Antibodies associated with high proteinuria in patient’s with lupus nephritis

In patients with lupus nephritis (LN), anti-ENO1, anti-H2A, and anti-ANXA1 antibodies were associated with high proteinuria, according to a study.

In this prospective analysis, the circulating IgG2 levels over 36 months of 91 patients with newly diagnosed LN, 31 patients with newly diagnosed systemic lupus erythematosus (SLE), and 99 patients within 2 years of an initial SLE diagnosis were reviewed. Anti-podocyte (ENO1), anti-nucleosome (DNA, histone 2 A, histone 3), and anti-circulating proteins (C1q, AnnexinA1-ANXA1) IgG2 antibodies were determined. Anti-ENO1, anti-H2A, and anti-ANXA1 decreased simultaneously with proteinuria. In most patients, anti-ENO1, anti-H2A, and anti-ANXA1 normalized within 12 months, however, anti-dsDNA IgG2 remained high over the 36-month study period.

Anti-ENO1 and anti-H2A had the highest association with proteinuria. Anti-ENO1 and anti-H2A identified 68% and 71%, respectively, of patients with high proteinuria and/or 58% with reduced estimated glomerula filtration rate (eGFR) for both antibodies compared with 23% and 17% of anti-dsDNA (agreement analysis).

Patients with LN who were anti-ENO1 positive had higher proteinuria than patients who were negative at T0. These patients also had the greatest reduction in proteinuria within 12 months.

Reference
Bruschi M, Moroni G, Sinico RA, et al. Serum IgG2 antibody multi-composition in systemic lupus erythematosus and in lupus nephritis (Part 2): prospective study. Rheumatol. 2020; https://doi.org/10.1093/rheumatology/keaa793