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Presence and Implications of Anti-Angiotensin Converting Enzyme-2 Immunoglobulin M Antibodies in Anti-Melanoma-Differentiation-Associated 5 Dermatomyositis.
Mecoli, Christopher A; Yoshida, Akira; Paik, Julie J; Lin, Cheng Ting; Danoff, Sonye; Hanaoka, Hironari; Rosen, Antony; Christopher-Stine, Lisa; Kuwana, Masataka; Casciola-Rosen, Livia.
  • Mecoli CA; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Yoshida A; Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
  • Paik JJ; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Lin CT; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Danoff S; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Hanaoka H; Keio University School of Medicine, Tokyo, Japan.
  • Rosen A; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Christopher-Stine L; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Kuwana M; Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
  • Casciola-Rosen L; Johns Hopkins University School of Medicine, Baltimore, Maryland.
ACR Open Rheumatol ; 4(5): 457-463, 2022 May.
Article in English | MEDLINE | ID: covidwho-1712012
ABSTRACT

OBJECTIVE:

Patients with anti-melanoma-differentiation-associated 5 (anti-MDA5)-positive dermatomyositis (DM) share several striking similarities to patients with SARS-CoV-2. Our objective was to assess the prevalence of anti-angiotensin converting enzyme-2 (ACE2) immunoglobulin M (IgM) antibodies, found in patients with severe SARS-CoV-2, in two independent anti-MDA5-positive DM cohorts.

METHODS:

Anti-ACE2 IgM antibodies were assayed by enzyme-linked immunosorbent assay (ELISA) in two anti-MDA5-positive DM cohorts a predominantly outpatient North American cohort (n = 52) and a Japanese cohort enriched for new-onset disease (n = 32). Additionally, 118 patients with SARS-CoV-2 with a spectrum of clinical severity were tested for anti-MDA5 antibodies by ELISA.

RESULTS:

Five of fifty-two (9.6%) North American patients and five of thirty-two (15%) Japanese patients were positive for anti-ACE2 IgM. In the North American cohort, all five patients with anti-ACE2 IgM antibodies had proximal muscle weakness, had interstitial lung disease, were significantly more likely to receive pulse dose methylprednisolone (80% vs 30%, P = 0.043), and had worse forced vital capacity (median 59% predicted vs 78%, P = 0.056) compared with the anti-ACE2-IgM-negative group. In the Japanese cohort, all five anti-ACE2-IgM-positive patients also required pulse dose methylprednisolone, and three of five (60%) patients died. Japanese patients with anti-ACE2 IgM had significantly worse oxygenation, as defined by a lower partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (233 vs 390, P = 0.021), and a higher alveolar-arterial oxygenation gradient (91 vs 23 mm Hg, P = 0.024) than the IgM-negative group.

CONCLUSION:

We describe anti-ACE2 IgM autoantibodies in two independent cohorts with anti-MDA5-positive DM. These autoantibodies may be biomarkers for severe disease and provide insight into disease pathogenesis.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: ACR Open Rheumatol Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: ACR Open Rheumatol Year: 2022 Document Type: Article