Antibodies against Small Ubiquitin-like Modifier Activating Enzyme May Be a Protective Factor from Rapid Progressive Interstitial Lung Disease in Patients Bearing Antibodies against Melanoma Differentiation Associated Gene 5.
Hung-Cheng TsaiWei-Sheng ChenYi-Syuan SunChien-Chih LaiYing-Ying YangWen-Ru ChouHsien-Tzung LiaoChang-Youh TsaiChung-Tei ChouPublished in: Journal of clinical medicine (2024)
Background: Anti-MDA5 antibody-bearing (anti-MDA5 + )-dermatomyositis (DM) or polymyositis (PM) is notorious for causing rapidly progressive interstitial lung disease (RPILD) and/or cancers with high mortality rate. However, anti-MDA5 antibodies (Abs) are also found in other connective tissue diseases and their link with RPILD, especially with regard to the mortality rate, are unknown. Methods: We retrospectively recruited 71 patients bearing anti-MDA5-Abs in serum, stratified them in terms of a presence or absence of RPILD, and evaluated their clinical features, laboratory findings, associated myositis antibodies, concurrent connective tissue disease (CTD) as well as newly developed malignancies. Results: In total, 39 (55%) patients presented with DM/PM, but 32 (45%) did not. In total, 22 of the former and 11 of the latter developed RPILD eventually, accounting for a total of 46% of all MDA-5 bearing patients. On the other hand, 15 of all 71 (21.1%) patients had cancers. Among the 32 patients who did not have DM/PM, 27 (38.0% of all 71) had other CTDs, indicating that only 5 (7.0% of 71) patients did not have CTDs. Senility (odds ratio (OR) = 1.816, p = 0.032), presence of anti-Ro-52 antibody (OR = 1.676, p = 0.018), elevated C-reactive protein (CRP, OR = 4.354, p < 0.001) and carcinoembryonic antigen (CEA, OR = 2.625, p = 0.005) posed risks for RPILD. High lactose dehydrogenase (LDH, p = 0.009), CRP ( p = 0.001) and CEA ( p = 0.001), ferritin ( p ≤ 0.001) and low albumin ( p ≤ 0.001) were significantly associated with mortality. Anti-SAE antibodies were negatively correlated with RPILD as analyzed by univariate (OR = 0.245, p = 0.017) and multivariate (OR = 0.058, p = 0.036) regressions, indicating that they may be a protective factor in relation to RPILD (OR = 0.543, p = 0.008) or fatality (OR = 0.707, p = 0.012), which was also demonstrated in subgroup analyses. Conclusions: In contrast to various risk factors for RPILD or mortality, anti-SAE antibodies might conversely be a protective factor in anti-MDA5 + patients.
Keyphrases
- end stage renal disease
- interstitial lung disease
- chronic kidney disease
- ejection fraction
- type diabetes
- systemic sclerosis
- randomized controlled trial
- risk assessment
- squamous cell carcinoma
- cardiovascular disease
- multiple sclerosis
- air pollution
- adipose tissue
- signaling pathway
- radiation therapy
- cell death
- risk factors
- magnetic resonance
- dna methylation
- open label
- heavy metals
- cell proliferation
- climate change
- computed tomography
- small molecule
- pi k akt
- genome wide
- contrast enhanced