Assessment of serum a proliferation-induced ligand level in patients with pemphigus vulgaris

Background Pemphigus vulgaris (PV) is a life-threatening autoimmune blistering disease where B cells are thought to play a central role. A proliferation-induced ligand (APRIL) is one of the members of tumor necrosis factor superfamily that has been shown to play an important role in B-cell biology and function. APRIL level was found elevated in a wide variety of autoimmune diseases yet its role in PV was not well studied. Objective To evaluate the serum APRIL level in newly diagnosed active PV patients and compare it with controlled PV patients on treatment and normal healthy participants. Patients and methods In a case–control comparative study, serum levels of APRIL was determined and compared in 50 participants. The cases included three groups: group A included 20 newly diagnosed PV patients who did not receive treatment with systemic steroids or immunosuppressant drugs; group B included 20 patients with PV in complete remission on therapy; and group C included 10 normal healthy controls. Results The mean serum APRIL level was 0.96 ± 0.80, 0.53 ± 0.15, and 0.49 ± 0.08 ng/ml in group A, group B, and group C, respectively. Serum APRIL level was significantly higher in group A than in groups B and C. No statistically significant difference was found between groups B and C. In spite of the higher serum APRIL level in controlled PV on treatment than the normal healthy control, the difference was not significant. There was no significant correlation between serum APRIL level and duration of disease or the age of the patients. Conclusion APRIL may play a role in the early, active stage of PV development; active PV patients had significantly higher APRIL serum level than both controlled PV patients on treatment and normal healthy participants. APRIL could be considered as a potential marker of early activation of PV. Targeting the APRIL system may be a potential therapeutic goal in the management of PV.