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Plasma levels of soluble interleukin 2 receptor, soluble CD30, interleukin 10 and B cell activator of the tumour necrosis factor family during follow-up in vasculitis associated with proteinase 3-antineutrophil cytoplasmic antibodies: associations with disease activity and relapse
  1. J-S F Sanders1,
  2. M G Huitma1,
  3. C G M Kallenberg1,
  4. C A Stegeman2
  1. 1Department of Internal Medicine, Division of Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
  1. Correspondence to:
    J-S F Sanders
    Department of Internal Medicine, Division of Clinical Immunology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 GZ Groningen, The Netherlands;j.sanders{at}int.umcg.nl

Abstract

Objectives: To evaluate whether T cell activation, as reflected by levels of soluble interleukin 2 receptor (sIL2R), soluble CD30 (sCD30), IL-10 and B cell activator of the tumour necrosis factor family (BAFF) at diagnosis and during initial follow-up, is predictive for persistent or renewed antineutrophil cytoplasmic antibody (ANCA) positivity and clinical relapse in patients with vasculitis associated with proteinase 3-antineutrophil cytoplasmic antibodies (PR3-ANCA).

Methods: 87 Patients with PR3-ANCA-associated vasculitis and at least 2 years of follow-up were included in the study. At diagnosis, and at 3, 6, 12, 18 and 24 months after diagnosis, cytoplasmic ANCA titres were detected by indirect immunofluorescence (IIF), and PR3-ANCA, sIL2R, sCD30, IL-10 and BAFF levels were assessed by ELISA. 31 healthy volunteers provided plasma samples for comparison. Levels of immune markers were related to ANCA positivity and relapse during follow-up.

Results: Plasma levels of sIL2R, sCD30 and BAFF were higher in patients than in controls at all time points. Plasma levels of sIL2R, sCD30 and IL-10 were higher at diagnosis and relapse than during remission. At 18 months, sCD30 (p<0.001) and sIL2R levels (p = 0.01) were significantly higher in PR3-ANCA-positive patients (detected by ELISA) than in PR3-ANCA-negative patients. ANCA-positive patients detected by ELISA or IIF at 24 months had significantly higher plasma sCD30 levels (p = 0.02 and p = 0.03, respectively) than ANCA-negative patients.

Conclusion: Increased T cell activation in patients with ANCA-associated vasculitis in remission during and after immunosuppressive treatment is associated with persistent or renewed ANCA positivity.

  • ANCA, antineutrophil cytoplasmic antibody
  • BAFF, B cell activator of the tumour necrosis factor family
  • BVAS, Birmingham Vasculitis Activity Score
  • C-ANCA, cytoplasmic antineutrophil cytoplasmic antibody
  • CRP, C reactive protein
  • IIF, indirect immunofluorescence
  • PR3-ANCA, proteinase 3-antineutrophil cytoplasmic antibodies
  • sCD30, soluble CD30
  • sIL2R, soluble interleukin 2 receptor
  • SLE, systemic lupus erythematosus

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Footnotes

  • Published Online First 27 February 2006

  • Competing interests: None.

  • Patients were asked to participate in studies on assessment of serological parameters including soluble IL-2R, CD30, IL-10 and BAFF, as parameters for immune activation and disease activity. These studies were approved by the Local Medical Ethical Committee.

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