Novel Analytes Associated with Cognitive Impairment in Patients with Systemic Lupus Erythematosus: Serum S100A8/a9, Mmp-9, and Il-6
Bibliographic record
Abstract
Objectives Cognitive impairment (CI) is a common manifestation in patients with systemic lupus erythematosus (SLE). Despite its impact on patient quality of life, treatments remain limited as its pathogenesis is poorly understood. The Automated Neuropsychological Assessment Metrics (ANAM) has superior patient acceptability and feasibility in ambulatory settings compared to the American College of Rheumatology Neuropsychological Battery (ACR-NB) [gold-standard test] and is validated in screening for CI in SLE. Data from our laboratory have revealed that serum S100A8/A9 and MMP-9 are associated with CI measured by the ACR-NB. We therefore aimed to determine if serum analytes are associated with CI measured by the ANAM. Methods We cross-sectionally analyzed the data of 327 adults aged 18-65 who were followed longitudinally between January 2016 and October 2019 at a single SLE center. All participants fulfilled the 2019 EULAR/ACR SLE classification criteria. Cognitive function was measured using ANAM throughput scores, and serum levels of 9 analytes (IL-10, IL-6, IFN-γ, TNF-α, TWEAK, S100B, S100A8/A9, NGAL and MMP-9) were measured using ELISA. The K-means algorithm was used to cluster patient data, and the Principal Component Analysis (PCA) characterized the clusters. The silhouette coefficient was calculated for 2 to 15 clusters to determine the optimal number of clusters. Results PCA identified 2 principal components explaining 36.2% of the variance in ANAM throughputs and serum analytes. The first component (26.7% of the variance) was correlated with ANAM throughputs, with the strongest contribution from procedural reaction time. The second component (9.44% of the variance) was correlated with serum analyte measurements, with the strongest contribution from TNF-alpha. A 2-cluster model had the highest silhouette value and classified the most patients. Cluster 1 had low throughput scores representing CI, and Cluster 2 had higher throughput scores representing no CI. A significant difference was observed in mean serum S100A8/A9 (SMD=0.362), MMP-9 (SMD=0.178) and IL-6 (SMD=0.311) between the clusters, reflected by their correlation with the first principal component (Figure 1). Serum levels of S100A8/A9, MMP-9 and IL-6 had a strongly negative correlation between the Go No Go and Running Memory throughputs. Figure interpretation: The biplot displays the clusters projected on the first two principal components, which explains 36.2% of the variance in ANAM throughputs and serum analytes. Axis x represents the first component (explains 26.7% of the variance), which correlates with ANAM throughputs. Axis y represents the second component (explains 9.44% of the variance), which correlates with serum analyte measurements. The arrows represent the variables, and their direction indicates the relationship between the variables and the clusters. The length of the arrows indicates the strength of the relationship between the variable it represents and the cognitive dimensions. Conclusion Serum S100A8/A9, MMP-9, and IL-6 are associated with CI in SLE as measured by the ANAM. Patient clusters with elevated serum S100A8/A9, MMP-9, and IL-6 had strongly negative associations with throughputs representing impairment in executive function, simple attention and processing speed. Further studies are needed to uncover mechanistic relationships between these analytes and CI in SLE, and whether they may represent valuable therapeutic targets.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".