Background/Purpose:

Patients with systemic lupus erythematosus (SLE) are susceptible to the development of posterior reversible encephalopathy syndrome (PRES). The main theory about the physiopathology of PRES suggests there is brain-blood barrier damage, which is associated with endothelial dysfunction, and characterized by vasogenic edema. However, to date there is no evidence about serologic markers associated with the development of PRES in SLE patients. The aim of this study was to determine whether PRES/SLE patients show a specific cytokine profile.

Methods: A transversal study was performed from November 2012 to March 2015 at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City. We included four groups of subjects: healthy controls (n=6), SLE patients in remission (n=6), SLE patients with SLEDAI scores >6 (n=6, neurological activity and infections were excluded) and patients with PRES/SLE (n=14). All SLE patients fulfilled at least 4 ACR criteria and PRES was defined as reversible neurological manifestations (seizures, visual abnormalities, acute confusional state, among others) associated with changes by magnetic resonance (iso or hypointensity in T1 and hyperintensity in T2/FLAIR). Serum samples were obtained during the first 48 hours after the PRES episode and they were analyzed by Cytometric Bead Array (Th1, Th2, Th17) and ELISA for CD40L and VEGF.

Results:

Table 1 shows clinical, laboratory and demographic patient features. IL-6 and IL-10 levels were significantly higher in PRES/SLE patients when compared to the rest of the groups (see table). There were no differences between groups regarding sCD40L levels (p=0.80), nor VEGF in SLE patients (p=0.77). There were no differences in platelets, leukocytes or hemoglobin among groups. Other analyzed cytokines (IL 2, 3, 4, 16, 17A, 18, and 12p40; IFNγ and TNFα) did not show significant differences among groups.

Conclusion:

SLE patients with PRES had higher IL-6 and IL-10 levels when compared to other SLE patients and healthy controls. Enhanced IL-6 serum levels could be associated with vascular endotelial cells activation, which might play a key role in the pathogenesis of PRES-related vasogenic edema. Moreover, increased IL-10 levels could act as a counterregulatory mechanism to contend with the inflammatory response driven by IL-6, which might explain the reversibility of the clinical manifestations that characterizes PRES. Prospective studies that include serial measurements of these serum cytokines, correlation with their levels in cerebrospinal fluid and the reversibility of image abnormalities, are needed to confirm our findings.

Table 1. Demographic, serologic and clinical characteristics

N/A= Not Applicable; N/D= Not Determined. Values in bold are statistically significant

¶Without neurological involvement         ¥p<0.0001 vs PRES/SLE                     ¥¥p=0.041 vs healthy controls           *p<0.05 vs other groups

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/differential-serum-cytokine-profile-in-patients-with-systemic-lupus-erythematosus-and-posterior-reversible-encephalopathy-syndrome-a-single-center-study/