title: Rapid decrease of anti-beta-glucan antibody as an indicator for early diagnosis of carinii pneumonitis and deep mycotic infections following immunosuppressive therapy in antineutrophil cytoplasmic antibody-associated vasculitis.
abstract: Deep mycosis (aspergillus pneumonia (AsP)) and carinii pneumonitis (PCP) are complications of immunosuppressive treatment for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The objective was to clarify the clinical significance of plasma titer of antibody against beta-glucans (anti-BG antibody) as a predictor of complications such as AsP or PCP and the prognosis of patients. Enzyme-linked immunosorbent assay was used to measure the plasma titer of antibodies against beta-glucans (BG) from Candida albicans in 22 healthy subjects and 52 patients with various stages of AAV. The mean plasma titer of the anti-BG antibody was 2,677 +/- 1,686 U in healthy subjects, 691 +/- 522 U in patients with untreated active vasculitis (n = 14), and 547 +/- 416 U in patients soon after immunosuppressive treatment (n = 24). Healthy subjects had significantly higher antibody titers than the other two groups (P < 0.05). Repeated measurements over the clinical course of AAV revealed an increase during remission to 1,180 +/- 130 U (n = 11), while there was a significant rapid decrease to 369 +/- 441 U (P < 0.01) concomitantly with elevation in plasma C-reactive protein and BG levels in patients with AAV that had AsP or PCP infection. Antifungal therapy resulted in a rapid rise of anti-BG antibody titer. Experiments in mice suggested that the anti-BG antibody neutralizes BG. Rapid decrease of the anti-BG antibody titer may be a useful indicator for diagnosis of the presence of AsP or PCP and for estimating the prognosis of patients with these opportunistic infections during immunosuppressive treatment of AAV.
authors.affiliation: Renal Unit of the Department of Internal Medicine, Hachioji Medical Center of Tokyo Medical University, Hachioji, Tokyo, Japan. myoshida@tokyo-med.ac.jp
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshida
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Hida
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshikawa
authors.forename: Iwao
authors.initials: I
authors.lastname: Nakabayashi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Akashi
authors.forename: Taeko
authors.initials: T
authors.lastname: Watanabe
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tomiyasu
authors.forename: Naohito
authors.initials: N
authors.lastname: Ohno
mesh_terms: D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000737:chemistry*; D000935:Antifungal Agents / Q000494:pharmacology*; D001230:Aspergillus / Q000378:metabolism; D002176:Candida albicans / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000276:immunology*; D011014:Pneumonia / Q000175:diagnosis*; D012074:Remission Induction; D015203:Reproducibility of Results; D014657:Vasculitis / Q000276:immunology*; D047071:beta-Glucans / Q000737:chemistry* / Q000378:metabolism
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D047071:beta-Glucans