New Autoantibody Specificities in Systemic Sclerosis and Very Early Systemic Sclerosis

• Main Authors: Roberto Lande, Raffaella Palazzo, Anna Mennella, Immacolata Pietraforte, Marius Cadar, Katia Stefanantoni, Curdin Conrad, Valeria Riccieri, Loredana Frasca
• Format: Article
• Language: English
• Published: MDPI AG 2021-03-01
• Series: Antibodies
• Subjects: autoimmune diseases; chemokine (C-X-C motif) ligand 4 (CXCL4); CXCL4-L1; autoantibodies; Systemic Sclerosis; Very Early Diagnosis of Systemic Sclerosis (VEDOSS)
• Online Access: https://www.mdpi.com/2073-4468/10/2/12

Chemokine (C-X-C motif) ligand 4 (CXCL4) is a biomarker of unfavorable prognosis in Systemic Sclerosis (SSc), a potentially severe autoimmune condition, characterized by vasculitis, fibrosis and interferon (IFN)-I-signature. We recently reported that autoantibodies to CXCL4 circulate in SSc patients and correlate with IFN-α. Here, we used shorter versions of CXCL4 and CXCL4-L1, the CXCL4 non-allelic variant, to search for autoantibodies exclusively reacting to one or the other CXCL4 form. Moreover, to address whether anti-CXCL4/CXCL4-L1 antibodies were present before SSc onset and predicted SSc-progression, we longitudinally studied two VEDOSS (Very Early Diagnosis of Systemic Sclerosis) patient cohorts, separating SSc-progressors from SSc-non-progressors. We found that anti-CXCL4-specific autoantibodies were present in both SSc and VEDOSS patients (both SSc-progressors and SSc-non-progressors). Anti-CXCL4-L1-specific autoantibodies were especially detected in long-standing SSc (lsSSc). Anti-CXCL4/CXCL4-L1 antibodies correlated with IFN-α and with specific SSc-skin features but only in lsSSc and not in early SSc (eaSSc) or VEDOSS. Thus, a broader antibody response, with reactivity spreading to CXCL4-L1, is characteristic of lsSSc. The early anti-CXCL4 autoantibody response seems qualitatively different from, and likely less pathogenic than, that observed in advanced SSc. Lastly, we confirm that anti-CXCL4 autoantibodies are SSc-biomarkers and uncover that also CXCL4-L1 becomes an autoantigen in lsSSc.