H+,K-ATPase antibodies in autoimmune gastritis: observations on the development of pernicious anemia.
The prevalence and development of antibodies to H+,K+-ATPase were investigated with a sensitive enzyme-linked immunosorbent assay in 86 patients with autoimmune atrophic gastritis (type A). Sixty-nine of the patients had pernicious anemia, and 17 had simple atrophic gastritis. Elevated titers were found in 93% of pernicious anemia probands. Women had higher levels than men: 3.24 versus 1.58 U/l (p = 0.002) (upper reference limit, 0.55 U/l). The antibody levels did not change over 1-4 years, but a gradual decrease in titers over decades was observed. All patients with pernicious anemia had low levels of pepsinogen A, a product of the gastric chief and mucous neck cells (median, 8.5 micrograms/l; reference range, 10-90 percentile, 64.4-195.5 micrograms/l), and elevated serum gastrin values (greater than 55 pmol/l) were found in 87%. Serum pepsinogen A, but not serum gastrin, correlated with H+,K(+)-ATPase antibody titers (r = 0.35, p = 0.01). In the 17 cases with simple atrophic gastritis, H+,K(+)-ATPase antibodies correlated inversely with fundic mucosal gland destruction. The data indicate that H+,K(+)-ATPase antibody titers reflect the immune responsiveness of a given patient as well as the antigenic amount, dependent on the degree of mucosal destruction and the duration of the disease.
Burman
P
P
Dept. of Internal Medicine, University Hospital, Uppsala, Sweden.
Karlsson
F A
FA
Lööf
L
L
Axelsson
C K
CK
Szesci
P B
PB
Borch
K
K
D000328:Adult; D000368:Aged; D000752:Anemia, Pernicious / Q000097:blood / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D000906:Antibodies / Q000032:analysis*; D001284:Atrophy; D001327:Autoimmune Diseases / Q000150:complications / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005756:Gastritis / Q000097:blood / Q000150:complications / Q000276:immunology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010435:Pepsinogens / Q000097:blood; D006180:Proton-Translocating ATPases / Q000276:immunology*; D000254:Sodium-Potassium-Exchanging ATPase / Q000276:immunology*
D000906:Antibodies; D010435:Pepsinogens; D006180:Proton-Translocating ATPases; D000254:Sodium-Potassium-Exchanging ATPase