New biomarker to identify adolescent-lupus patients at increased cardiovascular disease risk

Cardiovascular disease (CVD) is a leading cause of mortality for patients with lupus, an autoimmune disease characterised by chronic inflammation. However, traditional CVD risk factors do not identify patients at risk from a young age. This increased risk is likely due to prolonged inflammation and disease treatment burden.

Despite this knowledge, there are currently no guidelines for CVD management in lupus and more reliable biomarkers (measurable indicators of CVD) are needed, especially in young adolescent-lupus patients who are at greatest risk. This would allow for much earlier therapeutic and or lifestyle interventions to reduce CVD morbidity and mortality.

Risk stratification using lipoprotein measures

In this study, published in EBioMedicine, the research team found that in-depth analysis of the particles responsible for carrying blood fats around the body could be used to stratify patients according to their CVD risk in adolescent-lupus. A biomarker named the Apolipoprotein-B:Apolipoprotein-A1 ratio was shown to very accurately identify a group of patients with high CVD risk, which could be used in a clinical setting to inform treatment strategies and aid CVD monitoring for these young patients throughout life.

Strikingly, patients in the higher CVD risk group had immune cells that were more inflammatory and had characteristics similar to those found in adult patients with diagnosed CVD and experimental models of CVD. These young patients also had persistently more active disease over a 5-year follow-up period, suggesting that better control of their disease is required to decrease their risk for CVD.

Understanding cardiovascular disease development

The multidisciplinary research team - based at the Centre for Rheumatology, Centre for Adolescent Rheumatology Versus Arthritis and the Centre for Cardiometabolic & Vascular Science in UCL's Division of Medicine - are optimistic about these findings. Dr George Robinson, lead author and postdoctoral researcher, said: “To be able to identify patients at a young age who have an increased CVD risk could be a huge therapeutic success for lupus research, enabling early intervention to improve the quality of life for patients.”

Principal investigator Professor Liz Jury, said: “This work helps us to understand the mechanisms associated with CVD development in lupus from a young age.”

Professor Ines Pineda Torra (senior author), said: “This is a great example of how we can use high-throughput analyses and next generation genomic technologies to identify novel immune and metabolic mechanisms of early CVD development in adolescent-lupus patients. This will help us to understand CVD risk in autoimmunity.”

Dr Coziana Ciurtin (senior author) said: “There are no guidelines for CVD risk monitoring or management in lupus patients, especially within this young age group, so this new blood marker could help identify patients that require intensified disease monitoring and therapeutic or lifestyle interventions.”

Further information

• Research paper: 'Increased apolipoprotein-B:A1 ratio predicts cardiometabolic risk in patients with juvenile onset SLE.' EBioMedicine.
• Dr George Robinson academic profile
• Prof Liz Jury academic profile
• Prof Ines Pineda Torra academic profile
• Dr Coziana Ciurtin academic profile
• Centre for Adolescent Rheumatology Versus Arthritis at UCL / UCLH and GOSH
• Centre for Rheumatology at UCL
• Centre for Cardiometabolic and Vascular Science at UCL
• UCL media contact: Henry Killworth, h.killworth@ucl.ac.uk
• Main image: Model of a heart - photo by jesse orrico on Unsplash