Short List of Biomarkers Emerges to Predict Therapy Outcomes for Lupus Nephritis
Published August 2017 | The Journal of Rheumatology
After comparing 15 potential biomarkers, a research team from Cincinnati Children’s reports that a select few can serve as “outstanding” predictors for achieving remission of lupus nephritis (LN), one of the most dangerous symptoms of systemic lupus erythematous (SLE).
At some point, up to 60 percent of lupus patients will develop LN, an inflammatory state that disrupts kidney function. An estimated 10 percent of children diagnosed with LN develop end-stage renal disease. Of those, about 22 percent will die within five years of requiring dialysis.
Currently, diagnosing LN requires a kidney biopsy. Treatment can last up to six months and can include multiple medications. Having an early-detection tool for non-responders could improve outcomes.
“If confirmed in large independent cohorts, these early biomarkers may prove invaluable for the identification of patients at risk of poor LN outcomes,” says first author Hermine Brunner, MD, MSc, Director of the Division of Rheumatology. “They could help clinicians adjust medication dosing and decide to surveil patients more closely in the clinic.”
To that end, a team led by Brunner and Prasad Devarajan, MD, Director of the Division of Nephrology, evaluated the predictive power of 15 biomarkers. The study analyzed urine samples from 87 patients, 37 of whom responded to treatment.
The team found that a set of “RAIL” biomarkers—NGAL, MCP-1, adiponectin, KIM-1, ceruloplasmin, and hemopexin—were excellent across all timepoints at discriminating responders from non-responders. A combination of adiponectin, AGP, and transferrin, along with adiponectin and VDBP individually, also had excellent ability to anticipate treatment response at the three-month mark.
Since publication, clinicians at Cincinnati Children’s have begun evaluating the value of the selected biomarkers in routine clinic settings. Meanwhile, the Innovation Ventures team has begun discussions with potential partners to commercialize the RAIL biomarkers.
