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Urinary TWEAK as a biomarker of lupus nephritis: a multicenter cohort study

Noa Schwartz12, Tamar Rubinstein1, Linda C Burkly3, Christopher E Collins45, Irene Blanco1, Lihe Su3, Bernard Hojaili1, Meggan Mackay6, Cynthia Aranow6, William Stohl4, Brad H Rovin7, Jennifer S Michaelson3 and Chaim Putterman18*

Author Affiliations

1 Division of Rheumatology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA

2 Hadassah University Hospital, POB 12000, Ein Kerem, Jerusalem 91120, Israel

3 Biogen Idec, 14 Cambridge Center, Cambridge, MA 02142, USA

4 Department of Medicine, Division of Rheumatology, Los Angeles County + University of Southern California Medical Center and University of Southern California, Keck School of Medicine, 2011 Zonal Avenue, Los Angeles, CA 90033, USA

5 Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010, USA

6 Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA

7 Ohio State University Medical Center, 410 West 10th Avenue, Columbus, OH 43210, USA

8 Department of Microbiology and Immunology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA

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Arthritis Research & Therapy 2009, 11:R143  doi:10.1186/ar2816

See related editorial by Dhaun and Kluth,

Published: 28 September 2009



TNF-like weak inducer of apoptosis (TWEAK) has been implicated as a mediator of chronic inflammatory processes via prolonged activation of the NF-κB pathway in several tissues, including the kidney. Evidence for the importance of TWEAK in the pathogenesis of lupus nephritis (LN) has been recently introduced. Thus, TWEAK levels may serve as an indication of LN presence and activity.


Multicenter cohorts of systemic lupus erythematosus (SLE) patients and controls were recruited for cross-sectional and longitudinal analysis of urinary TWEAK (uTWEAK) and/or serum TWEAK (sTWEAK) levels as potential biomarkers of LN. The performance of TWEAK as a biomarker for nephritis was compared with routinely used laboratory tests in lupus patients, including anti-double stranded DNA antibodies and levels of C3 and C4.


uTWEAK levels were significantly higher in LN patients than in non-LN SLE patients and other disease control groups (P = 0.039). Furthermore, uTWEAK was better at distinguishing between LN and non-LN SLE patients than anti-DNA antibodies and complement levels, while high uTWEAK levels predicted LN in SLE patients with an odds ratio of 7.36 (95% confidence interval = 2.25 to 24.07; P = 0.001). uTWEAK levels peaked during LN flares, and were significantly higher during the flare than at 4 and 6 months prior to or following the flare event. A linear mixed-effects model showed a significant association between uTWEAK levels in SLE patients and their disease activity over time (P = 0.008). sTWEAK levels, however, were not found to correlate with the presence of LN or the degree of nephritis activity.


High uTWEAK levels are indicative of LN, as opposed to non-LN SLE and other healthy and disease control populations, and reflect renal disease activity in longitudinal follow-up. Thus, our study further supports a role for TWEAK in the pathogenesis of LN, and provides strong evidence for uTWEAK as a candidate clinical biomarker for LN.