title: IgG4 anti-phospholipase A2 receptor might activate lectin and alternative complement pathway meanwhile in idiopathic membranous nephropathy: an inspiration from a cross-sectional study.
abstract: The deposition of IgG4 of antibodies against phospholipase A2 receptor (anti-PLA2R) is predominating in the kidneys of patients with idiopathic membranous nephropathy, while its predictive value has not been determined. It was a retrospective study, and 438 patients were included. Serum samples of two time points [before intervention (baseline) and after 1.5-year treatment (endpoint)] were detected for total and IgG4 anti-PLA2R. IgG4 <0.26 RU/mL or total <20 RU/mL was considered as seronegativity. Bi-positivity/bi-negativity was defined when patients'antibodies were found positive or negative both at the baseline and endpoint. Completed remission (CR) was a major clinical outcome. A series of complement ingredients (MASP-1/2, MBL, C3a, C5a, Factor B, Ba, Bb and C5b-9) were measured in the patients of bi-positivity and bi-negativity: (1) meta-analysis based on six papers conducted seropositivity of anti-PLA2R was a useful predictor for achieving CR, but there was a high heterogeneity; (2) there was significant correlation between the baseline and decrease in IgG4 subclass and the achievement of CR; (3) bi-negativity of IgG4 has a high accuracy of predicting CR compared with total antibodies; (4) in patients of bi-positivity, those achieving CR showed lower MASP-1/2, MBL, C3a, C5a, FB, Ba and Bb than patients failing to achieve CR; (5) the titers of endpoint and decrease in Ba and Bb were associated with improvement of 24 h-UP in those of bi-positivity; and (6) the decrease in Ba was a significant factor for achieving CR in those of bi-positivity. Continuous IgG4 negativity was a useful tool to predict the achievement of CR; however, in patients of continuous IgG4 positivity, those with lower activation of lectin and alternative pathways would still more probably achieve CR.
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Jin
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Fagui
authors.initials: F
authors.lastname: He
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Changchun
authors.initials: C
authors.lastname: Li
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Qingman
authors.initials: Q
authors.lastname: Gao
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Guanglei
authors.initials: G
authors.lastname: Chen
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: He
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Minghui
authors.initials: M
authors.lastname: Song
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Zhuliang
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Fujun
authors.initials: F
authors.lastname: Shan
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China.
authors.forename: Ka
authors.initials: K
authors.lastname: Qi
authors.affiliation: PLA Kidney Therapeutic Center Integrated Traditional and Western Medicine, Beidaihe Sanatorium of Beijing Military Region, West Beach Road, No. 4, Beidaihe District, Qinhuangdao, China. malu281@163.com.
authors.forename: Lu
authors.initials: L
authors.lastname: Ma
mesh_terms: D000328:Adult; D000936:Antigen-Antibody Complex / Q000276:immunology / Q000378:metabolism*; D003170:Complement Pathway, Alternative; D037582:Complement Pathway, Mannose-Binding Lectin; D065187:Controlled Before-After Studies; D003430:Cross-Sectional Studies; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology / Q000378:metabolism*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D054507:Receptors, Phospholipase A2 / Q000276:immunology; D012074:Remission Induction; D012189:Retrospective Studies
chemical_list: D000936:Antigen-Antibody Complex; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D054507:Receptors, Phospholipase A2
keywords: Anti-phospholipase A2 receptor; Clinical outcomes; Complement; Idiopathic membranous nephropathy; IgG4 subclass; Meta-analysis
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