarkers in the diagnostic algorithm of ME/CFS.

BackgroundGround-glass opacification (GGO) is a common but non-specific radiological pattern on multislice spiral computed tomography (MSCT) scans which can refer to the interstitial or vascular involvement. Due to polymorphism of pulmonary pathology in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) GGO requires a multi-stage differential diagnosis the result of which will significantly affect the treatment regimen - a choice between antibiotic or cytostatic and high-dose hormonal therapy.ObjectivesThe aim of this study was to optimize the ability of MSCT for differentiating between interstitial and vascular involvement and detecting pulmonary thrombosis using newly developed post-processing techniques.Methods120 patients, aged 39.5 ± 13.7, with moderate-severe lupus activity were administrated a complex of laboratory, pulmonary function and imaging tests. It is the first time when post-processing techniques (PPTs) such as MPR (Multiplanar reformations), MIP (Maximum intensity projection), mIP (Minimum intensity projection) and especially color mapping were used for evaluation of vascular involvement on native MSCT scans of patients with SLE and APS. The criteria of pulmonary vasculitis on color maps were described as enhanced peripheral vascularization (vessel caliber enlargement and increase in vessel tortuosity) and perivascular edema. The criteria of pulmonary thrombosis - areas of micro-infarctions in the peripheral regions of lungs. CT angiography and pulmonary perfusion scintigraphy were chosen as methods of gold standard. Reconstructed scans were compared with native CT scans, CT angiograms and perfusion scans done by three diagnosticians.ResultsStatistics showed that the mean area under the receiver operating characteristic curve value increased significantly from 0.713 without the PPTs to 0.925 with the PPTs (P<0.05) in differentiating between vasculitis and pneumonic infiltration and increased significantly from 0.527 without the PPTs to 0.724 with the PPTs (P<0.05) in detecting thrombosis. Compared with CT angiogram and perfusion scans no differences in the involved regions were detected. Variants that were associated with enhanced peripheral vascularization on color maps in a significant manner were: rate of diffusion capacity (p=0.006), hypocomplementemia (p=0.01), hypoxemia (p=0.003), pulmonary hypertension (p=0.01). The presence of lupus anticoagulant in patients with SLE was associated with the development of pulmonary thromboembolism (p=0.001) and pulmonary vasculitis complicated with thrombosis in situ (p=0.04).Image 1. Multi-stage differential diagnosis of GGO in patients with SLE and APS using PPTs.ConclusionsPPTs are a useful addition to native MSCT scans in detecting early signs of pulmonary vasculitis, differentiating between vasculitis and pneumonic infiltration and evaluation of treatment-related changes. It equips radiologists to more easily detect areas with thrombosis especially thrombosis in situ due to pulmonary vasculitis.Disclosure of InterestN...

The article describes a clinical case of systemic lupus erythematosus (SLE) resistant to traditional treatment regimens and the first successful experience with the type I interferon inhibitor – anifrolumab, as part of an early access program in the Russian Federation. High efficacy and safety of the drug in the treatment of SLE with active lesions of the skin, mucous membranes and joints were noted.