Rheumatology (Oxford). 2023 Jan 16. pii: kead015. [Epub ahead of print]
OBJECTIVES: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) includes granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). ANCA triggers neutrophil extracellular trap formation, which releases either mitochondrial (mt) DNA or nuclear DNA (n) DNA, contributing to inflammation. Our aim was to prospectively examine the extent and nature of circulating DNA in AAV and the clinical utility of DNA quantification.METHODS: DNA was isolated from platelet-free plasma of consecutive GPA and MPA patients and healthy controls (HC). mtDNA and nDNA copy numbers were quantified by PCR. Clinical data including the Birmingham Vasculitis Activity Score (BVAS), were collected.
RESULTS: Ninety-two HC (median age 51 years, 58.7% female) and 101 AAV patients (80 GPA, 21 MPA, median age 64 years, 50.5% female, BVAS range: 0-30) were included. Median mtDNA copies were 13-fold higher in AAV than HC; nDNA concentrations did not differ. Patients with active AAV (BVAS > 0) had 4-fold higher median mtDNA copies than patients in remission (P= 0.03). mtDNA, unlike nDNA, correlated with BVAS (r = 0.30, P= 0.002) and was associated with AAV activity at multivariable analysis. Receiver operating characteristic curve analysis indicates that mtDNA quantification differentiates active AAV (BVAS >0) from HC with 96.1% sensitivity and 98.9% specificity (AUC 0.99). In 27 AAV patients with follow-up, mtDNA changes but not CRP or ANCA-titers correlated with BVAS changes (r = 0.56, P= 0.002).
CONCLUSIONS: mtDNA, unlike nDNA, is elevated in the plasma of AAV patients and may contribute to systemic inflammation. mtDNA could be superior to established biomarkers in the laboratory monitoring of AAV activity.
Keywords: ANCA-associated vasculitis; disease activity; innate immunity; mitochondrial DNA; neutrophil extracellular traps