Background/Purpose

SLE mainly affects young women and pregnancy in these patients has significant morbidity and mortality. Clinical and laboratory findings in lupus nephritis are similar to those found in patients with preeclampsia (PE), specifically hypertension, proteinuria and edema. It has been proposed the use of angiogenic factors, such as vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), and antiangiogenic factors, as soluble Fms-like tyrosine kinase-1 (sFlt-1), for the differential diagnosis between these two conditions, however available data in the literature about these cytokines in non-pregnant SLE patients are inconsistent. This study was designed to evaluate whether there are differences between serum levels of VEGF, PlGF and sFlt-1 in non-pregnant SLE patients with and without systemic disease activity and whether there are differences in these factors when comparing SLE patients with healthy women.

Methods

54 women with SLE (according to ACR classification criteria) followed at an outpatient clinic of rheumatology were included. They had no other autoimmune disease diagnosed and were divided according to disease activity. 30 patients had inactive disease (mean SLEDAI: 0.7), and 24 had active disease (mean SLEDAI: 11.6). Twenty-three women in this latter group had active nephritis, while 20 patients with inactive disease had history of lupus nephritis. Control group consisted of 34 healthy women who attended a gynecology outpatient clinic.

Results

The mean values of VEGF, PlGF and sFlt-1 of all groups are described on Table 1. Considering the three studied cytokines, the SLE patients had significantly higher mean serum levels than the control group (VEGF: 319.0 + 226.0 x 206.2 + 119.4, p=0.02; PlGF: 42.2 + 54.1 x 13.6 + 21.6, p=0.02; sFlt-1: 107.9 + 49.2 x 70.2 + 95.0, p=0.01). The group of patients with active disease also had significantly higher mean levels of all three factors than controls (VEGF: 331.0 + 216.8 x 206.2 + 119.4, p=0.02; PlGF: 41.2 + 47.3 x 13.6 + 21.6, p=0.02; sFlt-1: 120.5 + 42.4 x 70.2 + 95.0, p=0.02), whereas no statistical difference was found between the group with inactive SLE and the control group. The mean sFlt-1 levels were higher in patients with active SLE than the mean levels of patients with inactive disease (120.5 + 54.9 x 97.8 + 42.4, p=0.02), but there was no significant difference in mean serum of VEGF and PlGF levels between these two groups. 

Conclusion

Patients with active SLE have higher levels of VEGF, PlGF and sFlt-1 than controls. sFlt-1 was also higher in patients with active SLE than patients with inactive SLE. A better understanding of angiogenic and antiangiogenic factors in patients with SLE provided by this study allows the analysis of these cytokines in pregnant woman with SLE and possibly their subsequent application as differential method between PE and lupus nephritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/angiogenic-and-antiangiogenic-factors-in-patients-with-systemic-lupus-erythematosus/