Abstract
IntroductionBLyS and APRIL are cytokines from the tumor necrosis factor family which play an important role in systemic lupus erythematosus (SLE). Previous works suggested an association between both molecules and SLE disease activity although their correlation with lupus nephritis is not known. We therefore assessed serum BLyS and APRIL in active lupus nephritis patients.MethodsSerum samples from active lupus nephritis and at 6 months post-treatment were obtained. Serum levels of BLyS and APRIL (n = 47) as well as renal mRNA expression were measured. Serum levels of both molecules and clinical data (n = 27) were available at 6 months follow-up. All biopsy-proven lupus nephritis patients were treated with similar immunosuppressive drugs.ResultsSerum levels of APRIL were associated with proteinuria (Rs = 0.44, P value < 0.01) and degree of histological activity (Rs = 0.34; P value < 0.05) whereas BLyS levels were associated with complement levels (Rs = 0.46; P value < 0.01) and dosage of immunosuppressant. Interestingly, serum APRIL as well as its intrarenal mRNA levels were associated with resistance to treatment. From the receiver operating characteristic (ROC) analysis, high levels (> 4 ng/mL) of serum APRIL predicted treatment failure with a positive predictive value of 93 percent.ConclusionAPRIL could be a potential biomarker for predicting difficult-to-treat cases of lupus nephritis.
Highlights
B lymphocyte stimulator (BLyS) and a proliferationinducing ligand (APRIL) are cytokines from the tumor necrosis factor family which play an important role in systemic lupus erythematosus (SLE)
The correlation of serum BLyS and APRIL levels with SLE We studied the stored blood samples drawn at the time of clinically and histologically confirmed active nephritis
Serum levels of APRIL were positively correlated with the severity of renal histology Serum levels of APRIL in the active lupus nephritis (LN) ranged from 0.7 to 11 ng/ml with a mean ± SE of 4.1 ± 0.28 ng/ml. In this active LN study, we found that the serum levels of APRIL were positively correlated to the renal histology results
Summary
BLyS and APRIL are cytokines from the tumor necrosis factor family which play an important role in systemic lupus erythematosus (SLE). Previous works suggested an association between both molecules and SLE disease activity their correlation with lupus nephritis is not known. We assessed serum BLyS and APRIL in active lupus nephritis patients. B cell regulation plays an important role in the pathogenesis of systemic lupus erythematosus (SLE) and lupus nephritis (LN) [1,2]. Many approaches have targeted blocking specific pathways of B cell activation for the treatment of the disease. Anti-CD20 monoclonal antibody was able to normalize autoantibodies and serum complement levels even though its clinical efficacy for lupus nephritis was a failure in clinical trials [8].
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