Variable-region subgroup and specificity of cold agglutinins

Autoantibodies as chameleons

Autoantibody determinations are frequently used by rheumatologists to establish the diagnosis or assess follow up clinical status in patients with connective tissue diseases. Such autoantibodies are often presumed to have harmful effects, particularly since some such as anti-native DNA or anti-Ro have frequently been related to tissue damage or to functional impairments. However, there are many other autoantibodies which react with antigenic components of normal autologous tissues which have not been demonstrated to have self-damaging or harmful effects. Some of these autoantibodies may actually represent natural built-in mechanisms of feed-back inhibition, serving to modulate normal physiologic function. Autoantibodies may be compared to chameleons since their function or quality is often judged by the company they keep or by their anatomical localization. Since many autoantibodies to intra-cellular products seem to react with active sites of important biologic molecules, they may provide us with a much sharper image of a number of natural cellular functions.

Autoantibodies and the fetal antibody repertoire

Developing fetal B cells preferentially rearrange a restricted subset of the encoded antibody gene segments. There are striking structural similarities between elements expressed early in man and in mouse, most evident on comparison of murine VH elements from the VH7183 family to human VH elements of the VH3 family. The similarity is pronounced in two framework regions which together encode a possible binding site that is distinct from the classical antigen-combining site. By comparing all known human and murine VH gene sequences, we have demonstrated that these regions have been conserved in a family-specific manner throughout the mammalian radiation. The "non-conserved" spacer of the recombinase recognition signal is also highly conserved in a family-specific manner, suggesting a mechanism by which the expression of family-dependent features may be regulated. The evidence that such features contribute to the high incidence of self- and poly-specificity in the fetal antibody repertoire is reviewed.

Cold agglutination

Autoantibodies against red cells optimally reacting at 0 degree C, ie, CA, are normally found with low titers in the serum of human adults. High-titer CA may be induced by certain infectious agents, including M pneumoniae, EBV, CMV, and rubella virus, or may develop on the basis of chronic (malignant) B cell lymphoproliferation. The main clinical manifestation of cold agglutination is AIHA. Antigens and antibodies of cold agglutination are the best characterized reaction partners of a human autoimmune process. CA may recognize I and i antigens, which are lipid- and protein-linked branched and linear N-acetyl-lactosamine chains, respectively. They are precursors of the ABH blood group antigens and are converted into H by fucosylation. An alternative substitution by sialylation creates Gd, Fl, and probably Vo/Li antigens. CA with anti-Pr and anti-Sa specificities recognize 0-glycans with immunodominant sialyl groups on glycophorins. Several Pr subspecificities can be identified by chemically modified sialyl groups on glycophorins. Because CA in chronic lymphoproliferation are monoclonal antibodies, structure-specificity-interrelations of the antibodies could be identified by primary structure analyses of the N-terminal variable regions of H and L chains and by studies on CA idiotypes. Interrelations between distinct CA specificities and particular infectious agents could explain cold agglutination as a response to receptors for the agents or to the binding sites of antibodies against the agents. Interrelations also existing between certain CA isotypes (Ig classes and L chain types) and CA specificities could be a basis for the elucidation of the enigmatic etiology of chronic (malignant) monoclonal cold agglutination.

Idiotypic cross-reactivity of human and murine phosphorylcholine-binding immunoglobulins

The idiotypic cross-reactivity of mouse and human monoclonal immunoglobulins with binding activity for phosphorylcholine (PC) was investigated, using an idiotypic antibody elicited against the PC-binding human IgMFR. The isolated FR heavy chain proved to be a better inhibitor for the reaction of IgMFR with anti-FR than the FR light chain, but the intact protein was necessary for full idiotypic expression. PC was an inhibitor only at concentrations greater than 10(-3) M indicating that the idiotypic antibody was not combining site-directed. Among the murine PC-binding IgA myeloma proteins, MOPC 167 was found to be the best inhibitor, but its inhibitory capacity was about 4 orders of magnitude lower than that of the homologous IgMFR. McPC 603 was an even weaker inhibitor, while TEPC 15 effected no better inhibition than human monoclonal immunoglobulins without PC-binding activity. MOPC 167 has a most similar binding specificity to IgMFR as indicated by the high affinity for choline of these two proteins. TEPC 15 and McPC 603, on the other hand, exhibit a much lower affinity for choline. In addition to their similarity in specificity, proteins FR and MOPC 167 show important structural similarities within parts of their heavy and light chain variable domains. The data provide some evidence for the existence of idiotypic cross-reactivity between the two species man and mouse.

Inhibition of human anti-Gd cold agglutinins by sialyllactose

Two examples of IgM kappa-monotopic cold agglutinins occurring in patients with non-Hodgkin lymphomas, reacted with erythrocyte autoantigens, which were protease-resistant but were inactivated by neuraminidase. The cold agglutinins were inhibited by the trisaccharide sialyllactose [NeuNAc(alpha,2 leads to 3) Gal (beta, 1 leads to 4)Glc], which is not related to oligosaccharides known to inhibit anti-I/-i cold agglutinins, Anti-Pr cold agglutinins are not inhibited by sialyllactose, although N-acetylneuraminic acid (NeuNAc) is an essential component not only of Gd but also of Pr determinants. Gd determinants are not bound to erythrocyte membrane glycoproteins, but are apparently bound to membrane glycolipids (gangliosides).