Incidence of anti-mouse antibodies in thrombocytopenic patients with autoimmune disorders

Idiopathic thrombotycopenic purpura (ITP) is an autoimmune disorder in which circulating autoantibodies react with target antigens on the platelet membrane. In order to identify the autoimmune response in ITP, two MAIPA (Monoclonal Antibody (MAb) Immobilization of Platelet Antigen) assays (MAIPA I and MAIPA II) were performed on sera from thrombocytopenic patients. In the classic MAIPA assay (MAIPA I), control platelets were incubated simultaneously with human serum and a mouse MAb to a platelet glycoprotein. In MAIPA II, the control platelets were incubated first with the human serum and then, after washing, with the selected mouse MAb. A positive MAIPA I test but a negative MAIPA II has been shown to result from the presence of serum antibodies recognizing mouse MAb to platelet glycoproteins used in the assay. We compared the frequency of such 'anti-mouse' antibodies in patients with thrombocytopenia associated or not with other autoimmune states and in healthy donors with a normal platelet count. Statistically significant differences were found in the incidence of anti-mouse antibodies between patients and healthy donors. Furthermore, the identity of the targeted mouse MAbs varied in sera from the patients. The detected anti-mouse antibodies may include anti-idiotypic antibodies produced against cross-reactive idiotypes shared by human and mouse anti-platelet antibodies.

Inhibition of primates performed xenoantibody binding to pig aortic endothelial cells and its potential application to xenotransplantation

IgM xenoantibodies are believed to play the most important role in the hyperacute rejection of distantly related species. The purpose of this study was to determine whether DL-Penicillamine could inactivate binding and cytotoxicity of adult baboon performed xenoantibodies to pig endothelial cells. Different concentrations of DL-Penicillamine were used to treat pooled baboon serum over various lengths of time. In order to determine the reactivity of baboon natural xenoantibodies to pig endothelial cells complement-mediated cytotoxicity assay was used. ELISA assay was used to assess IgM and IgG binding to pig endothelial cells. Subsequently DL-Penicillamine was dialyzed to determine its potential clinical application. Results indicate that baboon performed xenoantibodies class IgM and IgG bind to pig endothelial cells, but only IgM xenoantibody is cytotoxic DL-Penicillamine treatment can significantly reduce cytotoxicity and eliminate binding of IgM xenoantibodies to pig endothelial cells despite continued binding of IgG xenoantibodies to pig endothelial cells. In addition, DL-Penicillamine can be dialyzed, suggesting that it may be applicable in xenotransplantation and its toxicity can be significantly reduced by routine hemodialysis.

Human NK cell-mediated direct and IgG-dependent cytotoxicity against xenogeneic porcine endothelial cells

Once hyperacute rejection has been prevented, the pig-to-human xenograft might be exposed to vascular cell-mediated rejection directed against vascular structures. In order to evaluate the relative importance of direct and antibody-dependent anti-endothelial cell-mediated cytotoxicity in different individuals, freshly isolated human blood leukocytes were incubated with confluent porcine aortic endothelial cells (PAEC) in a 4 h Cr-release cytotoxicity assay. Peripheral blood mononuclear cells (PBMC) and lymphocytes (PBL) of all subjects tested (but not monocytes or neutrophils) directly killed PAEC, with wide interindividual variations (from 2.8% to 32%). The addition of heat-inactivated autologous serum to PBMC and PBL (but not to myeloid cells) always enhanced cytotoxicity. This antibody-dependent cell-mediated cytotoxicity (ADCC) was also observed in the presence of adult pooled serum and cord blood pooled serum and was eliminated after adsorption of adult pooled serum to insoluble protein A, demonstrating that IgG is the only class of immunoglobulin involved in this phenomenon. Moreover, blocking Fc gamma RIII with an anti-CD16 mAb eliminated ADCC without affecting direct cytotoxicity. When the ADCC exerted by the PBL of all subjects was assessed with the same preparation of purified IgG, wide interindividual variations were again observed. Surprisingly, there was no correlation between direct cytotoxicity and ADCC although, as depletion experiments demonstrated, both were due to CD16+ natural killer (NK) cells. These results argue that CD16+ NK cells could play an important role in early vascular rejection of porcine discordant xenografts, by both a direct and an IgG xenoreactive natural antibody-dependent cell-mediated cytotoxicity.

Preferential association of V lambda x light chains with gamma 2a heavy chains in naturally occurring human myelin basic protein reactive antibodies

Active immunization with myelin basic protein (MBP) induces experimental allergic encephalomyelitis (EAE) in a variety of animal species, including rats and mice. We have previously described the ability of the newly described mouse lambda (lambda) variable (V) region V lambda x, to confer MBP reactivity to an Ab. In this report, we have evaluated the heavy (H) chain isotype distribution of V lambda x-bearing Abs in normal mouse serum. We demonstrate a biased H chain isotype association with V lambda x light (L) chains with a skewing towards gamma 2a and 2b isotypes. The IgG2a restriction in normal mouse Igs is even more evident in V lambda x-containing Abs that bind MBP. This was confirmed by the ability of purified polyclonal IgG2a Abs to bind MBP and the finding that most or all of the IgG2a Abs that bind MBP seem to harbor a V lambda x L chain. The specificity of naturally-occurring V lambda x-bearing Abs with MBP can be localized to a particular epitope encompassing residues 25-34 of the MBP molecule. Furthermore, virtually all of the reactivity of V lambda x-containing Abs with MBP peptide 25-34 is associated with the gamma 2a isotype. Collectively, these results suggest that the interaction of V lambda x with MBP seems to be facilitated by an association with gamma 2a which may reflect preferred VH usage by this isotype. Such unique pairing of particular H chains with V lambda x L chains in Abs that bind MBP may be indicative of a new B-cell component involved in the pathogenesis of EAE.

Comparison between aortic and sinusoidal liver endothelial cells as targets of hyperacute xenogeneic rejection in the pig to human combination

Endothelial cells of aortic origin are usually used in vitro as targets of hyperacute xenogeneic rejection, although endothelial cells from organs may have different properties. The sensitivities of aortic and liver endothelial cells to hyperacute xenogeneic rejection were compared in the pig to human combination. Sinusoidal liver endothelial cells were isolated and purified by collagenase perfusion of pig livers, sedimentation on a percoll gradient and selective adherence. Purity and viability of isolated liver endothelial cells after adherence were 85+/-6% and >95%, respectively. Endothelial cells from pig aortae (purity and viability >95%) were isolated by scraping. Immunoblotting analysis of xenoantigens on liver and aortic endothelial cell membranes preparations showed identical patterns. The strongest bands revealed by human IgM were located between 110 and 135 kD, while human IgG detected two major bands at 115 and 75kD. The membrane expression of xenoantigens recognized by human sera, analyzed by flow cytometry, was significantly lower on liver than on aortic endothelial cells (IgM: P=0.0006; IgG: P=0.0009). However, the complement-dependent cytotoxic activity of human sera was the same whether liver (54.5+/-1.4%) or aortic endothelial cells (50.0+/-4.2%) were used as targets. Taken together, those results allow the use of aortic instead of sinusoidal liver endothelial cells in the characterization of pig antigens recognized by human natural antibodies.

Cell and extracellular matrix rejection in arterial concordant and discordant xenografts in the rat

Vascularized xenografts are rejected acutely and hyperacutely in concordant or discordant combinations, respectively. We investigated the impact of the donor-recipient combination on the rejection of arterial xenografts, analyzing the cellular and extracellular matricial compartments. Aortic xenografts were performed in a concordant (hamster) and a discordant (guinea pig) combination with Lewis rat. Graft cells and immune effectors were characterized by immunohistochemistry after 15 min and up to 30 days postimplantation. Macroscopic and microscopic structure of the grafts was studied at 60 days. IgC in the concordant combination and C3, C5b9, and IgM in the discordant combination deposited on endothelial cells, acutely and hyperacutely, respectively. The same immune effectors deposited on medial smooth muscle cells, but later than on endothelial cells. In both combinations the medial extracellular matrix was covered by IgM and IgC and infiltrated by monocytes (90%) and T lymphocytes (10%), with elastinolysis in the vicinity of monocytes. However, elastin resorption in the media at day 60 differed in concordant and discordant xenografts(75+/-10% and 99+/-1%, respectively). Intimal thickening and aneurysm developed in concordant and discordant combinations, respectively. Unlike arterial allografts, arterial xenografts are not a homogeneous group. The donor-recipient combination determines the mechanism and the timing of graft cell rejection, as well as the magnitude of medial elastin injury. As a consequence, chronic graft remodeling differs in the two combinations.

Monoclonal antiidiotypic antibodies neutralize cytotoxic effects of anti-alphaGal antibodies

The aims of this study were to produce and characterize mouse monoclonal antiidiotypic antibodies (AIAs) that specifically bind human antipig (anti-alphaGal) antibodies and to select those AIAs that neutralize the cytotoxicity of human or baboon serum to pig (PK15) cells. Mice were immunized with human anti-pig antibodies, and hybridomas were produced using conventional techniques. From a total of 480 clones, 11 produced AIAs that bound with high affinity to human anti-alpha Gal IgG and F(ab')2 fragments, and individually reduced serum cytotoxicity to pig cells by 40 - 90%. Seven of the AIAs also bound to human peripheral B lymphocytes (that express the same idiotypes as the antibodies produce). Several combinations of two or three AIAs provided 100% protection of PK15 cells. Selected AIAs injected intravenously into baboons reduced the cytotoxicity of subsequently drawn sera by 50--80% for >48 hr. The cytotoxicity studies also indicated that there are at least two dominant idiotypes expressed in the human anti-alphaGal population. We conclude that AIAs against anti-alphaGal antibodies could be successfully used in 1) preoperative characterization of a recipient's anti-alphaGal profile, (2) prevention of hyperacute rejection of a pig organ, and (3) specific immunosuppression through elimination of anti-alphaGal-producing B lymphocytes.

[A patient showing increased T3 and T4 levels due to ALP-interfering substances and heterophilic antibody]

A 73-year-old male, who underwent resection of soft palate cancer and was under treatment for esophageal ulcer at our medical department, complained of palpitation. On the suspicion of hyperthyroidism, enzyme immunoassay (EIA) was performed. T3 and T4 were increased, and FT4 and TSH were normal. However, T3 and T4 measured again by radioimmunoassay (RIA) were normal. Therefore, the patient serum was examined for interfering substances such as antibody against bovine intestinal alkaline phosphatase (ALP) and heterophilic antibody. Substances interfering with ALP and anti-rabbit IgG human antibody were detected. It is necessary to consider the possible presence of these substances when results of EIA are evaluated.

Tumor necrosis factor-induced expression of porcine glycoproteins gp65 and gp100 recognized by human xenoreactive natural antibodies

In the pig-to-primate model of xenotransplantation, graft rejection is initiated by binding of the recipient's xenoreactive natural antibodies (XNA), mainly of the IgM type, to antigens constitutively expressed on donor endothelial cells (EC). As a consequence of XNA binding and complement fixation, the EC become activated, which is considered to be a major mechanism promoting hyperacute as well as later phases of graft rejection. It is not clear whether binding of XNA to activated EC also contributes to delayed rejection. We asked whether EC activation by cytokines results in the expression of other novel surface antigens recognized by XNA which might become relevant in progressive stages of graft rejection. We activated porcine aortic EC and smooth muscle cells with tumor necrosis factor (TNF), interleukin 1, or lipopolysaccharide and studied expression of new XNA-binding antigens. Expression of two glycoproteins, gp65 and gp100, was strongly induced by recombinant human TNF in EC but not in smooth muscle cells. Notably, gp100 expression was specific to TNF activation, whereas gp65 could also be induced by interleukin 1 or lipopolysaccharide. Cell surface labeling indicated that gp65 is expressed on the plasma membrane. Recognition of XNA-binding antigens on resting EC occurs via alpha-galactosyl epitopes. In contrast, gp65 and gp100 were recognized independently of this epitope. Our data show that gp65 and gp100 represent selective cytokine-induced markers on EC that may have importance in a porcine-to-primate model of xenotransplantation. Conceivable functions of gp65 and gp100 are discussed.

Pig alpha1, 3galactosyltransferase: a major target for genetic manipulation in xenotransplantation

Terminal carbohydrate residues of glycolipids and glycoproteins display polymorphism among as well as within various species. With the exception of Old World monkeys, great apes and man, the Gala1,3Gal structure is widely expressed in all mammals examined so far. The lack of expression of the glycosyltransferase responsible for the synthesis of Gala1,3Gal leads to the production of high titers of natural antibodies (NAb) against the Gala1,3Gal of other species. The inactivation of this gene occurred during early evolution of primates. Neutralization of viruses (e.g. retroviruses) carrying the epitope, by the pre-formed human NAb, indicates one possible evolutionary reason for the polymorphism of terminal carbohydrates among as well as within species. It has been shown that this epitope constitutes the major target, on pig endothelial cells (EC), for the pre-formed human NAb resulting in a hyperacute rejection (HAR) response. This currently makes transplantation of e.g. pig organs to humans impossible. Efforts are currently underway to prevent or to eradicate the expression of this epitope in transgenic pigs. Such pigs are likely to display a greatly increased resistance to the HAR.

Specificity of xenoreactive anti-Gal alpha 1-3Gal IgM for alpha-galactosyl ligands

The transplantation of organs from lower animals such as pigs into humans is prevented by a severe rejection reaction initiated by complement fixing xenoreactive natural antibodies. Most anti-pig xenoreactive natural antibodies in humans are thought to recognize Gal alpha 1-3Gal beta 1-4GlcNAc and are also thought to recognize, albeit less avidly, Gal alpha 1-6Glc. Gal alpha 1-6Glc has been used as a ligand for purification of 'anti-Gal alpha 1-3Gal antibodies' and as a therapeutic or reagent to prevent the binding of these antibodies to porcine organs or cells. We tested the specificity of anti-Gal alpha 1-3Gal IgM for Gal alpha 1-6Glc and related saccharides. Based on inhibition of binding of xenoreactive anti-Gal alpha 1-3Gal IgM to porcine cells by soluble saccharides, anti-Gal alpha 1-3Gal IgM in a human serum was found to consist of a mixture of antibodies which have a similar affinity for Gal alpha 1-3Gal but varying affinities for Gal alpha 1-6Glc and other structures. Twenty to 40% of the anti-Gal alpha 1-3Gal IgM from the population tested did not recognize Gal alpha 1-6Glc. The binding of anti-Gal alpha 1-3Gal IgM to Gal alpha 1-6Glc varied widely from individual to individual, some samples lacking almost entirely anti-Gal alpha 1-3Gal IgM which bound to Gal alpha 1-6Glc.

Characterization of porcine platelet glycoproteins recognized by human natural "anti-gal" antibodies

Human natural "anti-Gal" antibodies are specifically directed to Gal alpha 1-3Gal beta 1-4GlcNAc residues expressed on non-primate mammal and new world monkey cells. We investigated the relative involvement of purified IgG and IgM anti-Gal as xenoreactive natural antibodies (XNA). IgG and IgM were isolated from human plasma, and anti-Gal antibodies were purified by affinity chromatography on a Synsorb-14 column (Chembiomed, Edmonton, Alberta, Canada). Anti-Gal of both IgM and IgG classes represent the bulk of human XNA that bind to porcine platelets in enzyme-linked immunosorbent assay (ELISA). On immunoblots, normal human sera, as well as purified IgM and IgG fractions, reacted with 115-, 125-, 135-, 150-, 180-, 210-, and 240-kd) pig platelet proteins, whereas purified anti-Gal antibodies of both IgM and IgG classes mainly bound to 135-, 150-, 180-, and 210-kD glycoproteins. A low reactivity was observed in ELISA with anti-Gal free IgM and IgG, indicating that xenoantibodies are not solely directed to galactosyl epitopes. These antibodies revealed bands of 115, 125, and 240 kD, alpha-Galactosidase treatment of porcine platelet glycoproteins (gps) enriched by affinity chromatography abrogated the reactivity of 135- and 210-kD proteins. N- and O-glycosidase treatments demonstrated that alpha-galactosyl residues are located on the O-glycans of the 135-kD component. Finally, glycoproteins of 90 and 135 kD were identified by amino acid sequencing as the pig analogs of the human glycoproteins IIIa and IIb, respectively, whereas the 240-kD) component was identified as the porcine fibrinogen, using a new murine monoclonal antibody (naM147-7B6; IgG1) specific for its beta-chain.

Neutralization of myonecrosis, hemorrhage, and edema induced by Bothrops asper snake venom by homologous and heterologous pre-existing antibodies in mice

The ability of pre-existing antibodies to neutralize locally-acting toxins of Bothrops asper snake venom was investigated. Hemorrhage, myonecrosis, and edema were markedly reduced in actively immunized mice, although none of these effects was completely abolished. In mice passively immunized with equine antivenom, hemorrhage was prevented completely, while myonecrosis and edema were partially reduced. Pre-existing antibodies did not modify the early stage (< 3 hr) of venom-induced edema, but significantly accelerated the normalization of this effect within 24 hr. Passive administration of antivenom either 5 or 120 min before venom injection gave similar results, suggesting that the presence of antibodies in the intravascular compartment may fully neutralize locally acting toxins, in this experimental animal model. Overall, the homologous or heterologous origin of antibodies was not a significant factor influencing their in vivo neutralizing efficiency against local venom effects. Antibody titrations by enzyme-immunoassay using purified toxins and whole venom indicated that serum from actively-immunized mice had a higher proportion of anti-myotoxin antibodies than equine antivenom.

Different action of xenoreactive natural and immune antibodies on functioning cardiomyocytes

PNAB and IAB have totally different action on BCM. PNAB inhibit the contractile function of BCM by producing a reversible standstill and by disturbing the synchronization of the BCM-monolayer. IAB are cytotoxic and depend on the presence of complement.