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Abstract Number: 1626

Autoantibodies Against High Mobility Group Box 1 (HMGB1) in Patients with SLE

Fleur Schaper1, Gerda Horst1, Daan van Beijeren Bergen en Henegouwen1, Johan Bijzet1, Karina de Leeuw1, Alja Stel1, Pieter C Limburg2, Peter Heeringa3 and Johanna Westra1, 1Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, Netherlands, 2Laboratory Medicine, University Medical Center Groningen, Groningen, Netherlands, 3Pathology and Medical Biology, University Medical Center Groningen, Groningen, Netherlands

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: SLE and autoantibodies

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Session Information

Title: Systemic Lupus Erythematosus - Human Etiology and Pathogenesis: Autoimmune Disease Transition, Disease Subsets and Prediction of Flares, Cytokines and Autoantibodies

Session Type: Abstract Submissions (ACR)

Background/Purpose:

High mobility group box 1 (HMGB1) is a damage-associated molecular pattern and can be divided in three separate domains: the A Box, B Box and the acidic tail. Box A by itself serves as a competitive antagonist for HMGB1 and inhibits HMGB1 activity. In an earlier study we showed that anti-HMGB1 antibodies are present in Systemic Lupus Erythematosus (SLE) patients and may play a role in the pathogenesis of the disease, but are not present in patients with systemic vasculitis. In this study we investigate the relation between anti-HMGB1 antibodies and disease activity, renal involvement, anti-dsDNA antibodies and medication use. We performed cross-sectional and longitudinal analyses.

Methods:

Seventy-one SLE patients, 25 age and sex matched healthy controls (HC), and 15 disease control patients with incomplete lupus (fulfilled less than 4 of the ACR criteria), were included in this study. All 71 SLE patients were measured during quiescent or mild (SLEDAI ≤ 4) disease, and 28 were also measured during an exacerbation (SLEDAI ≥ 5). Furthermore, in a subgroup of patients (n=11) longitudinal levels of HMGB1 were determined over a period of three years. Serum levels of anti-HMGB1 IgG and IgM were measured using an in house ELISA. Epitope recognition was measured by ELISA against Box A and B IgG. Data are presented as arbitrary units (AU).

Results:

Quiescent as well as active SLE patients showed a significant increase in anti-HMGB1 IgG compared to HC (median 236 vs 339 vs 46 AU respectively). Incomplete lupus patients also had an increased anti-HMGB1 level compared to HC (p=0.03), but lower compared to SLE patients (ns). Patients recognized both Box A and Box B epitopes of the molecule. Anti-HMGB1 IgM levels were not different in patients versus controls. We did find an association with disease activity, as there was a significant decrease in Box A recognition after exacerbation (p=0.028). No differences were found comparing active patients with renal involvement to patients without for anti-HMGB1 IgG, IgM, Box A and Box B. There was also no effect of immunosuppressive medication, including hydroxychloroquine, on anti-HMGB1 levels. Finally, longitudinal values of anti-HMGB1 IgG showed similar patterns compared to anti-dsDNA and might even increase shortly before an increase in anti-ds DNA levels are seen.

Conclusion:

Anti-HMGB1 antibodies seem specific for SLE, as they were significantly increased compared to HC. Interestingly, also incomplete lupus patients showed already a minor increase of anti-HMGB1 antibodies. Antibodies directed to Box A decreased after an exacerbation, indicating a correlation with disease activity. Furthermore, longitudinally levels of anti-HMGB1 seemed to increase before an increase in anti-dsDNA levels occurred, which might indicate an interesting new biomarker in the follow-up of SLE patients.


Disclosure:

F. Schaper,
None;

G. Horst,
None;

D. van Beijeren Bergen en Henegouwen,
None;

J. Bijzet,
None;

K. de Leeuw,
None;

A. Stel,
None;

P. C. Limburg,
None;

P. Heeringa,
None;

J. Westra,
None.

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