Serologic Studies In Patients With Systemic Lupus Erythematosus And Central Nervous System Dysfunction

Abstract

Serologic studies were performed on 25 patients with systemic lupus erythematosus (SLE) during 29 acute episodes of central nervous system (CNS) disease. Increased anti-DNA antibody and decreased total serum hemolytic complement activity were observed only in those patients with associated extra-CNS disease manifestations. Patients with isolated CNS disease were otherwise in apparent clinical and serological remission regarding these two indices. No special association of cold-reactive IgM antilymphocyte antibodies was demonstrable in patients with ongoing CNS injury. Of special interest was an increased incidence of anti-Sm antibodies in the patients with CNS dysfunction relative to that in a large group BRUNNER, and DAVID KOFFLER of patients without neuropsychiatric disease. The incidence of anti-RNP was not increased.The data do not support direct involvement in SLE brain injury of either DNA/anti-DNA complexes or of lymphocytotoxic antibodies cross-reactive with brain cells, but do suggest an association of anti-Sm with CNS disease in this disorder.The pathogenesis of neuropsychiatric manifestations of systemic lupus erythematosus (SLE) has not been clearly defined. The enigma of central nervous system (CNS) injury contrasts with the considerable evidence implicating immune complexes as mediators of tissue injury in glomerulonephritis in SLE (1). Previous investigation of the mechanisms involved in brain injury has assumed an analogy with glomerulonephritis. Efforts directed toward complement (2-4), immunoglobulin (4,5), and anti-DNA or DNA/anti-DNA immune complex (4,6,7) determinations in cerebrospinal fluid have yielded conflicting data and have failed to establish clearly defined pathogenetic factors. The frequent absence of gross changes in cerebrospinal fluid protein and of pleocytosis (4,8,9) suggests that any abnormalities, if present, may be subtle.Distinctive serologic indices have not been identified, although little information is available in this area. Of interest is a recent demonstration of free DNA in the plasma of patients with CNS disease (lo), an observation suggesting participation of unusual antigen excess DNA/anti-DNA complexes in brain injury. Direct at-

Central Nervous System Lupus Erythematosus

“…Further studies of CSF complement and CSF anti-DNA qntibodies have also, by themselves, been unable to predict the presence of neurologic disease (25). No consistent relationship was found between the incidence or titer of serum antilymphocyte antibody in patients with or without neuropsychiatric manifestations of SLE (26). We find C-GMP, a normal constituent of the central nervous system, to be present in increased amounts in the CSF of SLE patients with active neurologic disease.…”

Antineurofilament antibody evaluation in neuropsychiatric systemic lupus erythematosus

“…Further study of these 3 procedures may heighten our diagnostic capabilities, expand our understanding of underlying pathophysiologic mechanisms, and perhaps have future therapeutic implications in this disease.…”

The Autoimmune Antigen me is Distinct and Related to Undifferentiated Connective Tissue Disease

“…In particular, the correlations between Sm antibody and nephritis and/or central nervous system involvement have varied considerably in published studies (13)(14)(15)17). Because of the possible relationship between the Me and Sm antigens (although they have been shown to be immunologically distinct in this study) and the preliminary indications that the Me system is most frequently associated with a mild undifferentiated connective tissue disease, it is possible that the discordant results…”

“…While there is general agreement that Sm antibodies have a strong correlation with SLE (12), whether the presence of Sm antibodies is associated with mild or more severe clinical features has remained controversial (13)(14)(15)(16)(17). In particular, the correlations between Sm antibody and nephritis and/or central nervous system involvement have varied considerably in published studies (13)(14)(15)17).…”

“…While there is general agreement that Sm antibodies are found almost exclusively in sera of patients with SLE (12), attempts to define clinical subsets of patients with SLE by the presence or absence of these antibodies have led to conflicting reports (13)(14)(15)(16)(17) antigens. CTNE was prepared from fresh calf thymus tissue by modification (5,6,31) of a previously described method (2).…”