1
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Amsler J, Everts-Graber J, Martin KR, Roccabianca A, Lopes C, Tourneur L, Mocek J, Karras A, Naccache JM, Bonnotte B, Samson M, Hanslik T, Puéchal X, Terrier B, Guillevin L, Néel A, Mouthon L, Witko-Sarsat V. Dysregulation of neutrophil oxidant production and interleukin-1-related cytokines in granulomatosis with polyangiitis. Rheumatology (Oxford) 2024; 63:2249-2258. [PMID: 37947315 DOI: 10.1093/rheumatology/kead578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Neutrophils play a key role in ANCA-associated vasculitis, both as targets of autoimmunity and as facilitators of vascular damage. In granulomatosis with polyangiitis (GPA), the data regarding the production of reactive oxygen species (ROS) in neutrophils are unclear. Further, recent data suggests that ROS production could have an anti-inflammatory effect through the regulation of inflammasomes and IL-1-related cytokines. We aimed to analyse ROS production in neutrophils from patients with GPA and investigate its association with IL-1-related cytokines and the autoantigen PR3. METHODS Seventy-two GPA patients with disease flare were included in the NEUTROVASC prospective cohort study. ROS production in whole blood of patients with active GPA was evaluated and compared with that in the same patients in remission or healthy controls. Associations between ROS production, PR3 membrane expression on neutrophils, serum levels of IL-1-related cytokines as well as inflammasome-related proteins were analysed. RESULTS We observed a robust defect in ROS production by neutrophils from patients with active GPA compared with healthy controls, independent of glucocorticoid treatment. Serum levels of IL-1-related cytokines were significantly increased in GPA patients, particularly in patients with kidney involvement, and levels of these cytokines returned to normal after patients achieved remission. Further, inflammasome-related proteins were significantly dysregulated in the cytosol of neutrophils as well as the serum from GPA patients. CONCLUSION Our data suggests that ROS production and regulation of inflammasomes in neutrophils from patients with GPA are disturbed and may be a potential therapeutic target. TRIAL REGISTRATION ClinicalTrials.gov, https://www.clinicaltrials.gov, NCT01862068.
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Affiliation(s)
- Jennifer Amsler
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Judith Everts-Graber
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katherine R Martin
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Inflammation Division, WEHI, and Department of Medical Biology, University of Melbourne, Parkville, Australia
| | - Arnaud Roccabianca
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Chloé Lopes
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Léa Tourneur
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Julie Mocek
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Marc Naccache
- Department of Pulmonology-Allergology-Thoracic Oncology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Bernard Bonnotte
- Service de Médecine Interne et Immunologie Clinique, CHU Dijon, Dijon, France
| | - Maxime Samson
- Service de Médecine Interne et Immunologie Clinique, CHU Dijon, Dijon, France
| | - Thomas Hanslik
- Service de Médecine Interne, Hôpital Ambroise-Paré, AP-HP, Boulogne Billancourt, France
| | - Xavier Puéchal
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Benjamin Terrier
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Loïc Guillevin
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Antoine Néel
- Service de Médecine Interne, CHU Nantes, Nantes, France
- CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | - Luc Mouthon
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Véronique Witko-Sarsat
- INSERM U1016, Institut Cochin, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
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2
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Granel J, Korkmaz B, Nouar D, Weiss SAI, Jenne DE, Lemoine R, Hoarau C. Pathogenicity of Proteinase 3-Anti-Neutrophil Cytoplasmic Antibody in Granulomatosis With Polyangiitis: Implications as Biomarker and Future Therapies. Front Immunol 2021; 12:571933. [PMID: 33679731 PMCID: PMC7930335 DOI: 10.3389/fimmu.2021.571933] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a rare but serious necrotizing auto-immune vasculitis. GPA is mostly associated with the presence of Anti-Neutrophil Cytoplasmic Antibody (ANCA) targeting proteinase 3 (PR3-ANCA), a serine protease contained in neutrophil granules but also exposed at the membrane. PR3-ANCAs have a proven fundamental role in GPA: they bind neutrophils allowing their auto-immune activation responsible for vasculitis lesions. PR3-ANCAs bind neutrophil surface on the one hand by their Fab binding PR3 and on the other by their Fc binding Fc gamma receptors. Despite current therapies, GPA is still a serious disease with an important mortality and a high risk of relapse. Furthermore, although PR3-ANCAs are a consistent biomarker for GPA diagnosis, relapse management currently based on their level is inconsistent. Indeed, PR3-ANCA level is not correlated with disease activity in 25% of patients suggesting that not all PR3-ANCAs are pathogenic. Therefore, the development of new biomarkers to evaluate disease activity and predict relapse and new therapies is necessary. Understanding factors influencing PR3-ANCA pathogenicity, i.e. their potential to induce auto-immune activation of neutrophils, offers interesting perspectives in order to improve GPA management. Most relevant factors influencing PR3-ANCA pathogenicity are involved in their interaction with neutrophils: level of PR3 autoantigen at neutrophil surface, epitope of PR3 recognized by PR3-ANCA, isotype and glycosylation of PR3-ANCA. We detailed in this review the advances in understanding these factors influencing PR3-ANCA pathogenicity in order to use them as biomarkers and develop new therapies in GPA as part of a personalized approach.
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Affiliation(s)
- Jérôme Granel
- Université de Tours, Plateforme B Cell Ressources (BCR) EA4245, Tours, France.,Service d'Immunologie Clinique et d'Allergologie, Centre Hospitalier Régional Universitaire, Tours, France
| | - Brice Korkmaz
- INSERM, Centre d'Etude des Pathologies Respiratoires (CEPR), UMR 1100, Tours, France
| | - Dalila Nouar
- Service d'Immunologie Clinique et d'Allergologie, Centre Hospitalier Régional Universitaire, Tours, France
| | - Stefanie A I Weiss
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, German Center for Lung Research (DZL) Munich and Max Planck Institute of Neurobiology, Planegg-Martinsried, Germany
| | - Dieter E Jenne
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, German Center for Lung Research (DZL) Munich and Max Planck Institute of Neurobiology, Planegg-Martinsried, Germany
| | - Roxane Lemoine
- Université de Tours, Plateforme B Cell Ressources (BCR) EA4245, Tours, France
| | - Cyrille Hoarau
- Université de Tours, Plateforme B Cell Ressources (BCR) EA4245, Tours, France.,Service d'Immunologie Clinique et d'Allergologie, Centre Hospitalier Régional Universitaire, Tours, France
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3
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Leacy E, Brady G, Little MA. Pathogenesis of ANCA-associated vasculitis: an emerging role for immunometabolism. Rheumatology (Oxford) 2021; 59:iii33-iii41. [PMID: 32348520 DOI: 10.1093/rheumatology/keaa023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/02/2020] [Indexed: 12/16/2022] Open
Abstract
ANCA-associated vasculitis (AAV) is a severe systemic autoimmune disease. A key feature of AAV is the presence of Anti-Neutrophil Cytoplasmic Antibodies (ANCA) directed against myeloperoxidase (MPO) or proteinase-3 (PR3). ANCA are key to the pathogenesis of AAV, where they activate innate immune cells to drive inflammation. Pre-activation or 'priming' of immune cells appears to be important for complete cellular activation in AAV. The burgeoning field of immunometabolism has illuminated the governance of immune cell function by distinct metabolic pathways. There is ample evidence that the priming events synonymous with AAV alter immune cell metabolism. In this review we discuss the pathogenesis of AAV and its intersection with recent insights into immune cell metabolism.
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Affiliation(s)
- Emma Leacy
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Gareth Brady
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
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4
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Granel J, Lemoine R, Morello E, Gallais Y, Mariot J, Drapeau M, Musnier A, Poupon A, Pugnière M, Seren S, Nouar D, Gouilleux-Gruart V, Watier H, Korkmaz B, Hoarau C. 4C3 Human Monoclonal Antibody: A Proof of Concept for Non-pathogenic Proteinase 3 Anti-neutrophil Cytoplasmic Antibodies in Granulomatosis With Polyangiitis. Front Immunol 2020; 11:573040. [PMID: 33101296 PMCID: PMC7546423 DOI: 10.3389/fimmu.2020.573040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a severe autoimmune vasculitis associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA) mainly targeting proteinase 3 (PR3), a neutrophilic serine proteinase. PR3-ANCA binding to membrane-bound PR3 on neutrophils induce their auto-immune activation responsible for vascular lesions. However, the correlation between PR3-ANCA level and disease activity remains inconsistent, suggesting the existence of non-pathogenic PR3-ANCA. In order to prove their existence, we immortalized B lymphocytes from blood samples of GPA patients in remission having persistent PR3-ANCA to isolate non-activating PR3-ANCA. We obtained for the first time a non-activating human IgG1κ anti-PR3 monoclonal antibody (mAb) named 4C3. This new mAb binds soluble PR3 with a high affinity and membrane-bound PR3 on an epitope close to the PR3 hydrophobic patch and in the vicinity of the active site. 4C3 is able to bind FcγRIIA and FcγRIIIB and has a G2F glycosylation profile on asparagine 297. 4C3 did not induce activation of neutrophils and could inhibit human polyclonal PR3-ANCA-induced activation suggesting that 4C3 is non-pathogenic. This characteristic relies on the recognized epitope on PR3 rather than to the Fc portion properties. The existence of non-pathogenic PR3-ANCA, which do not activate neutrophils, could explain the persistence of high PR3-ANCA levels in some GPA patients in remission and why PR3-ANCA would not predict relapse. Finally, these results offer promising perspectives particularly regarding the understanding of PR3-ANCA pathogenicity and the development of new diagnostic and therapeutic strategies in GPA.
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Affiliation(s)
- Jérôme Granel
- Plateforme B Cell Ressources (BCR) EA4245, Université de Tours, Tours, France.,Service transversal d'Immunologie Clinique et d'Allergologie, Centre Hospitalier Régional Universitaire, Tours, France
| | - Roxane Lemoine
- Plateforme B Cell Ressources (BCR) EA4245, Université de Tours, Tours, France
| | - Eric Morello
- Plateforme B Cell Ressources (BCR) EA4245, Université de Tours, Tours, France
| | - Yann Gallais
- Plateforme B Cell Ressources (BCR) EA4245, Université de Tours, Tours, France
| | - Julie Mariot
- Plateforme B Cell Ressources (BCR) EA4245, Université de Tours, Tours, France
| | - Marion Drapeau
- Plateforme B Cell Ressources (BCR) EA4245, Université de Tours, Tours, France
| | | | - Anne Poupon
- Physiologie de la Reproduction et des Comportements, INRA UMR 0085, CNRS UMR 7247, Université de Tours, Tours, France
| | - Martine Pugnière
- Institut de Recherche en Cancérologie, Institut Régional du Cancer, INSERM U1194, Université Montpellier, Montpellier, France
| | - Seda Seren
- Centre d'Etude des Pathologies Respiratoires, INSERM, UMR 1100, Tours, France.,Université de Tours, Tours, France
| | - Dalila Nouar
- Service transversal d'Immunologie Clinique et d'Allergologie, Centre Hospitalier Régional Universitaire, Tours, France
| | - Valérie Gouilleux-Gruart
- Université de Tours, Tours, France.,Laboratoire d'Immunologie, Centre Hospitalier Régional Universitaire, Tours, France
| | - Hervé Watier
- Université de Tours, Tours, France.,Laboratoire d'Immunologie, Centre Hospitalier Régional Universitaire, Tours, France
| | - Brice Korkmaz
- Centre d'Etude des Pathologies Respiratoires, INSERM, UMR 1100, Tours, France.,Université de Tours, Tours, France
| | - Cyrille Hoarau
- Plateforme B Cell Ressources (BCR) EA4245, Université de Tours, Tours, France.,Service transversal d'Immunologie Clinique et d'Allergologie, Centre Hospitalier Régional Universitaire, Tours, France
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5
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Ohlsson S, Holm L, Hansson C, Ohlsson SM, Gunnarsson L, Pettersson Å, Skattum L. Neutrophils from ANCA-associated vasculitis patients show an increased capacity to activate the complement system via the alternative pathway after ANCA stimulation. PLoS One 2019; 14:e0218272. [PMID: 31216309 PMCID: PMC6583988 DOI: 10.1371/journal.pone.0218272] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV), including granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), are autoimmune conditions associated with small vessel inflammation. Earlier studies indicate that complement activation via the alternative pathway plays a major role in the pathogenesis. In this study we have investigated if ANCA-activation of neutrophils from AAV patients leads to activation of the alternative complement pathway. C5a-primed neutrophils (PMN) from 10 AAV patients and 10 healthy controls (HC) were stimulated with PMA or IgG purified from PR3-ANCA positive patients (ANCA IgG). The supernatants were analyzed for release of complement proteins and markers of different granules by ELISA, and release of microparticles (MP) by flow cytometry. The ability of the supernatants to activate the alternative complement pathway was determined by incubation with normal serum and C3bBbP and C5a were measured by ELISA. MP were analyzed by flow cytometry and removed by centrifugation. The supernatants from the AAV patients’ neutrophils produced significantly more C3bBbP compared with HCs (p = 0.0001). C3bBbP levels correlated with the number of MP. After removal of MP from the supernatants, alternative pathway activation was significantly lower. This study shows that primed and ANCA-stimulated neutrophils from AAV patients have a greater ability to activate the alternative complement pathway compared to primed neutrophils from healthy controls. This finding emphasizes the role of complement in the pathogenesis of AAV - underlining the therapeutic potential of C5a and other complement blockade.
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Affiliation(s)
- Sophie Ohlsson
- Department of Nephrology, Institution of Clinical Sciences in Lund, Lund University, Lund, Sweden
- * E-mail:
| | - Lisa Holm
- Department of Nephrology, Institution of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Christina Hansson
- Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden
- Clinical Immunology and Transfusion Medicine, Region Skåne, Lund, Sweden
| | - Susanne M. Ohlsson
- Department of Nephrology, Institution of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Lena Gunnarsson
- Department of Nephrology, Institution of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Åsa Pettersson
- Department of Nephrology, Institution of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Lillemor Skattum
- Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden
- Clinical Immunology and Transfusion Medicine, Region Skåne, Lund, Sweden
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6
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Ahn E, So MW. Successful Treatment of Refractory Cutaneous Polyarteritis Nodosa with Adalimumab. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.4.302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Eunyoung Ahn
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min Wook So
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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7
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Ma TKW, McAdoo SP, Tam FWK. Targeting the tyrosine kinase signalling pathways for treatment of immune-mediated glomerulonephritis: from bench to bedside and beyond. Nephrol Dial Transplant 2017; 32:i129-i138. [PMID: 28391340 PMCID: PMC5410974 DOI: 10.1093/ndt/gfw336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/18/2016] [Indexed: 12/25/2022] Open
Abstract
Glomerulonephritis (GN) affects patients of all ages and is an important cause of morbidity and mortality. Non-selective immunosuppressive drugs have been used in immune-mediated GN but often result in systemic side effects and occasionally fatal infective complications. There is increasing evidence from both preclinical and clinical studies that abnormal activation of receptor and non-receptor tyrosine kinase signalling pathways are implicated in the pathogenesis of immune-mediated GN. Activation of spleen tyrosine kinase (SYK), Bruton's tyrosine kinase (BTK), platelet-derived growth factor receptor (PDGFR), epidermal growth factor receptor (EGFR) and discoidin domain receptor 1 (DDR1) have been demonstrated in anti-GBM disease. SYK is implicated in the pathogenesis of ANCA-associated GN. SYK, BTK, PDGFR, EFGR, DDR1 and Janus kinase are implicated in the pathogenesis of lupus nephritis. A representative animal model of IgA nephropathy (IgAN) is lacking. Based on the results from in vitro and human renal biopsy study results, a phase II clinical trial is ongoing to evaluate the efficacy and safety of fostamatinib (an oral SYK inhibitor) in high-risk IgAN patient. Various tyrosine kinase inhibitors (TKIs) have been approved for cancer treatment. Clinical trials of TKIs in GN may be justified given their long-term safety data. In this review we will discuss the current unmet medical needs in GN treatment and research as well as the current stage of development of TKIs in GN treatment and propose an accelerated translational research approach to investigate whether selective inhibition of tyrosine kinase provides a safer and more efficacious option for GN treatment.
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Affiliation(s)
- Terry King-Wing Ma
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK.,Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Stephen P McAdoo
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Frederick Wai Keung Tam
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
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8
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Choi M, Schreiber A, Eulenberg-Gustavus C, Scheidereit C, Kamps J, Kettritz R. Endothelial NF- κB Blockade Abrogates ANCA-Induced GN. J Am Soc Nephrol 2017; 28:3191-3204. [PMID: 28687535 DOI: 10.1681/asn.2016060690] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 05/18/2017] [Indexed: 01/15/2023] Open
Abstract
ANCA-associated vasculitis (AAV) is a highly inflammatory condition in which ANCA-activated neutrophils interact with the endothelium, resulting in necrotizing vasculitis. We tested the hypothesis that endothelial NF-κB mediates necrotizing crescentic GN (NCGN) and provides a specific treatment target. Reanalysis of kidneys from previously examined murine NCGN disease models revealed NF-κB activation in affected kidneys, mostly as a p50/p65 heterodimer, and increased renal expression of NF-κB-dependent tumor necrosis factor α (TNF-α). NF-κB activation positively correlated with crescent formation, and nuclear phospho-p65 staining showed NF-κB activation within CD31-expressing endothelial cells (ECs) in affected glomeruli. Therefore, we studied the effect of ANCA on NF-κB activation in neutrophil/EC cocultures in vitro ANCA did not activate NF-κB in primed human neutrophils, but ANCA-stimulated primed neutrophils activated NF-κB in ECs, at least in part via TNF-α release. This effect increased endothelial gene transcription and protein production of NF-κB-regulated interleukin-8. Moreover, upregulation of endothelial NF-κB promoted neutrophil adhesion to EC monolayers, an effect that was inhibited by a specific IKKβ inhibitor. In a murine NCGN model, prophylactic application of E-selectin-targeted immunoliposomes packed with p65 siRNA to downregulate endothelial NF-κB significantly reduced urine abnormalities, renal myeloid cell influx, and NCGN. Increased glomerular endothelial phospho-p65 staining in patients with AAV indicated that NF-κB is activated in human NCGN also. We suggest that ANCA-stimulated neutrophils activate endothelial NF-κB, which contributes to NCGN and provides a potential therapeutic target in AAV.
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Affiliation(s)
- Mira Choi
- Experimental and Clinical Research Center, the Charité Universitätsmedizin Berlin and the Max-Delbrück Center for Molecular Medicine at the Charité, Berlin, Germany; .,Nephrology and Internal Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Adrian Schreiber
- Experimental and Clinical Research Center, the Charité Universitätsmedizin Berlin and the Max-Delbrück Center for Molecular Medicine at the Charité, Berlin, Germany.,Nephrology and Internal Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Eulenberg-Gustavus
- Experimental and Clinical Research Center, the Charité Universitätsmedizin Berlin and the Max-Delbrück Center for Molecular Medicine at the Charité, Berlin, Germany
| | | | - Jan Kamps
- Department of Pathology and Medical Biology, Medical Biology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ralph Kettritz
- Experimental and Clinical Research Center, the Charité Universitätsmedizin Berlin and the Max-Delbrück Center for Molecular Medicine at the Charité, Berlin, Germany.,Nephrology and Internal Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
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9
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Frazier KS, Engelhardt JA, Fant P, Guionaud S, Henry SP, Leach MW, Louden C, Scicchitano MS, Weaver JL, Zabka TS. Scientific and Regulatory Policy Committee Points-to-consider Paper*. Toxicol Pathol 2015; 43:915-34. [DOI: 10.1177/0192623315570340] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Drug-induced vascular injury (DIVI) is a recurrent challenge in the development of novel pharmaceutical agents. Although DIVI in laboratory animal species has been well characterized for vasoactive small molecules, there is little available information regarding DIVI associated with biotherapeutics such as peptides/proteins or antibodies. Because of the uncertainty about whether DIVI in preclinical studies is predictive of effects in humans and the lack of robust biomarkers of DIVI, preclinical DIVI findings can cause considerable delays in or even halt development of promising new drugs. This review discusses standard terminology, characteristics, and mechanisms of DIVI associated with biotherapeutics. Guidance and points to consider for the toxicologist and pathologist facing preclinical cases of biotherapeutic-related DIVI are outlined, and examples of regulatory feedback for each of the mechanistic types of DIVI are included to provide insight into risk assessment.
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Affiliation(s)
| | | | | | | | | | - Michael W. Leach
- Pfizer—Drug Safety Research and Development, Andover, Massachusetts, USA
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10
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Capuozzo M, Ottaiano A, Nava E, Cascone S, Fico R, Iaffaioli RV, Cinque C. Etanercept induces remission of polyarteritis nodosa: a case report. Front Pharmacol 2014; 5:122. [PMID: 24917817 PMCID: PMC4042078 DOI: 10.3389/fphar.2014.00122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 05/09/2014] [Indexed: 01/30/2023] Open
Affiliation(s)
- Maurizio Capuozzo
- Department of Pharmacy at the Local Sanitary Agency Naples 3 South Naples, Italy
| | - Alessandro Ottaiano
- Department of Colorectal Oncology at the National Cancer Institute, "G. Pascale" foundation Naples, Italy
| | - Eduardo Nava
- Department of Pharmacy at the Local Sanitary Agency Naples 3 South Naples, Italy
| | - Stefania Cascone
- Department of Pharmacy at the Local Sanitary Agency Naples 3 South Naples, Italy
| | - Raffaella Fico
- Department of Pharmacy at the Local Sanitary Agency Naples 3 South Naples, Italy
| | - Rosario V Iaffaioli
- Department of Colorectal Oncology at the National Cancer Institute, "G. Pascale" foundation Naples, Italy
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11
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Anti-TNF-alpha therapy and systemic vasculitis. Mediators Inflamm 2014; 2014:493593. [PMID: 24719524 PMCID: PMC3955590 DOI: 10.1155/2014/493593] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 01/07/2014] [Accepted: 01/16/2014] [Indexed: 12/14/2022] Open
Abstract
TNF-α is a pleiotropic cytokine, which plays a major role in the pathogenesis of numerous autoimmune and/or inflammatory systemic diseases. Systemic vasculitis constitutes a group of rare diseases, characterized by inflammation of the arterial or venous vessel wall, causing stenosis and thrombosis. Treatment of the different type of vasculitis mainly relies on steroids and immunosuppressive drugs. In case of refractory or relapsing diseases, however, a second line of treatment may be required. Anti-TNF-α drugs have been used in this setting during the last 15 years with inconsistent results. We reviewed herein the use of anti-TNF-α therapy in different kind of vasculitis and concluded that, except for Behcet's disease, this therapeutic option has not demonstrated significant improvement in the treatment of vasculitis.
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Hoshino A, Nagao T, Ito-Ihara T, Ishida-Okawara A, Uno K, Muso E, Nagi-Miura N, Ohno N, Tokunaka K, Naoe S, Hashimoto H, Yasuhara M, Yamamoto K, Suzuki K. Trafficking of QD-Conjugated MPO-ANCA in Murine Systemic Vasculitis and Glomerulonephritis Model Mice. Microbiol Immunol 2013; 51:551-66. [PMID: 17579266 DOI: 10.1111/j.1348-0421.2007.tb03933.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In systemic vasculitis, the serum level of myeloperoxidase (MPO)-specific anti-neutrophil cytoplasmic autoantibodies (MPO-ANCA) is significantly elevated with the progression of disease. We have established a model of murine systemic vasculitis by administration of MPO-ANCA and fungal mannoprotein to C57BL/6 mice. We examined the role of MPO and MPO-ANCA in the pathogenesis of glomerulonephritis and systemic vasculitis in this model using quantum dots (QDs). We demonstrated that QD-conjugated MPO-ANCA (ANCA-QD) visualized the translocation of MPO on the neutrophil membrane surface after stimulation with proinflammatory cytokines. We also observed that MPO translocation on neutrophils in both patients with rapid progressive glomerulonephritis and these model mice without any stimulation, suggesting that MPO translocation is certain to contribute to the development of glomerular lesion. In addition, blood flow on the kidney surface vessel was significantly decelerated in both SCG/Kj mice and this model, suggesting that ANCA induces the damage of blood vessel. These results indicate that MPO-ANCA and surface-translocated MPO on the activated neutrophils coordinately plays essential roles in the initial steps of the glomerulonephritis.
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Affiliation(s)
- Akiyoshi Hoshino
- Department of Bioactive Molecules, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8640, Japan
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Hao J, Chen M, Zhao MH. Involvement of protein kinase C in C5a-primed neutrophils for ANCA-mediated activation. Mol Immunol 2012. [PMID: 23201854 DOI: 10.1016/j.molimm.2012.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
C5a and the neutrophil C5a receptor play a central role in antineutrophil cytoplasmic antibody (ANCA)-mediated neutrophil recruitment and activation. Our recent study found that activation of p38 mitogen-activated protein kinase (p38MAPK), extracellular signal-regulated kinase (ERK) and phosphoinositol 3-kinase (PI3K) are all important steps in the translocation of ANCA antigens by C5a-mediated priming and activation of neutrophils. The current study further investigated the protein kinase C (PKC) pathway of C5a-mediated neutrophils for ANCA-induced activation. The effect of the PKC inhibitor (bisindolylmaleimide I, BIS) was tested on respiratory burst and degranulation of C5a-primed neutrophils activated with ANCA, as well as on C5a-induced increase in expression of PR3 and MPO. For C5a-primed neutrophils for MPO-ANCA-induced respiratory burst, the mean fluorescence intensity (MFI) value was 369.8±18.8, which decreased to 308.3±14.2 upon pre-incubation with BIS (P<0.001). For PR3-ANCA-positive IgG, the MFI value increased in C5a-primed neutrophils, which decreased upon pre-incubation with BIS. The lactoferrin concentration increased from 414.8±26.9 ng/ml in the non-primed neutrophils supernatant to 1099.8±80.7 ng/ml in C5a-primed neutrophils induced by MPO-ANCA-positive IgG supernatant (P<0.001), and decreased to 814.5±45.3 ng/ml upon pre-incubation with BIS (P<0.01). The lactoferrin concentration also increased in C5a-primed neutrophils induced by PR3-ANCA-positive IgG supernatant and decreased upon pre-incubation with BIS. Membrane expression of PR3 (mPR3) expression increased from 788.0±87.5 in untreated cells to 1071.3±81.3 after C5a treatment and decreased to 827.3±48.1 by BIS (P<0.05). Activation of PKC is an important step in the translocation of ANCA antigens and C5a-induced activation of neutrophils by ANCA.
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Affiliation(s)
- Jian Hao
- Renal Division, Department of Medicine, Peking University, First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment Peking University, Ministry of Education, Peking-Tsinghua Center for Life Sciences, Beijing 100034, China
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Abstract
Neutrophils are pivotal to host defence during infectious diseases. However, activated neutrophils may also cause undesired tissue damage. Ample examples include small-vessel inflammatory diseases (vasculitis) that are associated with anti-neutrophil cytoplasmic autoantibodies (ANCA) residing in the patients' plasma. In addition to being an important diagnostic tool, convincing evidence shows that ANCA are pathogenic. ANCA-neutrophil interactions induce important cellular responses that result in highly inflammatory necrotizing vascular damage. The interaction begins with ANCA binding to their target antigens on primed neutrophils, proceeds by recruiting transmembrane molecules to initiate intracellular signal transduction and culminates in activation of effector functions that ultimately mediate the tissue damage.
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Affiliation(s)
- R Kettritz
- Nephrologie und Internistische Intensivmedizin Charité Virchow Klinikum and Experimental and Clinical Research Center, a joint co-operation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin-Buch, Berlin, Germany.
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Cartin-Ceba R, Peikert T, Specks U. Pathogenesis of ANCA-Associated Vasculitis. Curr Rheumatol Rep 2012; 14:481-93. [DOI: 10.1007/s11926-012-0286-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Homeister JW, Willis MS. The Molecular Biology and Treatment of Systemic Vasculitis in Children. MOLECULAR AND TRANSLATIONAL VASCULAR MEDICINE 2012. [PMCID: PMC7121654 DOI: 10.1007/978-1-61779-906-8_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary systemic vasculitides are rare in childhood but are associated with significant morbidity and mortality. The cause of the majority of vasculitides is unknown, although it is likely that a complex interaction between environmental factors, such as infections and inherited host responses, triggers the disease and determines the vasculitis phenotype. Several genetic polymorphisms in vasculitides have now been described, which may be relevant in terms of disease predisposition or development of disease complications. Treatment regimens continue to improve with the use of different immunosuppressive medications and newer therapeutic approaches such as biologic agents. This chapter reviews recent studies shedding light on the pathogenesis of vasculitis with emphasis on molecular biology where known, and summarizes current treatment strategies. We discuss new emerging challenges particularly with respect to the long-term cardiovascular morbidity for children with systemic vasculitis and emphasize the importance of future international multicenter collaborative studies to further increase and standardize the scientific base investigating and treating childhood vasculitis.
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Affiliation(s)
- Jonathon W. Homeister
- grid.410711.20000 0001 1034 1720, The University of North Carolina, McAllister Heart Institute, 101 Manning Drive, Chapel Hill, 27599-7525 USA
| | - Monte S. Willis
- grid.410711.20000 0001 1034 1720, The University of North Carolina, McAllister Heart Institute, 103 Mason Farm Road, Chapel Hill, 27599-7525 USA
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Anti-proteinase 3 anti-neutrophil cytoplasm autoantibodies recapitulate systemic vasculitis in mice with a humanized immune system. PLoS One 2012; 7:e28626. [PMID: 22247758 PMCID: PMC3256135 DOI: 10.1371/journal.pone.0028626] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 11/11/2011] [Indexed: 12/01/2022] Open
Abstract
Evidence is lacking for direct pathogenicity of human anti-proteinase-3 (PR3) antibodies in development of systemic vasculitis and granulomatosis with polyangiitis (GPA, Wegener's granulomatosis). Progress in study of these antibodies in rodents has been hampered by lack of PR3 expression on murine neutrophils, and by different Fc-receptor affinities for IgG across species. Therefore, we tested whether human anti-PR3 antibodies can induce acute vasculitis in mice with a human immune system. Chimeric mice were generated by injecting human haematopoietic stem cells into irradiated NOD-scid-IL2Rγ−/− mice. Matched chimera mice were treated with human IgG from patients with: anti-PR3 positive renal and lung vasculitis; patients with non-vasculitic renal disease; or healthy controls. Six-days later, 39% of anti-PR3 treated mice had haematuria, compared with none of controls. There was punctate bleeding on the surface of lungs of anti-PR3 treated animals, with histological evidence of vasculitis and haemorrhage. Anti-PR3 treated mice had mild pauci-immune proliferative glomerulonephritis, with infiltration of human and mouse leukocytes. In 3 mice (17%) more severe glomerular injury was present. There were no glomerular changes in controls. Human IgG from patients with anti-PR3 autoantibodies is therefore pathogenic. This model of anti-PR3 antibody-mediated vasculitis may be useful in dissecting mechanisms of microvascular injury.
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Hong Y, Eleftheriou D, Hussain AAK, Price-Kuehne FE, Savage CO, Jayne D, Little MA, Salama AD, Klein NJ, Brogan PA. Anti-neutrophil cytoplasmic antibodies stimulate release of neutrophil microparticles. J Am Soc Nephrol 2011; 23:49-62. [PMID: 22052057 DOI: 10.1681/asn.2011030298] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The mechanisms by which anti-neutrophil cytoplasmic antibodies (ANCAs) may contribute to the pathogenesis of ANCA-associated vasculitis are not well understood. In this study, both polyclonal ANCAs isolated from patients and chimeric proteinase 3-ANCA induced the release of neutrophil microparticles from primed neutrophils. These microparticles expressed a variety of markers, including the ANCA autoantigens proteinase 3 and myeloperoxidase. They bound endothelial cells via a CD18-mediated mechanism and induced an increase in endothelial intercellular adhesion molecule-1 expression, production of endothelial reactive oxygen species, and release of endothelial IL-6 and IL-8. Removal of the neutrophil microparticles by filtration or inhibition of reactive oxygen species production with antioxidants abolished microparticle-mediated endothelial activation. In addition, these microparticles promoted the generation of thrombin. In vivo, we detected more neutrophil microparticles in the plasma of children with ANCA-associated vasculitis compared with that in healthy controls or those with inactive vasculitis. Taken together, these results support a role for neutrophil microparticles in the pathogenesis of ANCA-associated vasculitis, potentially providing a target for future therapeutics.
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Affiliation(s)
- Ying Hong
- Infectious Diseases and Microbiology Unit, 30 Guilford Street, London WC1N 1EH, United Kingdom.
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Le Roux S, Pepper RJ, Dufay A, Néel M, Meffray E, Lamandé N, Rimbert M, Josien R, Hamidou M, Hourmant M, Cook HT, Charreau B, Larger E, Salama AD, Fakhouri F. Elevated soluble Flt1 inhibits endothelial repair in PR3-ANCA-associated vasculitis. J Am Soc Nephrol 2011; 23:155-64. [PMID: 22034638 DOI: 10.1681/asn.2010080858] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis exhibits endothelial damage, but the capacity for vessel repair in this disorder is not well understood. Here, we observed a marked increase in serum levels of soluble Flt1 (sFlt1), a potent inhibitor of vascular endothelial growth factor, in patients with active ANCA-associated vasculitis compared with patients during remission and other controls. Serum levels of sFlt1 correlated with C5a, an anaphylatoxin released after complement activation. Serum from patients with acute ANCA-associated vasculitis disrupted blood flow in the chicken chorioallantoic membrane assay, suggesting an antiangiogenic effect. Preincubation with excess human vascular endothelial growth factor prevented this effect. Anti-proteinase-3 (PR3) mAb and serum containing PR3-ANCA from patients with active vasculitis both induced a significant and sustained release of sFlt1 from monocytes, whereas anti-myeloperoxidase (MPO) mAb or polyclonal antibodies did not. However, the serum containing polyclonal PR3-ANCA did not induce release of sFlt1 from cultured human umbilical vein endothelial cells. In summary, these data suggest that anti-PR3 antibodies, and to a much lesser extent anti-MPO antibodies, increase sFlt1 during acute ANCA-associated vasculitis, leading to an antiangiogenic state that hinders endothelial repair.
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Affiliation(s)
- Sandrine Le Roux
- ITUN, U643, Department of Nephrology and Immunology, CHU de Nantes, 44000 Nantes, France
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21
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Abstract
Antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) comprises a group of systemic inflammatory vasculitides associated with circulating autoantibodies directed against the neutrophil granule components proteinase 3 and myeloperoxidase. ANCA interact with their target antigens on cytokine primed neutrophils, causing neutrophil activation via several signaling pathways that culminates in endothelial interaction, degranulation, cytokine production, and endothelial and tissue damage. The presence of autoantibodies implies the assistance of autoreactive T-helper cells and B cells, and a failure of regulatory mechanisms. This article reviews the current evidence for the pathogenic mechanisms culminating in autoantibody production, the effects of ANCA-neutrophil and neutrophil-endothelial interactions, and the mechanisms of tissue damage.
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Affiliation(s)
- Julia Flint
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham B4 6NH, UK
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Harper L. ANCA-associated vasculitis: is there a role for neutrophil apoptosis in autoimmunity? Expert Rev Clin Immunol 2010; 2:237-44. [PMID: 20477074 DOI: 10.1586/1744666x.2.2.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The primary small vessel systemic vasculitides are disorders that target small blood vessels, inducing vessel wall inflammation, and are associated with the development of antineutrophil cytoplasmic antibodies. Multiple organs are attacked including the lungs and kidneys. Increasing knowledge of pathogenesis suggests that the antibodies activate neutrophils inappropriately, leading to endothelial and vascular damage. Cytokines, such as tumor necrosis factor, can facilitate damage by priming neutrophils and activating endothelial cells. Apoptosis of infiltrating neutrophils is also disrupted by antineutrophil cytoplasmic antibody activation. Removal of these effete cells occurs in a proinflammatory manner, promoting persistent inflammation. The autoimmune response may be promoted by aberrant phagocytosis of apoptotic neutrophils by dendritic cells. Understanding pathogenesis can help to rationalize existing therapies and indicate new approaches to therapy.
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Affiliation(s)
- Lorraine Harper
- Renal Immunobiology, Division of Infection and Immunity, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Uriarte SM, McLeish KR, Ward RA. Anti-proteinase 3 antibodies both stimulate and prime human neutrophils. Nephrol Dial Transplant 2008; 24:1150-7. [PMID: 18952697 DOI: 10.1093/ndt/gfn580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Anti-neutrophil cytoplasmic antibodies (ANCA) against proteinase 3 (PR3) are postulated to injure vascular endothelium by inducing cytokine-primed neutrophils to release proteolytic enzymes and generate reactive oxygen species. Anti-PR3 induce exocytosis, and since priming is associated with upregulation of plasma membrane proteins by exocytosis of intracellular granules, we tested the hypothesis that anti-PR3 prime neutrophils in the absence of cytokines. METHODS Isolated human neutrophils were incubated with or without anti-PR3. Superoxide release was determined by measuring the reduction of ferricytochrome C. Exocytosis of secretory vesicles and specific granules was determined by measuring the expression of CD35 and CD66b, respectively, using flow cytometry. RESULTS Anti-PR3 (15 mug/mL) directly stimulated superoxide production and enhanced FMLP-stimulated superoxide production. Anti-PR3 (0.5 mug/mL) did not stimulate superoxide production but did enhance FMLP-stimulated superoxide production. Incubation of neutrophils with anti-PR3 resulted in time-dependent exocytosis of secretory vesicles and specific granules. Anti-PR3-induced exocytosis, but not superoxide production, was dependent on p38 mitogen-activated protein kinase. Conclusions. These data demonstrate that anti-PR3 can directly stimulate production of reactive oxygen species by neutrophils without cytokine priming, and that anti-PR3 prime neutrophils for increased FMLP-stimulated reactive oxygen species production. Anti-PR3 also induce exocytosis via a mechanism separate from their effect on reactive oxygen species production. These findings suggest that anti-PR3 ANCA may activate neutrophils and cause endothelial cell injury by multiple pathways, including some that are independent of priming by a second agent.
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Affiliation(s)
- Silvia M Uriarte
- Department of Medicine, University of Louisville, 615 S. Preston Street, Louisville, KY 40202-1718, USA
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25
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Hoshino A, Nagao T, Nakasuga A, Ishida-Okawara A, Suzuki K, Yasuhara M, Yamamoto K. Nanocrystal Quantum Dot-Conjugated Anti-Myeloperoxidase Antibody as the Detector of Activated Neutrophils. IEEE Trans Nanobioscience 2007; 6:341-5. [DOI: 10.1109/tnb.2007.909008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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von Vietinghoff S, Choi M, Rolle S, Luft FC, Kettritz R. Febrile temperatures control antineutrophil cytoplasmic autoantibody-induced neutrophil activation via inhibition of phosphatidylinositol 3-kinase/Akt. ACTA ACUST UNITED AC 2007; 56:3149-58. [PMID: 17763432 DOI: 10.1002/art.22832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Neutrophil activation by antineutrophil cytoplasmic autoantibodies (ANCAs) is central to the pathogenesis of the ANCA-associated vasculitides. Febrile infections occur frequently during these diseases, often in the context of immunosuppressive treatment. Heat exposure may affect the underlying pathophysiologic processes of the vasculitis. In this study we tested the hypothesis that short-term exposure to heat inhibits ANCA-induced neutrophil activation. METHODS After exposure to temperatures from 37 degrees C to 42 degrees C, human neutrophils were primed with either tumor necrosis factor alpha (TNFalpha) or granulocyte-macrophage colony-stimulating factor (GM-CSF) and stimulated with monoclonal antibodies to myeloperoxidase or to proteinase 3. Respiratory burst activity was assayed using rhodamine and a nitroblue tetrazolium reduction assay. Specific inhibition experiments against p38 MAPK, ERK, and phosphatidylinositol 3-kinase (PI 3-kinase)/Akt, and Western blotting with phospho-specific antibodies were used to identify key components in the antibody-induced respiratory burst. RESULTS A temperature-dependent reduction in ANCA-induced respiratory burst was observed over a range of heat exposures from 37 degrees C to 42 degrees C. Inhibition of human ANCA-induced neutrophil stimulation was significant at 40 degrees C (after priming with 2 ng/ml TNFalpha, mean [+/- SEM] fluorescence intensity [MFI] 114 +/- 12 at 37 degrees C versus 53 +/- 6 at 40 degrees C; after priming with 20 ng/ml GM-CSF, MFI 92 +/- 16 at 37 degrees C versus 35 +/- 6 at 40 degrees C; both P < 0.01). In the priming phase, the transient activation of the p38 MAPK, ERK, and PI 3-kinase/Akt pathways by TNFalpha was blocked by prior exposure of the neutrophils to heat, but GM-CSF-induced activation was unaltered by heat. However, in the second, antibody-induced wave of kinase activation, exposure to heat inhibited only the PI 3-kinase/Akt pathway, and these effects were independent of the priming agent used. CONCLUSION Short-term spikes of modest heat abrogate ANCA-induced activation of neutrophils via inhibition of PI 3-kinase/Akt signaling. Febrile responses in ANCA-mediated diseases may therefore have a physiologic purpose.
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Selamet U, Kovaliv YB, Savage CO, Harper L. ANCA-associated vasculitis: new options beyond steroids and cytotoxic drugs. Expert Opin Investig Drugs 2007; 16:689-703. [PMID: 17461741 DOI: 10.1517/13543784.16.5.689] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Small vessel vasculitic syndromes--Wegener's granulomatosis, microscopic polyangiitis and renal limited vasculitis (which are associated with circulating antineutrophil cytoplasmic autoantibodies)--are an important cause of renal failure. Present immunosuppressive regimens that are based on cyclophosphamide have significantly increased survival rates. However, these treatments are toxic, increase the risk of infection and do not cure disease. Therefore, newer approaches are required. Understanding disease pathogenesis has allowed rational use for newer therapies such as rituximab, which depletes B cells. Unfortunately, blockade of promising targets such as TNF-alpha, which was thought to be a pivotal cytokine in inflammation, has not shown benefit in a randomised controlled trial. Better understanding of the pathogenesis of the disease is the key to the development of novel targeted therapies, which are urgently required to improve patient prognosis. Gene therapy with targeted delivery of specific proteins is an exciting future prospect.
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Affiliation(s)
- Umut Selamet
- University of Birmingham, Division of Immunity and Infection, The Medical School, Edgbaston, Birmingham, B15 2TT, UK
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Colman R, Hussain A, Goodall M, Young SP, Pankhurst T, Lu X, Jefferis R, Savage COS, Williams JM. Chimeric antibodies to proteinase 3 of IgG1 and IgG3 subclasses induce different magnitudes of functional responses in neutrophils. Ann Rheum Dis 2007; 66:676-82. [PMID: 17204568 PMCID: PMC1954608 DOI: 10.1136/ard.2006.061374] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Antineutrophil cytoplasmic antibodies (ANCA) are associated with small-vessel vasculitis and have been implicated in its pathogenesis. The subclass distribution of ANCA IgG deviates from normal patterns, and it has been suggested that the IgG3 subclass may have pathogenic potential over the IgG1 subclass and may be more likely to be associated with active disease and renal involvement. OBJECTIVE To deal with potential pathogenicity, chimeric antibodies were constructed of IgG1 and three subclasses with human IgG1 or three constant regions and a murine-derived variable region that binds an epitope within the ANCA antigen proteinase 3 (PR3) that is recognised by human autoantibodies. METHODS The antibodies were characterised for binding to PR3, including affinity and avidity, before being used as tools to explore their ability to activate human neutrophils for superoxide release, cytokine release, degranulation and ability to induce neutrophil adhesion under flow. RESULTS Both subclass antibodies elicited similar neutrophil responses for superoxide release, degranulation and interleukin (IL) 8 production, although quantitative responses showed that the IgG1 subclass favoured degranulation and the IgG3 subclass favoured IL8 production. Both antibodies were able to convert neutrophils from selectin-dependent rolling adhesion to integrin-dependent stationary adhesion in a flow assay. CONCLUSIONS These findings indicate that humanised antibodies directed against a single epitope of PR3 can recapitulate the effects of polyclonal human ANCA, which recognises multiple PR3 epitopes. Further, PR3-ANCA of both IgG1 and IgG3 subclasses can activate neutrophils, although the more potent IL8 response by IgG3 PR3-ANCA may encourage further neutrophil recruitment and amplify injury.
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Affiliation(s)
- Rachel Colman
- Wellcome Trust Clinical Research Facility, University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
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Hewins P, Morgan MD, Holden N, Neil D, Williams JM, Savage COS, Harper L. IL-18 is upregulated in the kidney and primes neutrophil responsiveness in ANCA-associated vasculitis. Kidney Int 2006; 69:605-15. [PMID: 16514436 DOI: 10.1038/sj.ki.5000167] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In antineutrophil cytoplasm autoantibody (ANCA)-associated systemic vasculitis (ASV), autoantibody-induced neutrophil activation is believed to cause organ damage. In vitro, tumor necrosis factor alpha (TNFalpha) primes neutrophils for ANCA stimulation and TNFalpha blockade has been successfully used to treat ASV. Nonetheless, irreversible organ damage can still occur, suggesting that other cytokines may circumvent TNFalpha blockade. We report that interleukin (IL)-18 deposition, as assessed by immunoperoxidase staining, is increased in renal biopsies from ASV patients. Immunofluorescence microscopy demonstrated that podocytes are the predominant glomerular IL-18-positive cell type, whereas in the interstitium, myofibroblasts, distal tubular epithelium, and infiltrating macrophages stained for IL-18. In vitro, IL-18 primed superoxide production by ANCA-activated neutrophils comparably to TNFalpha. IL-18-primed, ANCA-induced superoxide production was unaffected by anti-TNFalpha antibody, which abrogated TNFalpha priming. Furthermore, TNFalpha and IL-18 phosphorylated neutrophil p38 mitogen-activated protein kinase (MAPK), but IL-18-mediated p38 MAPK phosphorylation was unaffected by anti-TNFalpha antibody. The p38 MAPK inhibitor, SB20358, reduced IL-18-primed, ANCA-induced superoxide production in a concentration-dependent manner. ANCA-induced superoxide release was also sensitive to the Leukotriene B4 (LTB4) inhibitor MK-886. IL-18 priming was not associated with increased ANCA antigen expression on isolated neutrophils. We conclude that IL-18 is likely to be important for neutrophil recruitment and priming in ASV. Therapies targeting single priming agents may have limited efficacy in controlling disease.
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Affiliation(s)
- P Hewins
- Renal Immunobiology, Medical School, University of Birmingham, Birmingham, UK
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Lu X, Garfield A, Rainger GE, Savage COS, Nash GB. Mediation of endothelial cell damage by serine proteases, but not superoxide, released from antineutrophil cytoplasmic antibody–stimulated neutrophils. ACTA ACUST UNITED AC 2006; 54:1619-28. [PMID: 16646023 DOI: 10.1002/art.21773] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate potential mediators of endothelial cell injury in systemic vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs), we investigated the factors controlling the neutrophil respiratory burst and endothelial release of von Willebrand factor (vWF) during neutrophil-endothelial cell interactions. METHODS Superoxide release from neutrophils binding to purified P-selectin or to tumor necrosis factor-activated endothelial cells was measured under flow or static conditions using the superoxide dismutase (SOD)-inhibitable reduction of ferricytochrome c. Neutrophils were activated with fMLP, normal IgG, or ANCA IgG. Enzyme-linked immunosorbent assay was used to measure vWF. Serine protease activity was measured enzymatically. RESULTS ANCA IgG or fMLP induced superoxide release when perfused over neutrophils that were rolling over P-selectin, but not those that were binding to endothelial cells. In static assays, endothelial cells inhibited superoxide production by neutrophils. Adenosine inhibited the respiratory burst, and, in cocultures, adenosine deaminase overcame the inhibitory effects of endothelial cells. Serine proteases were released during activated neutrophil-endothelial cell coculture. There was enhanced release of vWF during activated neutrophil-endothelial cell coculture; this was not inhibited by diphenyleneiodonium or by SOD plus catalase, but was inhibited by diisopropylfluorophosphate. CONCLUSION Endothelial cells inhibit superoxide generation by fMLP and ANCA-activated neutrophils. The release of vWF occurs during coculture and is sensitive to serine protease, but not NADPH oxidase inhibition. Serine proteases may play a more important role than reactive oxygen species as mediators of endothelial injury during ANCA-associated systemic vasculitis.
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Affiliation(s)
- X Lu
- University of Birmingham, Birmingham, UK
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Buckley CD, Ross EA, McGettrick HM, Osborne CE, Haworth O, Schmutz C, Stone PCW, Salmon M, Matharu NM, Vohra RK, Nash GB, Rainger GE. Identification of a phenotypically and functionally distinct population of long-lived neutrophils in a model of reverse endothelial migration. J Leukoc Biol 2005; 79:303-11. [PMID: 16330528 DOI: 10.1189/jlb.0905496] [Citation(s) in RCA: 238] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Recent studies have demonstrated that neutrophils are not a homogenous population of cells. Here, we have identified a subset of human neutrophils with a distinct profile of cell-surface receptors [CD54(high), CXC chemokine receptor 1(low) (CXCR1(low))], which represent cells that have migrated through an endothelial monolayer and then re-emerged by reverse transmigration (RT). RT neutrophils, when in contact with endothelium, were rescued from apoptosis, demonstrate functional priming, and were rheologically distinct from neutrophils that had not undergone transendothelial migration. In vivo, 1-2% of peripheral blood neutrophils in patients with systemic inflammation exhibit a RT phenotype. A smaller population existed in healthy donors ( approximately 0.25%). RT neutrophils were distinct from naïve circulatory neutrophils (CD54(low), CXCR1(high)) and naïve cells after activation with formyl-Met-Leu-Phe (CD54(low), CXCR1(low)). It is important that the RT phenotype (CD54(high), CXCR1(low)) is also distinct from tissue-resident neutrophils (CD54(low), CXCR1(low)). Our results demonstrate that neutrophils can migrate in a retrograde direction across endothelial cells and suggest that a population of tissue-experienced neutrophils with a distinct phenotype and function are present in the peripheral circulation in humans in vivo.
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Tse WY, Nash GB, Hewins P, Savage COS, Adu D. ANCA-induced neutrophil F-actin polymerization: implications for microvascular inflammation. Kidney Int 2005; 67:130-9. [PMID: 15610236 DOI: 10.1111/j.1523-1755.2005.00063.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The antineutrophil cytoplasmic antibody (ANCA)-positive vasculitides are characterized by a necrotizing vasculitis of small vessels with neutrophil infiltration. The reasons behind the selectivity for small vessels remain unclear, but may relate to the necessity for neutrophils to deform in order to pass through capillaries. The resistance to deformation of neutrophils largely arises from their actin cytoskeleton. It is hypothesized that ANCA, by inducing actin polymerization, increases neutrophil rigidity and contributes to their sequestration in capillaries. METHODS To test this hypothesis, neutrophils were treated with IgG-ANCA and the following characterizations: formation of filamentous F-actin (by flow cytometry); changes in morphology (by fluorescence and electron microscopy); and the potential to obstruct microvessels (by measuring entry times into micropipettes with comparable diameters to capillaries). The neutrophil signaling mechanisms activated by IgG-ANCA were investigated using blocking antibodies to Fcgamma receptors and inhibitors of tyrosine phosphorylation. Protein tyrosine phosphorylation was examined by immunoblotting of cell lysates, and calcium fluxes were measured by spectrofluorimetry of Fura-2 pentakis (acetoxymethyl) ester (Fura 2-AM) labeled neutrophils. RESULTS IgG-ANCA led to a significant dose-dependent actin polymerization over about 10 minutes. Over the same period, neutrophils became distorted in shape and more resistant to micropipette aspiration. Treatment with normal IgG caused less marked and delayed changes in these parameters. Actin polymerization required engagement of FcgammaRIIa receptor, tyrosine phosphorylation, and calcium fluxes. CONCLUSION These novel findings reveal signaling mechanisms that underlie ANCA-induced actin polymerization and might explain the predilection for small vessels in IgG-ANCA-associated vasculitis.
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Affiliation(s)
- Wai Y Tse
- Department of Nephrology, University of Birmingham, United Kingdom.
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Williams JM, Kamesh L, Savage COS. Translating basic science into patient therapy for ANCA-associated small vessel vasculitis. Clin Sci (Lond) 2005; 108:101-12. [PMID: 15504102 DOI: 10.1042/cs20040232] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
ANCA (anti-neutrophil cytoplasm antibody)-associated small vessel vasculitis is an inflammatory condition associated with the production of autoantibodies to neutrophil cytoplasmic components. The disorder results in destruction of the microvasculature, infiltration of neutrophils into tissues, which is followed later by mononuclear cells, leading to injury and the formation of granulomatous lesions. Initiators for the disease are undetermined but a pro-inflammatory environment is required. Other influencing factors may include environmental triggers, genetic propensity or infectious agents. The primary cellular event in the condition involves the neutrophils, which are likely to be responsible for the majority of tissue injury. Binding of the autoantibody to neutrophils initiates cell activation via a complex intracellular signalling cascade, culminating in the release of pro-inflammatory mediators, proteolytic enzymes and reactive oxygen species. Adhesion of neutrophils to endothelial cells is observed in vitro and more investigations in this area may explain the focussing of the disease to certain vessels/tissues. Current treatment regimens have substantial toxicity. Although newer developments are an improvement there is still a pressing need for more targeted therapies, which could be provided by extrapolating information emerging from basic scientific research.
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Affiliation(s)
- Julie M Williams
- Renal Immunobiology, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, U.K
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Holland M, Hewins P, Goodall M, Adu D, Jefferis R, Savage COS. Anti-neutrophil cytoplasm antibody IgG subclasses in Wegener's granulomatosis: a possible pathogenic role for the IgG4 subclass. Clin Exp Immunol 2004; 138:183-92. [PMID: 15373923 PMCID: PMC1809192 DOI: 10.1111/j.1365-2249.2004.02566.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A characteristic feature of Wegener's granulomatosis is the presence of antineutrophil cytoplasm antibodies (ANCA) to proteinase 3 (PR3). In vitro, ANCA activate neutrophils by co-ligating PR3 and FcgammaRIIa/IIIb receptors. ANCA are predominantly of the IgG isotype, and IgG1, IgG3 and IgG4 subclasses are particularly represented. To address the pathogenic role of individual ANCA-IgG subclass antibodies, patients' sera were screened using indirect immunofluorescence, enzyme-linked immunosorbent assay (ELISA) and subclass PR3-ELISA to identify patients with high titres of PR3-ANCA within the IgG1, IgG3 or IgG4 subclasses. Unfractionated ANCA-IgG and subclass fractions were isolated by affinity chromatography and compared for their capacities to stimulate superoxide production by primed human neutrophils. Donor neutrophils were analysed for constitutive and induced FcgammaRI expression by flow cytometry. The IgG1, IgG3 and IgG4 subclass fractions, isolated from three different ANCA sera, each stimulated superoxide production from neutrophils derived from multiple donors. Subsequently, IgG4 subclass fractions isolated from a further four ANCA positive sera demonstrated varying abilities to stimulate release of superoxide; unrelated to PR3-ANCA titre, neutrophil donor, or neutrophil FcgammaRI expression. The stimulation of superoxide release by IgG1- and IgG3-ANCA subclass fractions is consistent with the proposed mechanism of co-ligation of PR3 antigen and FcgammaRIIa/IIIb receptors. However, the demonstration of similar activity for the IgG4-ANCA subclass fractions isolated from some sera was unexpected. This activity was independent of neutrophil donor and expression of FcgammaRI, suggesting it was capable of activating neutrophils via constitutively expressed FcgammaRIIa/IIIb or co-ligation of other, unidentified, cell surface molecules.
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Affiliation(s)
- M Holland
- MRC Centre for Immune Regulation, The Medical School, University of Birmingham, Birmingham, UK
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Williams JM, Savage COS. Characterization of the Regulation and Functional Consequences of p21rasActivation in Neutrophils by Antineutrophil Cytoplasm Antibodies. J Am Soc Nephrol 2004; 16:90-6. [PMID: 15548565 DOI: 10.1681/asn.2004040264] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Antineutrophil cytoplasm antibodies (ANCA) are implicated in the pathogenesis of systemic vasculitis. ANCA are directed against antigens expressed on the surface of cytokine-primed neutrophils. It was shown previously that whole IgG ANCA and its fraction antigen binding [F(ab')(2)] fragment can activate the GTPase p21(ras). This study shows a functional involvement of this molecule in the ANCA activation of neutrophils by inhibiting the production of superoxide with farnesylthiosalicylic acid. Using the ras activation assay, farnesylthiosalicylic acid inhibits p21(ras) binding to its substrate at comparable concentrations to those seen for superoxide inhibition. It is also shown that activation of p21(ras) by ANCA is transient, peaking at 5 to 10 min and returning to baseline by 30 min. The use of ras isoform-specific antibodies in Western blots established, for the first time, that Harvey-ras is not present in human neutrophils, but both Kirsten-ras (K-ras) and Neuronal-ras are. Stimulation with ANCA is able to differentially activate K-ras without effects on neuronal-ras. The activation of p21(ras) by ANCA and its F(ab')(2) is prevented by inhibition of both Src kinases and phosphatidylinositol-3-kinase, indicating a cooperative role for both molecules in the G protein pathway activated by ANCA F(ab')(2) upstream of p21(ras). It is concluded that ANCA selectively activates K-ras during induction of a respiratory burst via pathways involving multiple upstream kinases.
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Affiliation(s)
- Julie M Williams
- Renal Immunobiology, MRC Centre for Immune Regulation, The Medical School, University of Birmingham, Birmingham, B15 2TT, UK
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Abdel-Salam B, Iking-Konert C, Schneider M, Andrassy K, Hänsch GM. Autoantibodies to neutrophil cytoplasmic antigens (ANCA) do not bind to polymorphonuclear neutrophils in blood. Kidney Int 2004; 66:1009-17. [PMID: 15327394 DOI: 10.1111/j.1523-1755.2004.00849.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Autoantibodies to neutrophil cytoplasmic antigens (ANCA), particularly to proteinase 3 (PR3), are found in the majority of patients with systemic Wegener's granulomatosis. The autoantibodies are widely used as diagnostic markers. Their role in the development and progression of the disease, however, is still under investigation. The primary target of ANCA, PR3, is located in the cytoplasm of polymorphonuclear neutrophils (PMN) or monocytes and is translocated to the cell surface upon stimulation. In patients with Wegener's granulomatosis PR3 is up-regulated most prominently during active disease. Despite the fact that both autoantibodies to PR3 and PMN expressing PR3 are present in patients with Wegener's granulomatosis, there is no evidence for binding of the autoantibodies to PMN. The present study was designed to analyze binding characteristics of autoantibodies to PR3 on PMN. METHODS AND RESULTS PMN of patients with active Wegener's granulomatosis (N= 10) were tested for autoantibody binding. Despite high autoantibody titer and PR3 expression on the PMN, no surface-bound IgG was found on PMN ex vivo. When ANCA-containing plasma from patients was incubated with isolated PMN, stimulated to express PR3, again no specific binding of the autoantibody could be detected. Also keeping the samples on ice did not allow surface detection of IgG, ruling out degradation or internalization of the autoantibodies. Only when purified IgG fractions were used, binding to PMN was seen in 14 of 25 patients. Already 1% of plasma, however, was sufficient to greatly reduce the IgG binding. Reduced binding of the IgG fraction was also seen when a larger reaction volume was used. CONCLUSION Our data indicate that autoantibodies to PR3 have a rather low affinity for surface-associated PR3 on PMN. This, in turn, argues against the hypothesis that ANCA contributes to the pathogenesis of the disease by stimulating viable PMN in whole blood.
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Affiliation(s)
- Bahaa Abdel-Salam
- Institut für Immunologie der Universität Heidelberg, Heidelberg, Germany
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Schreiber A, Luft FC, Kettritz R. Membrane proteinase 3 expression and ANCA-induced neutrophil activation. Kidney Int 2004; 65:2172-83. [PMID: 15149330 DOI: 10.1111/j.1523-1755.2004.00640.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Proteinase 3 is the major autoantigen in Wegener's granulomatosis (WG). Membrane PR3 expression is bimodal; low expressing cells (mPR3(low)) can be distinguished from cells with high expression (mPR3(high)) within a given individual. High mPR3 expression is a WG risk factor and is associated with relapse. However, no mechanisms for this important clinical observation have been provided. We tested the hypothesis that mPR3 expression, rather than the expression of other membrane molecules implicated in anti-neutrophil cytoplasmic autoantibodies (ANCA) activation, determines the robustness of the PR3-ANCA-mediated response. METHODS mPR3(low) and mPR3(high) neutrophils from a given individual were separated by magnetic cell sorting. Superoxide was measured by the ferricytochrome assay, and Akt phosphorylation by Western blotting. Double staining and flow cytometry were used to assay Fc gamma-receptor and beta 2-integrin expression with respect to the mPR3 phenotype. Degranulation was measured via beta-glucuronidase activity, migration with fibronectin-coated transwells, and cell quantification by the myeloperoxidase (MPO) assay. RESULTS PR3-ANCA-treated mPR3(high) versus mPR3(low) neutrophils showed more superoxide generation (33.7 +/- 15.2 nmol O(2) (-) to 14.6 +/- 8.4, P < 0.01), more degranulation (29%+/- 5 to 22%+/- 3, P < 0.05), and more PI3-K/Akt activation. In contrast, all responses in both mPR3 subsets were similar after other stimuli. We observed no differences in the beta 2-integrin, Fc gamma R IIa, and III expression with respect to the mPR3 subtype. Furthermore, we found no differences in the mobilization of PR3-containing granules and no differences in migration through fibronectin. CONCLUSION The degree of neutrophil mPR3 expression has definitive functional consequences.
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Affiliation(s)
- Adrian Schreiber
- HELIOS Klinikum-Berlin, Franz Volhard Clinic, and Max Delbrück Center for Molecular Medicine, Medical Faculty of the Charité, Humboldt University of Berlin, Germany
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Krupa A, Kato H, Matthay MA, Kurdowska AK. Proinflammatory activity of anti-IL-8 autoantibody:IL-8 complexes in alveolar edema fluid from patients with acute lung injury. Am J Physiol Lung Cell Mol Physiol 2004; 286:L1105-13. [PMID: 14729508 DOI: 10.1152/ajplung.00277.2003] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A significant fraction of IL-8 in lung fluids from patients with the acute lung injury (ALI) is associated with anti-IL-8 autoantibodies (anti-IL-8:IL-8 complexes), and lung fluid concentrations of these complexes correlate with development and outcome of ALI. In this study, we examined whether anti-IL-8:IL-8 complexes exhibit proinflammatory activity in vitro. These complexes were purified from pulmonary edema fluid samples obtained from patients with ALI. First, we found that IL-8 bound to the autoantibody retained its ability to trigger chemotaxis of neutrophils, whereas control antibody did not have significant chemotactic activity. Next, we examined the ability of anti-IL-8:IL-8 complexes to induce neutrophil activation, i.e., neutrophil respiratory burst and degranulation. Anti-IL-8:IL-8 complexes triggered superoxide and myeloperoxidase release from human neutrophils, and in contrast, the control antibody had no effect. We also demonstrated that IgG receptor, FcgammaRIIa, is the receptor involved in cellular activation mediated by these complexes. Blockade of FcgammaRIIa completely reverses activity of the complexes with the exception of chemotaxis. Both FcgammaRIIa and IL-8 receptors mediate chemotactic activity of anti-IL-8:IL-8 complexes, with FcgammaRIIa being, however, a predominant receptor. Furthermore, activity of the complexes is partially dependent on the activation of the mitogen-activated protein kinases, i.e., ERK and p38, important components of the FcgammaRIIa signaling cascade. Anti-IL-8:IL-8 complexes may therefore be involved in the pathogenesis of lung inflammation in clinical acute lung injury.
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Affiliation(s)
- Agnieszka Krupa
- Department of Biochemistry, University of Texas Health Center, 11937 US Highway 271, Tyler, TX 75708-3154, USA
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Rarok AA, Limburg PC, Kallenberg CGM. Neutrophil-activating potential of antineutrophil cytoplasm autoantibodies. J Leukoc Biol 2003; 74:3-15. [PMID: 12832437 DOI: 10.1189/jlb.1202611] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Accumulating in vivo and in vitro evidence supports the hypothesis that antineutrophil cytoplasm autoantibodies (ANCA) with specificity for proteinase 3 (PR3) and myeloperoxidase (MPO) are involved in the pathophysiology of small-vessel vasculitis. The best-described effector function of these autoantibodies is stimulation of neutrophils to produce reactive oxygen species and to release proteolytic enzymes. Neutrophil activation requires interaction of monomeric ANCA with PR3/MPO and Fcgamma receptors, but also other mechanisms--for instance, stimulation by ANCA-containing immune complexes--cannot be excluded. This review focuses on the mechanisms of neutrophil activation by ANCA. We discuss the molecules involved in ANCA binding to the neutrophil surface and in triggering the functional responses. We summarize current knowledge on the signal-transduction pathways initiated by ANCA and on the factors determining susceptibility of neutrophils to activation by these autoantibodies.
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Affiliation(s)
- Agnieszka A Rarok
- Department of Internal Medicine, University Hospital Groningen, The Netherlands
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40
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Williams JM, Ben-Smith A, Hewins P, Dove SK, Hughes P, McEwan R, Wakelam MJO, Savage COS. Activation of the G(i) heterotrimeric G protein by ANCA IgG F(ab')2 fragments is necessary but not sufficient to stimulate the recruitment of those downstream mediators used by intact ANCA IgG. J Am Soc Nephrol 2003; 14:661-9. [PMID: 12595502 DOI: 10.1097/01.asn.0000050223.34749.f4] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Anti-neutrophil cytoplasm autoantibodies (ANCA) are implicated in the pathogenesis of systemic vasculitis. Intact ANCA IgG activate superoxide generation in cytokine-primed neutrophils after binding their antigens and co-engaging Fcgamma receptors (FcgammaR). The contribution of antigen binding via ANCA F(ab')(2) fragments to signaling has been unclear. This study shows that both ANCA IgG and F(ab')(2) fragments of ANCA IgG induce significant GTPase activity, which could be blocked with pertussis toxin and anti-G(i) protein antibodies. Pertussis toxin inhibited ANCA IgG-induced superoxide generation but was without effect on superoxide production after conventional FcgammaR ligation. ANCA F(ab')(2) fragments did not induce superoxide generation. ANCA IgG activated PI 3-kinase-generating PIP(3), activated protein kinase B (PKB), and p21(ras); activation of each mediator was inhibited with pertussis toxin, but PI3K and PKB were not activated by ANCA IgG F(ab')(2) fragments. Intact ANCA IgG induced tyrosine phosphorylation, whereas F(ab')(2) fragments did not, and ANCA IgG-mediated superoxide generation was inhibited with genistein. Both genistein and pertussis toxin together completely abrogated the ANCA-induced oxidative burst. Genistein also inhibited ANCA IgG-induced PIP(3) generation and p21(ras) activation. These data implicate a novel ANCA IgG stimulated signaling pathway that involves both F(ab')(2)-mediated antigen binding and Fc-mediated FcgammaR ligation in cooperative interactions between G(i) proteins and tyrosine kinases that facilitates activation of downstream mediators.
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Affiliation(s)
- Julie M Williams
- Renal Immunobiology, MRC Centre for Immune Regulation, The Medical School, University of Birmingham, UK
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Abstract
Anti-neutrophil cytoplasm antibody associated vasculitides are autoimmune diseases that require treatment with powerful immunosuppressants in order to avert life threatening complications, principally renal failure and lung haemorrhage. Their pathogenesis remains unclear but the circulating autoantibodies are almost certainly instrumental in mediating vascular inflammation. Recent insights into leukocyte-autoantibody interactions support this assertion and may direct future therapeutic strategies, perhaps circumventing some of the toxicity associated with currently used drugs.
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Affiliation(s)
- Peter Hewins
- MRC Centre for Immune Regulation, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Affiliation(s)
- P Lesavre
- Service de néphrologie et Inserm U507, 161, rue de Sèvres, 75015 Paris, France
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43
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Affiliation(s)
- Lavanya Kamesh
- Renal Immunobiology, Division of Medical Sciences, The Medical School, University of Birmingham, Birmingham B15 277, UK
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Holland M, Takada K, Okumoto T, Takahashi N, Kato K, Adu D, Ben-Smith A, Harper L, Savage COS, Jefferis R. Hypogalactosylation of serum IgG in patients with ANCA-associated systemic vasculitis. Clin Exp Immunol 2002; 129:183-90. [PMID: 12100039 PMCID: PMC1906423 DOI: 10.1046/j.1365-2249.2002.01864.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The triad of small vessel vasculitides (SVV) comprise Wegener's granulomatosis (WG), microscopic polyangiitis (MPA) and Churg-Strauss syndrome (CS). All three are associated with presence of circulating IgG antineutrophil cytoplasm antibodies (ANCA) which target autoantigens contained, primarily, within neutrophil azurophilic granules. The widely accepted model of pathogenesis suggests that ANCA activate cytokine-primed neutrophils within the microvasculature, leading to by-stander damage to endothelial cells, and rapid escalation of inflammation with recruitment of mononuclear cells. Activation may be initiated, in vitro, by the coligation of the PR3 or MPO antigen, translocated to the cell surface, and FcgammaRIIa/FcgammaRIIIb receptors. This suggests that the IgG subclass profile of ANCA and, possibly, its glycosylation status could influence the inflammatory mechanisms activated. The glycosylation status of total IgG isolated from the sera of patients with WG (13), MPA (6) and CSS (1) was determined by analysis of the released oligosaccharides. A deficit in IgG galactosylation is demonstrated for all patient samples, compared to controls. The mean percentage values for the agalactosylated (G0) oligosaccharides were 57% (SD +/- 9.71), 47% (SD +/- 4.25) and 28% (SD +/- 4.09) for WG, MPO and control samples, respectively. The G0 levels for polyclonal IgG isolated from the sera of both WG and MPA patients were significantly increased compared to controls (P < 0.0001). The major glycoform present therefore is agalactosylated (G0) IgG. In previous studies the G0 glycoform of IgG has been shown to bind and activate mannan binding lectin, and hence to activate the complement cascade, and to facilitate mannose receptor binding and the uptake of IgG complexes by macrophages and dendritic cells. Both of these activities could impact on the processing and presentation of self-antigens in autoimmune disease.
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Affiliation(s)
- M Holland
- MRC centre for Immune regulation, The Medical School, University of Birmingham, UK
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Hattar K, Grandel U, Bickenbach A, Schwarting A, Mayet WJ, Bux J, Jessen S, Fischer C, Seeger W, Grimminger F, Sibelius U. Interaction of antibodies to proteinase 3 (classic anti-neutrophil cytoplasmic antibody) with human renal tubular epithelial cells: impact on signaling events and inflammatory mediator generation. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2002; 168:3057-64. [PMID: 11884479 DOI: 10.4049/jimmunol.168.6.3057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Among the anti-neutrophil cytoplasmic Abs (ANCA), those targeting proteinase 3 (PR3) have a high sensitivity and specificity for Wegener's granulomatosis (WG). A pathogenetic role for these autoantibodies has been proposed due to their capacity of activating neutrophils in vitro. Recently, PR3 was also detected in human renal tubular epithelial cells (TEC). In the present study, the effect of murine monoclonal anti-PR3 Abs (anti-PR3) and purified c-ANCA targeting PR3 from WG serum on isolated human renal tubular cell signaling and inflammatory mediator release was characterized. Priming of TEC with TNF-alpha resulted in surface expression of PR3, as quantified in immunofluorescence studies and by flow cytometry. Moreover, PR3 was immunoprecipitated on surface-labeled TEC. Primed TEC responded to anti-PR3 with a dose- and time-dependent activation of phosphoinositide hydrolysis, resulting in a remarkable accumulation of inositolphosphates. Control IgG was entirely ineffective, whereas PR3-ANCA reproduced the phosphoinositide response. The signaling response was accompanied by a pronounced release of superoxidanion into the cell supernatant. Moreover, large amounts of PGE(2) and, to a lesser extent, of thromboxane B(2), the stable metabolite of TxA(2), were secreted from anti-PR3-stimulated TEC. In parallel, a rise in intracellular cAMP levels was observed, which was blocked by the cyclooxygenase inhibitor indomethacin. We conclude that anti-PR3 Abs directly target renal TECs, thereby provoking pronounced activation of the phosphoinositide-related signal transduction pathway. Associated metabolic events such as the release of reactive oxygen species and lipid mediators may directly contribute to the development of renal lesions and loss of kidney function in WG.
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Affiliation(s)
- Katja Hattar
- Department of Internal Medicine, Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
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Harper L, Nuttall SL, Martin U, Savage COS. Adjuvant treatment of patients with antineutrophil cytoplasmic antibody-associated vasculitis with vitamins E and C reduces superoxide production by neutrophils. Rheumatology (Oxford) 2002; 41:274-8. [PMID: 11934963 DOI: 10.1093/rheumatology/41.3.274] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Neutrophils when activated generate a respiratory burst which has been implicated in the pathogenesis of primary systemic vasculitis. Neutrophils from patients with vasculitis have a greater respiratory burst than normal healthy donors. The aim of this study was to assess the effects of antioxidant treatment (vitamins E and C) on the generation of a respiratory burst from neutrophils isolated from patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. METHODS Neutrophils were isolated from patients with systemic vasculitis and healthy donors. Spontaneous superoxide generation was measured by the reduction of ferricytochrome c. The patients were treated with antioxidants, vitamins E and C, and spontaneous superoxide generation, vitamin C and total antioxidant capacity were measured before and after treatment. RESULTS The treatment of the patients with antioxidants resulted in a reduction in spontaneous superoxide generation (pre-treatment 8.41+/-0.7 nmol/10(6) cells; post-treatment 5.64+/-0.6 nmol/10(6) cells; P<0.05). There was no significant difference in the superoxide generation from normal controls who did not receive treatment, measured prior to commencement of the study and 10 days later (first reading 4.81+/-0.5 nmol/10(6) cells; second reading 5.32+/-0.4 nmol/10(6) cells; P>0.05). Total antioxidant capacity increased significantly following treatment with vitamins C and E (555.4+/-142 vs. 668.6+/-186 micromol/l trolox equivalent; P=0.01) as did vitamin C concentrations (56.5+/-27 vs. 137.7+/-64 micromol/l; P=0.002). CONCLUSIONS In this preliminary study, the treatment of patients with antioxidants, vitamins E and C, reduced neutrophil generation of superoxide and suggests that antioxidants may have an important role as adjuvant therapy. The evidence presented should form the basis of a larger randomized placebo-controlled trial of vitamins E and C as adjuvant therapy in patients with ANCA-associated systemic vasculitis.
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Affiliation(s)
- L Harper
- MRC Centre for Immune Regulation, Department of Medicine, The Medical School, Birmingham University, Edgbaston, Birmingham B15 2TT, UK
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47
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Abstract
Vasculitis is defined by the presence of leukocytes in the vessel wall with reactive damage to mural structures, leading to tissue ischemia and necrosis. The immunopathologic events that initiate the process of vascular inflammation and blood vessel damage are unclear. Damage of vascular endothelial cells and the recruitment and accumulation of the inflammatory infiltrate are determined by the endothelial cell and the bystanders, including the expression of adhesion molecules, the secretion of peptides and hormones, and the specific interaction with inflammatory cells. In addition to the endothelial cells, which provide costimulatory function, other cellular components and nonendothelial structures of the vessel wall are involved in controlling the inflammatory process, serve as antigen-presenting cells, and contribute with inflammatory mediators.
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Affiliation(s)
- Raquel Cuchacovich
- Section of Rheumatology, Department of Medicine, Louisiana State University Health Science Center, 1542 Tulane Avenue, New Orleans, LA 70112-2822, USA.
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Savage COS, Harper L, Holland M. New findings in pathogenesis of antineutrophil cytoplasm antibody-associated vasculitis. Curr Opin Rheumatol 2002; 14:15-22. [PMID: 11790991 DOI: 10.1097/00002281-200201000-00004] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There has been a profusion of studies related to the pathogenesis of antineutrophil cytoplasm antibody-associated small vessel vasculitis. Further definition of epitopes on the major antigens, proteinase-3 and myeloperoxidase, has been sought, and intracellular signal transduction pathways after antineutrophil cytoplasm antibody-neutrophil interactions are beginning to be explored. Antineutrophil cytoplasm antibody stimulation of neutrophils has highlighted the functional importance of the accelerated death that follows the initial activation. The consequences of neutrophil and monocyte activation for endothelium and tissue damage continue to point toward an inflammatory process that has become dysregulated. Factors that initiate vasculitis are being identified slowly. The most secure identifiable environmental trigger is the antithyroid drug propylthiouracil. It is likely that environmental factors operate against a background genetic susceptibility, and polymorphisms in genes for proteins associated with inflammation are being tested for possible links with small vessel vasculitides.
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Affiliation(s)
- Caroline O S Savage
- Division of Medical Sciences, The Medical School, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
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Radford DJ, Luu NT, Hewins P, Nash GB, Savage CO. Antineutrophil cytoplasmic antibodies stabilize adhesion and promote migration of flowing neutrophils on endothelial cells. ARTHRITIS AND RHEUMATISM 2001; 44:2851-61. [PMID: 11762946 DOI: 10.1002/1529-0131(200112)44:12<2851::aid-art473>3.0.co;2-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Recruitment of neutrophils to sites of inflammation requires coordinated regulation of their capture, activation, and migration on vascular endothelium. This study examines whether exposure of neutrophils to antineutrophil cytoplasmic antibodies (ANCAs) can disrupt this sequence of events. METHODS Isolated human neutrophils were perfused in the presence or absence of ANCA-positive IgG over endothelial cells that had been activated with either 2 units/ml or 100 units/ml of tumor necrosis factor alpha (TNFalpha) for 4 hours. RESULTS When endothelial cells were activated with 100 units/ml of TNFalpha, neutrophils were captured from flow, a small proportion of adherent cells rolled, and the majority transmigrated through the endothelial cell monolayer. When neutrophils were treated with ANCA IgG immediately before, 5 minutes before, or 15 minutes before perfusion, none rolled on contact with the endothelium, but the majority still transmigrated. When endothelial cells were activated with 2 units/ml of TNFalpha, the majority of untreated adherent neutrophils rolled, a few transmigrated, and the number that attached decreased with time during washout. In contrast, when neutrophils were pretreated with ANCA IgG just before perfusion, adhesion was stabilized, and the number of neutrophils that transmigrated was increased 10-fold. Priming of the neutrophils with TNFalpha before the addition of ANCA further increased the stability of neutrophil binding, but did not significantly increase transmigration. CONCLUSION Rather than frustrating the transmigration process, ANCAs promoted the migration of neutrophils through the endothelium. That the effect was evident at a relatively low level of endothelial activation suggests that ANCAs may potentiate the early vasculitic lesion and promote tissue damage and recruitment of other proinflammatory cells.
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Affiliation(s)
- D J Radford
- The Medical School, The University of Birmingham, UK
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Russell KA, Specks U. Are antineutrophil cytoplasmic antibodies pathogenic? Experimental approaches to understand the antineutrophil cytoplasmic antibody phenomenon. Rheum Dis Clin North Am 2001; 27:815-32, vii. [PMID: 11723766 DOI: 10.1016/s0889-857x(05)70237-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Antineutrophil cytoplasmic antibodies (ANCA) directed against the neutrophil enzymes PR3 and MPO are tightly associated with the development of small vessel vasculitis. This article reviews the large body of data derived from in vitro experiments documenting many different proinflammatory effects of these ANCA on neutrophils, monocytes, and endothelial cells. Taken in conjunction with clinical observations and data from animal models, a concept of the pathogenicity of ANCA emerges.
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Affiliation(s)
- K A Russell
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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