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233 Defining subsets in sle: the interplay among ifn-λ1, ifn-α and th17 axis cytokines
  1. V Oke1,
  2. S Brauner2,
  3. A Larsson3,
  4. J Gustafsson1,
  5. A Zickert1,
  6. I Gunnarsson1 and
  7. E Svenungsson1
  1. 1Karolinska Institutet, Department of Medicine- Rheumatology Clinic, Stockholm, Sweden
  2. 2Karolinska Institutet, Department of Medicine- Rheumatology research lab, Stockholm, Sweden
  3. 3Uppsala University, Department of Medical Sciences- Clinical Chemistry, Uppsala, Sweden


Background and aims Interferon (IFN)-αs are pivotal in systemic lupus erythematosus (SLE), and type III IFNs (IFN-λs) were recently also associated with SLE. We investigated levels of IFN-α and IFN-λ1, and related cytokines in SLE patients and controls.

Methods We included 261 SLE patients and 261 population controls. All were examined and assessed for current organ manifestations and disease activity/damage using SLAM, SLEDAI and ACR/SDI scales. Levels of IFN-λ1, IFN-α, IL-17A, IL-23 and IP-10 were measured by ELISA.

Results IFN-λ1 and IFN-α were detected in 29% and 44% of patients respectively, but their levels did not correlate. High serum levels of IFN-λ1 were positively associated with anti-nucleosome antibodies and lymphopenia, but negatively with musculoskeletal damage. Positive correlations between levels of IFN-λ1, IL-17A and IL-23 were observed. Patients with high levels of these three cytokines had more disease damage, especially renal. High levels of IFN-α were associated with mucocutaneous disease, leukopenia, low complement, Ro/SSA and La/SSB, whereas vascular events and antiphospholipid antibodies (aPL) were uncommon.

We identified two subgroups with high disease activity: one double IFN-λ1 and IFN-α high and another IP-10 high. The former had more neuropsychiatric manifestations, while the latter had more arthritis.

Conclusions Measurements of circulating IFN-λ1 and IFN-α define SLE patients with different characteristics. Levels of IFN-λ1 correlate with Th17 cytokines and identify a subgroup with more damage. Disease activity is associated with either upregulation of both type I and III IFNs, or independently with IP-10. Our findings could be of major importance when tailoring therapy for SLE patients with agents targeting IFN-pathways.

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