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Trad S, Nosbaum A, Musset L, Ghillani-Dalbin P, Launay D, Costedoat-Chalumeau N, Saadoun D, Cabane J, Hachulla E, Hanslik T, Frances C. Systemic sclerosis and prevalence of monoclonal immunoglobulin. Autoimmun Rev 2014; 13:1189-94. [PMID: 25151977 DOI: 10.1016/j.autrev.2014.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 07/07/2014] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this study was to estimate the prevalence of monoclonal immunoglobulin (MIg) among patients with systemic sclerosis (SSc) according to the capillary electrophoresis or immunofixation method of detection and to search for any related clinical correlations. PATIENTS AND METHODS Retrospective multicenter comparison of capillary electrophoresis and immunofixation results in SSc patients and of the characteristics of patients with and without MIg. RESULTS The study included 244 SSc patients (216 women and 28 men, mean age: 55±14 years). Median time since SSc diagnosis was 51 months [0-320]; disease was diffuse in 48% of cases. Ten percent of patients had cancer, including Waldenström macroglobulinemia (n=1) and multiple myeloma (n=3). Capillary electrophoresis showed a γ-globulin anomaly in 41% of cases, and immunofixation in 18%: MIg (13.5%) and restriction of heterogeneity (4.5%). Capillary electrophoresis failed to detect 60% of the 33 MIg patients. Measurable MIg concentrations were obtained from 7 patients. MIg patients were significantly older at SSc diagnosis than those without MIg (p=0.002), had a lower diffusing capacity (p=0.002), a higher prevalence of pulmonary hypertension and cancer (p=0.002) and were more frequently positive for anti-mitochondrial and anti-beta2-glycoprotein-I antibodies (p=0.03 and p=0.02, respectively). Multivariate analyses showed that only age at test [hazard ratio 1.03 (95% CI, 1.00-1.07, p=0.04)] and presence of cancer [hazard ratio 4.46 (95% CI, 1.6-12.4, p=0.004)] were associated with MIg. CONCLUSION Immunofixation detected a high prevalence of MIg among SSc patients especially in patients aged 50-years or older. MIg was not detected by the standard capillary electrophoresis in 60% of cases and was significantly associated with cancer.
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Affiliation(s)
- Salim Trad
- AP-HP, Internal Medicine Department 2, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France.
| | - Audrey Nosbaum
- AP-HP, Internal Medicine Department, Hôpital Saint-Antoine, 75012 Paris, France
| | - Lucile Musset
- AP-HP, Immunochemistry Laboratory, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France
| | - Pascale Ghillani-Dalbin
- AP-HP, Immunochemistry Laboratory, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France
| | - David Launay
- Internal Medicine Department, Hôpital Claude Huriez, CHRU, 59000 Lille, France; University Hospital, Lille, 75013 Paris, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Internal Medicine Department 2, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France; Université Pierre et Marie Curie, Paris 6, 75013 Paris, France
| | - David Saadoun
- AP-HP, Internal Medicine Department 2, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France; Université Pierre et Marie Curie, Paris 6, 75013 Paris, France
| | - Jean Cabane
- AP-HP, Internal Medicine Department, Hôpital Saint-Antoine, 75012 Paris, France; Université Pierre et Marie Curie, Paris 6, 75013 Paris, France
| | - Eric Hachulla
- Internal Medicine Department, Hôpital Claude Huriez, CHRU, 59000 Lille, France; University Hospital, Lille, 75013 Paris, France
| | - Thomas Hanslik
- AP-HP, Internal Medicine Department 2, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France; Versailles-Saint-Quentin-en-Yvelines University, 78000 Versailles, France
| | - Camille Frances
- Université Pierre et Marie Curie, Paris 6, 75013 Paris, France; AP-HP, Service de Dermatologie-Allergologie, Hôpital Tenon, 75020 Paris, France
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Carlizzi G, Ciarla MV, Di Luzio A, Labriola R, Frattolillo D, Spiridigliozzi P, Masala C, Strom R. Autoantibodies in patients with monoclonal gammopathies. Ann N Y Acad Sci 2007; 1107:206-11. [PMID: 17804548 DOI: 10.1196/annals.1381.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although autoantibody activities are rather often associated to monoclonal gammopathies, only monoclonal immunoglobulins of the IgM isotype are really directed against autoantigens that are often polysaccharides or are formed by highly repetitive structures. This strict association is frequently revealed also by clinical manifestations of the autoimmune response generated by the monoclonal macroglobulin. Most monoclonal immunoglobulins of non-IgM isotype are instead totally inactive toward self-antigens, the autoantibody activity being instead associated, if present, to polyclonal immunoglobulins. Although the same BAFF/APRIL system is involved in perpetuation of humoral autoimmunity as well as in stimulation of clonal B-cell expansion, the autoimmune commitment of B cells of a non-IgM isotype is hardly compatible with their possible involvement in an uncontrolled proliferation pathway, whose prerequisite is the homing of these B cells to the bone marrow compartment. The IgM-secreting cells appear instead to possess a much lower tendency, and/or a looser requirement, for their homing in the bone marrow prior to their actual proliferation. This may explain the quite different consequences, in terms of autoimmunity, between IgM and non-IgM paraproteinemias.
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Affiliation(s)
- Guglielmo Carlizzi
- Department of Cellular Biotechnologies and Hematology, University of Rome La Sapienza, Viale Regina Elena 324, I-00161 Rome, Italy
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