Thromb Haemost 2017; 117(11): 2194-2206
DOI: 10.1160/TH17-03-0221
Atherosclerosis and Ischaemic Disease
Schattauer GmbH Stuttgart

Serum Levels of Anti-PON1 and Anti-HDL Antibodies as Potential Biomarkers of Premature Atherosclerosis in Systemic Lupus Erythematosus

Patricia López
,
Javier Rodríguez-Carrio
,
Aleida Martínez-Zapico
,
Ángel I. Pérez-Álvarez
,
Raquel López-Mejías
,
Lorena Benavente
,
Lourdes Mozo
,
Luis Caminal-Montero
,
Miguel A. González-Gay
,
Ana Suárez
Further Information

Publication History

29 March 2017

23 July 2017

Publication Date:
30 November 2017 (online)

Abstract

The present study aimed to evaluate the possible role of immunoglobulin G (IgG) antibodies against high-density lipoproteins (HDL) and paraoxonase 1 (PON1) as possible biomarkers of cardiovascular disease (CVD) in systemic lupus erythematosus (SLE). To this end, levels of these autoantibodies, PON1 activity and total antioxidant capacity were quantified in serum samples from 198 SLE patients, 100 healthy controls (HC) and 42 non-autoimmune individuals with traditional cardiovascular risk factors. PON1 rs662 polymorphism was analysed in a subgroup of patients and controls. Subclinical CVD were determined by Doppler ultrasound in 118 SLE patients and 30 HC, analysing carotid intima-media thickness (IMT) and blood flow parameters in internal carotid, middle cerebral and basilar arteries. Serum levels of both anti-HDL and anti-PON1 antibodies were increased in SLE patients compared with HC (p < 0.001); however, only anti-PON1 antibodies, in addition to disease activity, were significant predictors of the impaired PON1 function in SLE (β  = −0.143, p = 0.045). Conversely, anti-HDL antibodies were associated with higher risk of CVD (odds ratio: 3.69; p = 0.012) and lower HDL levels at disease onset (ρ = −0.324, p = 0.044). Finally, anti-PON1 antibodies were associated with carotid IMT in SLE (β = 0.201, p = 0.008) and inversely related to cranial arteries blood flow velocities in patients with clinical and subclinical CVD (all p < 0.001). In sum, these findings allowed us to propose serum levels of anti-PON1 and anti-HDL antibodies as potential early biomarkers of endothelial damage and premature atherosclerosis in SLE, thus constituting useful therapeutic targets for the prevention of future CVD in these patients.

Funding

This work was supported by the European Union FEDER funds and Fondo de Investigación Sanitaria (FIS PI16/00113). J.R.-C. is a recipient of a grant from the ‘Juan de la Cierva’ program (FJCI-2015–23849; MICINN, Spain).


Supplementary Material

 
  • References

  • 1 Tsokos GC. Systemic lupus erythematosus. N Engl J Med 2011; 365 (22) 2110-2121
  • 2 Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med 2008; 358 (09) 929-939
  • 3 Piper MK, Raza K, Nuttall SL. , et al. Impaired endothelial function in systemic lupus erythematosus. Lupus 2007; 16 (02) 84-88
  • 4 Magder LS, Petri M. Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. Am J Epidemiol 2012; 176 (08) 708-719
  • 5 Lewandowski LB, Kaplan MJ. Update on cardiovascular disease in lupus. Curr Opin Rheumatol 2016; 28 (05) 468-476
  • 6 Selzer F, Sutton-Tyrrell K, Fitzgerald SG. , et al. Comparison of risk factors for vascular disease in the carotid artery and aorta in women with systemic lupus erythematosus. Arthritis Rheum 2004; 50 (01) 151-159
  • 7 Hak AE, Karlson EW, Feskanich D, Stampfer MJ, Costenbader KH. Systemic lupus erythematosus and the risk of cardiovascular disease: results from the nurses' health study. Arthritis Rheum 2009; 61 (10) 1396-1402
  • 8 Manzi S, Meilahn EN, Rairie JE. , et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997; 145 (05) 408-415
  • 9 de Leeuw K, Freire B, Smit AJ, Bootsma H, Kallenberg CG, Bijl M. Traditional and non-traditional risk factors contribute to the development of accelerated atherosclerosis in patients with systemic lupus erythematosus. Lupus 2006; 15 (10) 675-682
  • 10 Bruce IN. ‘Not only...but also’: factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosus. Rheumatology (Oxford) 2005; 44 (12) 1492-1502
  • 11 Frieri M, Stampfl H. Systemic lupus erythematosus and atherosclerosis: review of the literature. Autoimmun Rev 2016; 15 (01) 16-21
  • 12 Wilkinson IB, McEniery CM. Arterial stiffness, endothelial function and novel pharmacological approaches. Clin Exp Pharmacol Physiol 2004; 31 (11) 795-799
  • 13 Svenungsson E, Cederholm A, Jensen-Urstad K, Fei GZ, de Faire U, Frostegård J. Endothelial function and markers of endothelial activation in relation to cardiovascular disease in systemic lupus erythematosus. Scand J Rheumatol 2008; 37 (05) 352-359
  • 14 Pannier BM, Avolio AP, Hoeks A, Mancia G, Takazawa K. Methods and devices for measuring arterial compliance in humans. Am J Hypertens 2002; 15 (08) 743-753
  • 15 Polak JF, O'Leary DH. Carotid intima-media thickness as surrogate for and predictor of CVD. Glob Heart 2016; 11 (03) 295-312.e3
  • 16 Carbone F, Nencioni A, Mach F, Vuilleumier N, Montecucco F. Evidence on the pathogenic role of auto-antibodies in acute cardiovascular diseases. Thromb Haemost 2013; 109 (05) 854-868
  • 17 Charles-Schoeman C, Watanabe J, Lee YY. , et al. Abnormal function of high-density lipoprotein is associated with poor disease control and an altered protein cargo in rheumatoid arthritis. Arthritis Rheum 2009; 60 (10) 2870-2879
  • 18 Navab M, Reddy ST, Van Lenten BJ, Fogelman AM. HDL and cardiovascular disease: atherogenic and atheroprotective mechanisms. Nat Rev Cardiol 2011; 8 (04) 222-232
  • 19 Mackness MI, Arrol S, Durrington PN. Paraoxonase prevents accumulation of lipoperoxides in low-density lipoprotein. FEBS Lett 1991; 286 (1–2): 152-154
  • 20 Costa LG, Vitalone A, Cole TB, Furlong CE. Modulation of paraoxonase (PON1) activity. Biochem Pharmacol 2005; 69 (04) 541-550
  • 21 Batuca JR, Ames PRJ, Amaral M, Favas C, Isenberg DA, Delgado Alves J. Anti-atherogenic and anti-inflammatory properties of high-density lipoprotein are affected by specific antibodies in systemic lupus erythematosus. Rheumatology (Oxford) 2009; 48 (01) 26-31
  • 22 McMahon M, Grossman J, Skaggs B. , et al. Dysfunctional proinflammatory high-density lipoproteins confer increased risk of atherosclerosis in women with systemic lupus erythematosus. Arthritis Rheum 2009; 60 (08) 2428-2437
  • 23 Delgado Alves J, Kumar S, Isenberg DA. Cross-reactivity between anti-cardiolipin, anti-high-density lipoprotein and anti-apolipoprotein A-I IgG antibodies in patients with systemic lupus erythematosus and primary antiphospholipid syndrome. Rheumatology (Oxford) 2003; 42 (07) 893-899
  • 24 Delgado Alves J, Ames PRJ, Donohue S. , et al. Antibodies to high-density lipoprotein and beta2-glycoprotein I are inversely correlated with paraoxonase activity in systemic lupus erythematosus and primary antiphospholipid syndrome. Arthritis Rheum 2002; 46 (10) 2686-2694
  • 25 O'Neill SG, Giles I, Lambrianides A. , et al. Antibodies to apolipoprotein A-I, high-density lipoprotein, and C-reactive protein are associated with disease activity in patients with systemic lupus erythematosus. Arthritis Rheum 2010; 62 (03) 845-854
  • 26 Batuca JR, Ames PRJ, Isenberg DA, Alves JD. Antibodies toward high-density lipoprotein components inhibit paraoxonase activity in patients with systemic lupus erythematosus. Ann N Y Acad Sci 2007; 1108: 137-146
  • 27 Rodríguez-Carrio J, Alperi-López M, López-Mejías R. , et al. Antibodies to paraoxonase 1 are associated with oxidant status and endothelial activation in rheumatoid arthritis. Clin Sci (Lond) 2016; 130 (21) 1889-1899
  • 28 Charles-Schoeman C, Lee YY, Grijalva V. , et al. Cholesterol efflux by high density lipoproteins is impaired in patients with active rheumatoid arthritis. Ann Rheum Dis 2012; 71 (07) 1157-1162
  • 29 El-Banna H, Jiman-Fatani A. Anti-cyclic citrullinated peptide antibodies and paraoxonase-1 polymorphism in rheumatoid arthritis. BMC Musculoskelet Disord 2014; 15: 379
  • 30 Tanimoto N, Kumon Y, Suehiro T. , et al. Serum paraoxonase activity decreases in rheumatoid arthritis. Life Sci 2003; 72 (25) 2877-2885
  • 31 Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40 (09) 1725
  • 32 Rodríguez-Carrio J, Alperi-López M, López P, Ballina-García FJ, Abal F, Suárez A. Antibodies to high-density lipoproteins are associated with inflammation and cardiovascular disease in rheumatoid arthritis patients. Transl Res 2015; 166 (06) 529-539
  • 33 Rodríguez-Carrio J, López-Mejías R, Alperi-López M. , et al. Paraoxonase 1 activity is modulated by the rs662 polymorphism and IgG anti-high-density lipoprotein antibodies in patients with rheumatoid arthritis: potential implications for cardiovascular disease. Arthritis Rheumatol 2016; 68 (06) 1367-1376
  • 34 Touboul P-J, Hennerici MG, Meairs S. , et al. Mannheim carotid intima-media thickness consensus (2004-2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 2007; 23 (01) 75-80
  • 35 Touboul P-J, Hennerici MG, Meairs S. , et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012; 34 (04) 290-296
  • 36 Tselios K, Koumaras C, Gladman DD, Urowitz MB. Dyslipidemia in systemic lupus erythematosus: just another comorbidity?. Semin Arthritis Rheum 2016; 45 (05) 604-610
  • 37 Borba EF, Bonfá E. Dyslipoproteinemias in systemic lupus erythematosus: influence of disease, activity, and anticardiolipin antibodies. Lupus 1997; 6 (06) 533-539
  • 38 Toms TE, Panoulas VF, Kitas GD. Dyslipidaemia in rheumatological autoimmune diseases. Open Cardiovasc Med J 2011; 5: 64-75
  • 39 Gonzàlez M, Ribalta J, Vives G. , et al. Nuclear magnetic resonance lipoprotein subclasses and the APOE genotype influence carotid atherosclerosis in patients with systemic lupus erythematosus. J Rheumatol 2010; 37 (11) 2259-2267
  • 40 Srivastava R, Yu S, Parks BW, Black LL, Kabarowski JH. Autoimmune-mediated reduction of high-density lipoprotein-cholesterol and paraoxonase 1 activity in systemic lupus erythematosus-prone gld mice. Arthritis Rheum 2011; 63 (01) 201-211
  • 41 Esdaile JM, Abrahamowicz M, Grodzicky T. , et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2001; 44 (10) 2331-2337
  • 42 Kim J-Y, Lee E-Y, Park JK, Song YW, Kim JR, Cho KH. Patients with rheumatoid arthritis show altered lipoprotein profiles with dysfunctional high-density lipoproteins that can exacerbate inflammatory and atherogenic process. PLoS One 2016; 11 (10) e0164564
  • 43 Rosenson RS, Brewer Jr HB, Ansell BJ. , et al. Dysfunctional HDL and atherosclerotic cardiovascular disease. Nat Rev Cardiol 2016; 13 (01) 48-60
  • 44 Soran H, Schofield JD, Liu Y, Durrington PN. How HDL protects LDL against atherogenic modification: paraoxonase 1 and other dramatis personae. Curr Opin Lipidol 2015; 26 (04) 247-256
  • 45 Bhattacharyya T, Nicholls SJ, Topol EJ. , et al. Relationship of paraoxonase 1 (PON1) gene polymorphisms and functional activity with systemic oxidative stress and cardiovascular risk. JAMA 2008; 299 (11) 1265-1276
  • 46 Zhao Y, Ma Y, Fang Y. , et al. Association between PON1 activity and coronary heart disease risk: a meta-analysis based on 43 studies. Mol Genet Metab 2012; 105 (01) 141-148
  • 47 Kiss E, Seres I, Tarr T, Kocsis Z, Szegedi G, Paragh G. Reduced paraoxonase1 activity is a risk for atherosclerosis in patients with systemic lupus erythematosus. Ann N Y Acad Sci 2007; 1108: 83-91
  • 48 Sorenson RC, Bisgaier CL, Aviram M, Hsu C, Billecke S, La Du BN. Human serum paraoxonase/arylesterase's retained hydrophobic N-terminal leader sequence associates with HDLs by binding phospholipids : apolipoprotein A-I stabilizes activity. Arterioscler Thromb Vasc Biol 1999; 19 (09) 2214-2225
  • 49 Ahmed MM, Elserougy EM, Al-Gazzar II. , et al. Anti-apolipoprotein A-I antibodies and paraoxonase 1 activity in systemic lupus erythematosus. EXCLI J 2013; 12: 719-732
  • 50 Ombres D, Pannitteri G, Montali A. , et al. The gln-Arg192 polymorphism of human paraoxonase gene is not associated with coronary artery disease in Italian patients. Arterioscler Thromb Vasc Biol 1998; 18 (10) 1611-1616
  • 51 Regieli JJ, Jukema JW, Doevendans PA. , et al. Paraoxonase variants relate to 10-year risk in coronary artery disease: impact of a high-density lipoprotein-bound antioxidant in secondary prevention. J Am Coll Cardiol 2009; 54 (14) 1238-1245
  • 52 López-Pedrera C, Barbarroja N, Jimenez-Gomez Y, Collantes-Estevez E, Aguirre MA, Cuadrado MJ. Oxidative stress in the pathogenesis of atherothrombosis associated with anti-phospholipid syndrome and systemic lupus erythematosus: new therapeutic approaches. Rheumatology (Oxford) 2016; 55 (12) 2096-2108
  • 53 Manzi S. Systemic lupus erythematosus: a model for atherogenesis?. Rheumatology (Oxford) 2000; 39 (04) 353-359
  • 54 Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115 (04) 459-467
  • 55 Wu G-C, Liu H-R, Leng R-X. , et al. Subclinical atherosclerosis in patients with systemic lupus erythematosus: a systemic review and meta-analysis. Autoimmun Rev 2016; 15 (01) 22-37
  • 56 Selzer F, Sutton-Tyrrell K, Fitzgerald S, Tracy R, Kuller L, Manzi S. Vascular stiffness in women with systemic lupus erythematosus. Hypertension 2001; 37 (04) 1075-1082
  • 57 Tomoto T, Maeda S, Sugawara J. Influence of blood flow velocity on arterial distensibility of carotid artery in healthy men. J Physiol Sci 2017; 67 (01) 191-196
  • 58 Mattace-Raso FUS, van der Cammen TJM, Hofman A. , et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 2006; 113 (05) 657-663
  • 59 Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55 (13) 1318-1327
  • 60 Lanphere KR, Sharrar JM, Sibbitt WL, Roldan CR, Greene ER. Decreased arterial distensibility in patients with systemic lupus erythematosus. FASEB J 2009; 23 (01) 593.17
  • 61 Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol 2005; 25 (05) 932-943
  • 62 Firuzi O, Fuksa L, Spadaro C. , et al. Oxidative stress parameters in different systemic rheumatic diseases. J Pharm Pharmacol 2006; 58 (07) 951-957
  • 63 Förstermann U, Xia N, Li H. Roles of vascular oxidative stress and nitric oxide in the pathogenesis of atherosclerosis. Circ Res 2017; 120 (04) 713-735