Association of IgG Anti‐Brain Antibodies with Central Nervous System Dysfunction in Systemic Lupus Erythematosus

Abstract

Sera from 20 patients with systemic lupus erythematosus (SLE) and active central nervous system (CNS) dysfunction were examined by indirect immunofluorescence for antibodies to neuronal membrane determinants. Warm‐reactive IgG antibodies were demonstrable in 82% (9/11) of patients with clinical evidence for seizures or diffuse CNS disease, but these antibodies generally were absent in non‐CNS SLE sera or when focal neurologic deficit or psychosis was the primary CNS manifestation. Cold‐reactive antibodies of the IgM class were equally prevalent in patients with or without CNS disease and appeared to be more directly correlated with extra‐CNS systemic illness. Absorption experiments with lymphocytes, brain homogenate, and various other tissues suggested a predominant brainspecificity for IgG antibodies and partial lymphocyte cross‐reactivity for IgM antibodies. Interpretations of this special association between IgG anti‐brain antibodies and diffuse CNS dysfunction in SLE are discussed.

Antineuronal antibodies in neuropsychiatric systemic lupus erythematosus

“…However, the demonstration of antineuronal antibody activity in some patients without NP-SLE and the absence of this activity in some patients with NP-SLE (Tables 1 and 2 To explain the absence of antineuronal antibodies in some patients with clinical NP-SLE, one might hypothesize that in a significant subset of these patients, the pathogenesis of NP-SLE is not antibodymediated. This subset would probably include patients with focal manifestations, since the titer of antineuronal binding in these patients is considerably lower than in those with diffuse NP-SLE (Figure l), a trend noted previously by both Wilson (9) …”

“…A number of investigators have recently examined the clinical relevance of antibodies that react with brain-associated antigens in patients with clinically defined NP-SLE (4)(5)(6)(7)(8)(9)(10). Increased levels of lymphocytotoxins that cross-react with neuronal antigens in SLE sera or cerebrospinal fluid (CSF) have been shown to be associated with active neuropsychiatric disease (4-6).…”

Multiple serologic reactions and their relationship to clinical activity in systemic lupus erythematosus

“…Classifications that merely state that the disease was active if 1 or 2 systems were "involved" (24)(25)(26)(27)(28)(29) can have serious drawbacks. Initially, the University College Hospital (UCH) Middlesex lupus study group categorized the disease as inactive, mild, or severely active (13).…”

Binding Sites for Immune Components in Human Choroid Plexus

“…For example, circulating anti-brain antibodies have been demonstrated in systemic lupus erythematosus (25)(26)(27)(28). Immune complexes lodged in the choroid plexus of patients with this disease might induce a change in the permeability of the choroid plexus, allowing entry of circulating anti-brain antibodies normally excluded from the central nervous system.…”