title: APRIL, a proliferation-inducing ligand, as a potential marker of lupus nephritis.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  APRIL could be a potential biomarker for predicting difficult-to-treat cases of lupus nephritis.
authors.forename: Worapot
authors.initials: W
authors.lastname: Treamtrakanpon
authors.forename: Pornpen
authors.initials: P
authors.lastname: Tantivitayakul
authors.forename: Thitima
authors.initials: T
authors.lastname: Benjachat
authors.forename: Poorichaya
authors.initials: P
authors.lastname: Somparn
authors.forename: Wipawee
authors.initials: W
authors.lastname: Kittikowit
authors.forename: Somchai
authors.initials: S
authors.lastname: Eiam-ong
authors.forename: Asada
authors.initials: A
authors.lastname: Leelahavanichkul
authors.forename: Nattiya
authors.initials: N
authors.lastname: Hirankarn
authors.forename: Yingyos
authors.initials: Y
authors.lastname: Avihingsanon
mesh_terms: D000328:Adult; D053264:B-Cell Activating Factor / Q000097:blood / Q000235:genetics; D015415:Biomarkers / Q000097:blood*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015870:Gene Expression / Q000187:drug effects; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects / Q000378:metabolism* / Q000473:pathology; D008137:Longitudinal Studies; D008181:Lupus Nephritis / Q000097:blood* / Q000188:drug therapy / Q000235:genetics; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016896:Treatment Outcome; D053300:Tumor Necrosis Factor Ligand Superfamily Member 13 / Q000097:blood* / Q000235:genetics
chemical_list: D053264:B-Cell Activating Factor; D015415:Biomarkers; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; C114631:TNFSF13 protein, human; C505719:TNFSF13B protein, human; D053300:Tumor Necrosis Factor Ligand Superfamily Member 13; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D011241:Prednisone