A group of researchers at University College London (Centre for Rheumatology, Centre for Adolescent Rheumatology Versus Arthritis and Centre for Cardiometabolic and Vascular Science, Division of Medicine) have found a new biomarker that could identify patients with adolescent-lupus who are at greater risk of developing early cardiovascular disease (CVD), such as stroke and heart attack. This biomarker is associated with increased inflammation and a worsened clinical outcome over time for patients.
CVD is a leading cause of mortality for people with lupus. However, traditional CVD risk factors do not identify patients at risk from a young age. This increased risk is likely due to prolonged inflammation and disease treatment burden. Despite this knowledge, there are currently no guidelines for CVD management in lupus and more reliable biomarkers (measurable indicators of CVD) are needed, especially in young adolescent-lupus patients who are at greatest risk. This would allow for much earlier therapeutic and/or lifestyle interventions to reduce CVD morbidity and mortality.
In their paper, published in EBioMedicine, the scientists found that in-depth analysis of the particles responsible for carrying blood fats around the body could be used to stratify patients according to their CVD risk in adolescent-lupus. A biomarker named the Apolipoprotein-B:Apolipoprotein-A1 ratio was shown to very accurately identify a group of patients with high CVD risk, which could be used in a clinical setting to inform treatment strategies and aid CVD monitoring for these young patients throughout life. Strikingly, patients in the higher CVD risk group had immune cells that were more inflammatory and had characteristics similar to those found in adult patients with diagnosed CVD and experimental models of CVD. These young patients also had persistently more active disease over a five-year follow-up period, suggesting that better control of their disease is required to decrease their risk for CVD.
The multidisciplinary research team are optimistic about these findings. Dr George Robinson, lead author and postdoctoral researcher, said: “To be able to identify patients at a young age who have an increased CVD risk could be a huge therapeutic success for lupus research, enabling early intervention to improve the quality of life for patients.”
Professor Liz Jury, Principal Investigator and Professor in Experimental Rheumatology, said: “This work helps us to understand the mechanisms associated with CVD development in lupus from a young age.”
Dr Coziana Ciurtin, Consultant Rheumatologist and Principal Investigator of the Centre for Adolescent Rheumatology, said: “There are no guidelines for CVD risk monitoring or management in lupus patients, especially within this young age group, so this new blood marker could help identify patients that require intensified disease monitoring and therapeutic or lifestyle interventions.”
For more information you can read their new open access research article: