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Chauvet S, Roumenina LT, Aucouturier P, Marinozzi MC, Dragon-Durey MA, Karras A, Delmas Y, Le Quintrec M, Guerrot D, Jourde-Chiche N, Ribes D, Ronco P, Bridoux F, Fremeaux-Bacchi V. Both Monoclonal and Polyclonal Immunoglobulin Contingents Mediate Complement Activation in Monoclonal Gammopathy Associated-C3 Glomerulopathy. Front Immunol 2018; 9:2260. [PMID: 30333829 PMCID: PMC6175995 DOI: 10.3389/fimmu.2018.02260] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/11/2018] [Indexed: 01/28/2023] Open
Abstract
C3 glomerulopathy (C3G) results from acquired or genetic abnormalities in the complement alternative pathway (AP). C3G with monoclonal immunoglobulin (MIg-C3G) was recently included in the spectrum of “monoclonal gammopathy of renal significance.” However, mechanisms of complement dysregulation in MIg-C3G are not described and the pathogenic effect of the monoclonal immunoglobulin is not understood. The purpose of this study was to investigate the mechanisms of complement dysregulation in a cohort of 41 patients with MIg-C3G. Low C3 level and elevated sC5b-9, both biomarkers of C3 and C5 convertase activation, were present in 44 and 78% of patients, respectively. Rare pathogenic variants were identified in 2/28 (7%) tested patients suggesting that the disease is acquired in a large majority of patients. Anti-complement auto-antibodies were found in 20/41 (49%) patients, including anti-FH (17%), anti-CR1 (27%), anti-FI (5%) auto-antibodies, and C3 Nephritic Factor (7%) and were polyclonal in 77% of patients. Using cofactor assay, the regulation of the AP was altered in presence of purified IgG from 3/9 and 4/7 patients with anti-FH or anti-CR1 antibodies respectively. By using fluid and solid phase AP activation, we showed that total purified IgG of 22/34 (65%) MIg-C3G patients were able to enhance C3 convertase activity. In five documented cases, we showed that the C3 convertase enhancement was mostly due to the monoclonal immunoglobulin, thus paving the way for a new mechanism of complement dysregulation in C3G. All together the results highlight the contribution of both polyclonal and monoclonal Ig in MIg-C3G. They provide direct insights to treatment approaches and opened up a potential way to a personalized therapeutic strategy based on chemotherapy adapted to the B cell clone or immunosuppressive therapy.
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Affiliation(s)
- Sophie Chauvet
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Nephrology, Paris, France.,INSERM UMRS1138, Centre de Recherche des Cordeliers, Team "Complément et Maladies", Paris, France.,Université Paris Descartes Sorbonne Paris-Cité, Paris, France
| | - Lubka T Roumenina
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Team "Complément et Maladies", Paris, France.,Université Paris Descartes Sorbonne Paris-Cité, Paris, France.,Sorbonne Université, Paris, France
| | - Pierre Aucouturier
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Department of Immunology, Paris, France.,INSERM UMRS 938, Sorbonne Universités, UPMC Univ Paris 06, Hôpital Saint-Antoine, Paris, France
| | - Maria-Chiara Marinozzi
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Team "Complément et Maladies", Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Department of Immunology, Paris, France
| | - Marie-Agnès Dragon-Durey
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Team "Complément et Maladies", Paris, France.,Université Paris Descartes Sorbonne Paris-Cité, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Immunology, Paris, France
| | - Alexandre Karras
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Nephrology, Paris, France
| | - Yahsou Delmas
- Department of Nephrology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Dominique Guerrot
- Department of Nephrology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, UMRS 1076 Vascular Research Center of Marseille, Department of Nephrology, AP-HM, Marseille, France
| | - David Ribes
- Department of Nephrology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Ronco
- Sorbonne Université, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Nephrology, Paris, France.,INSERM UMRS1155, Hôpital Tenon, Paris, France
| | - Frank Bridoux
- Department of Nephrology, INSERM CIC 1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,Centre National de Référence Maladies Rares: Amylose al et Autres Maladies à Dépôts d'Immunoglobulines Monoclonales, Université de Poitiers, Poitiers, France
| | - Véronique Fremeaux-Bacchi
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Team "Complément et Maladies", Paris, France.,Université Paris Descartes Sorbonne Paris-Cité, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Department of Immunology, Paris, France
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2
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Watson R, Wearmouth E, McLoughlin AC, Jackson A, Ward S, Bertram P, Bennaceur K, Barker CE, Pappworth IY, Kavanagh D, Lea SM, Atkinson JP, Goodship THJ, Marchbank KJ. Autoantibodies to CD59, CD55, CD46 or CD35 are not associated with atypical haemolytic uraemic syndrome (aHUS). Mol Immunol 2015; 63:287-96. [PMID: 25150608 PMCID: PMC4452024 DOI: 10.1016/j.molimm.2014.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 07/16/2014] [Indexed: 01/31/2023]
Abstract
Autoantibody formation against Factor H (FH) is found in 7-10% of patients who are diagnosed with atypical haemolytic uraemic syndrome (aHUS). These autoantibodies predominately target the C-terminal cell binding recognition domain of FH and are associated with absence of FHR1. Additional autoantibodies have also been identified in association with aHUS, for example autoantibodies to Factor I. Based on this, and that there are genetic mutations in other complement regulators and activators associated with aHUS, we hypothesised that other complement regulator proteins, particularly surface bound regulators in the kidney, might be the target for autoantibody formation in aHUS. Therefore, we assayed serum derived from 89 patients in the Newcastle aHUS cohort for the presence of autoantibodies to CD46 (membrane cofactor protein, MCP), CD55 (decay accelerating factor, DAF), CD35 (complement receptor type 1, CR1; TP10) and CD59. We also assayed 100 healthy blood donors to establish the normal levels of reactivity towards these proteins in the general population. Recombinant proteins CD46 and CD55 (purified from Escherichia coli) as well as soluble CR1 (CD35) and oligomeric C4BP-CD59 (purified from eukaryotic cell media) were used in ELISA to detect high responders. False positive results were established though Western blot and flow cytometric analysis. After excluding false positive responders to bacterial proteins in the CD46 and CD55 preparations, and responses to blood group antigens in CD35, we found no significant level of patient serum IgG reactivity with CD46, CD55, CD35 or CD59 above that detected in the normal population. These results suggest that membrane anchored complement regulators are not a target for autoantibody generation in aHUS.
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Affiliation(s)
- Rachael Watson
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Emma Wearmouth
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Amy-Claire McLoughlin
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Arthur Jackson
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Sophie Ward
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Paula Bertram
- Division of Rheumatology, Washington University School of Medicine, St. Louis, MO, USA
| | - Karim Bennaceur
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Catriona E Barker
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Isabel Y Pappworth
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - David Kavanagh
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Susan M Lea
- Sir William Dunn School of Pathology, University of Oxford, UK
| | - John P Atkinson
- Division of Rheumatology, Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy H J Goodship
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Kevin J Marchbank
- Institutes of Cellular and Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK.
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Abstract
BACKGROUND Many aspects of autoimmune disease are not well understood, including the specificities of autoimmune targets, and patterns of co-morbidity and cross-heritability across diseases. Prior work has provided evidence that somatic mutation caused by gene conversion and deletion at segmentally duplicated loci is relevant to several diseases. Simple tandem repeat (STR) sequence is highly mutable, both somatically and in the germ-line, and somatic STR mutations are observed under inflammation. RESULTS Protein-coding genes spanning STRs having markers of mutability, including germ-line variability, high total length, repeat count and/or repeat similarity, are evaluated in the context of autoimmunity. For the initiation of autoimmune disease, antigens whose autoantibodies are the first observed in a disease, termed primary autoantigens, are informative. Three primary autoantigens, thyroid peroxidase (TPO), phogrin (PTPRN2) and filaggrin (FLG), include STRs that are among the eleven longest STRs spanned by protein-coding genes. This association of primary autoantigens with long STR sequence is highly significant (p<3.0x10(-7)). Long STRs occur within twenty genes that are associated with sixteen common autoimmune diseases and atherosclerosis. The repeat within the TTC34 gene is an outlier in terms of length and a link with systemic lupus erythematosus is proposed. CONCLUSIONS The results support the hypothesis that many autoimmune diseases are triggered by immune responses to proteins whose DNA sequence mutates somatically in a coherent, consistent fashion. Other autoimmune diseases may be caused by coherent somatic mutations in immune cells. The coherent somatic mutation hypothesis has the potential to be a comprehensive explanation for the initiation of many autoimmune diseases.
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Affiliation(s)
- Kenneth Andrew Ross
- Department of Computer Science, Columbia University, New York, New York, United States of America
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Carter CJ. Extensive viral mimicry of 22 AIDS-related autoantigens by HIV-1 proteins and pathway analysis of 561 viral/human homologues suggest an initial treatable autoimmune component of AIDS. ACTA ACUST UNITED AC 2012; 63:254-68. [PMID: 22077229 DOI: 10.1111/j.1574-695x.2011.00848.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
HIV-1 viral proteins, particularly the env protein, are homologous to 22 AIDS autoantigens, suggesting their creation by antiviral antibodies subsequently targeting human homologues. They include antibodies to T-cell receptors, CD4 and CD95, complement components, IgG, TNF and other immune-related proteins. Autoantibodies may compromise the immune system via knockdown of these key proteins, and autoimmune attack on the immune system itself, as supported by immune activation in early stages of infection and during the transition to AIDS. Over 500 human proteins contain pentapeptides or longer consensi, identical to viral peptides. Such homology explains the extensive viral/human interactome, likely related to the ability of viral homologues to compete with human counterparts as binding partners. Pathway analysis of these homologous proteins revealed their involvement in immune-related networks (e.g. natural killer cell toxicity/toll, T-cell/B-cell receptor signalling/antigen processing) and viral and bacterial entry and defence pathways (phagosome/lysosome pathways, DNA sensing/NOD/RIG-1 pathways) relevant to AIDS pathogenesis. At its inception, AIDS may have an autoimmune component selectively targeting the immune system. Immunosuppressive therapy or antibody removal, which has already achieved some success, might be therapeutically beneficial, particularly if targeted at removal of the culpable antibodies, via affinity dialysis.
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Affiliation(s)
- Chris J Carter
- PolygenicPathways, St Leonard's on Sea, East Sussex, UK.
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Bazsó A, Poór G, Gergely P, Kiss E. [Novel therapeutic possibilities in systemic lupus erythematosus]. Orv Hetil 2010; 151:735-40. [PMID: 20410000 DOI: 10.1556/oh.2010.28863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disorder involving different organs and organ systems with consequent characteristic clinical and serologic symptoms. Despite of the improvement in lupus survival, approximately 10-20% of patients do not respond to traditional immune suppressive therapies. Relapses are more frequent; e.g. after cyclophosphamide therapy diffuse proliferative nephritis flares in 1/3 of patients. Different immune competent cells and inflammatory mediators participate in the pathogenesis of SLE involving both the adaptive and innate immunity. Several pathogenic elements and mechanisms may serve as therapeutic targets, consequently. Authors summarize novel therapeutic possibilities and their mechanisms regarding the pathogenesis of SLE. Immune modulation of B and T cells, co-stimulatory pathways, cytokine network, soluble mediators and autologous hemopoietic stem cell transplantation are discussed.
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Affiliation(s)
- Anna Bazsó
- Országos Reumatológiai és Fizioterápiás Intézet, Budapest
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Erdei A, Isaák A, Török K, Sándor N, Kremlitzka M, Prechl J, Bajtay Z. Expression and role of CR1 and CR2 on B and T lymphocytes under physiological and autoimmune conditions. Mol Immunol 2009; 46:2767-73. [PMID: 19559484 DOI: 10.1016/j.molimm.2009.05.181] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 05/29/2009] [Indexed: 11/17/2022]
Abstract
The involvement of complement in the development and regulation of antibody responses under both healthy and pathological conditions is known for long. Unravelling the molecular mechanisms underlying the events however is still in progress. This review focuses on the role of complement receptors CR1 (CD35) and CR2 (CD21) expressed on T and B cells. Alteration in the expression and function of these receptors may contribute to the initiation and maintenance of immune complex mediated autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. Recent data regarding complement receptor expression on T lymphocytes and on memory B cells are also discussed.
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Affiliation(s)
- Anna Erdei
- Department of Immunology, Biological Institute, Eötvös Loránd University, Budapest, Hungary.
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Seelen MA, Trouw LA, Daha MR. Diagnostic and prognostic significance of anti-C1q antibodies in systemic lupus erythematosus. Curr Opin Nephrol Hypertens 2003; 12:619-24. [PMID: 14564199 DOI: 10.1097/00041552-200311000-00008] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The presence of a wide variety of autoantibodies is a characteristic finding in systemic lupus erythematosus. Autoantibodies against nuclear proteins, such as anti-nuclear and anti-double-stranded DNA antibodies, are used as diagnostic markers in systemic lupus erythematosus. Renal involvement is frequently found in systemic lupus erythematosus and is an important risk factor for death. Therefore, markers for the diagnosis and follow-up of nephritis are very important. Anti-C1q autoantibodies are strongly associated with renal involvement in systemic lupus erythematosus. This study will review recent findings on the pathogenic role and clinical importance of anti-C1q antibodies in lupus nephritis. RECENT FINDINGS Recent clinical studies have clearly emphasized the diagnostic relevance of anti-C1q autoantibody levels in patients with lupus nephritis. With a possible negative predictive value of 100%, anti-C1q autoantibodies are the only exclusive antibodies associated with the involvement of a single organ in systemic lupus erythematosus. Next to the clinical findings, the pathogenic significance of anti-C1q antibodies has been shown in an animal model. The deposition of autologous C1q in healthy glomeruli of mice after the infusion of anti-C1q antibodies induces moderate tissue damage. SUMMARY The latest insight into the pathogenesis of anti-C1q autoantibodies in the development of lupus nephritis and the recently demonstrated clinical importance of anti-C1q autoantibodies for the diagnosis of lupus nephritis support the value of further investigations. New diagnostic methods for the detection of anti-C1q and an accurate follow-up of antibody levels might be of use in clinical practice.
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Affiliation(s)
- Marc A Seelen
- Department of Nephrology, Leiden University Medical Center, The Netherlands.
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