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Disease Activity and Prediction of Therapeutic
Efficiency in SLE Patients

G.Valet1), Th.Dörner2)

1) Max-Planck-Institut für Biochemie, Martinsried,
2) University Hospital Charité, Berlin, Germany

1. Background: Systemic lupus erythematosus (SLE) is an *external link autoimmune disease with various inflammatory organ manifestations. The presence of anti-DNA antibodies accompanied by abnomalities in complement system, B-cell activity, T-B-cell interaction and phagocytosis are typical features of deviated immune functions in SLE.
Disease activity is commonly described by the systemic lupus erythematosus disease indicator ( *external link SLEDAI) which is determined from a variety of clinical parameters.

2. Goal: Considering the commonly altered B-cell activity in SLE it was investigated to which extent blood levels of CD27highpos plasma cells, CD27neg naive B-cells and CD19pos B-cells were associated with SLEDAI0-8 and SLEDAI>8> patients.

3. Results: The algorithmic (non parametric) classification of the available immunophenotype parameters (fig.1) shows that the immunophenotype parameters indicate SLE activity better (fig.2A) than the clinical and clinical chemistry parameters or all parameters together (fig.2B/C).
The selected immunophenotype parameters of the disease classification masks indicate increased frequency of CD19pos, CD27highpos/CD20neg and absolute counts of CD27highpos/CD20neg peripheral blood B-cells in conjunction with decreased frequency and absolute counts of CD27neg/CD20pos B-cells (fig.3A).
Increased (+) anti-DNA antibodies, circulating immune complexes (CIC), mucocutaneous or acute renal manifestations and ESR are the most discriminatory of the clinical and clinical chemistry parameters (fig.3B) while the classification of all parameters results in a mixture of both parameter types (fig.3C)
The reclassification of the learning set shows correct classification in most instances with mask coincidence factors between 0.60-1.00. This indicates that already a partial fit of the patient classification masks with the two disease classification masks SLEDAI0-8 and SLEDAI>8 is frequently sufficient for correct classifications (fig.4).

4. Conclusion and Outlook: Immunophenotype parameters indicate SLE disease activity to a higher degree than clinical and clinical chemistry parameters. Work in progress shows in addition that B-cell parameters in conjunction with clinical parameters permit to predict therapy responder and nonresponder patients with predictive values between 85-90%.
The observed discriminatory parameter patterns altogether underline the importance for the further collection of cellular parameters as equivalents of actual disease processes and future disease development.

Literature References:
L1 Jacobi A.M., M.Odendahl, K.Reiter, A.Bruns, G.M.Burmester, A.Radbruch, G.Valet, P.E.Lipsky, Th.Dörner: Correlation between circulating CD27high plasma cells and disease activity in patients with systemic lupus erythematosus. Arthritis & Rheumatism 48:1332-1342, (2003)

© 2017 G.Valet
Last Update: Jan 02, 2013