The pathogenic role of high-titer anti-Ro52 antibodies in neonatal lupus erythematosus: insights from a 9 case series.
- 1Department of Rheumatology and Immunology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
- 2Shenzhen University Medical School, Shenzhen University, Shenzhen, China.
Abstract
Background
Neonatal Lupus Erythematosus (NLE) is a rare acquired autoimmune disease caused by the transplacental transfer of maternal anti-Ro/SSA and anti-La/SSB antibodies. Despite the high prevalence of these antibodies in mothers with Systemic Lupus Erythematosus (SLE) and Sjögren's Syndrome (SS), the clinical manifestations in neonates are highly heterogeneous, ranging from transient cutaneous lesions to life-threatening congenital heart block (CHB).Methods
This study analyzed a case series of nine mother-infant pairs diagnosed with NLE. We integrated clinical outcomes, maternal serological profiles (including quantitative anti-Ro52, Ro60, and La titers), and pharmacological interventions to explore the determinants of disease severity and organ-specific manifestations.Results
Among the nine mothers, six (66.7%) had Sjögren's syndrome and three (33.3%) had systemic lupus erythematosus, including two with secondary antiphospholipid syndrome. Notably, 88.9% of mothers were diagnosed with autoimmune disease during or after the affected pregnancy. All mothers demonstrated antinuclear antibody positivity and were uniformly positive for anti-SSA/Ro, anti-SSB/La, and anti-Ro52 antibodies. Cardiac involvement occurred in three pregnancies, including recurrent complete CHB leading to pregnancy termination in one mother. One fetus with second-degree atrioventricular block received prompt dexamethasone therapy and achieved successful reversal of conduction abnormalities. Cutaneous manifestations were observed in five neonates, while hematologic involvement, primarily thrombocytopenia and anemia, occurred in four cases. Maternal hypocomplementemia and elevated inflammatory markers appeared to be associated with more severe fetal outcomes.Conclusion
All nine mothers (100%) tested positive for high-titer anti-Ro52 antibodies, a finding consistent with the proposed role of anti-Ro52 as a risk biomarker for NLE. Intensive fetal echocardiographic surveillance between 16 and 26 weeks of gestation is vital to capture the critical window of low-degree conduction block, where synergistic immunomodulation with dexamethasone can reverse fetal heart block prior to irreversible nodal fibrosis. NLE serves as an early warning sign of occult maternal autoimmune disease, requiring long-term maternal follow-up.
Related
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- Maternal Vaginal Pathogenic Bacterial Colonization and Early-Onset Neonatal Sepsis in Mwanza City, Tanzania: A Prospective Cohort Study.
- Navigating neonatal thrombosis: contemporary insights into a complex disorder in a unique population
BibTeX
@article{cheng2026pathogenic,
title = {{The pathogenic role of high-titer anti-Ro52 antibodies in neonatal lupus erythematosus: insights from a 9 case series.}},
author = {Shuo Cheng and Yi Jiang and Suo Zhang and Jiaming Huang and Xiaoxue Wang and Huanyu Xie and Meiying Wang},
journal = {Frontiers in pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1939494},
url = {https://europepmc.org/article/MED/42909017},
note = {CC BY},
}
RIS
TY - JOUR
TI - The pathogenic role of high-titer anti-Ro52 antibodies in neonatal lupus erythematosus: insights from a 9 case series.
AU - Shuo Cheng
AU - Yi Jiang
AU - Suo Zhang
AU - Jiaming Huang
AU - Xiaoxue Wang
AU - Huanyu Xie
AU - Meiying Wang
PY - 2026
DA - 2026/10/07
JO - Frontiers in pediatrics
DO - 10.3389/fped.2026.1939494
UR - https://europepmc.org/article/MED/42909017
AB - Background Neonatal Lupus Erythematosus (NLE) is a rare acquired autoimmune disease caused by the transplacental transfer of maternal anti-Ro/SSA and anti-La/SSB antibodies. Despite the high prevalence of these antibodies in mothers with Systemic Lupus Erythematosus (SLE) and Sjögren's Syndrome (SS), the clinical manifestations in neonates are highly heterogeneous, ranging from transient cutaneous lesions to life-threatening congenital heart block (CHB).Methods This study analyzed a case series of nine mother-infant pairs diagnosed with NLE. We integrated clinical outcomes, maternal serological profiles (including quantitative anti-Ro52, Ro60, and La titers), and pharmacological interventions to explore the determinants of disease severity and organ-specific manifestations.Results Among the nine mothers, six (66.7%) had Sjögren's syndrome and three (33.3%) had systemic lupus erythematosus, including two with secondary antiphospholipid syndrome. Notably, 88.9% of mothers were diagnosed with autoimmune disease during or after the affected pregnancy. All mothers demonstrated antinuclear antibody positivity and were uniformly positive for anti-SSA/Ro, anti-SSB/La, and anti-Ro52 antibodies. Cardiac involvement occurred in three pregnancies, including recurrent complete CHB leading to pregnancy termination in one mother. One fetus with second-degree atrioventricular block received prompt dexamethasone therapy and achieved successful reversal of conduction abnormalities. Cutaneous manifestations were observed in five neonates, while hematologic involvement, primarily thrombocytopenia and anemia, occurred in four cases. Maternal hypocomplementemia and elevated inflammatory markers appeared to be associated with more severe fetal outcomes.Conclusion All nine mothers (100%) tested positive for high-titer anti-Ro52 antibodies, a finding consistent with the proposed role of anti-Ro52 as a risk biomarker for NLE. Intensive fetal echocardiographic surveillance between 16 and 26 weeks of gestation is vital to capture the critical window of low-degree conduction block, where synergistic immunomodulation with dexamethasone can reverse fetal heart block prior to irreversible nodal fibrosis. NLE serves as an early warning sign of occult maternal autoimmune disease, requiring long-term maternal follow-up.
SN - 2296-2360
ER -