Allograft rejection and glomerular basement membrane antibodies in Alport's syndrome.
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.
Charytan
David
D
Center for Matrix Biology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Torre
Adriana
A
Khurana
Mona
M
Nicastri
Anthony
A
Stillman
Isaac E
IE
Kalluri
Raghu
R
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
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