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Autoimmune Diseases
Volume 2017 (2017), Article ID 1872846, 11 pages
Research Article

Anti-Myeloperoxidase Antibodies Associate with Future Proliferative Lupus Nephritis

1Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
2Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
3San Antonio Military Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, TX 78234, USA
4The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, 6707 Democracy Blvd, Bethesda, MD 20892, USA

Correspondence should be addressed to S. W. Olson

Received 4 August 2017; Revised 30 November 2017; Accepted 5 December 2017; Published 24 December 2017

Academic Editor: Ricard Cervera

Copyright © 2017 S. W. Olson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. The subclinical pathophysiology of proliferative lupus nephritis (PLN) has not been fully elucidated. Myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) is associated with PLN, but prediagnostic levels have not been reported. Methods. We performed a retrospective case-control Department of Defense Serum Repository (DoDSR) study comparing MPO-ANCA levels in longitudinal prediagnostic serum samples for 23 biopsy confirmed proliferative lupus nephritis (PLN) patients to DoDSR identified age, sex, race, and age of serum matched healthy and SLE without LN disease controls. We also compared the temporal relationship of MPO-ANCA to anti-double stranded DNA antibodies (dsDNAab). Results. A greater proportion of PLN patients had prediagnostic MPO-ANCA levels above ≥3 U/mL and ≥6 U/mL compared to SLE without LN (91% versus 43%, ; 57% versus 5%, , resp.). In subgroup analysis, the MPO-ANCA threshold of ≥3 U/mL was significant at <1 year (88% versus 39%, ) and 1–4 years (87% versus 38%, ) prior to diagnosis. Statistically significant subclinical MPO-ANCA levels (≥3 U/mL) occurred prior to statistically significant dsDNAab ≥ 3 IU/ml (89% versus 11%, ). Conclusions. Subclinical MPO-ANCA levels could distinguish future PLN from SLE without LN. MPO-ANCA manifests prior to clinical disease and subclinical dsDNAab to suggest that it may contribute directly to PLN pathogenicity.