title: Autoantibodies to native myeloperoxidase in patients with pulmonary hemorrhage and acute renal failure.
abstract: Sera from 245 patients were screened by indirect immunofluorescence for perinuclear/nuclear staining (P-ANCA) of ethanol-fixed neutrophils, a staining pattern which is associated with the presence of antibodies to myeloperoxidase. Using immunoblot and immunoprecipitation techniques on 15 P-ANCA-positive sera, 13 patients demonstrated antibody to purified or native myeloperoxidase but not to denatured myeloperoxidase. In patients with P-ANCA, the most frequent reason for medical attention was hemoptysis (8/13; 62%). Of the 15 sera with P-ANCA, acute renal failure was identified in 9 patients (60%). Five patients (33%) had both. All patients (eight of eight) with hemoptysis had antibodies which bound functional MPO as compared to three of seven P-ANCA-positive patients without hemoptysis (P less than 0.001), suggesting that antibodies which recognize conformational sites on native myeloperoxidase occur in a subgroup of patients with alveolar hemorrhage as their presenting clinical sign. These findings may provide insight into the disease process associated with P-ANCA. We further identify a subgroup of patients with a severe pulmonorenal syndrome and antibodies recognizing native myeloperoxidase.
authors.affiliation: Department of Molecular and Experimental Medicine, Scripps Clinic and Research Foundation, La Jolla, California 92037.
authors.forename: D E
authors.initials: DE
authors.lastname: Roberts
authors.forename: C
authors.initials: C
authors.lastname: Peebles
authors.forename: J G
authors.initials: JG
authors.lastname: Curd
authors.forename: E M
authors.initials: EM
authors.lastname: Tan
authors.forename: R L
authors.initials: RL
authors.lastname: Rubin
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000276:immunology*; D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies / Q000097:blood*; D005455:Fluorescent Antibody Technique; D006470:Hemorrhage / Q000150:complications / Q000276:immunology*; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000276:immunology*; D009195:Peroxidase / Q000276:immunology*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D009195:Peroxidase