Biomarkers for systemic lupus erythematosus – a focus on organ damage

ABSTRACT

Introduction

Systemic lupus erythematosus (SLE) is complex autoimmune disease with heterogenous manifestations, unpredictable disease course and response to treatment. One of the critical needs in SLE management is the identification of reliable biomarkers that can aid in early diagnosis, accurate monitoring of disease activity, and assessment of treatment response.

Areas covered

In the current review, we focus on the commonly affected organs (skin, kidney, and nervous system) in SLE to summarize the emerging biomarkers that show promise in disease diagnosis, monitoring and treatment response assessment. The subtitles within each organ domain were determined based on the most relevant and promising biomarkers for that specific organ damage.

Expert opinion

Biomarkers have the potential to significantly benefit the management of SLE by aiding in diagnosis, disease activity monitoring, prognosis, and treatment response assessment. However, despite decades of research, none has been validated and implemented for routine clinical use. Novel biomarkers could lead to the development of precision medicine for SLE, guide personalized treatment, and improve patient outcomes. Challenges in biomarker research in SLE include defining clear and clinically relevant questions, accounting for the heterogeneity of SLE, and confirming initial findings in larger, multi-center, multi-ethnic, independent cohorts that reflect real-world clinical scenarios.

KEYWORDS:

• Biomarker
• systemic lupus erythematosus
• cutaneous lupus erythematosus
• lupus nephritis
• neuropsychiatric systemic lupus erythematosus

Article highlights

• Systemic lupus erythematosus is a chronic autoimmune disease with clinical heterogeneity. Skin, kidney, and nervous system involvement are common in SLE and can lead to significant morbidity and mortality.

• The challenges of disease diagnosis and monitoring call for biomarkers to facilitate early detection, accurate diagnosis, and monitoring of disease activity in SLE patients.

• In cutaneous lupus erythematosus, biomarkers from blood and lesional skin play a critical role in early diagnosis, assessment of skin disease activity, differentiation between isolated CLE and SLE, and identification of treatment response.

• In lupus nephritis, multi-omics approaches have led to the discovery of diverse biomarkers, including proteins, and non-coding RNAs. One promising area is the identification of urine biomarkers.

• In NPSLE, the lack of a sensitive test and highly variable presentations make the diagnosis challenging. Studies are mainly focused on identifying biomarkers that can differentiate NPSLE from other neurological or psychiatric conditions.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by Youth Program of National Natural Science Foundation of China [82001709] and “Science and Technology Innovation Action Plan” medicine innovation fund [21Y31900200] by Science and Technology Commission of Shanghai Municipality.