Choroid Plexus Enlargement In Systemic Lupus Erythematosus: Relationship With Auto-Antibody Status And Neuropsychiatric Involvement
Mor Gueye1, Paolo Preziosa5, Giuseppe A. Ramirez6, Enrica Bozzolo2, Valentina Canti3, Monica Margoni4, Alessandro Meani4, Patrizia Rovere-Querini7, Angelo Manfredi6, Maria Rocca5, Massimo Filippi8
1Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, 2Unit of Immunology, Rheumatology, Allergy and Rare Diseases, 3Division of Immunogy, Transplantation & Infectious Diseases, 4Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 5Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, 6Unit of Immunology, Rheumatology, Allergy and Rare Diseases, and Division of Immunogy, Transplantation & Infectious Diseases, 7Division of Immunogy, Transplantation & Infectious Diseases, 8Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University
Objective:
To evaluate whether choroid plexus (CP) enlargement occurs in patients with systemic lupus erythematosus (SLE) compared to healthy controls (HC) and is associated with auto-antibody status, neuropsychiatric involvement (NP-SLE) and structural brain damage.
Background:
CP enlargement has been suggested as a marker of neuroinflammation in multiple sclerosis, being associated with disease activity and clinical disability. CP involvement in SLE immunopathology has been recently hypothesized, however, the associations between CP enlargement, auto-antibody status, clinical manifestations and brain structural damage have not been fully explored yet.
Design/Methods:
Brain 3T dual-echo and 3D T1-weighted sequences were acquired from 32 SLE patients and 32 age- and sex-matched HC. CP volume was manually obtained from 3D T1-weighted scans and normalized by head size. CP volumes were compared between HC and SLE patients stratified according to auto-antibody status (anti-antiphospholipid [APA] and anti-double-stranded DNA [ADNA] antibodies) and NP involvement using linear models. Associations between CP volume and clinical and structural MRI variables were explored using linear regression analyses.
Results:
Compared to HC, only SLE patients with positive autoantibody status (APA [n=18] or ADNA [n=24) showed significantly higher white matter (WM) lesion volume (LV) (p=0.020 and 0.033), whereas only SLE patients with APA antibodies had a significant CP enlargement (p=0.013). Compared to HC, both non-NP-SLE (n=20) and NP-SLE patients (n=12) showed significantly higher CP volume (p=0.002 and <0.001), whereas WM LV was significantly higher only in NP-SLE (p=0.001). Compared to non-NP-SLE, NP-SLE patients had significantly higher CP volume (p=0.024) and WM LV (p=0.015). No between-group volumetric brain differences were found. No significant associations of CP volume with disease duration and activity, WM LV and normalized brain volume were found.
Conclusions:
CP enlargement occurs in SLE patients, especially in those with APA and NP involvement, suggesting its potential role in the pathophysiology of SLE related brain involvement.