title: M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy.
abstract: BACKGROUND
  Idiopathic membranous nephropathy, a common form of the nephrotic syndrome, is an antibody-mediated autoimmune glomerular disease. Serologic diagnosis has been elusive because the target antigen is unknown.
  
  
  METHODS
  We performed Western blotting of protein extracts from normal human glomeruli with serum samples from patients with idiopathic or secondary membranous nephropathy or other proteinuric or autoimmune diseases and from normal controls. We used mass spectrometry to analyze the reactive protein bands and confirmed the identity and location of the target antigen with a monospecific antibody.
  
  
  RESULTS
  Serum samples from 26 of 37 patients (70%) with idiopathic but not secondary membranous nephropathy specifically identified a 185-kD glycoprotein in nonreduced glomerular extract. Mass spectrometry of the reactive protein band detected the M-type phospholipase A(2) receptor (PLA(2)R). Reactive serum specimens recognized recombinant PLA(2)R and bound the same 185-kD glomerular protein as did the monospecific anti-PLA(2)R antibody. Anti-PLA(2)R autoantibodies in serum samples from patients with membranous nephropathy were mainly IgG4, the predominant immunoglobulin subclass in glomerular deposits. PLA(2)R was expressed in podocytes in normal human glomeruli and colocalized with IgG4 in immune deposits in glomeruli of patients with membranous nephropathy. IgG eluted from such deposits in patients with idiopathic membranous nephropathy, but not in those with lupus membranous or IgA nephropathy, recognized PLA(2)R.
  
  
  CONCLUSIONS
  A majority of patients with idiopathic membranous nephropathy have antibodies against a conformation-dependent epitope in PLA(2)R. PLA(2)R is present in normal podocytes and in immune deposits in patients with idiopathic membranous nephropathy, indicating that PLA(2)R is a major antigen in this disease.
authors: Boston University School of Medicine, Boston, MA, USA.
authors: Laurence H
authors: LH
authors: Beck
authors: Ramon G B
authors: RG
authors: Bonegio
authors: Gérard
authors: G
authors: Lambeau
authors: David M
authors: DM
authors: Beck
authors: David W
authors: DW
authors: Powell
authors: Timothy D
authors: TD
authors: Cummins
authors: Jon B
authors: JB
authors: Klein
authors: David J
authors: DJ
authors: Salant
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D015153:Blotting, Western; D016009:Chi-Square Distribution; D000939:Epitopes / Q000276:immunology; D015433:Glomerulonephritis, Membranous / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007678:Kidney Glomerulus / Q000737:chemistry* / Q000276:immunology; D013058:Mass Spectrometry; D054507:Receptors, Phospholipase A2 / Q000276:immunology* / Q000302:isolation & purification
chemical_list: D001323:Autoantibodies; D000939:Epitopes; D007074:Immunoglobulin G; D054507:Receptors, Phospholipase A2