Heterogeneity in serum APRIL phenotypes among patients with SLE and relation to disease activity. (A) Serum samples collected from three representative normal controls (circles, triangles, squares) were assayed for APRIL levels. By definition, the first serum samples were collected on day 0. The dashed lines indicate 2SD above and below the geometric mean of all the values (n = 86) obtained from the 15 control subjects and arbitrarily define the "normal" range. (B-E) Serum samples collected from individual patients with SLE were assayed for APRIL levels (circles). Disease activity was measured by SLEDAI (bars). Results for representative patients exhibiting the "persistently normal" serum APRIL phenotype (B), the "persistently low" serum APRIL phenotype (C), the "intermittently raised" serum APRIL phenotype (D), or the "persistently raised" serum APRIL phenotype (E) are illustrated. (F) Serum APRIL levels plotted against the corresponding SLEDAI scores for the 523 individual serum samples from the 68 patients with SLE for whom serum APRIL levels and SLEDAI scores were both determined.