IGFBP2 function as a novel biomarker for active lupus nephritis

In search for new targets for the diagnosis and treatment of lupus nephritis (LN), we employed TMT-liquid chromatography-triple quadrupole mass spectrometry (TMT-LC–MS/MS) combined with RNA-seq and identified a panel of proteins that was dysregulated both at protein level and mRNA level in active LN patients compared with healthy controls. We chose to study the role of IGFBP2 since it is a relatively understudied protein in the context of LN. We further validated that IGFBP2 significantly increased and correlated with SLE activity index in active LN patients. The receiver operator characteristic (ROC) curve suggested that plasma IGFBP2 had a high diagnostic efficiency for distinguishing between inactive and active LN patients (AUC = 0.992; 95% CI = 0.974–1.000; P < 0.001). We demonstrated neutralizing IGFBP2-downregulated CD4 + T cell activation, upregulated the ratio of Treg, downregulated AKT/mTOR/4E-BP1 pathway, and significantly improved nephritis in MRL/lpr mice. In all, our work demonstrated IGFBP2 as a biomarker specific for active LN and blocking IGFBP2 could be a new target for treating LN. Key messages Plasma IGFBP2 is a promising diagnostic marker for distinguishing stable LN from active LN, and it is also a predictor for the poor prognosis of LN. Blockade of IGFBP2 can significantly improve the pathological damage of LN. IGFBP2 may regulate activation of CD4 + T and Treg ratio. Neutralizing IGFBP2 downregulates AKT/mTOR/4E-BP1 pathway.