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Serum Biomarkers of Inflammation, Fibrosis, and Cardiac Function in Facilitating Diagnosis, Prognosis, and Treatment of Anti-SSA/Ro-Associated Cardiac Neonatal Lupus

Saxena, Amit; Izmirly, Peter M; Han, Sung Won; Briassouli, Paraskevi; Rivera, Tania L; Zhong, Hua; Friedman, Deborah M; Clancy, Robert M; Buyon, Jill P
BACKGROUND: Cardiac manifestations of neonatal lupus (cardiac NL) include congenital heart block and cardiomyopathy. Several candidate biomarkers were evaluated in cases at risk for cardiac NL on the basis of potential roles in inflammation, fibrosis, and cardiac dysfunction: C-reactive protein (CRP); NT-pro-B-type natriuretic peptide (NT-proBNP); troponin I; matrix metalloproteinase (MMP)-2; urokinase plasminogen activator (uPA); urokinase plasminogen activator receptor (uPAR); plasminogen; and vitamin D. OBJECTIVES: Identification of maternal and fetal biomarkers associated with development and morbidity of cardiac NL should provide clues to pathogenesis with translational implications for management. METHODS: Cord (139) and maternal (135) blood samples collected during pregnancies at risk for cardiac NL were available for study. Levels of cord and maternal CRP, cord NT-proBNP, and cord troponin I were evaluated using multiplex assays. Cord and maternal vitamin D were assessed by liquid chromatography-mass spectrometry. MMP-2, uPA, uPAR, and plasminogen were evaluated using ELISA. RESULTS: Cord CRP, NT-proBNP, MMP-2, uPA, uPAR, and plasminogen levels were higher in cardiac NL-affected fetuses than in unaffected cases, independent of maternal rheumatic disease, season at highest risk of cardiac NL development, and medications taken during pregnancy. These biomarkers were positively associated with a disease severity score derived from known risk factors for mortality in cardiac NL. Maternal CRP and cord troponin I levels did not differ between the groups. Cord and maternal vitamin D levels were not significantly associated with cardiac NL, but average maternal vitamin D level during pregnancy was positively associated with longer time to postnatal pacemaker placement. CONCLUSIONS: These data support the association of fetal reactive inflammatory and fibrotic components with development and morbidity of cardiac NL. Following CRP and NT-proBNP levels after birth can potentially monitor severity and progression of cardiac NL. MMP-2 and the uPA/uPAR/plasminogen cascade provide therapeutic targets to decrease fibrosis. Although decreased vitamin D did not confer increased risk, given the positive influence on postnatal outcomes, maternal levels should be optimized.
PMCID:4545752
PMID: 26293764
ISSN: 1558-3597
CID: 1732472

Long-Term Outcomes in Cardiac Neonatal Lupus and Associated Risk Factors for Morbidity [Meeting Abstract]

Saxena, Amit; Izmirly, Peter M; Sahl, Sara; Friedman, Deborah; Buyon, Jill P
ISI:000370860203452
ISSN: 2326-5205
CID: 2029582

A Novel Severity Score Based on Cardiac Neonatal Lupus Manifestations Serves As a Predictor and Outcome Measure of Morbidity in Anti-Ro Exposed Fetuses [Meeting Abstract]

Saxena, Amit; Izmirly, Peter M; Han, Sung Won; Briassouli, Paraskevi; Rivera, Tania; Halushka, Mark; Zhong, Hua; Friedman, Deborah; Clancy, Robert; Buyon, Jill P
ISI:000370860203528
ISSN: 2326-5205
CID: 2029602

Prevention and Treatment in Utero of Autoimmune Associated Congenital Heart Block

Saxena, Amit; Izmirly, Peter M; Mendez, Barbara; Buyon, Jill P; Friedman, Deborah M
Transplacental transfer of maternal anti-Ro and/or anti-La autoantibodies can result in fetal cardiac disease including congenital heart block and cardiomyopathy, called cardiac Neonatal Lupus (NL). Thousands of women are faced with the risk of cardiac NL in their offspring, which is associated with significant morbidity and mortality. There are no known therapies to permanently reverse third degree heart block in NL, although several treatments have shown some effectiveness in incomplete heart block and disease beyond the atrioventricular node. Fluorinated steroids taken during pregnancy have shown benefit in these situations, although adverse effects may be concerning. Published data are discordant on the efficacy of fluorinated steroids in the prevention of mortality in cardiac NL. beta-agonists have been used to increase fetal heart rates in utero. The endurance of beta-agonist effect and its impact on mortality are in question, but when used in combination with other therapies, they may provide benefit. No controlled experiments regarding the use of plasmapheresis in cardiac NL have been performed, despite its theoretical benefits. Intravenous immunoglobulin was not shown to prevent cardiac NL at a dose of 400 mg/kg, although it has shown effectiveness in the treatment of associated cardiomyopathy both in utero and after birth. Retrospective studies have shown that hydroxychloroquine may prevent the recurrence of cardiac NL in families with a previously affected child, and a prospective open-label trial is currently recruiting patients in order to fully evaluate this relationship.
PMCID:4539276
PMID: 25050975
ISSN: 1061-5377
CID: 1075912

Serum Biomarkers of Inflammation and Fibrosis in Advancing Diagnosis, Prognosis and Treatment of Anti-Ro Associated Congenital Heart Block. [Meeting Abstract]

Saxena, Amit; Izmirly, Peter M.; Han, Sung Won; Markham, Andrew; Clancy, Robert M.; Buyon, Jill P.
ISI:000344384901078
ISSN: 2326-5191
CID: 3726342

Role of Fluorinated Steroids in Preventing the Progression of Anti-SSA/Ro Associated Isolated Congenital Heart Block to Disease Beyond the Conduction System [Meeting Abstract]

Shah, Ummara; Saxena, Amit; Sahl, Sara; Friedman, Deborah; Buyon, Jill P.; Izmirly, Peter M.
ISI:000344384903450
ISSN: 2326-5191
CID: 3726362

Elevated Regulatory Mediators and Interferon Gamma Associated Responses, but Not Interferon Alpha, BLyS or IP-10, Accompany High-Titer Anti-Ro Autoantibodies in Asymptomatic Mothers of Children with Neonatal Lupus. [Meeting Abstract]

Izmirly, Peter M; Clancy, Robert M; Munroe, Melissa; Rasmussen, Sara; Saxena, Amit; Scher, Jose U; Thanou, Aikaterini; Kamp, Stan; Merrill, Joan T; Buyon, Jill P; James, Judith
ISI:000344384903229
ISSN: 2326-5205
CID: 1444042

Letter to the Editor in response to the article "Preventing congenital neonatal heart block in offspring of mothers with anti-SSA/Ro and SSB/La antibodies: A review of published literature and registered clinical trials." by Gleicher N, Elkayam U, Autoimmun Rev. 2013 Sep;12(11):1039-45 [Letter]

Costedoat-Chalumeau, Nathalie; Izmirly, Peter; Wahren-Herlenius, Marie; Silverman, Earl; Brucato, Antonio; Boutjdir, Mohamed; Khamashta, Munther; Llanos, Carolina; Pisoni, Cecilia N; Friedman, Deborah M; Clancy, Robert; Phoon, Colin K L; Saxena, Amit; Buyon, Jill P
PMID: 24008147
ISSN: 1568-9972
CID: 628742

Neonatal lupus

Chapter by: Mendez, B; Saxena, A; Buyon, JP; Izmirly, PM
in: Contraception and Pregnancy in Patients with Rheumatic Disease by
pp. 251-272
ISBN: 9781493906734
CID: 1773532

Prenatal Exposure To Fluorinated Steroids Does Not Affect Long Term Morbidity In Cardiac Neonatal Lupus [Meeting Abstract]

Saxena, Amit ; Izmirly, Peter M. ; Sahl, Sara ; Friedman, Deborah ; Buyon, Jill P.
ISI:000325359203257
ISSN: 0004-3591
CID: 656482