The phospholipid requirement for Rho(D) antigen activity: mode of inactivation by phospholipases and of protection by anti-Rh0(D) antibody

Antibodies against phospholipids other than cardiolipin: potential roles for both phospholipid and protein

Autoantibodies to phospholipids other than cardiolipin have received less attention, to date, than anti-cardiolipin antibodies. This review focuses on these antibodies and potential roles for both phospholipid and protein in their reactivity. We review data in the literature indicating that antibodies to phosphatidylethanolamine and some lupus anticoagulant antibodies recognize phospholipid-binding proteins in association with phospholipid. Kininogens appear to be involved in the binding of antibodies to phosphatidylethanolamine, while phosphatidylserine-binding proteins, such as prothrombin and annexin V, have been implicated in lupus anticoagulant antibody recognition. These proteins bind to phospholipids that normally reside in the inner monolayer of the cell membrane, suggesting that exposure of these lipids is necessary for protein binding and antibody recognition to occur. In contrast, other autoantibodies, in particular those reactive with erythrocytes, appear to be directed at phospholipids that normally occur in the outer membrane leaflet, such as phosphatidylcholine. In summary, there is clearly accumulating evidence that antibodies to phospholipids other than cardiolipin recognize epitopes on phospholipid-binding proteins. It is not clear whether recognition of these epitopes is due to an increase in antigen density or a change in the protein or phospholipid structure, but it is likely that both protein and phospholipid structure play an important role in the in vivo interactions of these antibodies.

Immunology and clinical importance of antiphospholipid antibodies

Having reviewed the literature on the association of aPL antibodies with clinical manifestations, it is clear that this group of autoantibodies are of considerable importance. The presence of aPL antibodies in some but not all individuals confers a risk of a clinical syndrome characterized by recurrent arterial or venous thrombosis, thrombocytopenia, hemolytic anemia, or positive Coombs' test, and in females, recurrent idiopathic fetal loss. In SLE, the risk is approximately 40%, compared with a risk of 15% in the absence of aPL antibodies. However, only one half of persons possessing these antibodies have SLE, and overall the risk is around 30%. In some circumstances, such as in chlorpromazine or infection-associated aPL antibodies, there appears to be no increased risk. At the other end of the spectrum are seen patients whose only clinical manifestations comprise features of this clinical syndrome, and this entity has been designated the primary antiphospholipid syndrome (PAPS). aPL antibodies are also important because they are not uncommon. They have been found frequently in women with idiopathic recurrent fetal loss (30%), in non-autoimmune patients with ischemic heart disease (20%), or venous thrombosis (up to 30%), or stroke (4-47%), and in chronic immune thrombocytopenia (30%). These autoantibodies can be detected using sensitive solid-phase immunoassays employing the CL antigen, or in appropriate coagulation tests to detect LA activity. These assays are simple to perform but require care in selection of the best test and in interpretation of results. Current tests do not distinguish between those persons at risk of the clinical events and those not at risk. Detection of specific isotypes (especially IgG) and antibody level may aid in such a designation. Treatment of aPL antibody-associated syndromes remains a controversial subject. Since thromboses are associated with significant morbidity and potential mortality, there is a good argument for long-term preventive antithrombotic therapy, at least for as long as the antibodies are detectable, in those patients in whom clinical complications have previously occurred. It is not generally recommended that this treatment be offered to individuals in whom aPL antibodies are detected but who have not suffered previous thromboses, since the risk of such events does not appear to be equal within a group of aPL antibody-positive persons. This particularly applies to pregnant women, since live births and uncomplicated pregnancies are observed regularly in the presence of aPL antibodies without specific treatment. A previous history of at least one unexplained, late fetal loss is considered a prerequisite before intervention in subsequent pregnancies.(ABSTRACT TRUNCATED AT 400 WORDS)

Generation and metabolism of lipoxygenase products in normal and membrane-damaged cultured human keratinocytes

The production and metabolism of lipoxygenase eicosanoids were studied in cultured human keratinocytes. The identity of these eicosanoid structures was established by a variety of chromatographic and analytical techniques. Normal cultured keratinocytes did not produce lipoxygenase eicosanoids either spontaneously or when given arachidonic acid in the presence of permeabilizing concentrations of ethanol or dimethyl sulfoxide. Freeze-thawing of human neonatal and adult keratinocytes resulted in a rapid release of linoleic and arachidonic acids over time. Activation of a latent 15-lipoxygenase was demonstrated by the synthesis of 15-hydroxyeicosatetraenoic acid (15-HETE) and 13-hydroxyoctadecadienoic acid, and both these products were greatly increased in amount when the corresponding fatty acid precursor was added. Eicosanoid production by cells of newborn and adult origin was indistinguishable. Rapid metabolism of exogenous 15-HETE by normal keratinocytes was observed. Measurable quantities of esterified 15-HETE were found after 1 min, but by 18-20 h all the esterified 15-HETE was degraded to the extent that 80% of the recovered radioactivity was found in water-soluble form. In contrast, when labeled or unlabeled 5-HETE was used a much larger fraction was esterified intact (30% as opposed to 10%) and at the end of 18-20 hours a substantial peak of esterified 5-HETE remained. Intact esterified [3H] HETE were recovered only in the triacylglycerol fraction. The key findings that omega-6 lipoxygenase products are generated but not esterified by membrane-damaged keratinocytes, whereas these products are esterified but not generated by normal keratinocytes, may be of importance in transcellular metabolic control.

Incomplete warm hemolysins. II. Corresponding antigens and pathogenetic mechanisms in autoimmune hemolytic anemias induced by incomplete warm hemolysins

The pathogenesis of autoimmune hemolytic anemias induced by incomplete warm hemolysins (IWHs) is only poorly understood. Sera from eight patients with mostly severe IWH-related autoimmune anemias allowed us to address some key elements of the pathogenetic process. With the use of a modified enzyme-linked immunoassay we could show that (i) IWHs bound to native RBCs and (ii) IWHs initiated the activation of the complement cascade on native RBCs up to the level of C3. The interaction of IWHs with their corresponding antigens on red blood cell membranes, which were pretreated with different enzymes, showed that despite serological uniformity there are at least two different types of IWHs: (i) IWHs reacting with phospholipase susceptible antigens (six of the studied sera) and (ii) IWHs reacting with antigens which are hardly, if at all, phospholipase susceptible (two of the studied sera). Aside from Rh antibodies, most IWHs apparently belong to a second category of RBC antibodies whose corresponding antigens can be inactivated by phospholipase treatment of the cell membranes. IWHs showed no specificity for Rh antigens or the antigens of the I/i-system.

Divalent cation effects on the binding of human anti-phospholipid antibodies

Anti-phospholipid antibodies from sera of subjects with documented syphilis were measured as a result of their individual interactions with cardiolipin, phosphatidylserine and phosphatidic acid, each impregnated in nitrocellulose paper from chloroform solution, followed by reaction with a labelled second antibody. Binding curves generated by increasing the cardiolipin concentration over a standard area of nitrocellulose paper showed saturation. The presence of Ca2+ or Mg2+ during the antibody binding step resulted in a complex pattern of binding as a function of the cation concentration. When the extent of binding was normalized to percent of maximum bound, virtually super-impossible patterns were seen with different sera. These patterns were distinctive for both the phospholipid and the cation. The speculation is presented, albeit without any direct evidence, that the extent of antibody binding is sensitive to a variety of intermediate phospholipid phase structures which may be initiated by the presence of the specific divalent cation at a particular concentration.

Cholesterol effects on the interaction of cardiolipin with anti-cardiolipin antibody

Human antibodies to cardiolipin, phosphatidic acid and phosphatidylserine were assessed by binding to nitrocellulose paper and subsequent reaction with an enzyme-linked or radioactively labelled second antibody to human IgG. The addition of cholesterol to constant amounts of cardiolipin impregnated in the nitrocellulose paper resulted in a profound fall in antibody binding beginning at a 0.5 to 1 molar ratio of cholesterol to cardiolipin and stabilizing at about 15% of the original level. Antibody binding to phosphatidic acid and phosphatidylserine also showed extensive cholesterol-induced inhibition beginning at a slightly lower molar ratio of cholesterol to phospholipid. The structural array of neither the cardiolipin alone impregnated in nitrocellulose nor the phospholipid together with cholesterol is known. It is possible that the specific cardiolipin phase structure required for human antibody recognition was disrupted by cholesterol.

Characterization of the Ss sialoglycoprotein and its antigens in Rhnull erythrocytes

The Ss sialoglycoprotein (glycophorin B) and its antigens in Rhnull erythrocytes, which lack the Rhesus blood group antigens, due to apparently silent (amorphic type) or independent suppressor (regulator type) genes, were investigated. The quantity of the molecule in amorphic and in regulator type red cell membranes was found to be decreased by about 60%-70%, as judged from sodium-dodecylsulfate polyacrylamide gel electrophoresis. The Ss glycoprotein content in the erythrocytes from heterozygotes (regulator type) was diminished to an extent of about 30%. Confirming and extending previous studies, the S, s, Ux, Uz and 'N' antigens were slightly weakened in Rhnull erythrocytes. The U and Duclos receptors were only slightly or not depressed in amorphic Rhnull cells, but almost absent from or not detectable in those of the regulator type. This demonstrates that an additional alteration, apart from the decreased Ss glycoprotein content of the membranes, accounts for the weakness of these receptors in regulator type cells. We propose the hypothesis that (a) protein(s) encoded by the Rhesus locus form(s) a complex with the Ss glycoprotein. Thus, it (they) might facilitate the incorporation of the Ss glycoprotein into the membrane and also contribute to the complete expression of the U and Duclos antigens in normal cells.