APRIL, a proliferation-inducing ligand, as a potential marker of lupus nephritis

Arthritis Res Ther. 2012 Nov 21;14(6):R252. doi: 10.1186/ar4095.


Introduction: 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.

Conclusion: APRIL could be a potential biomarker for predicting difficult-to-treat cases of lupus nephritis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • B-Cell Activating Factor / blood
  • B-Cell Activating Factor / genetics
  • Biomarkers / blood*
  • Cyclophosphamide / therapeutic use
  • Drug Therapy, Combination
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Gene Expression / drug effects
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney / drug effects
  • Kidney / metabolism*
  • Kidney / pathology
  • Longitudinal Studies
  • Lupus Nephritis / blood*
  • Lupus Nephritis / drug therapy
  • Lupus Nephritis / genetics
  • Male
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Prednisone / therapeutic use
  • Prognosis
  • Reverse Transcriptase Polymerase Chain Reaction
  • Treatment Outcome
  • Tumor Necrosis Factor Ligand Superfamily Member 13 / blood*
  • Tumor Necrosis Factor Ligand Superfamily Member 13 / genetics


  • B-Cell Activating Factor
  • Biomarkers
  • Glucocorticoids
  • Immunosuppressive Agents
  • TNFSF13 protein, human
  • TNFSF13B protein, human
  • Tumor Necrosis Factor Ligand Superfamily Member 13
  • Cyclophosphamide
  • Mycophenolic Acid
  • Prednisone