To smell autoimmunity: Anti-P-ribosomal autoantibodies, depression, and the olfactory system

Kynurenine monooxygenase inhibition and associated reduced quinolinic acid reverses depression-like behaviour by upregulating Nrf2/ARE pathway in mouse model of depression: In-vivo and In-silico studies

Kynurenine pathway, a neuroimmunological pathway plays a substantial role in depression. Consistently, increased levels of neurotoxic metabolite of kynurenine pathway; quinolinic acid (QA) found in the suicidal patients and remitted major depressive patients. QA, an endogenous modulator of N-methyl-d-aspartate receptor is produced by microglial cells, may serve as a potential candidate for a link between antioxidant defence system and immune changes in depression. Further, nuclear factor (erythroid-derived 2) like 2 (Nrf2), an endogenous antioxidant transcription factor plays a significant role in maintaining antioxidant homeostasis during basal and stress conditions. The present study was designed to explore the effects of KMO-inhibition (Kynurenine monooxygenase) and association of reduced QA on Keap1/Nrf2/ARE pathway activity in olfactory bulbectomized mice (OBX-mice). KMO catalysis the neurotoxic branch of kynurenine pathway directing the synthesis of QA. KMO inhibitionshowed significant reversal of depressive-like behaviour, restored Keap-1 and Nrf2 mRNA expression, and associated antioxidant levels in cortex and hippocampus of OBX-mice. KMO inhibition also increased PI3K/AKT mRNA expression in OBX-mice. KMO inhibition and associated reduced QA significantly decreased inflammatory markers, kynurenine and increased the 5-HT, 5-HIAA and tryptophan levels in OBX-mice. Furthermore, molecular docking studies has shown good binding affinity of QA towards ubiquitin proteasome complex and PI3K protein involved in Keap-1 dependent and independent proteasome degradation of Nrf2 respectively supporting our in-vivo findings. Hence, QA might act as pro-oxidant through downregulating Nrf2/ARE pathway along with modulating other pathways and KMO inhibition could be a potential therapeutic target for depression treatment.

Olfactory threshold predicts treatment response in relapsing multiple sclerosis

Background:

Olfactory threshold (OT) is associated with short-term inflammatory activity in relapsing multiple sclerosis (RMS).

Objective:

We aimed to investigate OT for prediction of treatment response in RMS.

Methods:

In this 5-year prospective study on 123 RMS patients, OT was measured at disease-modifying treatment (DMT) initiation (M0), after 3 months (M3), and 12 months (M12) by Sniffin’ Sticks test. Primary endpoint was defined as an absence of relapse during the observation period, with Expanded Disability Status Scale (EDSS) progression and magnetic resonance imaging (MRI) activity being the secondary endpoints. Optimal cutoff values were determined by receiver operating characteristic analyses and their predictive value assessed by multivariable Cox regression models.

Results:

Higher OT scores at M0, M3, and M12 were independently associated with decreased relapse probability with the strongest risk reduction at M3 (hazard ratio (HR) = 0.44, p < 0.001). Improvement of OT scores from M0 to M3 (ΔOTM3) was also associated with reduced relapse risk (HR = 0.12, p < 0.001). OT score > 6.5 at M3 was the strongest predictor of relapse freedom (HR = 0.10, p < 0.001) with high diagnostic accuracy (positive predictive value (PPV) = 87%), closely followed by ΔOTM3 ⩾ 0.5 (HR = 0.12, p < 0.001, PPV = 86%).

Conclusions:

OT is an independent predictor of freedom of disease activity upon DMT initiation within 5 years and may be a useful biomarker of treatment response.

Inner nuclear layer and olfactory threshold are interlinked and reflect inflammatory activity in multiple sclerosis

Background

Retinal inner nuclear layer (INL) and olfactory threshold (OT) are associated with inflammatory activity in multiple sclerosis (MS).

Objective

The study aims to investigate (a) whether there is an association of INL and OT in MS and (b) if changes in INL and OT follow a time pattern in relation to MS relapse.

Methods

We assessed INL by optical coherence tomography and OT by Sniffin' Sticks in three different cohorts: a cross-sectional MS cohort (n = 260), a longitudinal, 3-year cohort of MS (n = 141) and healthy controls (n = 30), and a longitudinal, 24-weeks cohort with acute MS relapse (n = 28) and stable MS controls (n = 27).

Results

Cross-sectionally, INL and OT were strongly correlated with number but not localization of relapse in the previous 12 months and INL correlated with OT. Longitudinally, INL was thicker and OT score was lower short term in times of relapse activity, but not long term and independent of relapse localization. In acute MS relapse, INL and OT were altered compared with stable MS, again, independent of relapse localization resolving over 12-24 weeks with faster approximation to stable MS after escalation of disease-modifying treatment.

Conclusions

INL and OT are interlinked markers of short-term inflammatory activity, following a nearly congruent time pattern and independent of relapse localization, possibly reflecting a proinflammatory state within the central nervous system.

The relationship of olfactory function and clinical traits in major depressive disorder

People who have developed a good sense of smell could experience much more happiness and pleasure, which would trigger a discussion that olfactory disorder might correlate with the pathogenesis of major depressive disorder (MDD). Similar experiments conducted on rats have confirmed that nerve damage of olfactory pathway can induce a series of depression-like changes, including behavior, neurobiochemistry, and neuroimmunity. These changes will recover progressively with anti-depression treatment. While in similar studies on human beings, olfactory dysfunction has been found in people suffering from depression. This review briefly discusses the correlation between olfactory deficits and clinical traits of depression in different dimensions, such as the severity, duration and cognitive impairment of depression. Improving olfactory function may be expected to be a potential antidepressant therapy.

Evaluation of Olfactory Bulb Volumes in Patients With Rheumatoid Arthritis: A Retrospective Study

Objectives

This study aims to evaluate olfactory bulb (OB) volume in patients with rheumatoid arthritis (RA) using magnetic resonance imaging.

Patients and methods

In this retrospective and case-control study, OB volumes of 37 RA patients (6 males, 31 females; mean age 48.6±10.8 years; range, 18 to 65 years) were compared with those of 36 healthy control subjects (5 males, 31 females; mean age 46.5±6.9 years; range, 22 to 62 years). OB images were gained with a protocol of 256×256 matrix and a 24-cm field of view, repetition time=5000 milliseconds (TR 5000 msec), echo time=130 milliseconds (TE 130 msec), number of excitations=2 (NEX 2) and a 5 mm slice thickness. OB volume was computed with the aid of the above images using three dimensional views. The surface of each slice area was calculated in mm2 and all surfaces were added and multiplied by front-back length to obtain a volume in mm3.

Results

Left (70.5±14.4 vs. 91.1±12.2 mm3), right (73.9±15.1 vs. 91.2±12.4 mm3), and total (144.5±27.4 vs. 182.8±21.5 mm3) OB volumes were significantly lower in the RA group than in the control group (all p<0.05).

Conclusion

Patients with RA may be under risk of decreased OB volumes and related impaired odor functions which might affect the quality of life and activities of daily living adversely.

Naringenin protects against oxido-inflammatory aberrations and altered tryptophan metabolism in olfactory bulbectomized-mice model of depression

Oxido-inflammatory aberrations play a substantial role in the pathophysiology of depression. Oxido-inflammatory stress increases catabolism of tryptophan into kynurenine which leads to imbalance in kynurenine and serotonin levels in the brain. Naringenin a flavonoid, has been reported to possess antidepressant property by restoring serotonin and noradrenaline levels in the brain. Its effects on oxido-inflammatory aberrations in depression has not been investigated. With this background, the present study was designed to investigate the antidepressant-like potential of naringenin in olfactory bulbectomy (OBX)-induced neuroinflammation, oxidative stress, altered kynurenine pathway, and behavioural deficits in BALB/c mice. OBX-mice showed depression-like behavioural alterations characterized by hyperactivity in open field, increased immobility time in forced swim test and decreased sucrose preference. After 14 days, OBX-mice were treated by gavage with naringenin (25, 50 and 100 mg/kg) and fluoxetine (5 mg/kg) for two weeks. Naringenin significantly ameliorated depression-like behavioural alterations. Naringenin significantly restored corticosterone levels in serum and antioxidant enzymes (Catalase, SOD GSH), nitrite and MDA in cerebral cortex and hippocampus showing its anti-stress and antioxidant property. Naringenin also significantly decreased elevated pro-inflammatory cytokines like IL-1β, IL-6, TNF-α and NF-ҝβ levels. Naringenin also significantly increased neurotrophic growth factor like BDNF. Naringenin reversed altered levels of tryptophan, serotonin, 5-Hydroxyindole acetic acid and kynurenine in hippocampus and cortex. A positive correlation was found between KYN/TRP ratio and proinflammatory parameters while endogenous antioxidants were negatively correlated. In conclusion, naringenin showed potent neuroprotective effect in depression comparable to the fluoxetine by restoring alterations in kynurenine pathway via its antioxidant and anti-inflammatory potential.

Change of olfactory function as a marker of inflammatory activity and disability progression in MS

BACKGROUND

Impaired olfactory threshold has been reported in early inflammatory phases of MS, while impaired odor identification was associated with more widespread disability.

OBJECTIVE

To prospectively assess the development of olfactory function and its correlation with relapse and disability progression.

METHODS

In this prospective, 3-year longitudinal study on 151 MS patients and 30 healthy controls, three different qualities of olfactory function (threshold, discrimination, and identification) were quantified using the Sniffin' Sticks test. The influence of relapses and disability on olfactory function was analyzed at different time points and in a multivariate model.

RESULTS

Discrimination and identification capability significantly worsened over 3 years, while threshold did not. Threshold was markedly impaired in patients with relapse activity within 12 months, recovered in the absence of relapse, and was associated with a 2.5-fold increased risk of relapse. Deterioration of discrimination and identification was irreversible and both strongly associated with and predictive of EDSS progression.

CONCLUSION

Olfactory function changes over time in MS. Threshold impairment is transient and predicts inflammatory disease activity, while odor identification and discrimination are associated with disability progression. Olfactory dysfunction might be a useful and easily obtainable parameter to monitor patients with regard to inflammation and neurodegeneration in MS.

Decreased olfactory bulb volumes in patients with fibromyalgia syndrome

Among the other symptoms, impaired olfactory function such as odor identification, threshold, and discrimination have been reported in patients with fibromyalgia syndrome (FMS). To investigate olfactory bulb (OB) volumes in FMS, by using magnetic resonance imaging (MRI), and to make reasonable suggestions are the goals of the present study. The study included 62 individuals as the FMS group (n = 30) and the control group (n = 32). MRI examinations were performed by a 1.5-T scanner and a standard head coil was used for the images. The coronal T2-weighted images were used for to measure OB volumes. Right, left, and total OB volumes were calculated with the aid of these images. The mean age of the FMS group was 44.2 ± 8.3 years and the control group was 41.7 ± 3.53 years. The mean volume of the right OB was 74.9 ± 12.4 mm³ in the FMS group and was 92.6 ± 12.9 mm³ in the control group. The mean value of the left OB volume was 74.3 ± 10.8 mm³ in the FMS group and 92.8 ± 12.6 mm³ in the control group. The mean of the total OB volume was 146.6 ± 20.81 mm³ in the FMS group and 186.5 ± 23.5 mm³ in the control group. Left, right, and total OB volumes were significantly lower in the FMS group than in the control group (all p < 0.05). Female patients with FMS are under the risk of the decreased olfactory bulb volumes. This situation should be kept in mind for proper and reasonable management of this tough syndrome.

Development of autoantibodies precedes clinical manifestations of autoimmune diseases: A comprehensive review

The etiology of autoimmune diseases is due to a combination of genetic predisposition and environmental factors that alter the expression of immune regulatory genes through various mechanisms including epigenetics. Both humoral and cellular elements of the adaptive immune system play a role in the pathogenesis of autoimmune diseases and the presence of autoantibodies have been detected in most but not all autoimmune diseases before the appearance of clinical symptoms. In some cases, the presence or levels of these autoantibodies portends not only the risk of developing a corresponding autoimmune disease, but occasionally the severity as well. This observation is intriguing because it suggests that we can, to some degree, predict who may or may not develop autoimmune diseases. However, the role of autoantibodies in the pathogenesis of autoimmune diseases, whether they actually affect disease progression or are merely an epiphenomenon is still not completely clear in many autoimmune diseases. Because of these gaps in our knowledge, the ability to accurately predict a future autoimmune disease can only be considered a relative risk factor. Importantly, it raises the critical question of defining other events that may drive a patient from a preclinical to a clinical phase of disease.

Autoantibodies in Neuropsychiatric Disorders

Little is known about the etiology of neuropsychiatric disorders. The identification of autoantibodies targeting the N-methyl-d-aspartate receptor (NMDA-R), which causes neurological and psychiatric symptoms, has reinvigorated the hypothesis that other patient subgroups may also suffer from an underlying autoimmune condition. In recent years, a wide range of neuropsychiatric diseases and autoantibodies targeting ion-channels or neuronal receptors including NMDA-R, voltage gated potassium channel complex (VGKC complex), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA-R), γ-aminobutyric acid receptor (GABA-R) and dopamine receptor (DR) were studied and conflicting reports have been published regarding the seroprevalence of these autoantibodies. A clear causative role of autoantibodies on psychiatric symptoms has as yet only been shown for the NMDA-R. Several other autoantibodies have been related to the presence of certain symptoms and antibody effector mechanisms have been proposed. However, extensive clinical studies with large multicenter efforts to standardize diagnostic procedures for autoimmune etiology and animal studies are needed to confirm the pathogenicity of these autoantibodies. In this review, we discuss the current knowledge of neuronal autoantibodies in the major neuropsychiatric disorders: psychotic, major depression, autism spectrum, obsessive-compulsive and attention-deficit/hyperactivity disorders.

Impaired sense of smell and altered olfactory system in RAG-1(-∕-) immunodeficient mice

Immune deficiencies are often associated with a number of physical manifestations including loss of sense of smell and an increased level of anxiety. We have previously shown that T and B cell-deficient recombinase activating gene (RAG-1)(-∕-) knockout mice have an increased level of anxiety-like behavior and altered gene expression involved in olfaction. In this study, we expanded these findings by testing the structure and functional development of the olfactory system in RAG-1 (-∕-) mice. Our results show that these mice have a reduced engagement in different types of odors and this phenotype is associated with disorganized architecture of glomerular tissue and atrophy of the main olfactory epithelium. Most intriguingly this defect manifests specifically in adult age and is not due to impairment in the patterning of the olfactory neuron staining at the embryo stage. Together these findings provide a formerly unreported biological evidence for an altered function of the olfactory system in RAG-1 (-∕-) mice.

Olfactory impairment in patients with the fibromyalgia syndrome and systemic sclerosis

Patients with autoimmune diseases often present with olfactory impairment. The aim of the study was to assess the olfactory functions of female patients with fibromyalgia (FM) compared with patients with systemic sclerosis (SSc) and with healthy female controls. Olfactory functions were assessed in 24 patients with FM, 20 patients with SSc and 21 age-matched healthy controls. The sense of smell was evaluated using the Sniffin' Sticks test including the three stages of smell: threshold, discrimination, and identification (TDI) of the different odors. The severity of fibromyalgia was assessed using the fibromyalgia impact questionnaire (FIQ). The short form 36 (SF-36) questionnaire was also completed in order to seek a relationship between the patients perception of quality of life and the different aspects of the smell sense. Depression was evaluated in both FM and SSc patients utilizing the Beck depression inventory-II (BDI-II) questionnaire. Patients with FM had significantly lower TDI smell scores compared with both SSc patients and healthy controls (p < 0.005, One-Way ANOVA). Hyposmia (defined as TDI scores below 30) were observed in 14 of 24 (42 %) patients with FM compared to 3 of 20 (15 %) patients with SSc and 1 of the healthy controls (4.3 %) (p < 0.02). FM patients had significantly lower thresholds of smell compared to both healthy controls and patients with SSc (p < 0.001), whereas for patients with SSc only the ability to discriminate between odors was impaired (p < 0.006). We could not detect any statistical correlation between smell abilities and clinical manifestation of SSc or the FIQ and SF-36 scores among FM patients. However the correlation between depression, defined by the BDI-II score, and the sense of smell differed between patients with FM and patients with SSc. As only among SSc patients a lower sense of smell correlated with a higher BDI-II score (p = 0.02). Our findings suggest that there is a decrease in the sense of smell both in FM and SSc patients compared with healthy controls. However these impairments differ between patients group and might represent different mechanisms that affect the sense of smell.

Roles of olfactory system dysfunction in depression

The olfactory system is involved in sensory functions, emotional regulation and memory formation. Olfactory bulbectomy in rat has been employed as an animal model of depression for antidepressant discovery studies for many years. Olfaction is impaired in animals suffering from chronic stress, and patients with clinical depression were reported to have decreased olfactory function. It is believed that the neurobiological bases of depression might include dysfunction in the olfactory system. Further, brain stimulation, including nasal based drug delivery could provide novel therapies for management of depression.

Smell and autoimmunity: a comprehensive review

The sense of smell is an ancient sensory modality vital for sampling and perceiving the chemical composition of surrounding environments. Olfaction involves a pathway of biochemical and electrophysiological processes, which allows the conversion of molecular information into sensations. Disturbances in the olfactory function have been investigated mainly in neurological/neurodegenerative disorders such as Alzheimer's and Parkinson's diseases; impaired sense of smell has been associated with depressed mood. Only recently, smell capability was tested in other diseases, particularly autoimmune diseases. Shoenfeld and colleagues opened this chapter showing that patients affected with systemic lupus erythematosus (SLE) have disturbances in their olfactory functions and revealed its association with neuropsychiatric manifestations of the disease. This evidence was confirmed in experimental models and replicated in other SLE populations. The connection between autoimmunity and the sense of smell was lately emphasized by studies on patients with Sjögren's syndrome and in patients with other autoimmune/immune-mediated diseases, such as polydermatomyositis, recurrent spontaneous abortion, and hereditary angioedema. Genetic susceptibility and hormonal and environmental factors may play a role in these conditions. Olfactory receptor gene clusters are located in proximity to key locus of susceptibility for autoimmune diseases such as the major histocompatibility complex, suggesting not only a physic linkage, but a functional association. Nonetheless, gender- and hormone-mediated effects are fundamental in the development of autoimmune diseases. The different connections between smell and autoimmunity, genes and hormones may suggest that this is another tessera of a mosaic which is waiting the answer of Oedipus.

The future of autoimmunity

There have been enormous strides in our understanding of autoimmunity. These strides have come under the umbrellas of epidemiology, immunological phenotype and function, disease definitions and classification and especially new therapeutic reagents. However, while these advances have been herculean, there remains enormous voids. Some of these voids include genetic susceptibility and the interaction of genes and environment. The voids include induction of tolerance in preclinical disease and definitions of host susceptibility and responses to the expensive biologic agents. The voids include the so-called clustering of human autoimmune diseases and the issues of whether the incidence is rising in our western society. Other voids include the relationships between microbiology, vaccination, gut flora, overzealous use of antibiotics, and the role of nanoparticles and environmental pollution in either the induction or the natural history of disease. One cannot even begin to address even a fraction of these issues. However, in this special issue, we are attempting to discuss clinical issues in autoimmunity that are not usually found in generic reviews. The goal is to bring to the readership provocative articles that ultimately will lead to improvement in patient care.

Immunology, autoimmunity, and autoantibodies in Parkinson's disease

Recent revelations of immune alterations in Parkinson's disease have led to the convergence that an autoimmune mechanism may play a role in the etiopathogenesis of this neurodegenerative disease. In the current study, 77 Parkinson's disease patients and 77 matched healthy controls were analyzed for the presence of seven autoantibodies previously found to be associated with central nervous system manifestations namely: antineuronal-cells, anti-brain lysate, anti-dsDNA, anti-phosphatidylserine, anti-cardiolipin, anti-serotonin, and anti-melanocytes antibodies. Patients underwent systematic assessments of demographics, clinical, and biochemical manifestations. Three autoantibodies were found to be more prevalent among Parkinson's disease patients (antineuronal cells10.3% vs. 1.3%, p = 0.017; anti-brain lysate 9.1% vs. 1.3%, p = 0.032; anti-dsDNA 10.3% vs. 2.6%, p = 0.049). Clinical manifestations of Parkinson's disease, particularly dyskinesia and depression, were found to be associated with the presence of these autoantibodies.

Emerging tendency towards autoimmune process in major depressive patients: a novel insight from Th17 cells

Evidence indicates that there is an emerging tendency towards autoimmunity occuring in major depressive disorder (MDD). The aim of our study is to investigate the mechanism of autoimmune process in MDD from a novel insight of Th17 cells, which have been identified as the significant activators of autoimmunity. We included 40 patients with MDD and 30 healthy control subjects. An indirect immunofluorescence test was used for the detection of serum antinuclear antibodies (ANA), and revealed that the patient group was positive more frequently than the control group. By flow cytometric analysis, depressed subjects revealed a significant increase in peripheral Th17 cell number, and an obvious decrease in T-reg cell number, showing an imbalance of Th17/Treg ratio compared to healthy controls. We also found a higher level of RORγt (retinoic acid-related orphan receptor-γt, the specific transcription factor of Th17 cell) mRNA expression in peripheral blood lymphocytes by RT-PCR and serum concentration of IL-17 by ELISA in patients. In conclusion, our study showed a potential role of Th17 cells in the autoimmune process in MDD patients, thus contributing to the existing evidence of autoimmune inclination in MDD.

Olfactory threshold is impaired in early, active multiple sclerosis

Background: Olfactory dysfunction has been reported in multiple sclerosis (MS). However, to date no data are available on different qualities of olfactory function, namely odour identification, odour discrimination and odour perception threshold.

Objective: To assess different qualities of olfactory function in patients with MS and correlate these with demographic data, clinical data, depression, quality of life and cognitive functions.

Methods: In this cross-sectional study, 50 patients with MS or clinically isolated syndrome and 30 healthy controls were included. Olfactory function was measured using the Sniffin’ Sticks test.

Results: The scores for odour identification ( p = 0.001), odour perception threshold ( p = 0.037) and the combined score of odour identification, discrimination and perception threshold (TDI, p = 0.002) were significantly lower in MS. Hyposmia for identification ( p = 0.0017), threshold ( p = 0.017) and TDI score ( p = 0.0014) was more frequent in MS. Olfactory threshold was impaired in patients who were clinically active in the previous year ( p = 0.026) and in patients with a disease duration less than 2 years ( p = 0.0093). Identification score was negatively correlated with disease duration ( p = 0.0017). Olfactory function was not associated with disability, depression or quality of life.

Conclusions: We report evidence for qualitatively distinct hyposmia in MS, with increased smell threshold in the early inflammatory phases of the disease and impaired identification with a more widespread chronic disease.

Parkinson's disease, autoimmunity, and olfaction

Parkinson's disease (PD) is a common progressive neurodegenerative disorder, mainly classified as a movement disorder which manifests among others nonmotor symptoms such as olfactory dysfunction. The etiopathogenesis of this disease has yet to be elucidated, though it seems to be interconnected with a complex set of genetic, environmental, and immunological interactions. This review unfolds the immune alterations observed in PD patients by describing the increase in the innate immune components including complement and cytokines within their substantia nigra and cerebrospinal fluid (CSF). These alterations extended to the adaptive immune response with the elevation of T cells and autoantibodies (anti-alpha-synuclein and anti-GM1-ganglioside) in the peripheral blood and CSF of PD patients. Interestingly, another etiopathogenic triad has recently emerged linking PD to autoimmunity through olfactory dysfunction. Smell deficit is one of the earliest signs of PD and a unique observation suggesting olfactory declines to be a consequence of autoimmune mechanisms. Therefore, we considered several undisputed autoimmune diseases known for their olfactory consequences as template examples that may shed more light on the relationship between autoimmunity and PD. We hope that understanding the nature of this disease may lay the ground for successes in the quest to halt the progressive neurodegenerative process.

Hyperactivity induced by antiphospholipid syndrome serum

Antiphospholipid syndrome (APS) is a multisystem disorder characterized by arterial and venous thrombosis, pregnancy morbidity, and neuropsychiatric manifestations. Antiphospholipid IgG injected intracerebroventricularly (i.c.v.) cause behavioral hyperactivity in mice. In the present study we investigated the effects of APS whole-serum i.c.v. administration in female Balb/C mice. Control mice were injected with serum derived from healthy subjects or saline solution. Behavior was assessed by the staircase apparatus which combines locomotor (stair-climbing) exploratory activities and rearing as a measure of anxiety. Mice injected with serum from APS patients or serum from normal subjects showed a trend to an increase in the number of stairs climbed in the APS group. The results suggest a differential effect of specific IgG and other serum components in the CNS manifestations of APS.

Comparison of three anti-CCP antibody tests and rheumatoid factor in RA and control patients

It was the aim of this study to compare the diagnostic properties of two second generation anti-CCP antibodies assays (Quanta Lite CCP, Inova and EliA CCP, Phadia) with an assay containing a new antigen mixture (Quanta Lite CCP 3, Inova) and RF IgM.

METHODS

Sera from 86 RA patients and 90 control patients with other diseases, such as infections, connective tissue diseases, or other rheumatic diseases, were analysed using the four different methods. Specificity (84.4%) and PPV (80.3%) were lowest for RF IgM and highest for EliA CCP (specificity 97.8%, PPV 96.7%), the other values being close to those of EliA CCP. Sensitivity was highest for Quanta Lite CCP (73.3%). Efficiency was highest for Quanta Lite CCP (84.1%) at the lower cut off followed by EliA CCP at both cut offs (83.0%). The discrimination between RA sera (mean value 407.67 U/ml) and control sera (4.54 U/ml) and the relative risk (23.34) were best for EliA CCP. The results of this study reveal that there was no advantage of the anti-CCP antibodies assay applying a new antigen mixture (Quanta Lite CCP 3 ELISA) compared to two second generation anti-CCP antibodies assays (Quanta Lite CCP ELISA and EliA CCP).

Depression is an early disease manifestation in lupus-prone MRL/lpr mice

Many lupus patients develop neuropsychiatric manifestations, including cognitive dysfunction, depression, and anxiety. However, it is not clear if neuropsychiatric lupus is a primary disease manifestation, or is secondary to non-CNS disease. We found that MRL/lpr lupus-prone mice exhibited significant depression-like behavior already at 8 weeks of age, despite normal visual working memory, locomotor coordination and social preference. Moreover, depression was significantly correlated with titers of autoantibodies against DNA, NMDA receptors and cardiolipin. Our results indicate that lupus mice develop depression and CNS dysfunction very early in the course of disease, in the absence of substantial pathology involving other target organs.

Autoimmune pathology accounts for common manifestations in a wide range of neuro-psychiatric disorders: the olfactory and immune system interrelationship

Smell has traditionally been considered a less important sense when compared to sight or hearing, but recent research has unraveled important features inherent to the sense of smell. Once considered just a chemical sensor for sampling the environment, data from animal models and human studies currently imply numerous and complex effects of smell on behavior, mood, and on the immune response. In this review we discuss a possible inter-relationship between olfactory impairment, autoimmunity and neurological/psychiatric symptoms in several diseases affecting the central nervous system (CNS) such as Parkinson, Alzheimer's disease, autism, schizophrenia, multiple sclerosis and neuropsychiatric lupus erythematosus. We suggest that common manifestations are not mere coincidences. Current data from animal models show that neuropsychiatric manifestations are intimately associated with smell impairment, and autoimmune dysregulation, via autoantibodies (anti-NMDAR, anti-ribosomal P) or other mechanisms. From clues of pathological manifestations, we propose a novel approach to the understanding of the interactions between the CNS, the smell and the immune system.

Apoptosis of melanocytes in vitiligo results from antibody penetration

Vitiligo is a rather common disease characterized by depigmentation of skin and mucosae due to the loss of melanocytes, most likely as a result of autoimmune phenomena. In this study we demonstrated apoptotic markers in residual melanocytes in skin biopsies of patients with vitiligo, as well as the presence of serum antibodies to melanocyte-specific antigens in the vast majority of patients. Moreover, we were able to prove that serum IgG antibodies from vitiligo patients, but not from healthy controls, were capable to penetrate into cultured melanocytes in vitro, and trigger them to engage in apoptosis. Our results are consonant with the theory that melanocyte-specific antibodies are responsible for the deletion of melanocytes through antibody penetration and apoptosis.