Blood-brain barrier leakage in systemic lupus erythematosus is associated with gray matter loss and cognitive impairment

Lyna Kamintsky, Steven D. Beyea, John D. Fisk, Javeria A. Hashmi, Antonina Omisade, Cynthia Calkin, Tim Bardouille, Chris Bowen, Maher Quraan, Arnold Mitnitski, Kara Matheson, Alon Friedman, John G. Hanly

Research output: Contribution to journalArticlepeer-review


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.

Original languageAmerican English
Pages (from-to)1580-1587
Number of pages8
JournalAnnals of the Rheumatic Diseases
Issue number12
StatePublished - 1 Dec 2020


  • autoimmunity
  • Blood-brain barrier
  • cognitive impairment
  • magnetic resonance imaging
  • systemic lupus erythematosus

All Science Journal Classification (ASJC) codes

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • General Biochemistry,Genetics and Molecular Biology


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