Table 2.
Experimental and potential biomarkers for diffuse central neuropsychiatric systemic lupus erythematosus.
| Biomarker | Modality | Manifestations | Strengths | Weaknesses | Ref. | |
|---|---|---|---|---|---|---|
| MMSE | Psychometric | Cognitive dysfunction |
Some use in pediatrics; easy to administer |
Insensitive to mild cognitive impairment |
[11,53,54,58] | |
| PedANAM | Preliminarily validated in pediatric lupus |
Requires computer and software | [71,72] | |||
| fMRI | Neuroimaging | Cognitive dysfunction in pediatrics |
Increased sensitivity, indicates impairment in neuronal networks; noninvasive |
Expensive, difficult to administer to children |
[74–76] | |
| SPECT | cNPSLE | May be more sensitive functional imaging than fMRI |
Expensive, radiation exposure, contradictory studies in pediatrics, nonspecific in most adult studies |
[77–80] | ||
| Antineuronal | Cerebrospinal fluid |
Cognitive dysfunction in pediatrics; cNPSLE in adults |
Strong evidence for association in adults |
Not lupus specific | Requires lumbar puncture to obtain |
[81–89] |
| Anti-NR2 | cNPSLE, cognitive dysfunction, depression |
Strong evidence for association in adults, supportive evidence from experimental mouse models |
Studies in pediatrics show no association with cognition |
[91–96] | ||
| Anti-GFAP/anti- MAP2 |
cNPSLE | May indicate progressive disease versus resolving disease |
No studies in pediatrics | [109,110] | ||
| TWEAK/RANTES/ MCP-1 |
cNPSLE | TWEAK may be an early disease marker for cNPSLE |
Limited preliminary studies | [97,113–115] | ||
| Antiphospholipid | Serum | cNPSLE in pediatrics; cognitive dysfunction in adults |
Established lupus biomarker for focal cNSPLE |
To confirm positivity should be measured twice 12 weeks apart |
[26,49,84,99– 101,104–108] |
|
| Antiendothelial cell |
Mood disorder, psychosis |
May precede disease and identify patients at risk |
No studies in pediatrics | [39] | ||
| S100B | cNPSLE | May precede disease and identify patients at risk |
Contradictory studies, little data in pediatric cNPSLE |
[54,129–132] |
Selected experimental and potential biomarkers for cNPSLE and their strengths and weaknesses in terms of their utility in the management of pediatric lupus patients.
cNPSLE: Central neuropsychiatric systemic lupus erythematosus; fMRI: Functional MRI; GFAP: Glial fibrillary acidic protein; MAP2: Microtubule-associated protein 2; MMSE: Mini Mental Status Exam; PedANAM: Pediatric Automated Neuropsychologic Assessment Metrics; TWEAK: TNF-associated weak inducer of apoptosis.