Journal
ANNALS OF THE RHEUMATIC DISEASES
Volume 79, Issue 12, Pages 1580-1587Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/annrheumdis-2020-218004
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Funding
- Canadian Institutes of Health Research (CIHR) [MOP-88526, PJT148896]
- Nova Scotia Health Research Foundation (NSHRF) [MED-EST-2015-10067]
- Natural Sciences and Engineering Research Council of Canada (NSERC) [RGPIN 04293-17]
- Brain Canada (BC) [PSG2015-3780]
- Mitacs [IT11112]
- Nova Scotia Research Fund
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Objectives To examine the association between blood-brain barrier (BBB) integrity, brain volume and cognitive dysfunction in adult patients with systemic lupus erythematosus (SLE). Methods A total of 65 ambulatory patients with SLE and 9 healthy controls underwent dynamic contrast-enhanced MRI scanning, for quantitative assessment of BBB permeability. Volumetric data were extracted using the VolBrain pipeline. Global cognitive function was evaluated using a screening battery consisting of tasks falling into five broad cognitive domains, and was compared between patients with normal versus extensive BBB leakage. Results Patients with SLE had significantly higher levels of BBB leakage compared with controls (p=0.04). Extensive BBB leakage (affecting over >9% of brain volume) was identified only in patients with SLE (16/65; 24.6%), who also had smaller right and left cerebral grey matter volumes compared with controls (p=0.04). Extensive BBB leakage was associated with lower global cognitive scores (p=0.02), and with the presence of impairment on one or more cognitive tasks (p=0.01). Conclusion Our findings provide evidence for a link between extensive BBB leakage and changes in both brain structure and cognitive function in patients with SLE. Future studies should investigate the mechanisms underlying BBB-mediated cognitive impairment, validate the diagnostic utility of BBB imaging, and determine the potential of targeting the BBB as a therapeutic strategy in patients with SLE.
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