New Biomarkers of Lupus Nephritis May Help Predict Treatment Response

A recent study called Association of autoantibody concentrations and trajectories with lupus nephritis histologic features and treatment response published in Arthritis & Rheumatology identified autoantibodies in people with lupus nephritis (LN) that may predict treatment response and thus represent potential biomarkers of the disease.

LN is a common manifestation of systemic lupus erythematosus (SLE), a chronic, inflammatory autoimmune condition. While SLE can impact several major organ systems, LN specifically affects kidney function. People with LN may present with rash, photosensitivity, oral ulcers, seizures, or hematologic disorders, among other symptoms. 

Kidney biopsies are performed to confirm a diagnosis of LN, and disease types are determined by histological features (tissue structure) of the kidney. For example, proliferative LN is characterized by the presence of increased cells in the kidney and an accumulation of immune complexes (formed by antibodies and antigens). 

Despite treatment, many people with LN will eventually progress to end-stage renal disease. Identifying biomarkers for LN could help clinicians predict treatment response at the time of diagnosis and potentially improve clinical outcomes.

In this study, researchers screened blood samples from 268 people with proliferative LN from 5 clinical sites as part of an Accelerating Medicines Partnership LN longitudinal cohort study. Samples were tested for the presence of 13 autoantibodies at the time of kidney biopsy and 3, 6, and 12 months after biopsy. This study identified two autoantibodies–anti-C1q and anti-dsDNA–associated with treatment response. Higher baseline concentration of these autoantibodies predicted complete response to treatment at 12 months.

Histological features of the kidney in LN, which are evaluated prior to starting treatment, can change over time, and are not always associated with treatment response. Identification of biomarkers of LN may allow clinicians to better predict and help monitor response over time in a noninvasive way. Further data are required to better understand these biomarkers, especially since this study did not look at the associations between anti-C1q and anti-dsDNA and response to specific types of LN treatments.

Citation:

Fava, A., et al. (2024). Association of autoantibody concentrations and trajectories with lupus nephritis histologic features and treatment response. Arthritis & Rheumatology (Hoboken, N.J.), 10.1002/art.42941. Advance online publication. https://doi.org/10.1002/art.42941