Open AccessALCAM and VCAM-1 as urine biomarkers of activity and long-term renal outcome in systemic lupus erythematosus
Author(s) -
Ioannis Parodis,
Sirisha Gokaraju,
Agneta Zickert,
Kamala Vanarsa,
Ting Zhang,
Deena Habazi,
João Botto,
Clara Serdoura Alves,
Panagiotis Giannopoulos,
Anders Larsson,
Elisabet Svenungsson,
Iva Gunnarsson,
Chandra Mohan
Publication year - 2019
Publication title -
rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.957
H-Index - 173
eISSN - 1462-0332
pISSN - 1462-0324
DOI - 10.1093/rheumatology/kez528
Subject(s) - medicine , creatinine , renal function , proteinuria , lupus nephritis , kidney disease , odds ratio , gastroenterology , population , urine , urology , immunology , kidney , disease , environmental health
Objectives We investigated the cell adhesion molecules (CAMs) Vascular CAM 1 (VCAM-1) and Activated Leucocyte CAM (ALCAM) as urinary biomarkers in SLE patients with and without renal involvement. Methods Female SLE patients (n = 111) and non-SLE population-based controls (n = 99) were enrolled. We measured renal activity using the renal domain of the BILAG index and urine (U) and plasma (P) concentrations of soluble (s)VCAM 1 and U-sALCAM using ELISA. U-sCAM levels were next corrected by U-creatinine. Results U-sVCAM-1/creatinine and U-sALCAM/creatinine ratios were higher in SLE patients vs non-SLE controls (P < 0.001 for both), as well as in patients with active/low-active (BILAG A–C; n = 11) vs quiescent (BILAG D; n = 19) LN (P = 0.023 and P = 0.001, respectively). U-sALCAM/creatinine but not U-sVCAM-1/creatinine ratios were higher in patients with nephritis history (BILAG A–D; n = 30) vs non-renal SLE (BILAG E; n = 79) (P = 0.014). Patients with baseline U-sVCAM-1/creatinine ratios ≥75th percentile showed a 23-fold increased risk of a deterioration in estimated glomerular filtration rate by ≥25% during a 10-year follow-up (odds ratio: 22.9; 95% CI: 2.8, 189.2; P = 0.004); this association remained significant after adjustments for age, disease duration and organ damage. Traditional markers including anti-dsDNA antibodies did not predict this outcome. Conclusion While high U-sVCAM-1 levels appear to reflect SLE disease activity, sALCAM might have particular importance in renal SLE. Both U-sVCAM-1 and U-sALCAM showed ability to distinguish SLE patients with active renal involvement from patients with quiescent or no prior nephritis. High U-sVCAM-1 levels may indicate patients at increased risk for long-term renal function loss.