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Congratulations to Dr. Steven Beyea, Dr. Tim Bardouille, Dr. Chris Bowen, and Dr. Maher Quraan for their recent publication. 

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In adult patients with systemic lupus erythematosus (SLE), the relationship between blood-brain barrier (BBB) integrity, brain volume, and cognitive dysfunction was tested. Researchers included 65 ambulatory patients with SLE and 9 healthy controls who had undergone dynamic contrast-enhanced MRI scanning for quantitative assessment of BBB permeability. They assessed global cognitive function by screening tasks falling into five broad cognitive domains; this was compared between patients with normal vs extensive BBB leakage. Compared with controls, patients with SLE had significantly greater levels of BBB leakage. Extensive BBB leakage (affecting over >9% of brain volume) was found only in patients with SLE, who also had smaller right and left cerebral grey matter volumes vs controls. Extensive BBB leakage was correlated with lower global cognitive scores, and with impairment on one or more cognitive tasks. Future trials are required to evaluate the mechanisms underlying BBB-mediated cognitive impairment, confirm the diagnostic utility of BBB imaging, and ascertain the potential of targeting the BBB as a therapeutic strategy in patients with SLE.

Abstract

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.