New Potential Predictive Biomarker for Lupus Nephritis

A new study published in Lupus Science and Medicine looked to determine if the amount of neutrophil extracellular trap (NET) remnants (Elastase-DNA and HMGB1-DNA complexes) at the time of a lupus nephritis (LN, lupus-related kidney disease) flare can predict renal outcomes and identify people that require more aggressive therapy. NET formation or NETosis is a unique form of cell death. NETs are elevated in the plasma of people with autoimmune diseases. Inside the body, NETs are composed of DNA and have a central role in immune defense, protecting against infection and supporting immune-modulatory functions. 

Participants of the study were split into two groups: an exploratory cohort which included 92 people (49 with active systemic lupus erythematosus (SLE); 23 people with inactive SLE, and 20 healthy controls) to assess the association between NET remnant levels and the presence of active LN, and an LN cohort which included 109 people with active LN to determine if NET remnants can predict renal outcomes over 24 months. Researchers found NET remnants were 36% higher in those with active LN compared to people with active SLE without LN. People with SLE also had significantly higher NET remnants than healthy people. The people with higher baseline levels of NET remnant were less likely to achieve remission and more likely to progress to severe renal impairment in the 24 months following a flare. 

This study showcases that circulating Elastase-DNA and HMGB1-DNA complexes may serve as biomarkers for adverse renal outcomes, response to therapy, and decline in kidney function following LN flare. Further studies are needed to understand the role NETosis plays in LN and the measurement of NET remnants for identification of people at high risk for poor outcomes. Learn more about managing and preventing flares.

Read the study