title: Lipid peroxidation is enhanced in patients with systemic lupus erythematosus and is associated with arterial and renal disease manifestations.
abstract: OBJECTIVE
  Cardiovascular disease with premature atherosclerosis is common in patients with systemic lupus erythematosus (SLE). We previously identified elevated levels of oxidized low-density lipoprotein (OxLDL) together with elevated levels of autoantibodies related to OxLDL as risk factors for cardiovascular disease in female patients with SLE. Autoantibodies to OxLDL are common in SLE and cross-react with anticardiolipin antibodies (aCL). We therefore hypothesized that lipid peroxidation is enhanced in patients with SLE in general.
  
  
  METHODS
  One hundred forty-seven female patients with SLE and 60 age- and sex-matched controls were compared. A monoclonal antibody to oxidized phospholipids, EO6, was used to determine oxidation epitopes on LDL. Anti-OxLDL and autoantibodies to malondialdehyde (MDA)-modified LDL, cardiolipin, and oxidized aCL were determined by chemiluminescence technique.
  
  
  RESULTS
  As determined by binding of EO6, patients with SLE had a higher level of oxidized phospholipids on LDL (P = 0.005) compared with controls. The level of OxLDL (e.g., oxidized phospholipid/apolipoprotein B) was associated with arterial disease (P = 0.006) and renal manifestations (P = 0.04). As reported previously, levels of aCL, autoantibodies to OxLDL, and autoantibodies to MDA-modified LDL were enhanced and were closely correlated in SLE. Anticardiolipin antibodies from these SLE patients recognized mainly oxidized forms of cardiolipin, indicating that antigenic epitopes on cardiolipin are related to lipid peroxidation in patients with SLE.
  
  
  CONCLUSIONS
  In general, patients with SLE (particularly those with cardiovascular disease) had more oxidized epitopes on LDL compared with controls. Furthermore, aCL in these patients recognized epitopes generated during lipid peroxidation. Thus, "neo" self antigens on lipoproteins, generated during oxidation, are present in SLE and may be of importance for the development of premature cardiovascular disease and possibly also for other autoimmune phenomena observed in SLE.
authors.affiliation: Center for Infectious Medicine and Center for Metabolism and Endocrinology, Department of Medicine, Karolinska University Hospital, Huddinge, S-141 86 Stockholm, Sweden. johan.frostegard@medhs.ki.se
authors.forename: Johan
authors.initials: J
authors.lastname: Frostegård
authors.forename: Elisabet
authors.initials: E
authors.lastname: Svenungsson
authors.forename: Ruihua
authors.initials: R
authors.lastname: Wu
authors.forename: Iva
authors.initials: I
authors.lastname: Gunnarsson
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Lundberg
authors.forename: Lars
authors.initials: L
authors.lastname: Klareskog
authors.forename: Sohvi
authors.initials: S
authors.lastname: Hörkkö
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Witztum
mesh_terms: D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood; D000936:Antigen-Antibody Complex / Q000097:blood; D001158:Arteries; D001323:Autoantibodies / Q000097:blood; D016022:Case-Control Studies; D000939:Epitopes / Q000097:blood; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D015227:Lipid Peroxidation / Q000276:immunology; D008055:Lipids / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology / Q000378:metabolism*; D008875:Middle Aged; D014652:Vascular Diseases / Q000209:etiology*
chemical_list: D017153:Antibodies, Anticardiolipin; D000936:Antigen-Antibody Complex; D001323:Autoantibodies; D000939:Epitopes; D008055:Lipids