title: Allograft rejection and glomerular basement membrane antibodies in Alport's syndrome.
abstract: BACKGROUND
  Anti-glomerular basement membrane (GBM) antibodies occasionally occur in Alport patients after renal allograft transplantation.
  
  
  METHODS
  We report a patient with Alport's syndrome who lost four transplants each within the first year post transplantation. We searched for the presence of anti-GBM antibodies using recombinant NC1 domains of type IV collagen. Immunoblotting, enzyme linked immunosorbent assay (ELISA), and immunofluorescence were used to detect the presence of antibodies against the glomerular basement membrane.
  
  
  RESULTS
  High antibody titers to the alpha3 chain (the Goodpasture antigen) and alpha5 chain of type IV collagen were detected. Review of pathologic specimens showed features of vascular rejection in all specimens.
  
  
  CONCLUSIONS
  The association of high titer anti-GBM antibodies and vascular rejection may be important. When vascular rejection occurs in Alport patients, the presence of anti-GBM antibodies should be sought. Recombinant anti-GBM assays should be used if standard anti-GBM testing is equivocal.
authors.affiliation: Center for Matrix Biology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: David
authors.initials: D
authors.lastname: Charytan
authors.forename: Adriana
authors.initials: A
authors.lastname: Torre
authors.forename: Mona
authors.initials: M
authors.lastname: Khurana
authors.forename: Anthony
authors.initials: A
authors.lastname: Nicastri
authors.forename: Isaac E
authors.initials: IE
authors.lastname: Stillman
authors.forename: Raghu
authors.initials: R
authors.lastname: Kalluri
mesh_terms: D000328:Adult; D000906:Antibodies / Q000032:analysis*; D001323:Autoantibodies / Q000032:analysis*; D001324:Autoantigens / Q000276:immunology; D001485:Basement Membrane / Q000276:immunology; D024141:Collagen Type IV / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005455:Fluorescent Antibody Technique; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D015151:Immunoblotting; D007678:Kidney Glomerulus / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D009394:Nephritis, Hereditary / Q000276:immunology* / Q000601:surgery
chemical_list: D000906:Antibodies; D001323:Autoantibodies; D001324:Autoantigens; C478159:COL4A5 protein, human; D024141:Collagen Type IV; C051951:antiglomerular basement membrane antibody; C057112:type IV collagen alpha3 chain