Background/Purpose: Reliable non-invasive biomarkers for lupus nephritis (LN) are lacking. We investigated two adhesion molecules as urinary biomarkers in LN, i.e. vascular cell adhesion molecule 1 (VCAM-1) and activated leukocyte cell adhesion molecule (ALCAM), the latter also known as cluster of differentiation 166 (CD166).

Methods: Patients with systemic lupus erythematosus (SLE) (n=111, all female) and non-SLE population based controls (n=99, all female) were included. At inclusion, we assessed renal activity using the renal descriptors of the SLE disease activity index 2000 (SLEDAI-2K) and the renal domain of the British Isles Lupus Assessment Group (BILAG) index. Renal BILAG was not assessed in patients with end-stage renal disease (n=2). Urine and plasma VCAM-1 and urine ALCAM levels in samples obtained from patients and controls at the time of inclusion were estimated using enzyme-linked immunosorbent assay. Urine VCAM-1 and ALCAM levels were next adjusted by urine creatinine. For comparisons, we used the Mann-Whitney U test.

Results: In comparative analysis between SLE patients and controls, we observed higher urine VCAM-1 levels (P=0.001) and a trend towards higher plasma VCAM-1 concentrations (P=0.051) in SLE patients, but urine levels of ALCAM did not differ between the two groups. Furthermore, urinary VCAM-1/creatinine and ALCAM/creatinine ratio levels were higher in SLE patients (P<0.001 for both). We next conducted comparative analysis between SLE patients with current renal activity (renal BILAG A–C; n=10) and SLE patients with no current renal activity or no history of renal involvement (renal BILAG D–E; n=98). In this analysis, plasma VCAM-1 and urine ALCAM levels were higher in patients with active renal SLE (P=0.007 and P=0.009, respectively), but urine VCAM-1 levels were not found to differ. Urinary VCAM-1/creatinine and ALCAM/creatinine ratio levels were higher in SLE patients with renal activity (P=0.029 and P=0.001, respectively). Finally, we compared SLE patients with a renal SLEDAI-2K>0 (n=31) with SLE patients with renal SLEDAI-2K=0 (n=80). Here, plasma VCAM-1 concentrations were higher in patients with renal SLEDAI-2K>0 (P=0.018), but urine levels of VCAM-1 and ALCAM did not differ. However, both urinary VCAM-1/creatinine and urinary ALCAM/creatinine ratio levels were higher in SLE patients with renal SLEDAI-2K>0 (P=0.023 and P=0.006, respectively).

Conclusion: A role of VCAM-1 in SLE and LN is implicated. While VCAM-1 appears to reflect SLE disease state, ALCAM might have particular importance in renal SLE. After correction for creatinine, urine levels of both VCAM-1 and ALCAM showed ability to distinguish between SLE patients with active renal involvement compared to SLE patients with quiescent nephritis or no nephritis history.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-role-of-vascular-cell-adhesion-molecule-1-and-activated-leukocyte-cell-adhesion-molecule-in-lupus-nephritis/