Clinical value of determining the markers of vascular wall damage in patients with ANCA-associated vasculitis and polyarteritis nodosa


  • L. B. Petelytska O. O. Bogomolets National Medical University, Kyiv, Ukraine,
  • O. B. Yaremenko O. O. Bogomolets National Medical University, Kyiv, Ukraine,



systemic vasculitis, ANCA-associated vasculitis, polyarteritis nodosa, biomarkers, diagnosis, endothelin-1, alpha-actin-2, elastin



The aim of the study – to determine the diagnostic value of serum levels of endothelin-1, alpha-actin-2 and elastin in patients with primary systemic vasculitis.

Materials and methods. Twenty eight patients with ANCA-associated vasculitis, 8 patients with polyarteritis nodosa of moderate or high vasculitis activity (BVAS >11) and 26 healthy subjects (control group) were examined. Serum levels of endothelin-1, alpha-actin-2 and elastin were determined by immunoassay using commercial kits of Biomedica, Biorbyt and Bender Medsystems.

Results. The level of endothelin-1 in patients with primary systemic vasculitis did not significantly differ from that of the control group, but its level (0.40 ± 0.33 pmol/l) was significantly higher in patients with kidney involvement (n = 15) compared with patients without kidney damage (0.28 ± 0.22 pmol/l, P = 0.04) and the control group (0.27 ± 0.10 pmol/l, P < 0.01). The level of alpha-actin-2 in the group of patients with ANCA-associated vasculitis was twice as high as in the control group (P < 0.05), which can be used for diagnosis this group of diseases (AUC 0.96 ± 0.16; 95 % CI 0.60–1.00; sensitivity 83 %, specificity 84 %, P <0.01). The level of elastin in the group of patients with polyarteritis nodosa was significantly higher not only in comparison to the control group (1.6 times, P < 0.05), but also in comparison to patients with ANCA-associated vasculitis (1.9 times, P < 0.01). According to the ROC analysis of the elastin diagnostic value for differential diagnosis of polyarteritis nodosa and ANCA-associated vasculitis, the AUC was 0.81 ± 0.10; 95 % CI 0.60–1.00; sensitivity 75 %, specificity 89 %, P < 0.01.

Conclusions. The elevated level of alpha-actin-2 with high sensitivity and specificity allows the diagnosis of ANCA-associated vasculitis in patients suspected of these diseases. The serum level of elastin is almost twice as high in patients with polyarteritis nodosa compared to patients with ANCA-associated vasculitis, which can be used in the differential diagnosis of primary systemic vasculitis. An elevated serum endothelin-1 level is found in patients with kidney damage.




Ball, G. V., & Bridges, S. L. (2014). Nomenclature and classification of vasculitic syndromes. In G. V. Ball, , Fessler B. J., S. L. Bridges Jr (Eds.), Oxford Textbook of Vasculitis (3rd ed., pp. 3 4). Oxford University Press.

Ozen, S. (2017). The changing face of polyarteritis nodosa and necrotizing vasculitis. Nature Reviews Rheumatology, 13, 381 386.

Yates, M., & Watts, R. (2017). ANCA-associated vasculitis. Clinical Medicine, 17(1), 60 64.

Alibaz-Oner, F., Koster, M., Crowson, C., Makol, A., Ytterberg, S., Salvarani, C., Matteson, E., & Warrington, K. (2017). Clinical Spectrum of Medium-Sized Vessel Vasculitis. Arthritis Care & Research, 69(6), 884 891.

Yates, M., Watts, R., Bajema, I., Cid, M., Crestani, B., Hauser, T., Hellmich, B., Holle, J., Laudien, M., Little, M., Luqmani, R., Mahr, A., Merkel, P., Mills, J., Mooney, J., Segelmark, M., Tesar, V., Westman, K., Vaglio, A., … Mukhtyar, C. (2016). OP0053 Eular/ERA-EDTA Recommendations for The Management of Anca-Associated Vasculitis. Annals Of The Rheumatic Diseases, 75(Suppl. 2), 74.2 74.

Westman, K., Flossmann, O., & Gregorini, G. (2015). The long-term outcomes of systemic vasculitis. Nephrology Dialysis Transplantation, 30(Suppl. 1), i60–i66.

Tan, J., Dehghan, N., Chen, W., Xie, H., Esdaile, J., & Avina-Zubieta, J. (2017). Mortality in ANCA-associated vasculitis: ameta-analysis of observational studies. Annals of the Rheumatic Diseases, 76(9), 1566–1574.

Yaremenko, O. B., & Petelytska, L. B. (2017). ANTsA-asotsiiovani vaskulity: heterohennist klinichnykh proiaviv, prohnoz, suchasni mozhlyvosti farmakoterapii [ANCA-associated vasculitis: heterogeneity of clinical manifestations, prognosis, current opportunities of pharmacotherapy]. Medical science of Ukraine, 13(1 2), 98 105. [in Ukrainian].

Savige, J., Trevisin, M., & Pollock, W. (2018). Testing and reporting antineutrophil cytoplasmic antibodies (ANCA) in treated vasculitis and non-vasculitic disease. Journal of Immunological Methods, 458, 1–7.

McKinney, E., Willcocks, L., Broecker, V., & Smith, K. (2014). The immunopathology of ANCA-associated vasculitis. Seminars in Immunopathology, 36(4), 461–478.

Zhou, N., Stoll, S., Leimena, C., & Qiu, H. (2018). Vascular Smooth Muscle Cell. In K. Sakuma (Ed.), Vascular Smooth Muscle Cell. Muscle Cell And Tissue – Current Status Of Research Field (pp. 209 227). IntechOpen.

Szekanecz, Z., Kerekes, G., & Koch, A. (2014). Biology of endothelial cells. In G. V. Ball, , Fessler B. J., S. L. Bridges Jr (Eds.), Oxford Textbook of Vasculitis (3rd ed., p. 43). Oxford University Press.

Xu, J., & Shi, G.-P. (2014). Vascular wall extracellular matrix proteins and vascular diseases. Biochimica et Biophysica Acta (BBA) – Molecular Basis of Disease, 1842(11), 2106–2119.

Syniachenko, O. V., Bevzenko, T. B., Yermolayeva, M. V., Sedaia, L. V., & Malakhova, Z. V. (2015). Endotelial'naya funktsiya sosudov i reologicheskie svoistva krovi pri ANCA-assotsiirovannom sistemnom vaskulite [Endothelial function of blood vessels and blood rheology in ANCA-associated systemic vasculitis]. Ukrainian Journal of Rheumatology, (62), 81 86. [in Russian].

Steubl, D., Block, M., Herbst, V., Nockher, W. A., Schlumberger, W., Satanovskij, R., Angermann, S., Hasenau, A.-L., Stecher, L., Heemann, U., Renders, L., & Scherberich, J. (2016). Plasma Uromodulin Correlates With Kidney Function and Identifies Early Stages in Chronic Kidney Disease Patients. Medicine, 95(10), Article e3011.

How to Cite

Petelytska LB, Yaremenko OB. Clinical value of determining the markers of vascular wall damage in patients with ANCA-associated vasculitis and polyarteritis nodosa. Zaporozhye Medical Journal [Internet]. 2020Feb.10 [cited 2024May20];22(1). Available from:



Original research