New Biomarkers and Biomarker Panels Show Promise for Diagnosing and Monitoring Patients with Lupus

VBCR - August 2013, Volume 2, No 4 - Personalized Medicine in Rheumatology

By Rosemary Frei, MSc

There are finally some bright prospects in the search for accurate tools to diagnose patients with systemic lupus erythematosus (SLE) and to monitor the effects of treatment on the disease, according to the authors of a recent review article (Liu CC, et al. Biomarkers in systemic lupus erythematosus: challenges and prospects for the future. Ther Adv Musculoskelet Dis. 2013;5:210-233).

The diagnosis of SLE is very challenging, because the disease comprises a wide array of abnormalities and clinical manifestations across many organs, as well as the significant variation between patients. The search for biomarkers for lupus has intensified, and in recent years, the knowledge of SLE pathogenesis has burgeoned, together with an increase in the number of candidate biomarkers.

Focus on Biomarker Panels in Lupus Management
According to the authors of this review, new biomarker panels show particular promise for increasing the accuracy of diagnosing, monitoring, and stratifying the severity of SLE.

“We have at least one potentially interesting panel, but we need to work more collaboratively to increase the use and refining of the panels that
are currently available,” senior author Joseph M. Ahearn, MD, Chief Scientific Officer, Allegheny Singer Research Institute, and Codirector of the Lupus Center of Excellence, West Penn Allegheny Health System, Pittsburgh, PA, told Value-Based Care in Rheu­ma­tology.

Dr Ahearn is a coinventor of one of the biomarker panels for the diagnosis of SLE. His view, which is shared by many others in the field, is that single biomarkers cannot accurately track this complex disease. Therefore, refining lupus biomarker panels is necessary for optimizing the clinical diagnosis and follow-up of the individual patient.

The array of lupus biomarkers being developed for clinical use includes molecules involved in reduced DNA methylation and histone modification, as well as interferon-inducible proteins, a number of interferons and interleukins, and T-cell–related biomarkers. In addition, anti-C1q antibodies have been shown by several research teams to be very useful for monitoring renal involvement and/or predicting renal flares, noted Dr Ahearn and colleagues.

Several groups have tackled the task of creating biomarker panels for lupus:

  • One panel has been tested on a small number of patients and appears to have some promise. It consists of 30 genes involved in aberrant T-cell function in patients with SLE. Dr Ahearn and his team wrote in their review that this array has potential for diagnosis and stratification of patients with lupus, but it needs to be validated in larger numbers of patients
  • Another panel comprises a subset of genes that are associated with poor prognosis in patients with SLE, but is in very early stages of testing and refining
  • The third panel is a 5-biomarker panel called Avise SLE, which is the one Dr Ahearn coinvented.

“We started with ANA [antinuclear antibodies] and anti-dsDNA [double-stranded DNA]—which have been used for SLE diagnosis for dec­ades—and added 3 other biomarkers to them. That way, physicians don’t have to relinquish what they’ve been using for a long time,” explained Dr Ahearn.

A study that comprised 210 patients with SLE, 178 patients with other rheumatic diseases, and 205 healthy participants showed that the use of a subset of 4 of these 5 biomarkers—erythrocyte-bound C4d, B-cell–bound C4d, ANA, and antimutated citrullinated vimentin antibody—correctly identified 72% of the patients with SLE. Adding the remaining biomarker, anti-dsDNA, led to 80% sensitivity and 87% specificity rates among the SLE-positive patients.

“It’s critical that there be continued support for research on biomarkers and biomarker panels,” said Dr Ahearn. “To be able to move forward with personalized or precision medicine, we need to be able to deliver the right drug to the right patient at the right time. And that starts with getting the diagnosis right—if we don’t have the right diagnosis, then everything else downstream is going to be misdirected and will lead to wasted resources.”

Related Items
MBDA May Predict Post-TNFi Flares in Patients with Rheumatoid Arthritis
Rosemary Frei, MSc
VBCR - December 2015, Volume 4, No 6 published on December 15, 2015 in Personalized Medicine in Rheumatology
RA Disease Marker Proving to Be Versatile
Rosemary Frei, MSc
VBCR - December 2015, Volume 4, No 6 published on December 15, 2015 in Personalized Medicine in Rheumatology
MBDA May Predict RA Relapses During DMARD Tapering
Rosemary Frei, MSc
VBCR - December 2015, Volume 4, No 6 published on December 15, 2015 in Personalized Medicine in Rheumatology
Autoantibodies in Patients with RA Could Lead to More Precise Diagnosis, Therapy
E. K. Charles
VBCR - October 2014, Volume 3, No 5 published on October 30, 2014 in Personalized Medicine in Rheumatology
Advances in Genotyping Pinpoints to Genetic Determinant
Phoebe Starr
VBCR - August 2014, Volume 3, No 4 published on September 12, 2014 in Personalized Medicine in Rheumatology
Gene Expression Profiling Shows Potential in Personalized Medicine for RA
E. K. Charles
VBCR - June 2014, Volume 3, No 3 published on July 1, 2014 in Personalized Medicine in Rheumatology
Novel Plasma Cell Signature May Be Useful in a Range of Rheumatic Disorders
Alice Goodman
VBCR - April 2014, Volume 3, No 2 published on April 23, 2014 in Personalized Medicine in Rheumatology
New RA Susceptibility Locus Identified
Alice Goodman
VBCR - April 2014, Volume 3, No 2 published on April 23, 2014 in Personalized Medicine in Rheumatology
Future Therapies May Come from Modulation of Cell Signaling in Rheumatic Disease
Phoebe Starr
VBCR - February 2014, Volume 3, No 1 published on February 21, 2014 in Personalized Medicine in Rheumatology
Osteoarthritis Biomarker Field Fraught with Challenges
VBCR - December 2013, Volume 2, No 6 published on December 30, 2013 in Personalized Medicine in Rheumatology
Last modified: May 21, 2015
  • Rheumatology Practice Management
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology