Increased serum APRIL differentially correlates with distinct cytokine profiles and disease activity in systemic lupus erythematosus patients

Cytokines play an important role in the pathogenesis of systemic lupus erythematosus (SLE). Among the cytokines that regulate B cell homeostasis is a proliferation-inducing ligand (APRIL). This study aimed to determine whether serum levels of APRIL are raised in patients with SLE and correlate with disease activity or proinflammatory cytokines production, or both. Serum APRIL, interleukin-17 (IL-17), IL-4 and interferon gamma (IFN-γ) levels were measured in forty patients with SLE and 30 healthy controls. Disease activity was assessed by SLE disease activity index (SLEDAI), and results were correlated with serum APRIL levels. Serum APRIL levels were significantly higher in patients with SLE than in healthy controls. Positive correlation was found between serum APRIL levels and total SLEDAI score and anti-dsDNA antibody titers. Moreover, serum APRIL levels was significantly higher in patients with arthritis, mucocutaneous manifestations and proteinuria. APRIL is increased in patients with active SLE accompanying the increase of IL-17 and IFN-γ. Significant positive correlations between serum levels of APRIL and IL-17 and IFN-γ and a negative correlation between serum levels of APRIL and IL-4 were found. The results suggest that APRIL may be an important marker of disease activity in patients with SLE. We provide the analyses of APRIL levels in patients with SLE, suggesting new tools for the diagnosis, prognosis and possible therapeutic management of SLE.

Predictive role of urinary neutrophil gelatinase-associated lipocalin in lupus nephritis

OBJECTIVES

To evaluate the role of urinary neutrophil gelatinase-associated lipocalin (uNGAL), or lipocalin-2, in systemic lupus erythematosus (SLE) patients as a biomarker of renal activity and flares.

METHODS

Fifty subjects were divided into three groups: the first group comprised 14 SLE patients with no renal disease, the second group 16 SLE patients with active renal disease, the third group 20 apparently normal volunteers. At the beginning of the study clinical and laboratory data including uNGAL were collected. All patients were followed up serially in visits. At each visit, urine samples were collected for measurement of uNGAL as well as for standard urinalysis and a urine protein/creatinine ratio.

RESULTS

A highly significant difference was seen in uNGAL in all studied groups. Correlation was noticed between uNGAL and laboratory parameters of renal disease activity. There was significant positive correlation between renal SLEDAI and uNGAL levels. uNGAL is a significant predictor for renal disease activity and renal flare.

CONCLUSION

The more active the renal disease, the higher the measured levels of uNGAL, suggesting that it is a potential biomarker of active renal disease. uNGAL can be a predictive biomarker that could be followed serially to forecast renal disease activity and lupus nephritis flare.

Predictors of subclinical cardiovascular affection in Egyptian patients with juvenile idiopathic arthritis subtypes

Background

To assess the subclinical cardiovascular affection in juvenile idiopathic arthritis (JIA) Egyptian patient subtypes using Doppler ultrasonography (US) for carotid and femoral arteries and detecting their predictors

Results

Forty percent of the patients were polyarticular type, while 40% were systemic onset and 20% were oligoarticular. There was a statistically significant difference between JIA and controls in all parameters of subclinical atherosclerosis by ultrasonography except right external carotid velocity and (right and left) femoral velocity. There was also a highly significant increase in intima-media thickness (IMT) in systemic onset type of JIA. There was a statistically positive correlation between increased internal carotid velocity (right and left) and high erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), lipid profile, and disease activity. High disease activity and lipid profile were valid predictors of subclinical atherosclerotic cardiovascular affection in JIA.

Conclusion

Increased cardiovascular risks and subclinical atherosclerosis in patients with JIA especially systemic onset type may be due to higher prevalence of multiple risk factors in these patients. Doppler ultrasonography is a simple, non-invasive technique which can be used to detect subclinical atherosclerosis in JIA. Control of disease activity by treat to target strategy and proper diet control should be applied for every patient with JIA especially those with systemic onset type for future prevention of cardiovascular disease.

APRIL Level as a Marker of Disease Activity in Treated Rheumatoid Arthritis Patients: Association with Disease Activity and Anti-CCP Antibody

Rheumatoid arthritis (RA) is a chronic autoimmune disease with joint inflammation and autoantibody production. Cytokines play an important role in the pathogenesis of RA. Among the cytokines that regulate B cell homeostasis is the "A Proliferation-Inducing Ligand" (APRIL). To determine the differences in APRIL in response to treatment in anti- cyclic citrllinated peptides (anti-CCP) positive versus anti-CCP negative patients with established RA. Concentrations of APRIL in sera of 10 anti-CCP positive RA patients, 18 anti-CCP negative RA patients, and 12 healthy controls were measured by enzyme-linked immunosorbent assay (ELISA) at treatment initiation and after 6 months of treatment with methotrexate and hydroxychloroquine. Correlations between serum anti-CCP, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), 28-joint Disease Activity Score (DAS28), and serum level of APRIL were analyzed. Serum APRIL levels were increased in rheumatoid arthritis patients in comparison with healthy volunteers. APRIL correlated positively with disease activity; swollen joint count, visual analog score and simplified disease activity index (all P < 0.05). In addition, APRIL was significantly higher in patients with positive anti-CCP. After treatment, APRIL levels significantly decreased in the anti-CCP positive RA patients than in anti-CCP negative RA patients. In conclusions, serum APRIL may be a good predictor marker for joint injury and therapeutic response in patients with RA.