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APRIL, a proliferation-inducing ligand, as a potential marker of lupus nephritis.

Treamtrakanpon W, Tantivitayakul P, Benjachat T, Somparn P, Kittikowit W, Eiam-ong S, Leelahavanichkul A, Hirankarn N, Avihingsanon Y - Arthritis Res. Ther. (2012)

Bottom Line: Serum 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.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: 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 although their correlation with lupus nephritis is not known. We therefore assessed serum BLyS and APRIL in active lupus nephritis patients.

Methods: Serum 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.

Results: Serum 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.

Conclusion: APRIL could be a potential biomarker for predicting difficult-to-treat cases of lupus nephritis.

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Related in: MedlinePlus

Comparisons of blood levels for BLyS (A) and APRIL (B) and treatment response. Each dot represents a baseline serum level of individual patient. CR means complete response to treatment by ACR criteria. Non-CR means partial or non-responses. ACR, American College of Rheumatology; APRIL, a proliferation-inducing ligand; BlyS, B lymphocyte activation protein.
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Figure 2: Comparisons of blood levels for BLyS (A) and APRIL (B) and treatment response. Each dot represents a baseline serum level of individual patient. CR means complete response to treatment by ACR criteria. Non-CR means partial or non-responses. ACR, American College of Rheumatology; APRIL, a proliferation-inducing ligand; BlyS, B lymphocyte activation protein.

Mentions: After six months of immunosuppressive therapy, 30% (7 of 27) of the patients achieved complete response (CR). There were no differences in the serum levels of BLyS among the CR and non-CR prior to treatment (Figure 2A). However, the serum levels of APRIL from the CR group were lower when compared to the non-CR group, but had not reached statistical significance (Figure 2B). Six patients from the CR group (86%) had serum levels of APRIL less than 4 ng/ml prior to treatment (Figure 2B). Unlike the CR group, 14/20 (70%) patients from the non-CR group had serum levels of APRIL more than 4 ng/ml prior to treatment. We therefore performed the ROC; we found that the serum levels of APRIL at 4 ng/ml could accurately predict response to treatment with a sensitivity of 65% and a specificity of 87.5%. The calculated area under the ROC curve was 0.713 (95% confidence interval = 0.49 to 0.93). The positive predictive value (PPV) and negative predictive value (NPV) were 93% and 54%, respectively. This cutoff level is the same value as the one obtained earlier from the mean serum levels of APRIL. This indicated that the value selected for the cutoff was appropriate in distinguishing response to treatment.


APRIL, a proliferation-inducing ligand, as a potential marker of lupus nephritis.

Treamtrakanpon W, Tantivitayakul P, Benjachat T, Somparn P, Kittikowit W, Eiam-ong S, Leelahavanichkul A, Hirankarn N, Avihingsanon Y - Arthritis Res. Ther. (2012)

Comparisons of blood levels for BLyS (A) and APRIL (B) and treatment response. Each dot represents a baseline serum level of individual patient. CR means complete response to treatment by ACR criteria. Non-CR means partial or non-responses. ACR, American College of Rheumatology; APRIL, a proliferation-inducing ligand; BlyS, B lymphocyte activation protein.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3674621&req=5

Figure 2: Comparisons of blood levels for BLyS (A) and APRIL (B) and treatment response. Each dot represents a baseline serum level of individual patient. CR means complete response to treatment by ACR criteria. Non-CR means partial or non-responses. ACR, American College of Rheumatology; APRIL, a proliferation-inducing ligand; BlyS, B lymphocyte activation protein.
Mentions: After six months of immunosuppressive therapy, 30% (7 of 27) of the patients achieved complete response (CR). There were no differences in the serum levels of BLyS among the CR and non-CR prior to treatment (Figure 2A). However, the serum levels of APRIL from the CR group were lower when compared to the non-CR group, but had not reached statistical significance (Figure 2B). Six patients from the CR group (86%) had serum levels of APRIL less than 4 ng/ml prior to treatment (Figure 2B). Unlike the CR group, 14/20 (70%) patients from the non-CR group had serum levels of APRIL more than 4 ng/ml prior to treatment. We therefore performed the ROC; we found that the serum levels of APRIL at 4 ng/ml could accurately predict response to treatment with a sensitivity of 65% and a specificity of 87.5%. The calculated area under the ROC curve was 0.713 (95% confidence interval = 0.49 to 0.93). The positive predictive value (PPV) and negative predictive value (NPV) were 93% and 54%, respectively. This cutoff level is the same value as the one obtained earlier from the mean serum levels of APRIL. This indicated that the value selected for the cutoff was appropriate in distinguishing response to treatment.

Bottom Line: Serum 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.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: 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 although their correlation with lupus nephritis is not known. We therefore assessed serum BLyS and APRIL in active lupus nephritis patients.

Methods: Serum 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.

Results: Serum 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.

Conclusion: APRIL could be a potential biomarker for predicting difficult-to-treat cases of lupus nephritis.

Show MeSH
Related in: MedlinePlus