Autoantibodies Recognizing Specificity Protein 4 Co-occur With Anti-Transcription Intermediary Factor 1 and Are Associated With Distinct Clinical Features and Immunogenetic Risk Factors in Juvenile Myositis

Abstract

Objective: Autoantibodies recognizing specificity protein 4 (Sp4) were recently discovered in adults with idiopathic inflammatory myopathies (IIM). Anti-Sp4 autoantibodies co-occurred in patients with anti-transcription intermediary factor 1 (anti-TIF1) autoantibody-positive dermatomyositis (DM) and were associated with a reduced risk of cancer. In the present study, the prevalence and clinical features associated with anti-Sp4 autoantibodies in juvenile-onset IIM were investigated.

Methods: Serum samples from 336 patients with juvenile myositis in a cross-sectional cohort and 91 healthy controls were screened for anti-Sp4 autoantibodies using enzyme-linked immunosorbent assay. Clinical characteristics, outcomes, and HLA alleles of those with and those without anti-Sp4 autoantibodies were compared.

Results: Anti-Sp4 autoantibodies were present in 23 patients (7%) with juvenile myositis and were not present in any of the controls. Anti-Sp4 autoantibodies were found among each clinical myositis subgroup. The frequency of TIF1 autoantibody positivity was significantly higher among those with anti-Sp4 autoantibodies (21 [91%] versus 92 [30%], P < 0.001). In the anti-TIF1 autoantibody-positive subgroup, Raynaud's phenomenon (8 [38%] versus 2 [2%], P < 0.001) was more common and peak aspartate aminotransferase was significantly lower in those with anti-Sp4 autoantibodies. None of the patients with anti-Sp4 autoantibodies required a wheelchair. Among White patients, DQA1*04 and DRB1*08 were associated with anti-Sp4 autoantibodies.

Conclusion: Anti-Sp4 autoantibodies were found in patients with juvenile-onset IIM, predominantly those with coexisting anti-TIF1 autoantibodies. Patients with anti-Sp4 autoantibodies represent a phenotypic subset of anti-TIF1 autoantibody-positive myositis characterized by frequent Raynaud's phenomenon and less pronounced muscle involvement, similar to adults with these autoantibodies. Novel immunogenetic risk factors for White patients with IIM were identified among juveniles with anti-Sp4 autoantibodies.

Figure 1.

Swarm plot of anti-Sp4 autoantibody ELISA results for juvenile healthy controls and juvenile myositis patients. The dashed line of 0.294 AU indicates the cut-off level for anti-Sp4 autoantibody positivity. None of the 91 healthy controls and 23 of 327 myositis patients were positive. Of the 23 with anti-Sp4 autoantibodies, 19 had JDM, 1 had JPM, and 3 had JCTM. Anti-TIF1 autoantibodies were detected by immunoprecipitation-immunoblotting. Twenty-one of 113 anti-TIF1 autoantibody-positive patients had anti-Sp4 autoantibodies. All 21 patients with anti-TIF1 autoantibodies were confirmed to have anti-TIF1 autoantibodies via ELISA. Abbreviations: AU, arbitrary units; ELISA, enzyme-linked immunosorbent assay; JDM, juvenile dermatomyositis; JPM, juvenile polymyositis; JCTM, juvenile connective tissue myositis; TIF1, transcriptional intermediary factor 1.