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Cheng YJ, Jia XY, Cao HR, Zhao XY, Zhou XJ, Yu XJ, Xu R, Zhou FD, Wang SX, Cui Z, Zhao MH. Primary membranous nephropathy in two siblings with one combined with anti-glomerular basement membrane disease: a case report. BMC Nephrol 2023; 24:183. [PMID: 37349681 PMCID: PMC10286333 DOI: 10.1186/s12882-023-03132-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/20/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The phospholipase A2 receptor (PLA2R) associated with membranous nephropathy (MN) is an organ-specific autoimmune disease associated with PLA2R and human leukocyte antigen (HLA) genes. Familial PLA2R-related MN is rarely reported. The combination of anti-GBM disease and MN has been well documented, though the mechanism behind it remains unclear. CASE PRESENTATION We describe two siblings diagnosed with pathology-confirmed PLA2R-related MN 1 year apart. And one of the two siblings developed an anti-GBM disease. The high-resolution HLA typing showed identical alleles in both siblings, specifically heterozygotes of DRB1*15:01/*03:01. CONCLUSION We describe a familial case of PLA2R-related MN supporting the role of genetic factors that HLA-DRB1*15:01 and DRB1*03:01 predispose patients in the development of PLA2R-related MN in the Han Chinese population. The combination of MN and anti-GBM disease may also partially be associated with the same susceptible HLA allele DRB1*15:01.
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Affiliation(s)
- Yan-Jiao Cheng
- Renal Division, Peking University First Hospital, Beijing, 100034, PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Xiao-Yu Jia
- Renal Division, Peking University First Hospital, Beijing, 100034, PR China.
- Institute of Nephrology, Peking University, Beijing, 100034, PR China.
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China.
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China.
| | - Hong-Ru Cao
- Renal Division, Affiliated Hospital of Chifeng University, Chifeng, 024005, PR China
| | - Xiao-Yi Zhao
- Renal Division, Affiliated Hospital of Chifeng University, Chifeng, 024005, PR China.
| | - Xu-Jie Zhou
- Renal Division, Peking University First Hospital, Beijing, 100034, PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Xiao-Juan Yu
- Renal Division, Peking University First Hospital, Beijing, 100034, PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Rong Xu
- Renal Division, Peking University First Hospital, Beijing, 100034, PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Fu-de Zhou
- Renal Division, Peking University First Hospital, Beijing, 100034, PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Su-Xia Wang
- Renal Division, Peking University First Hospital, Beijing, 100034, PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Zhao Cui
- Renal Division, Peking University First Hospital, Beijing, 100034, PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Beijing, 100034, PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
- Peking-Tsinghua Center for Life Sciences, Beijing, 100871, PR China
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2
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Koshy K, Prasad J, Vazirani J, Snell G. Case Report: Bilateral Lung Transplantation for Rapidly Progressive Undifferentiated Interstitial Lung Disease—A Cautionary Tale. Transplant Proc 2023; 55:703-705. [PMID: 36997380 DOI: 10.1016/j.transproceed.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/30/2023]
Abstract
Interstitial lung disease is fast becoming one of the most common indications for lung transplantation (LTx); however, LTx for Goodpasture's syndrome with pulmonary involvement has not been previously described in the literature. In this report, we outline the case of a young male with undifferentiated rapidly progressive interstitial lung disease who ultimately received a bilateral sequential LTx after deterioration requiring extracorporeal membrane oxygenation. The original disease soon recurred in the graft, and unfortunately, the patient did not survive. The diagnosis of Goodpasture's syndrome was made postmortem and was not clearly evident on examination of the native explanted tissue, nor was there an elevated titer of antiglomerular basement membrane antibodies during his initial work-up. We hypothesize that the donor and recipient's HLA profile made him more susceptible to aggressive disease. In hindsight, active Goodpasture's disease would have been a contraindication to proceed to transplantation. This case is a cautionary reminder of the high stakes of performing LTx without a certain diagnosis.
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3
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Boukouaci W, Rivera-Franco MM, Volt F, Wu CL, Rafii H, Cappelli B, Scigliuolo GM, Kenzey C, Ruggeri A, Rocha V, Gluckman E, Tamouza R. Comparative analysis of the variability of the human leukocyte antigen peptide-binding pockets in patients with acute leukaemia. Br J Haematol 2023; 200:197-209. [PMID: 36263991 DOI: 10.1111/bjh.18517] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 01/14/2023]
Abstract
The association between acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) and the human leukocyte antigens (HLA) has rarely been studied in terms of diversity of peptide-binding pockets. The objective of this study was to analyse whether motifs of HLA class I and class II peptide-binding pockets and/or their amino acid positions were differentially associated with ALL and AML. We included 849 patients from the Eurocord/European Blood and Marrow Transplant registry. The HLA peptide-binding pockets whose amino acid variability was analysed were B and F for HLA class I, P4, P6, and P9 for HLA-DRB1, and P4 and P9 for HLA-DQB1. The motif RFDRAY in P4 of HLA-DRB1*16:01/02/03/05 alleles and the motif YYVSY in P9 of HLA-DQB1*05:02/04/05 alleles, were statistically associated with ALL (corrected p value [pc ] = 0.001 and pc = 0.035 respectively). The frequency of serine 57 in the P9 of HLA-DQB1 was higher in ALL (odds ratio 2.09, 95% confidence interval: 1.27-3.44; pc = 0.037). Our analysis suggests that specific motifs in terms of HLA class II pockets and amino acids might be unique to ALL. The associations identified in this study encourage further investigation oF the role of HLA peptide-binding pockets and their amino acids in immune processes underpinning acute leukaemia and ultimately in immunotherapy settings.
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Affiliation(s)
| | - Monica M Rivera-Franco
- Eurocord, Hôpital Saint-Louis APHP, Institut de Recherche de Saint-Louis (IRSL) EA3518, Université de Paris Cité, Paris, France
| | - Fernanda Volt
- Eurocord, Hôpital Saint-Louis APHP, Institut de Recherche de Saint-Louis (IRSL) EA3518, Université de Paris Cité, Paris, France
| | - Ching-Lien Wu
- INSERM U955, IMRB, Univ Paris Est Créteil, Créteil, France
| | - Hanadi Rafii
- Eurocord, Hôpital Saint-Louis APHP, Institut de Recherche de Saint-Louis (IRSL) EA3518, Université de Paris Cité, Paris, France
| | - Barbara Cappelli
- Eurocord, Hôpital Saint-Louis APHP, Institut de Recherche de Saint-Louis (IRSL) EA3518, Université de Paris Cité, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Graziana Maria Scigliuolo
- Eurocord, Hôpital Saint-Louis APHP, Institut de Recherche de Saint-Louis (IRSL) EA3518, Université de Paris Cité, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Chantal Kenzey
- Eurocord, Hôpital Saint-Louis APHP, Institut de Recherche de Saint-Louis (IRSL) EA3518, Université de Paris Cité, Paris, France
| | - Annalisa Ruggeri
- Eurocord, Hôpital Saint-Louis APHP, Institut de Recherche de Saint-Louis (IRSL) EA3518, Université de Paris Cité, Paris, France.,Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vanderson Rocha
- Eurocord, Hôpital Saint-Louis APHP, Institut de Recherche de Saint-Louis (IRSL) EA3518, Université de Paris Cité, Paris, France.,Service of Hematology, Transfusion and Cell Therapy, and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, Hospital das Clínicas, São Paulo University, São Paulo, Brazil
| | - Eliane Gluckman
- Eurocord, Hôpital Saint-Louis APHP, Institut de Recherche de Saint-Louis (IRSL) EA3518, Université de Paris Cité, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Ryad Tamouza
- INSERM U955, IMRB, Univ Paris Est Créteil, Créteil, France
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4
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Ponticelli C, Calatroni M, Moroni G. Anti-glomerular basement membrane vasculitis. Autoimmun Rev 2023; 22:103212. [PMID: 36252931 DOI: 10.1016/j.autrev.2022.103212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/11/2022] [Indexed: 12/27/2022]
Abstract
Antiglomerular basement membrane disease (anti-GBM) is a rare life-threatening autoimmune vasculitis that involves small vessels and it is characterized by circulating autoantibodies directed against type IV collagen antigens expressed in glomerular and alveolar basement membrane. The typical clinical manifestations are the rapidly progressive glomerulonephritis and the alveolar hemorrhage. The diagnosis is usually confirmed by the detection of anti-GBM circulating antibodies. If not rapidly recognized, anti-GBM disease can lead to end stage kidney disease (ESKD). An early diagnosis and prompt treatment with immunosuppressive therapies and plasmapheresis are crucial to prevent a poor outcome. In this review, we discuss the primary form of anti-GBM (the so called Goodpasture syndrome) but also cases associated with other autoimmune diseases such as antineutrophil-cytoplasmic-antibody (ANCA) vasculitis, membranous nephropathy, IgA nephritis and systemic lupus erythematosus (SLE), as well as the few cases of anti-GBM vasculitis complicating kidney transplantation in the Alport syndrome.
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Affiliation(s)
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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5
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Kuang H, Liu J, Jia XY, Cui Z, Zhao MH. Autoimmunity in Anti-Glomerular Basement Membrane Disease: A Review of Mechanisms and Prospects for Immunotherapy. Am J Kidney Dis 2023; 81:90-99. [PMID: 36334986 DOI: 10.1053/j.ajkd.2022.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/10/2022] [Indexed: 11/06/2022]
Abstract
Anti-glomerular basement membrane (anti-GBM) disease is an organ-specific autoimmune disorder characterized by autoantibodies against the glomerular and alveolar basement membranes, leading to rapidly progressive glomerulonephritis and severe alveolar hemorrhage. The noncollagenous domain of the α3 chain of type IV collagen, α3(IV)NC1, contains the main target autoantigen in this disease. Epitope mapping studies of α3(IV)NC1 have identified several nephritogenic epitopes and critical residues that bind to autoantibodies and trigger anti-GBM disease. The discovery of novel target antigens has revealed the heterogeneous nature of this disease. In addition, both epitope spreading and mimicry have been implicated in the pathogenesis of anti-GBM disease. Epitope spreading refers to the development of autoimmunity to new autoepitopes, thus worsening disease progression, whereas epitope mimicry, which occurs via sharing of critical residues with microbial peptides, can initiate autoimmunity. An understanding of these autoimmune responses may open opportunities to explore potential new therapeutic approaches for this disease. We review how current advances in epitope mapping, identification of novel autoantigens, and the phenomena of epitope spreading and mimicry have heightened the understanding of autoimmunity in the pathogenesis of anti-GBM disease, and we discuss prospects for immunotherapy.
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Affiliation(s)
- Huang Kuang
- Renal Division, Peking University First Hospital, Beijing, People's Republic of China; Institute of Nephrology, Peking University, Beijing, People's Republic of China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jing Liu
- Renal Division, Peking University First Hospital, Beijing, People's Republic of China; Institute of Nephrology, Peking University, Beijing, People's Republic of China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China; Peking-Tsinghua Center for Life Sciences, Beijing, People's Republic of China
| | - Xiao-Yu Jia
- Renal Division, Peking University First Hospital, Beijing, People's Republic of China; Institute of Nephrology, Peking University, Beijing, People's Republic of China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
| | - Zhao Cui
- Renal Division, Peking University First Hospital, Beijing, People's Republic of China; Institute of Nephrology, Peking University, Beijing, People's Republic of China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Beijing, People's Republic of China; Institute of Nephrology, Peking University, Beijing, People's Republic of China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China; Peking-Tsinghua Center for Life Sciences, Beijing, People's Republic of China
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6
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Boudko SP, Bauer R, Chetyrkin SV, Ivanov S, Smith J, Voziyan PA, Hudson BG. Collagen IV α345 dysfunction in glomerular basement membrane diseases. II. Crystal structure of the α345 hexamer. J Biol Chem 2021; 296:100591. [PMID: 33775698 PMCID: PMC8093946 DOI: 10.1016/j.jbc.2021.100591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022] Open
Abstract
Our recent work identified a genetic variant of the α345 hexamer of the collagen IV scaffold that is present in patients with glomerular basement membrane diseases, Goodpasture’s disease (GP) and Alport syndrome (AS), and phenocopies of AS in knock-in mice. To understand the context of this “Zurich” variant, an 8-amino acid appendage, we developed a construct of the WT α345 hexamer using the single-chain NC1 trimer technology, which allowed us to solve a crystal structure of this key connection module. The α345 hexamer structure revealed a ring of 12 chloride ions at the trimer–trimer interface, analogous to the collagen α121 hexamer, and the location of the 170 AS variants. The hexamer surface is marked by multiple pores and crevices that are potentially accessible to small molecules. Loop-crevice-loop features constitute bioactive sites, where pathogenic pathways converge that are linked to AS and GP, and, potentially, diabetic nephropathy. In Pedchenko et al., we demonstrate that these sites exhibit conformational plasticity, a dynamic property underlying assembly of bioactive sites and hexamer dysfunction. The α345 hexamer structure is a platform to decipher how variants cause AS and how hypoepitopes can be triggered, causing GP. Furthermore, the bioactive sites, along with the pores and crevices on the hexamer surface, are prospective targets for therapeutic interventions.
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Affiliation(s)
- Sergei P Boudko
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biochemistry, Center for Structural Biology, Vanderbilt University, Nashville, Tennessee, USA.
| | - Ryan Bauer
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sergei V Chetyrkin
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sergey Ivanov
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jarrod Smith
- Department of Biochemistry, Center for Structural Biology, Vanderbilt University, Nashville, Tennessee, USA
| | - Paul A Voziyan
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Billy G Hudson
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biochemistry, Center for Structural Biology, Vanderbilt University, Nashville, Tennessee, USA; Aspirnaut, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, USA
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7
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Pokidysheva EN, Seeger H, Pedchenko V, Chetyrkin S, Bergmann C, Abrahamson D, Cui ZW, Delpire E, Fervenza FC, Fidler AL, Fogo AB, Gaspert A, Grohmann M, Gross O, Haddad G, Harris RC, Kashtan C, Kitching AR, Lorenzen JM, McAdoo S, Pusey CD, Segelmark M, Simmons A, Voziyan PA, Wagner T, Wüthrich RP, Zhao MH, Boudko SP, Kistler AD, Hudson BG. Collagen IV α345 dysfunction in glomerular basement membrane diseases. I. Discovery of a COL4A3 variant in familial Goodpasture's and Alport diseases. J Biol Chem 2021; 296:100590. [PMID: 33774048 PMCID: PMC8100070 DOI: 10.1016/j.jbc.2021.100590] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Diseases of the glomerular basement membrane (GBM), such as Goodpasture’s disease (GP) and Alport syndrome (AS), are a major cause of chronic kidney failure and an unmet medical need. Collagen IVα345 is an important architectural element of the GBM that was discovered in previous research on GP and AS. How this collagen enables GBM to function as a permselective filter and how structural defects cause renal failure remain an enigma. We found a distinctive genetic variant of collagen IVα345 in both a familial GP case and four AS kindreds that provided insights into these mechanisms. The variant is an 8-residue appendage at the C-terminus of the α3 subunit of the α345 hexamer. A knock-in mouse harboring the variant displayed GBM abnormalities and proteinuria. This pathology phenocopied AS, which pinpointed the α345 hexamer as a focal point in GBM function and dysfunction. Crystallography and assembly studies revealed underlying hexamer mechanisms, as described in Boudko et al. and Pedchenko et al. Bioactive sites on the hexamer surface were identified where pathogenic pathways of GP and AS converge and, potentially, that of diabetic nephropathy (DN). We conclude that the hexamer functions include signaling and organizing macromolecular complexes, which enable GBM assembly and function. Therapeutic modulation or replacement of α345 hexamer could therefore be a potential treatment for GBM diseases, and this knock-in mouse model is suitable for developing gene therapies.
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Affiliation(s)
- Elena N Pokidysheva
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Harald Seeger
- Nephrology Division, University Hospital Zurich, Zurich, Switzerland
| | - Vadim Pedchenko
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sergei Chetyrkin
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carsten Bergmann
- Department of Medicine and Nephrology, University Hospital Freiburg, Freiburg, Germany; Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany
| | - Dale Abrahamson
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Zhao Wei Cui
- Renal Division, Peking University First Hospital, Beijing, PR China
| | - Eric Delpire
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron L Fidler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Aspirnaut Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Agnes B Fogo
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ariana Gaspert
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Maik Grohmann
- Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany
| | - Oliver Gross
- Clinic of Nephrology and Rheumatology, University Medical Center Goettingen, University of Goettingen, Goettingen, Germany
| | - George Haddad
- Nephrology Division, University Hospital Zurich, Zurich, Switzerland
| | - Raymond C Harris
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Clifford Kashtan
- Division of Pediatric Nephrology, University of Minnesota Medical School and Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - A Richard Kitching
- Centre for Inflammatory Diseases, Monash University Department Medicine, Nephrology, Monash Health, Clayton, VIC, Australia
| | - Johan M Lorenzen
- Nephrology Division, University Hospital Zurich, Zurich, Switzerland
| | - Stephen McAdoo
- Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Charles D Pusey
- Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Marten Segelmark
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Alicia Simmons
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Aspirnaut Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul A Voziyan
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timo Wagner
- Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany
| | - Rudolf P Wüthrich
- Nephrology Division, University Hospital Zurich, Zurich, Switzerland
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Beijing, PR China
| | - Sergei P Boudko
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Andreas D Kistler
- Department of Internal Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Billy G Hudson
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Matrix Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Aspirnaut Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA; Center for Structural Biology, Vanderbilt University, Nashville, Tennessee, USA; Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, USA.
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8
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Koneczny I, Yilmaz V, Lazaridis K, Tzartos J, Lenz TL, Tzartos S, Tüzün E, Leypoldt F. Common Denominators in the Immunobiology of IgG4 Autoimmune Diseases: What Do Glomerulonephritis, Pemphigus Vulgaris, Myasthenia Gravis, Thrombotic Thrombocytopenic Purpura and Autoimmune Encephalitis Have in Common? Front Immunol 2021; 11:605214. [PMID: 33584677 PMCID: PMC7878376 DOI: 10.3389/fimmu.2020.605214] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
IgG4 autoimmune diseases (IgG4-AID) are an emerging group of autoimmune diseases that are caused by pathogenic autoantibodies of the IgG4 subclass. It has only recently been appreciated, that members of this group share relevant immunobiological and therapeutic aspects even though different antigens, tissues and organs are affected: glomerulonephritis (kidney), pemphigus vulgaris (skin), thrombotic thrombocytopenic purpura (hematologic system) muscle-specific kinase (MuSK) in myasthenia gravis (peripheral nervous system) and autoimmune encephalitis (central nervous system) to give some examples. In all these diseases, patients’ IgG4 subclass autoantibodies block protein-protein interactions instead of causing complement mediated tissue injury, patients respond favorably to rituximab and share a genetic predisposition: at least five HLA class II genes have been reported in individual studies to be associated with several different IgG4-AID. This suggests a role for the HLA class II region and specifically the DRβ1 chain for aberrant priming of autoreactive T-cells toward a chronic immune response skewed toward the production of IgG4 subclass autoantibodies. The aim of this review is to provide an update on findings arguing for a common pathogenic mechanism in IgG4-AID in general and to provide hypotheses about the role of distinct HLA haplotypes, T-cells and cytokines in IgG4-AID.
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Affiliation(s)
- Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Konstantinos Lazaridis
- Department of Immunology, Laboratory of Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - John Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece.,1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tobias L Lenz
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany
| | - Socrates Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece.,Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry and Department of Neurology, Medical Faculty, Christian-Albrechts-University Kiel, Kiel, Germany
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9
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Gu QH, Huynh M, Shi Y, Jia XY, Luo JJ, Jiang TJ, Cui Z, Ooi JD, Kitching AR, Zhao MH. Experimental Antiglomerular Basement Membrane GN Induced by a Peptide from Actinomyces. J Am Soc Nephrol 2021; 31:1282-1295. [PMID: 32444356 DOI: 10.1681/asn.2019060619] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 03/22/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Antiglomerular basement membrane (anti-GBM) disease is associated with HLA-DRB1*1501 (the major predisposing genetic factor in the disease), with α3127-148 as a nephritogenic T and B cell epitope. Although the cause of disease remains unclear, the association of infections with anti-GBM disease has been long suspected. METHODS To investigate whether microbes might activate autoreactive T and B lymphocytes via molecular mimicry in anti-GBM disease, we used bioinformatic tools, including BLAST, SYFPEITHI, and ABCpred, for peptide searching and epitope prediction. We used sera from patients with anti-GBM disease to assess peptides recognized by antibodies, and immunized WKY rats and a humanized mouse model (HLA-DR15 transgenic mice) with each of the peptide candidates to assess pathogenicity. RESULTS On the basis of the critical motif, the bioinformatic approach identified 36 microbial peptides that mimic human α3127-148. Circulating antibodies in sera from patients with anti-GBM recognized nine of them. One peptide, B7, derived from Actinomyces species, induced proteinuria, linear IgG deposition on the GBM, and crescent formation when injected into WKY rats. The antibodies to B7 also targeted human and rat α3127-148. B7 induced T cell activation from human α3127-148-immunized rats. T cell responses to B7 were detected in rats immunized by Actinomyces lysate proteins or recombinant proteins. We confirmed B7's pathogenicity in HLA-DR15 transgenic mice that developed kidney injury similar to that observed in α3135-145-immunized mice. CONCLUSIONS Sera from patients with anti-GBM disease recognized microbial peptides identified through a bioinformatic approach, and a peptide from Actinomyces induced experimental anti-GBM GN by T and B cell crossreactivity. These studies demonstrate that anti-GBM disease may be initiated by immunization with a microbial peptide.
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Affiliation(s)
- Qiu-Hua Gu
- Renal Division, Peking University First Hospital, Beijing, PR China.,Institute of Nephrology, Peking University, Beijing, PR China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, PR China
| | - Megan Huynh
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Yue Shi
- Renal Division, Peking University First Hospital, Beijing, PR China.,Institute of Nephrology, Peking University, Beijing, PR China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, PR China
| | - Xiao-Yu Jia
- Renal Division, Peking University First Hospital, Beijing, PR China.,Institute of Nephrology, Peking University, Beijing, PR China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, PR China
| | - Jie-Jian Luo
- Key Laboratory of Protein and Peptide Pharmaceuticals, National Laboratory of Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, PR China
| | - Tai-Jiao Jiang
- Key Laboratory of Protein and Peptide Pharmaceuticals, National Laboratory of Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, PR China.,Suzhou Institute of Systems Medicine, Suzhou, Jiangsu, PR China
| | - Zhao Cui
- Renal Division, Peking University First Hospital, Beijing, PR China .,Institute of Nephrology, Peking University, Beijing, PR China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, PR China
| | - Joshua D Ooi
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - A Richard Kitching
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Monash Medical Centre, Clayton, Victoria, Australia.,Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Paediatric Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Beijing, PR China.,Institute of Nephrology, Peking University, Beijing, PR China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, PR China.,Peking-Tsinghua Center for Life Sciences, Beijing, PR China
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10
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Shi Y, Jia XY, Gu QH, Wang M, Cui Z, Zhao MH. A Modified Peptide Derived from Goodpasture Autoantigen Arrested and Attenuated Kidney Injuries in a Rat Model of Anti-GBM Glomerulonephritis. J Am Soc Nephrol 2019; 31:40-53. [PMID: 31666297 DOI: 10.1681/asn.2019010067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 09/09/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In Goodpasture disease, the noncollagenous domain 1 of the α3 chain (α3NC1) of type IV collagen is the main target antigen of antibodies against glomerular basement membrane (GBM). We previously identified a nephritogenic epitope, P14 (α3127-148), that could induce crescentic nephritis in WKY rats, and defined its core motif. Designing a modified peptide, replacing critical pathogenic residues with nonpathogenic ones (on the basis of homologous regions in α1NC1 chain of type IV collagen, known to be nonpathogenic), might provide a therapeutic option for anti-GBM GN. METHODS We synthesized a modified peptide, replacing a single amino acid, and injected it into α3-P14-immunized rats from day 0 (the early-treatment group) or a later-treatment group (from days 17 to 21). A scrambled peptide administrated with the same protocol served as a control. RESULTS The modified peptide, but not the scrambled peptide, attenuated anti-GBM GN in both treatment groups, and halted further crescent formation even after disease onset. Kidneys from the modified peptide-treated rats exhibited reductions in IgG deposits, complement activation, and infiltration by T cells and macrophages. Treatment also resulted in an anti-inflammatory cytokine profile versus a proinflammatory profile for animals not receiving the modified peptide; it also reduced α3-P14-specific T cell activation, modulated T cell differentiation by decreasing Th17 cells and enhancing the ratio of Treg/Th17 cells, and inhibited binding of α3-P14 to antibodies and MHC II molecules. CONCLUSIONS A modified peptide involving alteration of a critical motif in a nephritogenic T cell epitope alleviated anti-GBM GN in a rat model. Our findings may provide insights into an immunotherapeutic approach for autoimmune kidney disorders such as Goodpasture disease.
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Affiliation(s)
- Yue Shi
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; and
| | - Xiao-Yu Jia
- Renal Division, Peking University First Hospital, Beijing, China; .,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; and
| | - Qiu-Hua Gu
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; and
| | - Miao Wang
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; and
| | - Zhao Cui
- Renal Division, Peking University First Hospital, Beijing, China; .,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; and
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; and.,Peking-Tsinghua Center for Life Sciences, Beijing, China
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11
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Robson KJ, Ooi JD, Holdsworth SR, Rossjohn J, Kitching AR. HLA and kidney disease: from associations to mechanisms. Nat Rev Nephrol 2018; 14:636-655. [DOI: 10.1038/s41581-018-0057-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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12
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HLA class II alleles differing by a single amino acid associate with clinical phenotype and outcome in patients with primary membranous nephropathy. Kidney Int 2018; 94:974-982. [PMID: 30173899 DOI: 10.1016/j.kint.2018.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/19/2018] [Accepted: 06/01/2018] [Indexed: 11/23/2022]
Abstract
Genome-wide associations and HLA genotyping have revealed associations between HLA alleles and susceptibility to primary membranous nephropathy. However, associations with clinical phenotypes and kidney outcome are poorly defined. We previously identified DRB1*1501 and DRB1*0301 as independent risk alleles for primary membranous nephropathy. Here, we investigated HLA associations with demographic characteristics, anti-phospholipase A2 receptor (PLA2R) antibody, treatment response and kidney outcome after a median follow-up of 52 months in 258 patients. DRB1*0301, but not DRB1*1501, was associated with a significantly higher level of PLA2R antibody (odds ratio 1.58, 95% confidence interval 1.13-2.22). Although DRB1*1502, which differs from DRB1*1501 by a single amino acid, was not a risk allele for primary membranous nephropathy (odds ratio 1.01), it was associated with significantly lower estimated glomerular filtration rates both at baseline (1.79, 1.18-2.72) and at last follow-up (1.72, 1.17-2.53), a significantly worse renal outcome by Kaplan-Meier analysis and a significantly higher risk of end-stage renal disease by Cox regression analysis (hazard ratio 4.52, 1.22-16.74). Nevertheless, the absence of remission remained the only independent risk factor for end-stage renal disease by multivariate analysis. DRB1*1502 was also associated with a significantly higher median PLA2R antibody level [161.4 vs. 36.3 U/mL] and showed interaction with DRB1*0301 for this variable. Thus, HLA genes control PLA2R antibody production and primary membranous nephropathy severity and outcome. Additionally, DRB1*1502 behaves like a modifier gene with a strong predictor value when associated with HLA risk alleles. Other modifier genes need further investigations in larger cohorts.
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13
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Pedchenko V, Kitching AR, Hudson BG. Goodpasture's autoimmune disease - A collagen IV disorder. Matrix Biol 2018; 71-72:240-249. [PMID: 29763670 DOI: 10.1016/j.matbio.2018.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/10/2018] [Indexed: 02/04/2023]
Abstract
Goodpasture's (GP) disease is an autoimmune disorder characterized by the deposition of pathogenic autoantibodies in basement membranes of kidney and lung eliciting rapidly progressive glomerulonephritis and pulmonary hemorrhage. The principal autoantigen is the α345 network of collagen IV, which expression is restricted to target tissues. Recent discoveries include a key role of chloride and bromide for network assembly, a novel posttranslational modification of the antigen, a sulfilimine bond that crosslinks the antigen, and the mechanistic role of HLA in genetic susceptibility and resistance to GP disease. These advances provide further insights into molecular mechanisms of initiation and progression of GP disease and serve as a basis for developing of novel diagnostic tools and therapies for treatment of Goodpasture's disease.
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Affiliation(s)
- Vadim Pedchenko
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, United States; Center for Matrix Biology, Department of Biochemistry, Department of Pathology, Microbiology and Immunology, Department of Cell and Developmental Biology, Vanderbilt Ingram Cancer Center, Vanderbilt Institute of Chemical Biology, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - A Richard Kitching
- Centre for inflammatory diseases, Monash University Department of Medicine, 246 Clayton Rd, Clayton, VIC 3168, Australia; Department of Nephrology, Monash Health, 246 Clayton Rd, Clayton, VIC 3168, Australia; Department and Pediatric Nephrology, Monash Health, 246 Clayton Rd, Clayton, VIC 3168, Australia
| | - Billy G Hudson
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, United States; Center for Matrix Biology, Department of Biochemistry, Department of Pathology, Microbiology and Immunology, Department of Cell and Developmental Biology, Vanderbilt Ingram Cancer Center, Vanderbilt Institute of Chemical Biology, Vanderbilt University Medical Center, Nashville, TN, United States
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14
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Evolving Insights for MHC Class II Antigen Processing and Presentation in Health and Disease. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40495-017-0097-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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