Auto antibodies in the cerebrospinal fluid of patients with systemic lupus erythematosus

Abstract

Autoantibodies may play an important role in the pathogenesis of centpal nervous system (CNS) disease in systemic lupus erythematosus (SLE). We obtained cerebrospinal fluid (CSF) and, in some cases, sera from 19 SLE patients with CNS lupus and from 12 SLE patients without CNS lupus. Autoantibodies to saline solable cellular antigens were detected in the CSF of lupus patients and reflected those present in the serum. These antibodies were distinct from the previously described antineuronal antibodies. Analysis of the fine specificities of the anti-saline soluble cellular antigen antibodies revealed that the antiribosomal P protein antibody was present in 4 of 4 patients with lupus psychosis and was enriched in the CSF of 1 patient. Sera containing antiribosomal P protein showed prominent cytoplasmic staining of human cortical neurons, as well as an epithelial cell substrate. These observations, together with the increase in intrathecal 1gG synthesis detected in 71% of patients tested, suggest that several populations of antibodies may contribute to the enhanced immunologic activity in the CSF of CNS lupus patients. Abnormalities of the central nervous system (CNS) function in systemic lupus erythematosus (SLE) often occur in the absence of generalized disease activity (1). In view of the paucity of morphologic changes detected in brains of patients studied postmortem (2,3), the pathogenesis of CNS lupus is uncertain. Several observations, including evidence for antineuronal membrane antibodies (4-9), an elevated IgG index (lo), and possible oligoclonal bands in the cerebrospinal fluid (CSF) (lo), suggest that antibodies could play a role in the pathogenesis of CNS lupus. Since it has been proposed that autoantibodies to specific nuclear (1 1) and cytoplasmic (12) antigens play a role in the pathogenesis of other presumed imrnunologically mediated neurologic syndromes, we characterized the specificities of autoantibodies found in the cerebrospinal fluid of lupus patients. PATIENTS AND METHODSPatients. Cerebrospinal fluid samples were obtained from 31 inpatients at The Hospital for Special Surgery and The New York Hospital. Eleven patients had serum samples drawn simultaneously. Each patient satisfied the revised criteria for SLE established by the American Rheumatism Association (13).CNS dysfunction secondary to SLE was defined, according to the criteria of Kassan and Lockshin (14), as an abnormality of neurologic function that is different from a prior state once metabolic abnormalities, infections, neoplasms, drug-induced abnormalities, and other independent neurologic diseases have been excluded. Steroids were believed to be responsible for neurologic dysfunction (seizures, psychosis) when there was a clear temporal relationship between CNS dysfunction and increased steroid dose. Non-neurologic disease activity was defined as the presence of 1 of the following: typical dermatitis, serositis, thrombocytopenia, recent onset of arthritis, or nephritis (recent onset of proteinuria [> 1 gm proteid24 hours], hematuri...

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Juvenile parkinsonism as a manifestation of systemic lupus erythematosus: Case report and review of the literature

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