Differential Serum Cytokine Profile in Patients with Systemic Lupus Erythematosus and Posterior Reversible Encephalopathy Syndrome

Summary

SLE patients 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, current evidence regarding its physiopathogenic mechanisms is quite scant. The aim of this study was to analyze the expression of different serum cytokines, as well as VEGF and sCD40L, in patients with PRES/SLE and to compare them with levels in SLE patients without PRES and in healthy controls. We performed a transversal study in a tertiary care center in Mexico City. We included 32 subjects (healthy controls, n=6; remission SLE, n=6; active SLE, n=6 and PRES/SLE patients, n=14). PRES was defined as reversible neurological manifestations (seizures, visual abnormalities, acute confusional state), associated with compatible changes by MRI. Serum samples were obtained during the first 36 hours after the PRES episode and were analyzed by Cytometric Bead Array, Luminex Multiplex assay or ELISA. IL-6 and IL-10 levels were significantly higher in PRES/SLE patients (p=0.013 and 0.025, respectively) when compared to the other groups. Furthermore, IL-6 and IL-10 levels displayed a positive correlation (r=0.686, p=0.007). There were no differences among groups regarding other cytokines, sCD40L or VEGF levels. A differential serum cytokine profile was found in PRES/SLE patients, with increased IL-6 and IL-10 levels. Our findings, which are similar to those described in other neurological manifestations of SLE, support the fact that PRES should be considered among the SLE-associated neuropsychiatric syndromes. This article is protected by copyright. All rights reserved.