Anti-neutrophil cytoplasm antibodies and anti-glomerular basement membrane antibodies: two coexisting distinct autoreactivities detectable in patients with rapidly progressive glomerulonephritis.
Circulating autoantibodies against the Goodpasture antigen (alpha 3 chain of type IV collagen) in the glomerular basement membrane (anti-GBM) and anti-neutrophil cytoplasm antibodies (ANCA) are each associated clinically with the development of a rapidly progressive glomerulonephritis. Antibodies with both these specificities coexist in a subset of patients, raising the possibility that they might be a result of cross-reactivity. In this study we have shown that 21% of patients with anti-GBM antibodies also had ANCA, and by using cross-inhibition assays, antigen-specific enzyme-linked immunosorbent assays, and Western blot analysis, these were shown to be two distinct populations of autoantibodies. In patients with both specificities, a greater proportion of the ANCA had specificity for myeloperoxidase (73.5%) than in patients with ANCA alone (36.6%). The presence of ANCA should be ascertained in all patients with anti-GBM disease as the prognosis for these double-positive patients may be dependent on both populations of antibodies.
Short
A K
AK
Department of Medicine, University of Cambridge, United Kingdom.
Esnault
V L
VL
Lockwood
C M
CM
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies / Q000097:blood*; D001485:Basement Membrane / Q000276:immunology; D015415:Biomarkers / Q000097:blood*; D015153:Blotting, Western; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D000939:Epitopes; D005455:Fluorescent Antibody Technique; D005921:Glomerulonephritis / Q000276:immunology*; D006801:Humans; D007678:Kidney Glomerulus / Q000276:immunology*; D011863:Radioimmunoassay
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D015415:Biomarkers; D000939:Epitopes