Prevalence and clinical significance of anti-C1q antibodies in cutaneous and systemic lupus erythematosus
Autoantibodies against C1q are strongly linked to immune-complex disorders like systemic lupus erythematosus (SLE). Although anti-C1q antibodies have received much interest in the recent years, their biological functions remain unclear. Anti-C1q antibodies are strongly associated with lupus nephritis. The aim of this study was to determine the prevalence of anti-C1q antibodies in Egyptian lupus patients as well as to evaluate the associations between anti C1q antibodies and clinical and serologic parameters of patients with cutaneous and systemic lupus erythematosus. Fifty-eight patients of lupus erythematosus were recruited in the study, and they were divided into 3 groups according to their clinical presentations and laboratory investigations; group (1) consists of 20 patients with musculoskeletal manifestations, mainly arthritis (34.5%), group (2) consists of 12 patients with lupus nephritis (20%), and group (3) consists of 26 patients with cutaneous lupus (44.8%). Fourteen age and sex matched healthy subjects served as controls. Complete blood picture, kidney function tests, liver function tests and anti-double stranded DNA were done for all the studied patients. Anti-C1q antibodies were determined by immunometric enzyme immunoassay for all the studied subjects. Anti-C1q antibodies were positive in (63.8%) of lupus erythematosus (LE) patients and (0%) of controls. Moreover, the serum anti-C1q antibodies titers were significantly higher (P < 0.001) in all lupus erythematosus patients (both systemic and cutaneous) when compared to healthy controls. Surprisingly, serum anti-C1q antibodies were significantly higher in patients with cutaneous lupus than those with lupus nephritis (P <0.001). Anti-C1q titers were significantly correlated with levels of anti–double stranded DNA (P <0.001), as well as with proteinuria (<0.05) in lupus nephritis patients. It was concluded that anti C1q antibodies might play a pathogenic role in the pathogenesis of cutaneous lupus and could positively be associated with evolution to SLE. Moreover, it could predict patients who subsequently develop nephritis, thus early use of immune modulators in cutaneous lupus could improve patients’ prognosis by decreasing the possibility of evolution to systemic lupus complications, mainly nephritis.
Keywords: Anti-C1q; Systemic lupus erythematosus; Cutaneous lupus erythematosus; Lupus nephritis; Complement; Proteinuria