ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 799

Acetylcholinesterase Is Highly Expressed in the Inflamed Vessel Wall of Patients with Giant Cell Arteritis

Philip Therkildsen1, Berit Dalsgaard Nielsen1, Kresten Krarup Keller2, Torben Steiniche3, Lars Christian Gormsen4, Ib Tønder Hansen5 and Ellen-Margrete Hauge6, 1Department of Rheumatology, Aarhus University Hospital, Aarhus C, Denmark, 2Rheumatology, Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, 3Department of Histopathology, Aarhus University Hospital, Aarhus C, Denmark, 4Nuclear Medicine and PET Center, Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Århus C, Denmark, 5Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, 6Department of Rheumatology, Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , ,

Session Information

Date: Sunday, November 5, 2017

Title: Vasculitis Poster I: Large Vessel Vasculitis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: The temporal artery biopsy (TAB) remains the gold standard in the diagnosis of giant cell arteritis (GCA). However, TABs are false-negative in 40% of cases. Cellular studies have shown that activated immune cells upregulate the expression of acetylcholinesterase (AChE). If AChE is upregulated in the active GCA vessel wall, it may potentially improve the TAB as a diagnostic tool. The purpose was to investigate the in-situ expression of AChE in the vessel wall of patients with TAB-positive GCA and compare to non-GCA patients. Methods: In this histological case-control study, TABs from a total of 24 TAB-positive GCA and 44 TAB-negative non-GCA patients were retrospectively included from the period 2012-2015. Only positive TABs showing clear transmural inflammation were included. Clinical data were obtained from electronic patient records to confirm or dismiss clinical diagnosis. Immunohistochemical methods were used to determine the AChE expression and verified using positive/negative controls. The histological inflammation and AChE expression were assessed and graded on 0-1-2 scale by a pathologist, blinded to clinical data. Solitary AChE staining of the media was not included in the assessment. Results: All positive TABs showed ACHE expression, 10/24 showed high AChE expression (grade 2) and 14/24 showed moderate AChE expression (grade 1). No non-specific AChE expression was observed outside the media in any of the negative TABs from non-GCA patients (i.e. grade 0). The AChE expression was in 79% agreement with the histological inflammation. Prednisolone treatment did not suppress the AChE expression. Neither the AChE expression, nor the histological inflammation showed correlation with any clinical findings. Clinical characteristics of included patients are shown in table 1. Conclusion: High to moderate AChE expression was observed in all 24 biopsies from TAB-positive GCA patients, and the AChE expression was in good agreement with the histological inflammation. No false positive staining was observed in any of the 44 TABs from TAB-negative non-GCA patients. This indicates that AChE could be a potential biomarker in GCA and may play a significant role in the inflammatory process in GCA.

Table 1: Baseline characteristics

Variables

Positive biopsy diagnosed with GCA N=24

Negative biopsy diagnosed with PMR N=21

Negative biopsy diagnosed with other disease1 N=23

p value

Age (mean (95% CI), years)

70.1 (67.5-72.8)

71.6 (67.5-75.6)

68.7 (64.1-73.3)

0.565

Females – no. (%)

16/24 (67)

11/21 (52)

13/23 (57)

0.613

Time from symptoms to hospital admission (median (95% CI), days)

41 (27-63)

70 (37-132)

83 (40-170)

0.198

Cumulative prednisolone dose before biopsy (median (95% CI), mg)

204 (136-308)

136 (81-231)

197 (73-535)

0.672

Fulfilled ACR criteria for GCA – no. (%)

23/24 (96)

2/21 (10)

7/23 (30)

0.000*

Localized headache2 – no. (%)

17/22 (77)

2/18 (11)

9/20 (45)

0.000*

Abnormal temporal artery3 – no. (%)

14/23 (61)

4/18 (22)

9/19 (47)

0.047*

ESR (mean (95% CI), mm/hour)

73.9 (62.2-85.5)

39.1 (25.6-52.6)

40.3(25.0-55.6)

0.000*

CRP (median (95% CI), mg/l)

65.8 (44.8-96.5)

33.3 (20.9-53.0)

8.0 (3.8-16.6)

0.000*

Continuous variables are expressed as mean (95% CI); in cases of logarithmic transformation, data are expressed as median (95% CI). Binomial variables are expressed as number (percentage). * Statistical significant

1 Cancer, osteo arthritis, infection, or ischemic vascular disease.

2 New unilateral headaches localized in either the occipital, frontal or temporal region.

3 Tenderness, thickening or decreased pulse of the temporal artery.

   
Disclosure: P. Therkildsen, None; B. D. Nielsen, None; K. K. Keller, None; T. Steiniche, None; L. C. Gormsen, None; I. Tønder Hansen, None; E. M. Hauge, None.

To cite this abstract in AMA style:

Therkildsen P, Nielsen BD, Keller KK, Steiniche T, Gormsen LC, Tønder Hansen I, Hauge EM. Acetylcholinesterase Is Highly Expressed in the Inflamed Vessel Wall of Patients with Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/acetylcholinesterase-is-highly-expressed-in-the-inflamed-vessel-wall-of-patients-with-giant-cell-arteritis/. Accessed .

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