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IL-6, IL-17 may be biomarkers for disease activity in patients with lupus nephritis
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Interleukin-6 and interleukin-17 may be biomarkers for disease activity and predictive of remission in patients with lupus nephritis, according to a recently published study.
Seventy-two Egyptian women who met American College of Rheumatology (ACR) criteria for systemic lupus erythematosus (SLE) and 70 healthy women matched for age were enrolled in a study. Participants were excluded in the presence of comorbid autoimmune or renal disease, infection or malignancies.
Participants were followed every 2 months for 1 year. Visits included assessment of disease with the SLE Disease Activity Index (SLEDAI) and laboratory evaluations, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), 24-hour proteinuria, markers of kidney function, anti-dsDNA antibodies, complement (C) 3 and C4, interleukin (IL)-6 and IL-17.
Patients were classified at each visit by disease activity. Active disease was defined as a SLEDAI score above 4 and ACR renal criteria were used to diagnose nephritis. At baseline, 30 patients were classified with active nephritis and 42 were inactive. Patients with active disease were treated with cyclophosphamide infusion pulse therapy, followed by azathioprine and low dose glucocorticoids. The inactive group was treated with azathioprine, hydroxychloroquine or low-dose steroids.
Baseline serum IL-6 and IL-17 levels were significantly higher in patients compared to healthy women (12.12 pg/mL vs. 7.4 pg/mL, 18.55 pg/mL vs. 9.5 pg/mL). In patients with SLE and active nephritis, significantly higher levels of IL-6, IL-17, SLEDAI scores, ESR, anti-dsDNA titers, 24-hour proteinuria and serum creatinine were seen compared to patients with SLE and inactive nephritis, while C3, C4, red blood cells (RBCs) and hemoglobin concentrations were lower in patients with active disease compared to inactive patients.
At baseline, a positive correlation was seen between IL-6 and high SLEDAI scores, high anti-dsDNA titers and 24-hour proteinuria. A negative correlation was observed between IL-6 and C3 and RBCs.
A significant, positive correlation at baseline was also observed between IL-17 and high SLEDAI scores, high anti-dsDNA titers, 24-hour proteinuria and reduced C3 and RBCs.
During periods of disease activity and inactivity, a positive a positive association was seen with IL-6 and IL-17. Receiver operating characteristics analysis revealed the optimal threshold IL-6 level was 12.3 pg/mL with a 90% sensitivity and 90.5% specificity and a positive predictive value of 87.1. The optimal cutoff IL-17 level was 19.7 pg/mL with 93.3% sensitivity and 92.9% specificity and a positive predictive value of 90.3. As predictors of remission from lupus nephritis, IL-6 at 2.8 pg/mL was 83.3% sensitive and 88.9% specific while IL-17 at 27 pg/mL was 91.7% sensitive and 72.7% specific. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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