title: Clonality and specificity of cryoglobulins associated with HCV: pathophysiological implications.
abstract: OBJECTIVE
  Hepatitis C virus (HCV) infection plays a central role in the pathogenesis of mixed cryoglobulinemia through molecular mechanisms which remain to be elucidated. The aim of this study was to investigate the role of antibody responses to HCV in the pathogenesis of cryoglobulinemia through characterization of the anti-HCV specificity and immunochemical characteristics of the immunoglobulins involved in cryoprecipitation.
  
  
  METHODS
  Sera from 50 consecutive patients with chronic HCV infection (RNA positive) were screened for the presence of cryoglobulins. The two major components of cryoprecipitates, IgM rheumatoid factors and IgG, were separated by high performance liquid chromatography and analyzed for immunochemical composition by immunoblotting and antibody specificity by ELISA and immunoblotting using recombinant HCV proteins and synthetic peptides as antigens.
  
  
  RESULTS
  Cryoprecipitates were observed in 27 patients and characterized by immunofixation: 13 (48%) were classified as type II and 14 (52%) as type III. Monoclonal immunoglobulins were detected by immunoblotting in 20 cryoprecipitates: IgM in 14 samples and IgG in 14, with a clear preponderance of IgG3 (12/14). Specificity studies on sera and purified IgM and IgG fractions from cryoprecipitates revealed enrichment in cryoglobulins, predominantly polyclonal IgG1, reactive with the HCV structural proteins, whereas specificities for nonstructural viral proteins were relatively less represented compared to whole serum. No restricted pattern of fine specificity was observed. IgG3 subclass was apparently not involved in HCV nucleoprotein binding.
  
  
  CONCLUSIONS
  Our findings do not support a direct link between monoclonal cryoglobulins and immune response to HCV According to the proposed pathogenetic model, HCV infection can induce the formation of cryoprecipitable rheumatoid factors, sustain their production, and eventually lead to monoclonal B-cell expansion through several cooperative mechanisms.
authors.affiliation: Laboratori di Ricerca-Area Infettivologica, Istituto di Clinica delle Malattie Infettive, University of Pavia and IRCCS Policlinico San Matteo, Italy. istinf@ipv36.unipv.it
authors.forename: M U
authors.initials: MU
authors.lastname: Mondelli
authors.forename: I
authors.initials: I
authors.lastname: Zorzoli
authors.forename: A
authors.initials: A
authors.lastname: Cerino
authors.forename: A
authors.initials: A
authors.lastname: Cividini
authors.forename: M
authors.initials: M
authors.lastname: Bissolati
authors.forename: L
authors.initials: L
authors.lastname: Segagni
authors.forename: V
authors.initials: V
authors.lastname: Perfetti
authors.forename: E
authors.initials: E
authors.lastname: Anesi
authors.forename: P
authors.initials: P
authors.lastname: Garini
authors.forename: G
authors.initials: G
authors.lastname: Merlini
mesh_terms: D000911:Antibodies, Monoclonal; D000914:Antibodies, Viral / Q000096:biosynthesis; D000918:Antibody Specificity; D003449:Cryoglobulinemia / Q000209:etiology / Q000503:physiopathology*; D006526:Hepatitis C / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007120:Immunochemistry; D007074:Immunoglobulin G / Q000097:blood; D008403:Mass Screening / Q000379:methods; D011446:Prospective Studies
chemical_list: D000911:Antibodies, Monoclonal; D000914:Antibodies, Viral; D007074:Immunoglobulin G