Department of Pediatric Infectious Disease, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey.
Department of Microbiology and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey.
Lupus. 2020 Sep;29(10):1263-1269. doi: 10.1177/0961203320940029. Epub 2020 Jul 9.
Clinical and laboratory investigations have revealed that Epstein-Barr virus (EBV) is involved in altered immunological response of systemic lupus erythematosus (SLE). Higher seroprevalence rates of anti-EBV antibodies and increased viral load are demonstrated in adult SLE patients. The prevalence of BK polyomavirus (BKV) reactivation is also suggested to be higher in SLE. Herein, we aimed to evaluate the immune response of children with SLE to EBV antigens in addition to EBV and BKV DNA. We also tried to evaluate whether these serological results differ from another connective tissue disease - juvenile systemic sclerosis (jSS) - and healthy individuals.
Serum levels of EBV early antigen diffuse (EA-D) IgG, EBV nuclear antigen-1 IgG, EBV viral capsid antigen (VCA), cytomegalovirus (CMV) IgG, EBV DNA, CMV DNA and urinary BKV DNA were evaluated in healthy controls and in patients with a diagnosis of juvenile SLE (jSLE) and jSS.
A total of 70 jSLE patients, 14 jSS patients and 44 sex-matched healthy individuals were involved in the study. EBV VCA was positive in 84.2% of jSLE patients, 85.7% of jSS patients and 36.3% of healthy controls. EBV EA-D IgG positivity was significantly higher in jSLE patients compared to jSS patients and healthy controls (20% vs. 7.1% and 0%, = 0.005). EBV VCA positivity was associated with malar rash and immunological disorder, but there was no statistical significance in other antibody positivity in terms of clinical and haemogram findings and autoantibody positivity. CMV DNA positivity was present in only 2.8% of jSLE patients. None of the jSS patients or the healthy controls had CMV DNA positivity. EBV DNA and BKV DNA were also negative in all three groups.
The results of our study assume a relationship between SLE and EBV, but we could not demonstrate an association between CMV and BKV. The negative DNA results in contrast to serological positivity can be interpreted as an altered and impaired immune system and increased viral susceptibility. These results suggest that EBV contributes to disease continuity, even if it does not directly cause development.
临床和实验室研究表明，EB 病毒（EBV）参与了系统性红斑狼疮（SLE）的免疫反应改变。成人 SLE 患者的 EBV 抗体血清阳性率更高，病毒载量也增加。此外，BK 多瘤病毒（BKV）再激活的患病率也被认为在 SLE 中更高。在此，我们旨在评估儿童 SLE 对 EBV 抗原的免疫反应，除 EBV 和 BKV DNA 之外。我们还试图评估这些血清学结果是否与另一种结缔组织疾病——幼年特发性关节炎（jSS）——和健康个体不同。
评估健康对照组、幼年特发性关节炎（jSLE）和幼年特发性关节炎（jSS）患者的 EBV 早期抗原弥散（EA-D）IgG、EBV 核抗原-1 IgG、EBV 病毒衣壳抗原（VCA）、巨细胞病毒（CMV）IgG、EBV DNA、CMV DNA 和尿 BKV DNA 血清水平。
共有 70 例 jSLE 患者、14 例 jSS 患者和 44 名性别匹配的健康个体参与了研究。84.2%的 jSLE 患者、85.7%的 jSS 患者和 36.3%的健康对照组 EBV VCA 阳性。与 jSS 患者和健康对照组相比，jSLE 患者 EBV EA-D IgG 阳性率显著更高（20%比 7.1%和 0%，=0.005）。EBV VCA 阳性与蝶形红斑和免疫紊乱相关，但在其他抗体阳性方面，临床和血液学发现以及自身抗体阳性方面无统计学意义。仅 2.8%的 jSLE 患者 CMV DNA 阳性。无 jSS 患者或健康对照组 CMV DNA 阳性。三组均 EBV DNA 和 BKV DNA 均为阴性。
我们的研究结果表明 SLE 与 EBV 之间存在关联，但我们无法证明 CMV 和 BKV 之间存在关联。与血清学阳性相比，DNA 结果阴性可解释为免疫系统改变和受损以及病毒易感性增加。这些结果表明，EBV 有助于疾病的持续性，即使它不会直接导致疾病的发展。
